What does this mean for the future of the profession?

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Steve_Zissou

Steve_Zissou

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www.whitehouse.gov

Executive Order on Protecting and Improving Medicare for Our Nation's Seniors | The White House

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: Section 1. P
www.whitehouse.gov www.whitehouse.gov

" conducting a comprehensive review of regulatory policies that create disparities in reimbursement between physicians and non-physician practitioners and proposing a regulation that would, to the extent allowed by law, ensure that items and services provided by clinicians, including physicians, physician assistants, and nurse practitioners, are appropriately reimbursed in accordance with the work performed rather than the clinician’s occupation. "
 
Steve_Zissou said:
I guess my question should have specified “if this passes.” If parity in pay and autonomy are given to mid-levels for Medicare, if my understanding of the proposal is correct. If I’ve misunderstood the proposal, let me know.
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I suspect it won't pass, not because the AMA, which is toothless and useless, is looking out for us but because I think enough people have sense in realizing that de-incentivizing the medical degree is the wrong way to go.
 
Mass Effect said:
I suspect it won't pass, not because the AMA, which is toothless and useless, is looking out for us but because I think enough people have sense in realizing that de-incentivizing the medical degree is the wrong way to go.
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That would be my hope. Its discouraging to see this as a student. Worrisome that leadership doesn't really see the value in all the education/time put into becoming a physician.
 
Steve_Zissou said:
. Worrisome that leadership doesn't really see the value in all the education/time put into becoming a physician.
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The way i read it , it says it will look at current policies that lead to reimbursement differences and propose policies to fix that.
So enmass organizations replace physicians with Midlevels. Probably leading to less people wanting to become physicans considering why would I go through step 1-3 and years of residency if some midlevel can legally do the exact same thing, and get reimbursed the same way in a fraction of the time and rigor.
 
Mass Effect said:
I suspect it won't pass, not because the AMA, which is toothless and useless, is looking out for us but because I think enough people have sense in realizing that de-incentivizing the medical degree is the wrong way to go.
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You have a lot of faith in the government to look at the longterm effect of their actions. I could easily see this happening.

Have you ever talked to local politicians that make policy changes that affect residents/physicians? They literally have no idea what's going on or how our training works.
 
I don’t really get it. Very vague. This is mentioned under a heading regarding reforms to allow providers to spend more time with patients. They may mean to increase reimbursement per patient so providers do not feel like they have to grind out so many short patient visits to be solvent. Patient satisfaction may improve. I do not see how simply increasing reimbursement for PAs/NPs is helpful from the standpoint of Medicare. More to pay out, unless they are planning to reduce reimbursements across the board and pay everyone the same for the “work.”

There’s a lot to flesh out. Not enough details here IMO.
 
Why would patients even see a mid-level? You have to pay the exact same co-pay and deductible. Why pay the same for less qualifications?

One time I broke my own code of not being seen by a mid-level, but I was kinda desperate and it was a PA so I made the appointment anyway. Then the morning of the appointment, her office called to tell me she cancelled my appointment because her child got sick.

That way my first and last appointment with a mid-level.
 
hallowmann said:
You have a lot of faith in the government to look at the longterm effect of their actions. I could easily see this happening.

Have you ever talked to local politicians that make policy changes that affect residents/physicians? They literally have no idea what's going on or how our training works.
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True. But they're also patients. When their kid gets sick, how many of them say "time to call the NP"?

Dantrolene FC said:
Why would patients even see a mid-level? You have to pay the exact same co-pay and deductible. Why pay the same for less qualifications?

One time I broke my own code of not being seen by a mid-level, but I was kinda desperate and it was a PA so I made the appointment anyway. Then the morning of the appointment, her office called to tell me she cancelled my appointment because her child got sick.

That way my first and last appointment with a mid-level.
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I mean, doctors do that too. They take sick days and sometimes it's because their kid is sick. I wouldn't see a mid-level if you don't want, but not because her child got sick the day of your appointment.
 
Dantrolene FC said:
Why would patients even see a mid-level?
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You wont have a ****ing choice!! Thats the point.. This mid-level **** started with clinton and obama added the steroids and they are not done yet until your salary is the same as a NP..
 
Dantrolene FC said:
Why would patients even see a mid-level? You have to pay the exact same co-pay and deductible. Why pay the same for less qualifications?

