This is what happens when medicine is encroached by mid-level professions..

[imtheman25]

I get a lot of flack on this forum for being a staunch opponent of granting too much power to mid-level providers, but this is exactly why!! I am interested to know your opinions? How can medical students help stop this, while being respectful?

Skin Cancers Rise, Along With Questionable Treatments

Excerpts/TLDR:
"All this private equity money behind (derm clinics), hire a bunch of P.A.’s and nurses and stick them out in clinics on their own. And they’re acting like doctors.”

"...believing he would be seen by the dermatologist. Instead, he was seen by a young woman in a lab coat, whom he assumed was a physician, though she did not identify herself as one. She biopsied 10 different lesions."

"physician assistant told Mr. Dalman that he would need radiation on basal cell carcinomas on his temple, shoulder and ear (WTF). He said he tried to argue with her, explaining that he’d had many similar lesions in the past that were removed with a simple scrape."

PA missed a lesion "It turned out to be a malignant melanoma, not documented by the physician assistant"

"The Times found that 75 percent of the patients they (PA/APRN run clinic) treated for various skin problems had been diagnosed with Alzheimer’s disease"

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[bigindian4891]

How are you not banned yet

 

[Brahnold Bloodaxe]

How are you not banned yet

How are you not banned yet.

 

[mimelim]

I get a lot of flack on this forum for being a staunch opponent of granting too much power to mid-level providers, but this is exactly why!! I am interested to know your opinions? How can medical students help stop this, while being respectful?

Skin Cancers Rise, Along With Questionable Treatments

Excerpts/TLDR:
"All this private equity money behind (derm clinics), hire a bunch of P.A.’s and nurses and stick them out in clinics on their own. And they’re acting like doctors.”

"...believing he would be seen by the dermatologist. Instead, he was seen by a young woman in a lab coat, whom he assumed was a physician, though she did not identify herself as one. She biopsied 10 different lesions."

"physician assistant told Mr. Dalman that he would need radiation on basal cell carcinomas on his temple, shoulder and ear (WTF). He said he tried to argue with her, explaining that he’d had many similar lesions in the past that were removed with a simple scrape."

PA missed a lesion "It turned out to be a malignant melanoma, not documented by the physician assistant"

"The Times found that 75 percent of the patients they (PA/APRN run clinic) treated for various skin problems had been diagnosed with Alzheimer’s disease"

My opinion is that your reading comprehension is lacking. This article is about shady dermatology practices that uses anecdotes about shady doctors and PAs. Trying to use a dramatic, emotion laden article based on anecdote to form a reasoned opinion is foolhardy.

 

[DrfluffyMD]

My opinion is that your reading comprehension is lacking. This article is about shady dermatology practices that uses anecdotes about shady doctors and PAs. Trying to use a dramatic, emotion laden article based on anecdote to form a reasoned opinion is foolhardy.

This article bring up excellents point that deserve to be discussed:

1. Overutilization by mid levels due to their lack of clinical training, leading to increased used of diagnostic resouces (radiology and pathology) to compensate for their comparatively lack of clinical acumen as a group.

2. Underdiagnosis/miss of important finding due to comparative lack of clinical acume, or (not mention in the article) in procedural fields, direct harm to the patients due to lack of technical knowledge.

I believe those two points should be addressed before we jump on and belittle the OP.

 

[Psai]

This article bring up excellents point that deserve to be discussed:

1. Overutilization by mid levels due to their lack of clinical training, leading to increased used of diagnostic resouces (radiology and pathology) to compensate for their comparatively lack of clinical acumen as a group.

2. Underdiagnosis/miss of important finding due to comparative lack of clinical acume, or (not mention in the article) in procedural fields, direct harm to the patients due to lack of technical knowledge.

I believe those two points should be addressed before we jump on and belittle the OP.

He's probably just plotting a way to relabel those procedures as vascular dermatology so he can hand them to his own midlevels

 

[masaraksh]

He's probably just plotting a way to relabel those procedures as vascular dermatology so he can hand them to his own midlevels

Thats debatable. Are vascular surgeons really in need of more business. This is how I envision their practice:

Angio -> angioplasty -> stent -> thrombosis -> more stent -> bypass -> angio -> stent -> bypass -> thombosis -> bleed -> bleedbosis -> amp -> more amp -> call ortho + bigger amp ->

 

[DrfluffyMD]

Well, here is the issue with mid levels associated with surgical practice.

A while ago, some surgeons figured out that if they are able to operate all day everyday and leave most of the clinical work to someone else, they can make more.

Then they realized that if they can train mid levels to do “easier” procedures, they can make even more.

