US news article....formulate your own opinions

[ThinkFast007]

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Since it mentioned gas and it's recent, i thought i should post it on here for all to read.

start reading circa page 3

http://www.usnews.com/usnews/issue/050131/health/31turf.htm

 

[UTSouthwestern]

Since it mentioned gas and it's recent, i thought i should post it on here for all to read.

start reading circa page 3

http://www.usnews.com/usnews/issue/050131/health/31turf.htm

Just proves that this situation is not unique to our profession. It doesn't even begin to touch the issue of outsourcing that is affecting other subspecialties.

I also find it exceedingly amusing that other specialties' national organizations are now calling for collaborative efforts to stem the tide of midlevel legal actions when our organizations have been calling for this for almost 15 years.

 

[ThinkFast007]

Just proves that this situation is not unique to our profession. It doesn't even begin to touch the issue of outsourcing that is affecting other subspecialties.

I also find it exceedingly amusing that other specialties' national organizations are now calling for collaborative efforts to stem the tide of midlevel legal actions when our organizations have been calling for this for almost 15 years.

great point...i was thinking along the same lines....

I just saw this today...i can already imagine the phone calls from my non-med friends about this in a few days..

 

[bogatyr]

These articles never address the malpractice situation for physician extenders when they get privileges to practice independently. How do their insurance rates compare with a physician? Can they be sued? Are the plaintiffs awarded the same astronomical decisions when the defendent doesn't have an MD after their name?

 

[UTSouthwestern]

These articles never address the malpractice situation for physician extenders when they get privileges to practice independently. How do their insurance rates compare with a physician? Can they be sued? Are the plaintiffs awarded the same astronomical decisions when the defendent doesn't have an MD after their name?

No and no. Although physician extenders want to dissolve physician supervision, they do NOT want to absorb the liability of an independent practitioner. The majority remain employees of the hospital, clinic, surgicenter, etc. and use the umbrella coverage of the facility to cover liability. Let the physicians take care of the difficult patients and let them absorb the high insurance costs and let them get the lawsuits, etc. while the midlevels take the easy patients and make the easy money. That in essence is what it boils down to: The push for expanded midlevel/non-physician care isn't to increase access, it's to cut into physician practices by taking away the bread and butter cases.

 

[redstorm]

i swear... they make it easier and easier for other people to practice medicine and harder and harder for physicians to practice.. namely harder to get a license.. harder to be board certified.... more and more exams... more hoops after hoops to jump through.. is this because of bureacracy or what.. It is truly truly un****ing believable some of the **** you have to go through..

 

[ThinkFast007]

i swear... they make it easier and easier for other people to practice medicine and harder and harder for physicians to practice.. namely harder to get a license.. harder to be board certified.... more and more exams... more hoops after hoops to jump through.. is this because of bureacracy or what.. It is truly truly un****ing believable some of the **** you have to go through..

One word MONEY.

I think its the older doctors (by this I mean doctors that have been practicing for a while, not older as in 'age'). These older docs have gotten their fame/glory from medicine. now they are thinking of just one thing....money and how to make it fast. all they desire to do is have a great clientele and be very efficient, so they'll hire PAs/ or the like and have these people do their 'scutwork'. I say this, because i just talked to an attending who hires PAs and basically distributes them to hospitals at a PRN basis.

bottom line...i feel these 'older' docs are in some way contributing to this ongoing 'demise'/takeover. perhaps and even 'selling out' their own profession........

 

[jwk]

One word MONEY.

I think its the older doctors (by this I mean doctors that have been practicing for a while, not older as in 'age'). These older docs have gotten their fame/glory from medicine. now they are thinking of just one thing....money and how to make it fast. all they desire to do is have a great clientele and be very efficient, so they'll hire PAs/ or the like and have these people do their 'scutwork'. I say this, because i just talked to an attending who hires PAs and basically distributes them to hospitals at a PRN basis.

bottom line...i feel these 'older' docs are in some way contributing to this ongoing 'demise'/takeover. perhaps and even 'selling out' their own profession........

Anesthetists are hardly a new profession. CRNA's have been around more than 100 years, and even AA's for more than 30 now. There is a shortage of anesthesia providers of all types for the forseeable future.

As far as PA's - they provide a valuable service, and all though some may be doing "scutwork", they also allow physicians who are ever-pressed to see more patients per day to do just that. I don't think PA's are going into the profession looking to push MD's out of the way. Quite the contrary - they work WITH physicians, hence the "P" in PA. And remember that in most states, each individual physician may have a maximum of two PA's.