One time I broke my own code of not being seen by a mid-level, but I was kinda desperate and it was a PA so I made the appointment anyway. Then the morning of the appointment, her office called to tell me she cancelled my appointment because her child got sick.

That way my first and last appointment with a mid-level.
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From my experience with trying to get established with a new PCP where I currently live, I got a recommendation for someone from a friend, tried to schedule an appointment, and showed up and found out that the office had designated an APRN as my "PCP". She actually wasn't bad at all, and I'm young and healthy enough that I decided to let it slide, and then within a year she left the practice. I decided I was going to get my next annual physical with the MD I had been recommended, so I scheduled an appointment 4 months in advance, only to get an email a couple weeks before that he decided to go on vacation that day and that I could schedule another physical for another 3-4 months in advance or get on a waitlist. I took the WL and sure enough got another APRN fresh out of school, and the physical she gave me was far below the level I was expected to have at the end of med school orientation. I am now in search of an actual PCP at a different practice.

So, to answer your question, sometimes scummy practices shunt you away from MD/DOs and don't explain that an APRN is any different.
 
Dantrolene FC said:
Why would patients even see a mid-level? You have to pay the exact same co-pay and deductible. Why pay the same for less qualifications?

One time I broke my own code of not being seen by a mid-level, but I was kinda desperate and it was a PA so I made the appointment anyway. Then the morning of the appointment, her office called to tell me she cancelled my appointment because her child got sick.

That way my first and last appointment with a mid-level.
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Because sometimes there isn't an option available to see a physician. This is why midlevel expansion is a massive threat that needs to be taken seriously
 
I have an unpopular opinion, but here goes...

If you really want to go into a field that gets paid for procedures, do surgery. Not EM...not anesthesia.....surgery. Seriously. NP's and PA's are no where near capable of doing the bread & butter things that get us paid. This is true for pretty much every surgical specialty.

If legislation like this passes, I really see it applying to small office procedures (skin biopsies, IUD's, etc.) or hospital procedures that 3rd/4th year medical students get to do (central lines, bronchoscopies, thora/paracentesis, etc.) If NPs/PAs get paid just as much to do these basic procedures compared to an MD, so be it. If salary-based physician compensation continues to increase it won't matter how much we bill for these basic procedures, because the hospital gets the money anyway. Those in private practice can make more money off their PAs/NPs for doing easy procedures (as long as they assume liability).

It's preposterous to think that my skin biopsy/central line is worth more than one done by a PA/NP just because I have MD behind my name. On the other hand, I've seen Dr. Pimple Popper do worse things to people under the knife than some PAs/NPs.

Lastly, I don't think this is a slippery slope argument. PAs/NPs are nowhere near qualified to be primary proceduralists in the OR. Hospitals and procedural privilege committees will never allow it, the liability is greater than the benefits.

Hell, I'm a resident and patients still ask me if attending Dr.Whoever is the only person doing their surgery.
 
So what is the solution so everyone on here can stop bitching??

Everyone here cries every time a new school opens up because “diluting our profession” or whatever, puppets the “immigrants are taking our jobs!!” Line, and is ready to start a damn war over the mid levels. When it takes over 4 months to get an appointment for people, what is the magic solution? We need more doctors and residency slots. People are still getting sick more than ever.

Unless you wanna work 80+ hours a week as a doc your whole life, there isn’t another option. Everyone here expects to have great lifestyle and money no matter what they do. It’s incredible naive and amazing people can’t put themselves on the other side for a minute.
Please someone correct me if I’m wrong but I’m so damn tired of seeing the same BS all over here, with no solutions discussed. Quit your complaining and do something if it’s so dire. I hate militant midlevels as much as the next guy and think they’re gonna kill a lot of people if they keep expanding, but if they stay in their lane it’s incredibly helpful. Maybe I don’t see what it’s like in a major urban center but in the middle of the country it isn’t exactly saturated with doctors...
 
OnePunchBiopsy said:
I have an unpopular opinion, but here goes...

If you really want to go into a field that gets paid for procedures, do surgery. Not EM...not anesthesia.....surgery. Seriously. NP's and PA's are no where near capable of doing the bread & butter things that get us paid. This is true for pretty much every surgical specialty.

