This is 100% true. Inpt payment model for medical illness is so beyond broken that hospitals taking care of sick people lose money if they don't have (non-general) surgery or caths done. Maybe the next time we pass a healthcare bill we can eat some painful truths in medicine that ortho/cards/CT surgery/neurosurgery can't be the gods of inpatient revenue generation if we expect our healthcare system to function in a healthy way. Probably not because of the veritable ocean of money behind these interest groups but one can hope.
You have it wrong there. Emergency medicine jobs are the sewer plant jobs.....do you honestly prefer to be doing what EM does vs IM?
Having midlevels take over the (currently) lucrative bread and butter procedures powered by private equity desire for $$$$ will only continue. And it won’t be any better if we shifted to singlepayer or gov run healthcare (VA pushes the use of NPs and CRNA. NHS cuts your pay into less than half)
I agree with the general sentiment, but I would say that in 20 years, single payer system with a bunch of over-worked and underpaid physicians is the more likely scenario. But either way, you're right. Race to the bottom in whichever form suits the powers that be.
I think when any specialty is super appealing youre going to have more people going into it. I believe psych NPs are going to threaten Psych because they haven't kept up with need and many don't take insurance.
Whether acute inpatient hospitalizations make or lose money depends on:
This is a good point. I just don't think that such a thing is going to lead to a glut of IM trained docs (the market tightening and making hospitalist an even suckier job than it already is), but I could be wrong, especially given the numbers that would like to use IM as a stepping stone.
The difference is there aren't enough specialists at most hospitals to be able to just punt the way the NPs can in EM. Although some physicians consult a lot due to different issues, they rarely do it out of ignorance and will manage at least simple stuff. NPs do not know how to manage even the smallest things
Yeah I mean, in the world where EM is just overglorified triage but not actual management, NPs make sense. In the world where you're actually stabilizing crashing patients and true emergencies, that would need a physician ultimately.
It comes down to E/M and billing, and with the U.S. hospital-based billing system one specialty can only bill once per calendar day, but multiple specialties can bill on the same patient for the same day. The extra consults requested by someone who is pan-consulting creates additional billable patient encounters that otherwise with not have been billed for if the consult was not done. So instead of the hospitalist trying to managing all the issues and billing only once per day, having multiple consult services also seeing the patient easy day creates much multiple billable notes (that if done in enough volume justifies hiring the specialist). So this would arguably make the job as a hospitalist less sucky in that they can spend less time per patient and just have someone else manage a specific problem. Though the hospitalist, as the primary team, would be spending more time on discharge planning and dispo stuff which to some can make the job more sucky.
Having an oversupply of PAs and NPs might actually make the job of a hospitalist or ED physician more tolerable. Especially if it comes to the point that they make $80k/year for a full time job (which is near what an RN makes and only slightly more than a resident), it'll be more financially justified to hire them on non-teaching services to do the more scutty work that makes the hospitalist attendings don't like to do (like putting in orders, answering pages from nurses, writing notes, calling consults etc). Most of the cush hospitalist jobs I've seen that have lower burnout and lower turnover are on teaching services that have residents do nearly all the grunt work, but for places that can't get residents would have a more affordable option to hire midlevels for cheap and turning them into replacements for residents.
With the way their online schools are proliferating, it'll all come collapsing on them soon. Being an RN will soon be a more lucrative career. This is why I strongly oppose opening up more residency slots. The bottleneck of residency is what keeps us doctors from having our salaries collapse
I would not go as far to say it's much harder to replace hospitalist than EM docs. It's probably a little harder--but not much.
The escape hatch of IM is fellowship. Internal medicine owns every organ-based medical sub specialty except dermatology. I don’t think any other field has the number of fellowship options im does.
I just can't imagine an IM doc consulting other services for syncope. It would be a hard no-no in my program.
Agree that undifferentiated syncope in a patient with limited medical history is poor form. If you had strong suspicion of cardiogenic syncope based of EKG data, prior cardiogenic syncopal episode, the patient had a complex medical hx. etc., Cardiology probably needs to see the patient.
Agree. No prior hx, Normal EKG, normal echo. Tele monitor did not capture anything for over 24 hrs. Why you are calling me?
Agreed.
This x10000.
Yet it happens... all... the... time... ::sigh::
Maybe the NP that ordered the consult did it on purpose because they couldn't remember who you normally consult for syncope?
It's ok they keep doing that so I can still have a job.
I think you mixed up neurology and psychiatry… unless you are the one that manages 4 outpatient aeds
This is 100% wrong. Hospitals bill on a DRG, which covers all the hospital services, from meds to janitors to nurses, etc. The doctors bill E&M codes separately and get paid a la carte.
Err, that's exactly what I said. More consultants means more testing that's not going to be paid out by the DRG.
