UC Davis midlevels over students?

[physiciansforpatients]

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On my last rotation I got pulled aside on the first day by the head of the department to tell me that’s the np students will get first crack at seeing the better cases and any procedures that come our way.

Good times.

This is where we are at, folks.

How do we change this?

This is not something that will resolve itself and is going to take tremendous physician push back. I don't want to just shamelessly plug PPP, so here is my advice and what I'm doing:

1. I will not train and/or hire NP/PAs. I will collaborate only as necessary. I am not anti-NP/PA, but I know their limits and I cannot support what the AANP is pushing for.
2. I make it clear that physician training is far superior to midlevel training. If anyone needs stats or data, let me know, I have a plethora to go against the poorly designed studies they tout.
3. I am as active as possible in contacting legislators during voting sessions on scope of practice laws (one just happened and we had a really solid turn out against it). I seek out institutions that are pro-physician lead care (AOA is currently against scope of practice change, whereas The Robert Wood Johnson Foundation and the IOM are currently pro-NP lead care).
4. I pay attention to the AANP agenda as much as possible. I look at their webinars and their posted minutes to see their very active plans on lobbying and reframing themselves as better more desirable "providers," than physicians.
5. Speaking of providers. I will NEVER refer to myself as a provider.
6. I will always advocate for my patients to receive the best care possible and that means physician care. That is because I know for a fact you CANNOT deliver the level of care physicians give with 500 hours of shadowing and a non-clinical doctorate. No studies about A1c, or whatever arbitrary stat b/w physicians and midlevels can change that.
7. I will call out institutions that are betraying physicians such as those that fire entire an entire department of pediatricians to replace them with NPs in order to make a quick buck, or institutions like UC Davis who would undermine their medical students to serve a money making program.
8. I will be just as vocal and raise lobbying as our opposition, until our message is clear and the reality is of physicians leading health care instead of greedy admin with MBAs, NPs with non-clinical doctorates and insurance companies.

 

[realitysickness]

Hi I was recently accepted to UCD and am thrilled at the prospect of attending but this news is giving me serious second thoughts... what can I do to hold the administration accountable? Should I email Admissions about this through our applicant portal? Call Admissions?

 

[Goro]

Hi I was recently accepted to UCD and am thrilled at the prospect of attending but this news is giving me serious second thoughts... what can I do to hold the administration accountable? Should I email Admissions about this through our applicant portal? Call Admissions?

Better to complain to the Clinical Dean's, the Dean, and the University system chancellor/President/Provost/CEO.

Also have politicians in that loop. And always make this about patient safety.

 

[heartofadoctor]

Hi I was recently accepted to UCD and am thrilled at the prospect of attending but this news is giving me serious second thoughts... what can I do to hold the administration accountable? Should I email Admissions about this through our applicant portal? Call Admissions?

hello!

UCD is a great school, I'm almost done there. Don't message anyone and be on their radar. I hope admins will fix this and i bet they will. Don't take a risk especially if it's the only school you got into or if it is the only california school you an go to. This stuff hasnt happened before to my knowledge and i believe they will fix it. Don't contact leadership. It isnt a good idea to be put on the radar as a potential future student once youre admitted if you actually will go here.

 

[operaman]

Hi I was recently accepted to UCD and am thrilled at the prospect of attending but this news is giving me serious second thoughts... what can I do to hold the administration accountable? Should I email Admissions about this through our applicant portal? Call Admissions?

I think it’s absolutely fair to contact admissions and ask for additional information. I’d start with email and simply tell them you’ve heard online about this possibility of shifting most of the med students to remote rotation sites. Tell them you are skeptical of any rumor you read online and that you would like to know to what extent it may be true and how it may impact your class. It likely wasn’t discussed during the interview day yet is important for prospective applicants who are trying to find the best situation for themselves and their families.

The school should make a public statement about their plans or at least where things currently stand. If students could potentially spend most of their 3rd and 4th years at sites in another city, then that should be clearly disclosed on the front end. There are other schools end even residency programs who do this at baseline but are very open about it. Davis should be transparent on this issue as well.