If legislation like this passes, I really see it applying to small office procedures (skin biopsies, IUD's, etc.) or hospital procedures that 3rd/4th year medical students get to do (central lines, bronchoscopies, thora/paracentesis, etc.) If NPs/PAs get paid just as much to do these basic procedures compared to an MD, so be it. If salary-based physician compensation continues to increase it won't matter how much we bill for these basic procedures, because the hospital gets the money anyway. Those in private practice can make more money off their PAs/NPs for doing easy procedures (as long as they assume liability).

It's preposterous to think that my skin biopsy/central line is worth more than one done by a PA/NP just because I have MD behind my name. On the other hand, I've seen Dr. Pimple Popper do worse things to people under the knife than some PAs/NPs.

Lastly, I don't think this is a slippery slope argument. PAs/NPs are nowhere near qualified to be primary proceduralists in the OR. Hospitals and procedural privilege committees will never allow it, the liability is greater than the benefits.

Hell, I'm a resident and patients still ask me if attending Dr.Whoever is the only person doing their surgery.
Click to expand...

Don’t be so sure. I’ve seen surgical PAs and NPs in the OR who the surgeon would have them start and close without attending even being present. Seen it for general surgery and OB/GYN surgical cases. I’ve seen a mid level perform a C section with minimal attending involvement.
 
TAVR4life said:
Don’t be so sure. I’ve seen surgical PAs and NPs in the OR who the surgeon would have them start and close without attending even being present. Seen it for general surgery and OB/GYN surgical cases. I’ve seen a mid level perform a C section with minimal attending involvement.
Click to expand...

Starting and closing are far different than performing the key aspect of the procedure. This is like comparing the driver of a formula 1 car to the person who parks it.

While surgical PAs/NPs are capable of starting and closing without supervision, this is after years of work during which they are overseen by an attending surgeon. Midlevels fresh out of school often don't even know how to make incision. These years of on-the-job training under a supervising surgeon preclude a future in which mid levels will graduate into positions as unsupervised proceduralists in an operating room.

A C section is a straight forward procedure: perform a cutdown to the giant uterus and open it. Still sounds like the attending was in the room. Who do they call to fix the bowel when it gets injured? Not a mid level.
 
OnePunchBiopsy said:
Starting and closing are far different than performing the key aspect of the procedure. This is like comparing the driver of a formula 1 car to the person who parks it.

While surgical PAs/NPs are capable of starting and closing without supervision, this is after years of work during which they are overseen by an attending surgeon. Midlevels fresh out of school often don't even know how to make incision. These years of on-the-job training under a supervising surgeon preclude a future in which mid levels will graduate into positions as unsupervised proceduralists in an operating room.

A C section is a straight forward procedure: perform a cutdown to the giant uterus and open it. Still sounds like the attending was in the room. Who do they call to fix the bowel when it gets injured? Not a mid level.
Click to expand...

That’s how it all starts. They get more and more responsibility with time and experience. They’ll argue for autonomy for the simple cases leaving the more complex, higher risk procedures (and thus higher liability cases) for the MDs—they did the same for primary care patients and anesthesia cases. They’re even doing some IR and colonoscopies.

Remember the hospital administration will push for this, ultimately they would rather pay PA/NP level salaries rather than pay physician salary. The hospital administration are the ones pushing to get equal reimbursements between MDs and mid levels because ultimately the plan is to have everything go through several mid levels with a MD supervising. Hospital administrators get to increase their profits while lowering their expenses by paying at a lower salary. Several powerful stakeholders are vying for a share of physician salaries including hospital administrations, nurses and other mid levels, insurance industry, federal government and most importantly the public. In the end there won’t be actual savings at the patient level there will only be a redistribution of the money to the stronger stakeholders.

Physicians should have been more active as leaders and in politics. Physicians should have been the leaders in administration instead they gave it up to MBAs and nurses. The lobbying was also severely lacking for physicians.

Surgery is relatively more protected than non-surgery based fields but it’s not immune.
 
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What do people mean by "if it passes"? This is an EO from October that is directing HHS to study physician / midlevel pay disparities. It then tells HHS to propose regulation (not legislation!) to shift compensation to work instead of occupation.

(c) conducting a comprehensive review of regulatory policies that create disparities in reimbursement between physicians and non-physician practitioners and proposing a regulation that would, to the extent allowed by law, ensure that items and services provided by clinicians, including physicians, physician assistants, and nurse practitioners, are appropriately reimbursed in accordance with the work performed rather than the clinician’s occupation.
Click to expand...