My concern about this practice model, often utilized in vascular surgery, is that if we switch away from fee for service and go into a single payer or outcome focused system, we will suddenly have many, many quasiclinicians with subpar training whose previous primary mission is to provide a large intake out of which surgical managements are distilled from. I suppose many of those surgical mid levels will be without a job then.

Think about it another way. I am Joe the vascular surgeon/IR guy, I can either make 200k a year seeing 10 pts a day and do a leg revascularization every 2 days, or i can make 500k a year do 5 revascularization a day all day everyday by hiring 10 NPs and be in the angiosuite all day.

Now let’s say that single payers came along suddenly and I realize that government will end up paying me 150k a year, whether I do 5 revascularization a day or 1 every two days.

What will I do? I’ll be doing the minimum amount of work I need to do to maintain my skills, comfort and income. Why should I work more and give each patients less time and increase my lability if more volume doesnt translate into more income?

I can’t image how an indivdual practice would be viable with any mid levels under this model.

 

[WingedOx]

I get a lot of flack on this forum for being a staunch opponent of granting too much power to mid-level providers, but this is exactly why!

You get a lot of flack for poorly understanding the subjects that you're posting about, regardless of subject.

 

[zero0]

It's a delicate balancing act, trying to squeeze the most money out of your practice using midlevels while not endangering anyone's life. Sometimes you overshoot. Think he cares? No, the only reason hes not killing people left and right in the first place is for fear of being sued or losing his meal ticket, not because he cares. All too common in medicine.

 

[Thor123422]

Now let’s say that single payers came along suddenly and I realize that government will end up paying me 150k a year, whether I do 5 revascularization a day or 1 every two days.

Maybe I'm ignorant, but this constant pay with variable work seems like an unrealistic scenario, even if we go single payer.

Single payer as far as I know just means that the government pays for services, not that the government determines your salary as a physician.

 

[DrfluffyMD]

Maybe I'm ignorant, but this constant pay with variable work seems like an unrealistic scenario, even if we go single payer.

Single payer as far as I know just means that the government pays for services, not that the government determines your salary as a physician.

They want to eventually remove fee for service. That results in a constant salary plus minus productivity bonus structure. If productivity bonus is set at a current level of work, but only give like 15% bonus, why would someone work 200% harder to get 15% bonus?

 

[Mona nucleosis]

They want to eventually remove fee for service. That results in a constant salary plus minus productivity bonus structure. If productivity bonus is set at a current level of work, but only give like 15% bonus, why would someone work 200% harder to get 15% bonus?

Precisely, at that point I'd rather spend the time reading investment books.

We already see a glimpse of gov-run healthcare at the VA here

 

[BabyHero]

Well, here is the issue with mid levels associated with surgical practice.

A while ago, some surgeons figured out that if they are able to operate all day everyday and leave most of the clinical work to someone else, they can make more.

Then they realized that if they can train mid levels to do “easier” procedures, they can make even more.

My concern about this practice model, often utilized in vascular surgery, is that if we switch away from fee for service and go into a single payer or outcome focused system, we will suddenly have many, many quasiclinicians with subpar training whose previous primary mission is to provide a large intake out of which surgical managements are distilled from. I suppose many of those surgical mid levels will be without a job then.

Think about it another way. I am Joe the vascular surgeon/IR guy, I can either make 200k a year seeing 10 pts a day and do a leg revascularization every 2 days, or i can make 500k a year do 5 revascularization a day all day everyday by hiring 10 NPs and be in the angiosuite all day.

Now let’s say that single payers came along suddenly and I realize that government will end up paying me 150k a year, whether I do 5 revascularization a day or 1 every two days.

What will I do? I’ll be doing the minimum amount of work I need to do to maintain my skills, comfort and income. Why should I work more and give each patients less time and increase my lability if more volume doesnt translate into more income?

I can’t image how an indivdual practice would be viable with any mid levels under this model.

Of course, a single payer system is a disaster and everyone with a brain knows it. We'll all be covered, however, that doesn't mean all will have quality health care. It will open the door for those with limited resources to be stuck seeing unqualified under-trained providers, likely not physicians. Equally disturbing is having our pay set by the government and all the regulations that follow would eliminate private practice physicians.

 

[BabyHero]

Maybe I'm ignorant, but this constant pay with variable work seems like an unrealistic scenario, even if we go single payer.

Single payer as far as I know just means that the government pays for services, not that the government determines your salary as a physician.

Yes, the government determines how much it pays for services. How exactly does this not translate to your salary? Connect the dots.

 

[WingedOx]

Maybe I'm ignorant, but this constant pay with variable work seems like an unrealistic scenario, even if we go single payer.

Single payer as far as I know just means that the government pays for services, not that the government determines your salary as a physician.