 

[Indebt4Life]

They’re going to rescind an acceptance for asking a legitimate question? Not ruffling any feathers hasn’t seemed to benefit the profession, why continue with the same tactic. There’s a way to do it with grace.

Heartofadoctor
This type of avoidant, don’t say anything for fear of being targeted, just turn your head the other way chicken behavior is exactly why we are in this situation to begin with. I vehemently disagree. Ask the necessary questions NOW. Hold this medical school accountable. This is NOT fair. Young people attending Medical school is a SACRIFICE!! Sacrifice time and money

 

[libertyyne]

Heartofadoctor
This type of avoidant, don’t say anything for fear of being targeted, just turn your head the other way chicken you know what behavior is exactly why we are in this situation to begin with. I vehemently disagree. Ask the necessary questions NOW. Hold this medical school accountable. This is NOT fair. Young people attending Medical school is a SACRIFICE!! Sacrifice time and money

It's easy to say these things when you personally don't have anything on the line.

 

[AnatomyGrey12]

****, at this rate I'm finna be an MD / DO / NP / PA and CRNA.

Hey but on the bright side you will only need to take some quick online courses to get there

Hi I was recently accepted to UCD and am thrilled at the prospect of attending but this news is giving me serious second thoughts... what can I do to hold the administration accountable? Should I email Admissions about this through our applicant portal? Call Admissions?

Do you have another acceptance that you liked? If you have another option then it allows you to be bolder in your wording. If not then frame things the way Operaman suggested above

 

[chrissyxf]

It's not a dual program. NP students and PA students are just taking the same basic science classes together in the School of Nursing, but they are separate programs with separate requirements to get in.

It IS a dual program. It allows the same student to take both the NP and the PA licensing exam. It is explained on their website. The student completes one year of NP school and then applies to be in the dual program to complete the PA component.

M.S. nurse practitioner and physician assistant | Betty Irene Moore School of Nursing at UC Davis

 

[PharmlyDoc]

I'm a pharmacy student and I've had to drive an hour on average to all my rotations. That is, an hour to and then an hour from. I don't know about medical school, but for pharmacy the preceptors don't care how long students have to drive nor do they care about heavy traffic.

I have found that medical students typically have more say-so than pharmacy students about injustices put upon them. I hope you guys fix this. As for pharmacy students, we just put our heads down and play the game.

 

[Indebt4Life]

It's easy to say these things when you personally don't have anything on the line.

Libertyne
You don't know me at all to say something like that. Physicians (with real jobs and families to take care of) who are fighting the midlevel take over and the AANP have everything on the line. Google Steve Maron MD pediatrician and you will see what I mean.

 

[IsWhat]

It is possible the teaching teams at their affiliated hospital(s) simply prefer to teach PA students. I rotated at a hospital who refuses to take the local MD students, but takes PA students from the same school. Apparently the MD students were showing up late, refusing to do call, lacked bedside manner, etc. I hope this is an isolated incident, and not some systemic problem where PA students are outperforming the medical students at their institutions.

 

[NicMouse64]

It is possible the teaching teams at their affiliated hospital(s) simply prefer to teach PA students. I rotated at a hospital who refuses to take the local MD students, but takes PA students from the same school. Apparently the MD students were showing up late, refusing to do call, lacked bedside manner, etc. I hope this is an isolated incident, and not some systemic problem where PA students are outperforming the medical students at their institutions.

Doing this has gotten students dismissed from my school. Most of my classmates have exceptional bedside manner and would never do things like that. This is the problem of the institution and school for admitting such brats and not instituting severe consequences for those students. Students of MEDICINE should get priority on MEDICAL education.

 

[MerYangBey]

It is possible the teaching teams at their affiliated hospital(s) simply prefer to teach PA students. I rotated at a hospital who refuses to take the local MD students, but takes PA students from the same school. Apparently the MD students were showing up late, refusing to do call, lacked bedside manner, etc. I hope this is an isolated incident, and not some systemic problem where PA students are outperforming the medical students at their institutions.