The fact that people in this thread don't understand what's actually happening points to a future in which the healthcare lobbyists control the agenda.
 
Chibucks15 said:
So what is the solution so everyone on here can stop bitching??

Everyone here cries every time a new school opens up because “diluting our profession” or whatever, puppets the “immigrants are taking our jobs!!” Line, and is ready to start a damn war over the mid levels. When it takes over 4 months to get an appointment for people, what is the magic solution? We need more doctors and residency slots. People are still getting sick more than ever.
Click to expand...

The magic solution is med school expansion AND residency expansion.
 
BorderlineQueen said:
Some people don't want that though since an influx of physicians would lower wages.
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? huh

The massive wave of midlevels is consuming jobs previously used for physicians and it’s only getting worse. Further, I cannot comprehend how people don’t understand midlevel use and massive rise decreases pay for physicians. It’s more doctors for less positions (ie doctors willing to accept lower pay) since the c suites are using mid levels for physician jobs. Clear examples are seen in emergency medicine and internal medicine. I’m just amazed people don’t see this. Even more amazed at the *****s who train midlevels and the utterly *****ic students and residents who defend their use/ position.
 
TAVR4life said:
That’s how it all starts. They get more and more responsibility with time and experience. They’ll argue for autonomy for the simple cases leaving the more complex, higher risk procedures (and thus higher liability cases) for the MDs—they did the same for primary care patients and anesthesia cases. They’re even doing some IR and colonoscopies.
Click to expand...

Again you emphasize my point, mid-level takeover is definitely an issue, however mostly for non-surgical specialties. More people are learning how to cannulate blood vessels, intubate, and use a colonoscope.

TAVR4life said:
Remember the hospital administration will push for this, ultimately they would rather pay PA/NP level salaries rather than pay physician salary. The hospital administration are the ones pushing to get equal reimbursements between MDs and mid levels because ultimately the plan is to have everything go through several mid levels with a MD supervising. Hospital administrators get to increase their profits while lowering their expenses by paying at a lower salary. Several powerful stakeholders are vying for a share of physician salaries including hospital administrations, nurses and other mid levels, insurance industry, federal government and most importantly the public. In the end there won’t be actual savings at the patient level there will only be a redistribution of the money to the stronger stakeholders.
Click to expand...

Let's not forget, this is medicare we are talking about here. While medicare reimbursements are a major consideration at some hospitals, many rely mostly on private insurance. Getting private insurance to reimburse equally for physician and mid-level procedures is a different ball game. I do agree though, the bloating of hospital administration is a problem for physicians, mid-levels, and patients; I believe it is the key problem facing our healthcare system and why many people are pushing for Medicare for All.

TAVR4life said:
Physicians should have been more active as leaders and in politics. Physicians should have been the leaders in administration instead they gave it up to MBAs and nurses. The lobbying was also severely lacking for physicians.
Click to expand...

I agree, physicians have definitely dropped the ball in the political realm, especially compared to nurses. Physicians should seek out spots on hospital administration boards and committees when possible to survive.

TAVR4life said:
Surgery is relatively more protected than non-surgery based fields but it’s not immune.
Click to expand...

Surgery is very protected. Hell, physicians without true surgical training even have a tough time masquerading as surgeons. If we're assuming this is a slippery slope argument then nothing is immune.

I don't think this is a slippery slope.

Call me an optimist, but I think both physicians and mid-levels can co-exist and adapt. If that means I'm doing a big case in the OR while my PA does a skin biopsy in clinic, so be it. Enough gloom and doom.
 
90% of day of sick visits I’ve had for myself, wife or kid for the last 3 years have been with an NP/PA. From an end user perspective, it makes total sense. Primary care, Peds and Anesthesia are the most at risk fields, but only for the boring s**t.

You will never have a CRNA run the OR on a complex patient, or an NP be the primary provider for the 12 yo CF kid. Everyone worries about mid level expansion, but they have a fairly low ceiling to the scope of practice that will always require MD supervision.
 
