What % of Pain MD's job could be done cheaper by mid-level?

[drusso]

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Maybe 50%?

 

[lobelsteve]

0%. If they could be done by mid level than they were not Pain MD jobs.

 

[hyperalgesia]

If you include all the garbage that I do, entering orders into EHR, clicking buttons, coding, etc. For procedures, the EHR comes into play too, and complying with JC requirements... I'll go with 50%.

I'm thinking if you gave me midlevels AND exam room space and computer support and they handled basically everything except true medical decision making (not "can I have an early refill?") and the actual procedure (not preparing the kit, loading syringes, etc), I could increase productivity by 50% and keep the same quality of care. Keep in mind this is the VA. It's very inefficient and docs have to do a lot more than other places.

 

[DODOCSS]

60-70% bs

 

[Orin]

Could be and should be are different things, but our system has midlevels performing fluoroscopically guided procedures.

 

[Ducttape]

I’ve worked with mid levels. Both in pain and other fields.

They can be very well trained. Yet they do not know what they don’t know. I would say that they can be taught 40% of pain medicine, if you do not include procedural medicine.

 

[drusso]

0%. If they could be done by mid level than they were not Pain MD jobs.

I wonder what it is you do is so unique that it can't be emulated by a lesser trained individual at one-half the cost to the system?

 

[lobelsteve]

I wonder what it is you do is so unique that it can't be emulated by a lesser trained individual at one-half the cost to the system?

My mommy says I am special. Lesser trained. Emulated.
Engineering aphorism. You can have it cheaper, faster, better. Pick two.

For 50% of our patients it can be done. Most people get better for acute isues with little or no care. But we cannot foretell who falls into that 50%. For chronic pain, no one gets cured. This is where edication, experience, and training come into play. The ability to efficiently extract a history and perform the appropriate exam prpoerly is not within the capabilities of the vast majority of non MDs. The ability to glean more information than what is spoken is inherent capability, but can be taught to a degree. Where the biggest separation lies is the skill of taking a history, exam, labs, screening tools, and imaging- then synthesizing the less costly, less aggressive to more aggressive, most efficient way of getting the patient more functional without the patient bailing out.

Or in simple Lobelian terms, because I am better than you.

 

[Extralong]

... Where the biggest separation lies is the skill of taking a history, exam, labs, screening tools, and imaging- then synthesizing the less costly, less aggressive to more aggressive, most efficient way of getting the patient more functional without the patient bailing out.

Yep. I agree

 

[Ferrismonk]

"Can" is different than "should". Same as the CRNA vs. Anesthesiologist argument. CRNAs can "do" everything an anesthesiologist can. They just don't really understand what the @#$% they're doing.