I feel like no Med student would pass their rotations if they did those things. At least they would get terrible evals. (I’ve never heard of someone refusing to take call lol, every Clerkship has requirements that need to be met)
Saying that the PA or nursing students have better bed side manner is part of the problem. It’s part of the “we care more about your wellbeing” advertising scheme that NPs currently have.

 

[Perrotfish]

Heartofadoctor
This type of avoidant, don’t say anything for fear of being targeted, just turn your head the other way chicken behavior is exactly why we are in this situation to begin with. I vehemently disagree. Ask the necessary questions NOW. Hold this medical school accountable. This is NOT fair. Young people attending Medical school is a SACRIFICE!! Sacrifice time and money

I mean, I get the attitude, but no. You can't hold a medical school or residency accountable for anything while you're in training. They can easily drop you and move on to another candidate without a single dollar of tuition lost. They have all the power and you have none. The eighth law applies and whatever they do, you have to roll with it.

As an attending its more complicated. Now you have something your employer/board/advocacy organization wants you can walk away if they do things you don't like. Advocacy can still hurt your career, but it can also achieve results and is unlikely to actually ruin your career completely. If you want to advocate, the time is after you've finished residency.

 

[Perrotfish]

It is possible the teaching teams at their affiliated hospital(s) simply prefer to teach PA students. I rotated at a hospital who refuses to take the local MD students, but takes PA students from the same school. Apparently the MD students were showing up late, refusing to do call, lacked bedside manner, etc. I hope this is an isolated incident, and not some systemic problem where PA students are outperforming the medical students at their institutions.

Another possibility is that both the MD and the PA students are unpleasant to work with, but the medical school was asking local physicians to act as preceptors for free while the PA school offered a generous stipend for each student precepted. Its a pretty common model for MD schools not to pass on any of your tuition to the people who are actually teaching you.

 

[Perrotfish]

I feel like no Med student would pass their rotations if they did those things.

I passed Ob/Gyn, therefore you can pass a medical school rotation while doing those things.

 

[MerYangBey]

I passed Ob/Gyn, therefore you can pass a medical school rotation while doing those things.

Lol I guess standards differ across the county 😉😉

 

[evilbooyaa]

On my last rotation I got pulled aside on the first day by the head of the department to tell me that the np students will get first crack at seeing the better cases and any procedures that come our way.

Good times.

This is where we are at, folks.

How do we change this?

Report to LCME, anything else is unacceptable IMO.

I understand it's easy to say this with nothing on the line, but I would find a way to have LCME know about this. You could try clinical dean's but it's unlikely to help if they're all in the cabal together.

I will not train any NP or PA students during my entire career.

 

[Iz_FtB]

Where are the physicians from the mid-level thread a few weeks back who had nothing but glowing experiences to share?

Not sure why the med student opinion is devalued when we will bear the brunt of this nonsense as our "mentors" sell us out.

 

[deleted787552]

Where are the physicians from the mid-level thread a few weeks back who had nothing but glowing experiences to share?

Not sure why the med student opinion is devalued when we will bear the brunt of this nonsense as our "mentors" sell us out.

You can probably tag them all. Not sure they’re gonna be on your side though. From what I got, their arguments were basically

1) midlevels will be around longer than med students on a rotation so it’s more beneficial in the long run to train them

2) med students don’t show much interest as mid levels

3) mid levels are very nice and helpful to us

4) med students should learn from them too since they have more experience then them and medicine is a team effort

I’m sure there’s More but these were what stuck out to me. It was pretty disheartening to see physicians disregard the opinions of med students like that.

 

[evilbooyaa]

But there's a difference in a discussion between medical students and graduated mid levels and a discussion between medical STUDENTS and midlevel STUDENTS, right? Right?

 

[VA Hopeful Dr]

Where are the physicians from the mid-level thread a few weeks back who had nothing but glowing experiences to share?