ChiTownBHawks said:
? huh
I’m just amazed people don’t see this. Even more amazed at the *****s who train midlevels and the utterly *****ic students and residents who defend their use/ position.
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I am amazed as well.
utterly amazed.
But here is the deal, organizations hire physicians and part of the deal is that they train midlevels. Its non-negotiable. If they want the job and MONEY they train midlevels....
It's utterly shameful but thats the deal.
this profession is for ****
 
I continue to have a hard time getting worked up about most of this. Medicine/doctors are not immune to market forces. Everyone knows medical care is expensive, and people are looking to save money. If a patient or hospital can get the same care from a PA/NP as they could from a physician, why should they not take advantage of that? My only concern continues to be PA/NPs practicing out of their scope. That should be part of their training. I have acknowledged that it does not take 4 years of medical school and 3 years of IM residency (which is more than half inpatient) to do some of the things in outpatient care and where there is a large need for providers.

If you are concerned about others "taking our jerbs," you have to go into a role that is difficult to replace. Like everyone else who is working. Our training does not automatically confer upon us more value, regardless of the task actually being performed.
 
Chemist0157 said:
I continue to have a hard time getting worked up about most of this. Medicine/doctors are not immune to market forces. Everyone knows medical care is expensive, and people are looking to save money. If a patient or hospital can get the same care from a PA/NP as they could from a physician, why should they not take advantage of that? My only concern continues to be PA/NPs practicing out of their scope. That should be part of their training. I have acknowledged that it does not take 4 years of medical school and 3 years of IM residency (which is more than half inpatient) to do some of the things in outpatient care and where there is a large need for providers.

If you are concerned about others "taking our jerbs," you have to go into a role that is difficult to replace. Like everyone else who is working. Our training does not automatically confer upon us more value, regardless of the task actually being performed.
Click to expand...
The problem with your argument "it doesnt take 4 years of medical school to some of the things in outpatient care" is nobody knows what some of those things are. In other words, sometimes its easy and straightforward, sometimes it is very very difficult and most of the time it is somewhere in the middle. But to just give independent authority to nurses is downright absolute INSANITY and for a physician to state this is equally dangerous and foolish. How about making medical Assistants independent. They go to school for 1-2 years? How about LPNs? Why cant they be independent?

You can legislate everyone out of a job. IT would solve the cost problem.. But actually it wouldnt. Because it would still cost the same but the middle man would take a bigger cut... Most of us have our heads stuck in our rears and wont see it for what it is. Healthcare is a extremely dirty dirty game and corrupt as all get out
 
Oh its a facebook groups..
Anesthesiology is a dangerous space to be in currently, especially if one is early in training.. or recently graduated because who knows what the space will look like in 10-15 years. The necessity of a physician and the demand very likely can contract significantly. Just very dangerous.
Having said that, the "Nurse Anesthesiologist" moniker is quite amusing because it forces them to refer to themselves as "NURSES" if they choose to use the word"Anesthesiologist" and you know how they love to refer to themselves as nurses. Unless they are saying something like, "What do I know? Im "Just a Nurse"..

Oh, man.... the mess that these politicians have made of healthcare. and you aint seen nothing yet..
 
PieOHmy said:
The problem with your argument "it doesnt take 4 years of medical school to some of the things in outpatient care" is nobody knows what some of those things are. In other words, sometimes its easy and straightforward, sometimes it is very very difficult and most of the time it is somewhere in the middle. But to just give independent authority to nurses is downright absolute INSANITY and for a physician to state this is equally dangerous and foolish. How about making medical Assistants independent. They go to school for 1-2 years? How about LPNs? Why cant they be independent?

You can legislate everyone out of a job. IT would solve the cost problem.. But actually it wouldnt. Because it would still cost the same but the middle man would take a bigger cut... Most of us have our heads stuck in our rears and wont see it for what it is. Healthcare is a extremely dirty dirty game and corrupt as all get out
Click to expand...

I was under the impression PAs/NPs could be trained to treat common problems? No? They can be trained to determine when it is out of their scope. They do not need the knowledge base to pass STEP tests to carry out what I am thinking. They would have as much authority as their training takes them like the rest of us. They can be liable for anything done out of negligence, malintent, etc like the rest of us.

The scarcity of primary care in certain areas is a far more dangerous situation than what I am describing, and it is far more foolish to think an MD should make more money to do the same job that others could do WHILE actually not having anyone to provide that service. It's like when my little boys would rather tear up a toy so no one has it rather than share. From a health population standpoint, the current system is not working.