NP's - now that may be another story. 🙄

 

[IM/AnesthMD]

The whole issue, from its front cover to the contents within, was not so discreetly biased in favor of nurses/PAs and their efforts to gain independance. In many of the articles it quotes various NPs/PAs describing themselves as "just as safe as MDs" and tried to paint them as the underdogs trying to fight MDs who are 'obviously' all tyrants, lazy, only want to make money, and wish to eliminate mid-level practitioners from making any money. The articles essentially were attempting to recreate the dooms-day hysteria of 10 years ago that never materialized into reality.

It is interesting that the authors of the articles are named but not identified--their sources of funding/background/relationship to healthcare field etc..

It is also interesting that rarely were any physicians quoted in the articles (and only ones that agreed with the use of non-mds).

Overall, this magazine and others of its genre are suspect to say the least. Sensationalized journalism equates to only slightly more credibility than the Enquirer/Star/teeny bopper magazines.

 

[el guapo]

Taking care of patients independently is not a God-given right as this article would imply, it is a PRIVELEDGE that is earned by working through 4 years of college at the top of one's class, gaining entry into a medical school, and then sacrificing time and money through medical education and residency training. This trains you in the breadth and depth of medical knowledge necessary to accept responsibility of holding another persons life and health in your hands. It is not earned by cutting corners, entering the job market, and then holding a midlevel job for long enough that you feel comfortable in upgrading your status in health care by practicing independently. That is cheating the system, practicng beyond the level that one has earned in their training.

I am all for the defined role of midlevels in healthcare, they serve a need, and in their role can practice safe and effective medicine in that role. But they are not qualified to be in independent, critical decision making positions any more than a paralegal is qualified to take a lead postion in a trial. Physicians need to stand up to protect the job that they have earned, to be the SOLE profession that is the decision makers in health care. That is what we have invested the years of focus and effort to do, physicians and physicians alone. We need to write letters to the editors of biased garbage like this US News article, we need to lobby at the state and local level. We need to invest the time and money to protect the future of our profession from those who overstep their authority and chip away at our profession. We need to kick start the AMA and established physicians into taking an active role in this. We need to stand together as those who have chosen to make the extraordinary investment to be the leaders in providing health care.

 

[jwk]

Taking care of patients independently is not a God-given right as this article would imply, it is a PRIVELEDGE that is earned by working through 4 years of college at the top of one's class, gaining entry into a medical school, and then sacrificing time and money through medical education and residency training. This trains you in the breadth and depth of medical knowledge necessary to accept responsibility of holding another persons life and health in your hands. It is not earned by cutting corners, entering the job market, and then holding a midlevel job for long enough that you feel comfortable in upgrading your status in health care by practicing independently. That is cheating the system, practicng beyond the level that one has earned in their training.



I am all for the defined role of midlevels in healthcare, they serve a need, and in their role can practice safe and effective medicine in that role. But they are not qualified to be in independent, critical decision making positions any more than a paralegal is qualified to take a lead postion in a trial. Physicians need to stand up to protect the job that they have earned, to be the SOLE profession that is the decision makers in health care. That is what we have invested the years of focus and effort to do, physicians and physicians alone. We need to write letters to the editors of biased garbage like this US News article, we need to lobby at the state and local level. We need to invest the time and money to protect the future of our profession from those who overstep their authority and chip away at our profession. We need to kick start the AMA and established physicians into taking an active role in this. We need to stand together as those who have chosen to make the extraordinary investment to be the leaders in providing health care.

Lighten up a little - and put your credentials in your profile. You'll have a little more credibility if you do. Are you an MD, student, what? Oh, and learn how to spell. That'll help too.

Yessir massah, I'll does whatever you wants me to do. Is that really what you want? No - you don't, trust me.

Mid-level providers certainly have a place in today's medical community. And we have NOT cut corners to be where we are and we certainly haven't cheated the system. I have never claimed I'm as good as an MD nor would I. And PA (or AA or FNP or CNM) to MD is nowhere near the same as Paralegal:Attorney. Get real. That shows a complete lack of knowledge and understanding on your part regarding mid-level providers.

Don't lump all non-physicians into the same category, especially with the level of contempt you already hold, and your limited knowledge of the various fields. And don't assume that some magazine article represents the cutting edge of medical practice and politics. There's a wide range of non-physician practitioners out there. Some have a simple certificate. Many of us have master's degrees. And the vast majority of us don't wish to be or pretend to be physicians.