Not sure why the med student opinion is devalued when we will bear the brunt of this nonsense as our "mentors" sell us out.

That thread was about midlevels, not midlevel students, who were hired by the specific department to work for them.

 

[VA Hopeful Dr]

But there's a difference in a discussion between medical students and graduated mid levels and a discussion between medical STUDENTS and midlevel STUDENTS, right? Right?

Ah, beat me to it.

 

[Iz_FtB]

But there's a difference in a discussion between medical students and graduated mid levels and a discussion between medical STUDENTS and midlevel STUDENTS, right? Right?

I'm not terribly sensitive to the distinction. Both cited cases end with the medical student (or resident per that other thread) being depriorotized in favor of the mid level (employee or student).

I see it all as part of the same trend. Lobbying of the benefits of midlevels without acknowledging the drawbacks. Give an inch and lose a mile seems the order of the day.

 

[fldoctorgirl]

A friend of mine at another medical school has a sister who graduated last week with her online NP degree.

Online. Degree.

If we've gotten to the point where someone can get a degree to care for patients online, I think we've already lost the battle.

Oh, lets not forget my other friend, who's a physician (a podiatrist) and is telling his daughter to go become either a PA or an NP because the lifestyle is better.

 

[Matthew9Thirtyfive]

A friend of mine at another medical school has a sister who graduated last week with her online NP degree.

Online. Degree.

If we've gotten to the point where someone can get a degree to care for patients online, I think we've already lost the battle.

Oh, lets not forget my other friend, who's a physician (a podiatrist) and is telling his daughter to go become either a PA or an NP because the lifestyle is better.

Terrifying knowing she can now go out and endanger patients.

 

[fldoctorgirl]

Terrifying knowing she can now go out and endanger patients.

As far as I know, she plans on going and injecting botox into people and doing other beauty treatments to make easy money. What a joke.

 

[SpartanWolverine]

...
5. Speaking of providers. I will NEVER refer to myself as a provider. ...

I know I'm pulling this from quite a ways up but... besides the fact that the term 'provider' is thrown about all the time by administration and nursing staff I absolutely hate how many physicians also now use the term 'provider'. It hurts my brain every time I hear it. And now my pharmacist friend is talking about how they're basically functioning as a 'provider' and is doing the same work as a primary care doc.

... also recently seeing NPs listed as patients' primary care physician makes me a little bit ill.

 

[Matthew9Thirtyfive]

And now my pharmacist friend is talking about how they're basically functioning as a 'provider' and is doing the same work as a primary care doc.

The inferiority complex is real.

 

[DO2015CA]

The inferiority complex is real.

We should take this as a compliment lol. It’s hard to make good primary care look easy. We’ve done our jobs too well when they think they can do primary care well.

 

[Matthew9Thirtyfive]

We should take this as a compliment lol. It’s hard to make good primary care look easy. We’ve done our jobs too well when they think they can do primary care well.

True enough. It still needs to be combated though. Patients are being harmed by people running around playing doctor with a degree they printed out at home.

 

[DO2015CA]

True enough. It still needs to be combated though. Patients are being harmed by people running around playing doctor with a degree they printed out at home.

No doubt. I agree

 

[Matthew9Thirtyfive]

So maybe I'm out of the loop, and I would never call an individual physician, NP, pharmacist, etc. a "provider," or a group of physicians, NPs, pharmacists, etc. "providers" - I would call them by their proper titles. But I always interpreted "providers" and referring to a group of various types of healthcare professionals - we are all providing care in our various roles. So what is the proper term for that if not providers?

Not trying to be contentious lol, just genuinely wondering.

The issue many have with the term provider is it has been used by midlevels to blur the difference between physicians and midlevels, creating a false equivalency. “We’re all providers” is exactly what they want people to say and patients to think.

 

[deleted787552]

So maybe I'm out of the loop, and I would never call an individual physician, NP, pharmacist, etc. a "provider," or a group of physicians, NPs, pharmacists, etc. "providers" - I would call them by their proper titles. But I always interpreted "providers" and referring to a group of various types of healthcare professionals - we are all providing care in our various roles. So what is the proper term for that if not providers?