You then go into this tirade about MAs? LPNs? Is anyone talking about that here? What would an LPN do in independent practice? However, I am glad you brought that up because I can draw a similarity between having only RNs doing a job any MA or LPN could do. You think my practice is going to fire all MAs to replace them with RNs and pay them RN salaries because they have better training, or do you think I am going to hire someone who is trained to do a job but at a lower price?

Now. What I have mostly been describing is primary care. I see extenders working inpatient under doc supervision which seems appropriate. I don't see any running around working independently. They shouldn't do anything beyond their training. I can't speak to anethesia, OR, etc as I know nothing about those situations. I feel pretty well protected in my corner as a specialist, but I am sure some areas would be threatened. It can be challenging to determine what is appropriate concern for patient care and what is just outright greed. I have seen both here.
 
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PieOHmy said:
Oh its a facebook groups..
Anesthesiology is a dangerous space to be in currently, especially if one is early in training.. or recently graduated because who knows what the space will look like in 10-15 years. The necessity of a physician and the demand very likely can contract significantly. Just very dangerous.
Having said that, the "Nurse Anesthesiologist" moniker is quite amusing because it forces them to refer to themselves as "NURSES" if they choose to use the word"Anesthesiologist" and you know how they love to refer to themselves as nurses. Unless they are saying something like, "What do I know? Im "Just a Nurse"..

Oh, man.... the mess that these politicians have made of healthcare. and you aint seen nothing yet..
Click to expand...

With due respect, I still think Anesthesiology will take a longer time to hit bottom than medical specialties. First of all, they have the highest paid midlevels out of any other specialty, at $160k+ a year working 40 hours a week. Unless CRNAs learn to take call and handle their own emergencies straight out of school, physicians graduating residency are never going to be paid a lower $/hour. Second, surgery is one of the only services that truly appears to be increasing in demand in the next decade. There won’t be any sudden contracture, only a question of how much of the extra demand will be met by CRNAs vs physicians. Third, do you really think the US will be the first country in the world to have nurses take over all their anesthesia? Even in countries with equivalents, like Switzerland, anesthesiologist physicians are still in demand and are one of the highest paid specialties.
 
[
ace_inhibitor111 said:
Third, do you really think the US will be the first country in the world to have nurses take over all their anesthesia?
Click to expand...
Yes I do. You seem to believe that anyone in the USA that matters really cares who gives anesthesia. They only care if tons of people are dying but thats not happening. The leadership in Anesthesiology is terrible. They dont know what to do. YOu have the nurses calling themselves Anesthesiologists for petes sake. All this spells "big ****ing trouble" and if you think that someone will wake up one day and say we cantreplace aceinhibitor with a nurse because thats not how they do it in switzerland you have your head further up your ass than i thought. American Medicine has been bought and sold in fact it was bought and sold 20 years ago but it wasnt as apparent as it is today..

take home message: YOu are ****IED !!!!
 
PieOHmy said:
[

Yes I do. You seem to believe that anyone in the USA that matters really cares who gives anesthesia. They only care if tons of people are dying but thats not happening. The leadership in Anesthesiology is terrible. They dont know what to do. YOu have the nurses calling themselves Anesthesiologists for petes sake. All this spells "big ****ing trouble" and if you think that someone will wake up one day and say we cantreplace aceinhibitor with a nurse because thats not how they do it in switzerland you have your head further up your ass than i thought. American Medicine has been bought and sold in fact it was bought and sold 20 years ago but it wasnt as apparent as it is today..

take home message: YOu are ****IED !!!!
Click to expand...

Worst case scenario the anesthesiologist just offers to be paid as much $/hr as the CRNA ($240-250k a year for 60 hours a week). There is no situation where a hospital would choose a CRNA over an anesthesiologist for the same pay. Certain procedures and surgeries are also still out of reach to CRNAs. Obviously, it's not an ideal case, but there is no doomsday scenario where anesthesiologists will be out of a job. The point I'm making with Switzerland is that in every country in the world, anesthesiologists are among the most in demand doctors. If it were so easy to get rid of them and replace them with nurses then it would have been done already.
 
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Ask For A Physician

Not all healthcare providers in the United States have the same training. Know the difference. Ask for a physician.
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Posted on the medicine subreddit.
 
PieOHmy said:
You wont have a ****ing choice!! Thats the point.. This mid-level **** started with clinton and obama added the steroids and they are not done yet until your salary is the same as a NP..
Click to expand...
If our salaries were the same, then what incentive would administrators have to hire NPs over doctors?
 
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