Oh, BTW, I'm just curious - did you vote for Kerry or Bush? Why am I asking? Because most idealogues such as you voted for Kerry, who, in case you didn't know, was all for the huge expansion of non-physician mid-level providers.

 

[powermd]

Jwk- I forgot exactly which variety of mid-level you are, but 1) remind me, and 2) could you please explain exactly what should be the limits of practice for a CRNA (since this is an anesthesia board)?

In my experience it seems the less training one has, the less likely one will know and appreciate their limits in a particular field. Politics aside, I think that's what makes physicians so nervous about mid-level's desiring increased scope of practice. In real life, I haven't seen any mid-level stepping beyond their scope of practice, but articles like the one this thread is discussing make it sound like the desire to do so is commonplace.

 

[jwk]

Wow, that was slick, you caught a spelling error. I did learn to spell quite well, actually, I would never have graduated with honors from UC had I not. But that seems like a long, long time ago, since for the past four years, I have been applying myself to understanding at the highest level all that Western society has to teach about the practice of medicine, to the tune of about 100 hrs/week, without pay, while going into debt six figures to finance this education. You know how it is, right? Oh yes, I guess you don't know at all.

Please don't get me wrong, as you may or may not have read in my post, I do have a great deal of respect for the job that midlevels do. I have gotten along very well with all of the midlevels and nurses and ancillary staff that I have had the pleasure of working with, and learning from as a student. My problem is when an individual without the proper training, and sacrifice, seeks to practice indepently at the expense of those who do, as advocated in the US News article. That IS cutting corners, whether you acknowledge so or not. And I would like to know why you seem to take issue when physicians or medical students voice their informed opinions on how care is provided, and sugges that we be more assertive in defining how health care is provided . Midelvels are not equal to physicians in their qualifications or ability to indepently provide health care, as that article we are discussing hints. You seem to acknowledge this point, but you are not comfortable when a medical student voices it.

Do you feel inadequate?

Ah, it's amazing the chip that you already have on your shoulder and haven't finished medical school yet.

I don't practice independently. I don't seek to practice independently. Inadequate? Hardly. I am very comfortable as part of my large anesthesia care team practice. I'm sure you haven't read my other posts on this board, particularly the CRNA/AA/MD threads, but if you do, you'll see that I would generally disagree with the Newsweek article, and I don't believe that mid-level practitioners should be practicing independent of physicians.

You say you have a "great deal of respect for the job that midlevels do". I hope you do, because except for that statement, your tone indicates otherwise. Depending on your eventual specialty, you'll probably learn that you will come to depend on many of them in your day-to-day routines.

And I have no problem with you voicing your opinion, as you shouldn't with mine.

 

[jwk]

Jwk- I forgot exactly which variety of mid-level you are, but 1) remind me, and 2) could you please explain exactly what should be the limits of practice for a CRNA (since this is an anesthesia board)?

In my experience it seems the less training one has, the less likely one will know and appreciate their limits in a particular field. Politics aside, I think that's what makes physicians so nervous about mid-level's desiring increased scope of practice. In real life, I haven't seen any mid-level stepping beyond their scope of practice, but articles like the one this thread is discussing make it sound like the desire to do so is commonplace.

I think you will see a lot of the professional organizations, particularly the nursing ones, seeking independent practice. CRNA's are a classic example, as an organization. But - I work with three dozen CRNA's, all of whom CHOOSE to work as part of a care team practice, just like hundreds of others that I know. However, their professional organization is all over the independent practice issue as you well know.

From where I sit, as an AA, I have always and will always work in an anesthesia care team environment, with MD's, CRNA's, and AA's all working together for the benefit of the patient. Obviously the MD heads the team. I think that's as it should be. Do I have a brain to think with and a mouth to speak my mind? Absolutely. Do I contribute to the team? Absolutely. Do I have disagreements with the MD's I work with? Sure. We discuss differences of opinion in how things should be done every day. Sometimes they'll agree with me, sometimes they won't. They value my education and 25 years of experience, just as I value theirs. I'm not the boss - but I'm not the servant either.

 

[impetigo]

Found a (free) link to the US News article here:

http://highestratednews.orb6.com/stories/usnews/20050202/medicinesturfwars.php

Clearly this is a crucial time for our profession and field; once you give up your turf, it's not going to be so easy to get it back.