Not trying to be contentious lol, just genuinely wondering.

You know how physicians are called Dr. xyz by everyone. WTF do you call a PA/NP? Part of me thinks forcing us to use 'provider' was actually intentional - to make PAs, NPs, physicans etc all seem like they're on the same level. This was the end goal all along you guys! 😱

 

[DO2015CA]

The issue many have with the term provider is it has been used by midlevels to blur the difference between physicians and midlevels, creating a false equivalency. “We’re all providers” is exactly what they want people to say and patients to think.

Lol they can have the term provider. I will correct them/my patients that I am a physician not a provider. This takes the power out of the term provider and makes it synonymous with midlevel. If enough physicians corrected their patients then it wouldn’t take long for the public to understand providers aren’t doctors.

 

[Matthew9Thirtyfive]

Lol they can have the term provider. I will correct them/my patients that I am a physician not a provider. This takes the power out of the term provider and makes it synonymous with midlevel. If enough physicians corrected their patients then it wouldn’t take long for the public to understand providers aren’t doctors.

Agree. The problem is that physicians are using the term as well.

 

[Perrotfish]

I know I'm pulling this from quite a ways up but... besides the fact that the term 'provider' is thrown about all the time by administration and nursing staff I absolutely hate how many physicians also now use the term 'provider'. It hurts my brain every time I hear it. And now my pharmacist friend is talking about how they're basically functioning as a 'provider' and is doing the same work as a primary care doc.

... also recently seeing NPs listed as patients' primary care physician makes me a little bit ill.

Yeah but you want a word that means physicians + NPs + PAs. It comes up a lot. As in "the providers all have to have the new opiate training done by 16:00", or "all of the providers have a meeting in conference room C at lunch".

You know how physicians are called Dr. xyz by everyone. WTF do you call a PA/NP? Part of me thinks forcing us to use 'provider' was actually intentional - to make PAs, NPs, physicans etc all seem like they're on the same level. This was the end goal all along you guys! 😱

For civilians working in the military healthcare system, at least where I've worked, we've used the credential before the last name. So 'Doctor Perrotfish', 'PA Oldcorpsman', 'RN Ratched', or 'NP Schmuckatelli'

I always thought it was a good system, though I've never heard it used outside of the military.

 

[Matthew9Thirtyfive]

Yeah but you want a word that means physicians + NPs + PAs. It comes up a lot. As in "the providers all have to have the new opiate training done by 16:00", or "all of the providers have a meeting in conference room C at lunch".


For civilians without a rank the military uses the credential before the last name. So 'Doctor Perrotfish', 'PA Oldcorpsman', 'RN Ratchet', or 'NP Schmuckatelli'

I always thought it was a good system, though I've never heard it used outside of the military.

We did that at the first hospital I worked at. Worked well except for the one NP who called herself Dr. to patients.

 

[deleted787552]

Okay but what is the correct term to collectively refer to physicians + midlevels?

Why can't we just say physicians and midlevels? We can't be that lazy lol. I still think using 'provider' is meant to take away the difference in authority between the two- make them all seem equal cause god forbid a hierarchy exist

 

[DO2015CA]

Okay but what is the correct term to collectively refer to physicians + midlevels?

 

[Wahkoon]

Okay but what is the correct term to collectively refer to physicians + midlevels?

I don’t see the need. They both fall under the greater term of healthcare professionals

 

[Angus Avagadro]

So maybe I'm out of the loop, and I would never call an individual physician, NP, pharmacist, etc. a "provider," or a group of physicians, NPs, pharmacists, etc. "providers" - I would call them by their proper titles. But I always interpreted "providers" and referring to a group of various types of healthcare professionals - we are all providing care in our various roles. So what is the proper term for that if not providers?

Not trying to be contentious lol, just genuinely wondering.

y I dont see the word Provider anywhere on my diploma, so I prefer to be referred to as a physician. Control the language, control the argument.