It's a good rule to follow to assume that about 95% of posters talking about health care economics on the allo board are talking out of their ass.

 

[BabyHero]

It's a good rule to follow to assume that about 95% of posters talking about health care economics on the allo board are talking out of their ass.

Doubtful

 

[Thor123422]

Yes, the government determines how much it pays for services. How exactly does this not translate to your salary? Connect the dots.

You should work on your CARS score.

Of course, a single payer system is a disaster and everyone with a brain knows it. We'll all be covered, however, that doesn't mean all will have quality health care. It will open the door for those with limited resources to be stuck seeing unqualified under-trained providers, likely not physicians. Equally disturbing is having our pay set by the government and all the regulations that follow would eliminate private practice physicians.

Oh, so you really don't know anything about what single payer actually means.

Good to know I can just ignore the rest of your posts.

They want to eventually remove fee for service. That results in a constant salary plus minus productivity bonus structure. If productivity bonus is set at a current level of work, but only give like 15% bonus, why would someone work 200% harder to get 15% bonus?

Who is "they"?

 

[WingedOx]

Doubtful

hmm, wonder where the ban came from?

edit: actually a quick look at his posts reveals a lot.

 

[VincentAdultman]

Doubtful

Twenty two days before Bannage. Not shabby.

 

[787593]

How are you not banned yet.

Duck season!

 

[Goro]

hmm, wonder where the ban came from?

edit: actually a quick look at his posts reveals a lot.

Twenty two days before Bannage. Not shabby.

I smelled troll respawn yesterday when that loon attacked me in the Osteo forum. A high inflammatory post/total post ratio from a newly joined member seems to be the tip-off. Kudos to the moderators for protecting the forums.

 

[Football Pig]

Protecting the forums?? Protecting them from what exactly? My best guess is anyone that disagrees with you. The direction SDN has taken over the last several years is causing many to avoid posting or participating. Most of the moderators are obnoxious idiots. The number of users on SDN is pathetic given the number of premeds, medical students, residents, and physicians. SDN unwritten rules are largely to blame for this. Disagree with someone like idiot. I challenge anyone to disagree with GoroTard or any other moderator and count how long your account lasts. This place is pathetic. SDN has redefined what it means to be a troll.+

I'm back with another of my many many accounts. Yes, ban this one and I'll come back with another. I've seen accounts that wren't even mine get banned because the weren't pro-SDN unwritten policy and rules.

 

[Football Pig]

I smelled troll respawn yesterday when that loon attacked me in the Osteo forum. A high inflammatory post/total post ratio from a newly joined member seems to be the tip-off. Kudos to the moderators for protecting the forums.

I'm sure you did idiot. Anyone who disagrees with you is "trolling." I recall your ignorant self being suspended a few months ago after getting way more warnings than anyone else would ever get. They finally had to suspend you. For me, never get a warning or suspension. Nah, I get banned immediately.

BTW....Trump is great.

 

[WingedOx]

Protecting the forums?? Protecting them from what exactly? My best guess is anyone that disagrees with you. The direction SDN has taken over the last several years is causing many to avoid posting or participating. Most of the moderators are obnoxious idiots. The number of users on SDN is pathetic given the number of premeds, medical students, residents, and physicians. SDN unwritten rules are largely to blame for this. Disagree with someone like idiot. I challenge anyone to disagree with GoroTard or any other moderator and count how long your account lasts. This place is pathetic. SDN has redefined what it means to be a troll.+

I'm back with another of my many many accounts. Yes, ban this one and I'll come back with another. I've seen accounts that wren't even mine get banned because the weren't pro-SDN unwritten policy and rules.

He seems well-adjusted and totally without any chronic self-induced mental health issues.

 

[Winged Scapula]

Protecting the forums?? Protecting them from what exactly? My best guess is anyone that disagrees with you. The direction SDN has taken over the last several years is causing many to avoid posting or participating. Most of the moderators are obnoxious idiots. The number of users on SDN is pathetic given the number of premeds, medical students, residents, and physicians. SDN unwritten rules are largely to blame for this. Disagree with someone like idiot. I challenge anyone to disagree with GoroTard or any other moderator and count how long your account lasts. This place is pathetic. SDN has redefined what it means to be a troll.+

I'm back with another of my many many accounts. Yes, ban this one and I'll come back with another. I've seen accounts that wren't even mine get banned because the weren't pro-SDN unwritten policy and rules.

1) Goro is not a member of staff
2) Goro himself will tell you that staff has often disagreed with him and we have had numerous complaints and he's been subject to administrative action. He's far from protected nor are people who disagree with him
3) We may be idiots but I think you've proven you are. You get banned immediately because it is clear, not unwritten but clear in our TOS that if you are banned for trolling you are not welcome back with another account.