 

[Goro]

y I dont see the word Provider anywhere on my diploma, so I prefer to be referred to as a physician. Control the language, control the argument.

What terms are HMOs using?

 

[Matthew9Thirtyfive]

Okay but what is the correct term to collectively refer to physicians + midlevels?

Healthcare professionals? That’s the only real term that includes both. Provider is a propaganda term.

Normally I would say that in an office or hospital setting away from patients, eg, in an administrative situation, saying providers would be okay. But with this topic, you just can’t. You use that term once and they’ll start using it to every patient under the sun. A physician is a physician, and a midlevel is a midlevel. There’s nothing insulting about the term midlevel. It accurately describes what they are, and they only pretend it’s insulting to guilt you into calling them providers.

 

[VA Hopeful Dr]

Healthcare professionals? That’s the only real term that includes both. Provider is a propaganda term.

Normally I would say that in an office or hospital setting away from patients, eg, in an administrative situation, saying providers would be okay. But with this topic, you just can’t. You use that term once and they’ll start using it to every patient under the sun. A physician is a physician, and a midlevel is a midlevel. There’s nothing insulting about the term midlevel. It accurately describes what they are, and they only pretend it’s insulting to guilt you into calling them providers.

This is ridiculous.

Is provider sometimes used to blur the lines? No doubt.

Is it also used as a convenient way to say "people who provide medical care to patients"? Obviously.

Just yesterday we had a meeting for all physicians and midlevels about changes in our benefits. So the invitation was titled "Provider Benefit Meeting". I'm around 100% sure that HR isn't trying to promote the midlevel agenda. "Physician and Midlevel Benefit Meeting" is needlessly wordy.

 

[deleted787552]

It’s not a personal thought you have, it is 100% a fact. Anyone who says otherwise is either in bed with the admin or incredibly blind/ naive

True haha. Last time I mentioned something like this, I got blasted for asserting ‘my opinion’ so I’m covering my backside this time around

I still don’t get how we’ve transitioned from a hierarchy system based on knowledge/experience to “we’re all on the same level”

 

[deleted787552]

This is ridiculous.

Just yesterday we had a meeting for all physicians and midlevels about changes in our benefits. So the invitation was titled "Provider Benefit Meeting". I'm around 100% sure that HR isn't trying to promote the midlevel agenda. "Physician and Midlevel Benefit Meeting" is needlessly wordy.

Why? It’s actually more specific. At least then you know only those 2 groups need to attend.

Ive recently discovered that the definition of provider varies between hospitals. Provider doesn’t just refer to docs/PAs/NPs. At one of the hospitals, I shadowed at, they called techs and childlife support “providers” which according to your definition makes sense cause they provide a service to patients

 

[VA Hopeful Dr]

Why? It’s actually more specific. At least then you know only those 2 groups need to attend.

Ive recently discovered that the definition of provider varies between hospitals. Provider doesn’t just refer to docs/PAs/NPs. At one of the hospitals, I shadowed at, they called techs and childlife support “providers” which according to your definition makes sense cause they provide a service to patients

I've worked for 5 hospitals to this point and in every one of them Provider meant doctor, PA, and NP.

Never seen techs, nurses, RT, or anyone else called it.

 

[Matthew9Thirtyfive]

This is ridiculous.

Is provider sometimes used to blur the lines? No doubt.

Is it also used as a convenient way to say "people who provide medical care to patients"? Obviously.

Just yesterday we had a meeting for all physicians and midlevels about changes in our benefits. So the invitation was titled "Provider Benefit Meeting". I'm around 100% sure that HR isn't trying to promote the midlevel agenda. "Physician and Midlevel Benefit Meeting" is needlessly wordy.

I'm not talking about HR. I'm talking about midlevels. I've worked with multiple midlevels who really wanted to be thought of as a doctor. They would introduce themselves as doctor to patients, use the term provider when referring to MD/DO/NP/PA to confuse patients, etc. It is a real thing.