What specialties will have the most and least midlevel encroachment?

[deleted6669]

Mount Sinai Hospital in NYC has NPs doing diagnostic caths and I believe one does PCI.

See my post #23 above. PAs have been doing diagnostic caths at Duke for almost 20 years.

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[AnatomyGrey12]

Then the salaries haven't dropped enough.

Also there are still enough positions available in the cities if people are staying there. Eventually, there will be no more job slots in cities and people who graduate from those type of schools will have to go rural.

I don't think you understand the business model of medicine... This is literally impossible.

 

[Astra]

I don't think you understand the business model of medicine... This is literally impossible.

How so? This is my understanding. Correct me if I am wrong.

You graduate. You either get hired by a hospital, clinic or you set up your own shop. All the positions are full at the hospitals in town and clinics. Tons of private practices, enough for the population. So you have to go rural.

 

[AlbinoHawk DO]

ORLANDO, Fla. -- A study by Duke University Medical Center researchers has shown that
physician assistants, with proper training can successfully perform cardiac catheterizations.

"Under the careful supervision of experienced attending cardiologists, trained physician
assistants can perform diagnostic cardiac catheterization, including coronary angiography, with
procedural times and complication rates similar to those of cardiology fellows. This is the first
large study that demonstrates that this is a safe practice," said Dr. Richard Krasuski, a Duke
cardiology fellow who led the study which was presented Wednesday at the 50th Annual
Scientific Session of the American College of Cardiology.

...

The Duke study compared 929 diagnostic cardiac catheterizations performed by PAs with
supervision by a cardiologist to 4,521 catheterizations performed by cardiology fellows.
Cardiology fellows are physicians receiving three to four years of advanced training in cardiology
after completing an internal medicine residency.
https://www.ncbi.nlm.nih.gov/pubmed/12772231

Well, no ****. If you have mommy and daddy looking that you don't mess up, of course you'll do as well as the fellow doing it alone.

 

[NYCGuy86]

See my post #23 above. PAs have been doing diagnostic caths at Duke for almost 20 years.

Yes I saw. PAs and NPs have been doing caths for quite some time.

NPs and PAs at Mount Sinai also do diagnostic cerebral angiograms.

 

[AnatomyGrey12]

How so? This is my understanding. Correct me if I am wrong.

You graduate. You either get hired by a hospital, clinic or you set up your own shop. All the positions are full at the hospitals in town and clinics. Tons of private practices, enough for the population. So you have to go rural.

At that point you will honestly have people just not going into medicine instead of being funneled into these rural areas. A better option is to make the NPs go out there seeing as that was their whole sales pitch for getting autonomy, but no they have their own derm "residencies"

 

[Astra]

A better option is to make the NPs go out there seeing as that was their whole sales pitch for getting autonomy, but no they have their own derm "residencies"

You'll get a smaller number but there will always be people who want to be doctors and make 200k+.


Exactly regarding NP. I'd rather have my proposed system than having money grubbing NP's who use that as an excuse to encroach on our turf.

At that point you will honestly have people just not going into medicine instead of being funneled into these rural areas

 

[deleted6669]

At that point you will honestly have people just not going into medicine instead of being funneled into these rural areas. A better option is to make the NPs go out there seeing as that was their whole sales pitch for getting autonomy, but no they have their own derm "residencies"

some of us work rural..... I have 3 rural jobs. 2 solo and 1 double coverage.

 

[deleted6669]

NPs and PAs at Mount Sinai also do diagnostic cerebral angiograms.

wow!

 

[sliceofbread136]

It seems that the most virulent anti-midlevel attitudes in these forums are coming from pre-meds and medical students. And pre-clinical medical students at that.

Yeah, they probably know about as little as some random dude with a phd

 

[pulmoblast]

Mount Sinai Hospital in NYC has NPs doing diagnostic caths and I believe one does PCI.

Wow...I guess I stand corrected...I thought cardiologists were smarter than this


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[MrChance2]

Screw the PAs. Even the PA students at my med school are annoying.

I used to teach the MCAT and I ended up seeing the most annoying and condescending student in my class in my schools PA program. N=1. We still haven't talked. She was basically obsessed with being a dermatologist or nothing. Short story I guess. I like most PAs.

 

[AnatomyGrey12]

I used to teach the MCAT and I ended up seeing the most annoying and condescending student in my class in my schools PA program. N=1. We still haven't talked. She was basically obsessed with being a dermatologist or nothing. Short story I guess. I like most PAs.

It's rather unfortunate because in reality most of practicing PAs are very down to earth and understand their role, and are exceptionally good at it. The few high and mighty "I learn in 2 what you do in 4" types give the rest a bad name.

 

[sliceofbread136]

I used to teach the MCAT and I ended up seeing the most annoying and condescending student in my class in my schools PA program. N=1. We still haven't talked. She was basically obsessed with being a dermatologist or nothing. Short story I guess. I like most PAs.

Lol, I too knew a very condescending and annoying person in undergrad who is now at my institution's PA program.

 

[themockjock]

See my post #23 above. PAs have been doing diagnostic caths at Duke for almost 20 years.

My first thought when reading this was "NO!"

But now I kinda wonder... A PA who's been doing nothing but diagnostic angios for the last 10 years is probably a lot better than a fresh fellow who was an internal medicine resident 3 months prior.

On vascular rotations I think I get consulted on one groin or wrist access complication by the cards fellows once or twice every week...

Although if it were my diagnostic or simple interventional cath, I'd probably go to the insanely busy PP attending who has been doing nothing but caths for the last 25 years... And then go to the ivory tower for my CABG.

 

[Warderino92]

http://www.modernhealthcare.com/article/20161213/NEWS/161219974 saw someone posted this on reddit today. Looks like NPs get their scope expanded except for CRNAs in the VA system if i'm reading it right.

 

[holdthemayo]

But now I kinda wonder... A PA who's been doing nothing but diagnostic angios for the last 10 years is probably a lot better than a fresh fellow who was an internal medicine resident 3 months prior.

I see this logic used too often in these discussions as if all midlevels are created with years of experience. The correct comparison is would a fresh faced PA be as good as a fresh fellow and would a PA who has been doing angios for 10 years be as good as a cardiologist who has been doing angios for 10 years? Obviously the MD/DO is the better option in either scenario.

 

[AnatomyGrey12]

http://www.modernhealthcare.com/article/20161213/NEWS/161219974 saw someone posted this on reddit today. Looks like NPs get their scope expanded except for CRNAs in the VA system if i'm reading it right.

"Here veterans! Thank you for risking your lives and dedicating yourselves to this country. As a reward this is your nurse!" .....

 

[SansaStarkMD]

Every specialty is open to encroachment. The best specialties will be the ones that can compete. Office based with low over head. .. the private option.

 

[themockjock]

I see this logic used too often in these discussions as if all midlevels are created with years of experience. The correct comparison is would a fresh faced PA be as good as a fresh fellow and would a PA who has been doing angios for 10 years be as good as a cardiologist who has been doing angios for 10 years? Obviously the MD/DO is the better option in either scenario.

Which is why I said I would go to the insanely busy PP cardiologist for my own cath.

And as for any patient who would let a PA near their coronary arteries... caveat emptor.

 

[deafdealer]

Our best option is the fact that midlevels (NPs especially) want to get paid the same. They are actively pushing this in state legislatures across the country, and have already passed a law in Oregon. Once the incentive to hire them is gone, they will be too. I don't really have a huge problem with the work/training that most PAs do/get, but NPs are another story

 

[deleted6669]

Our best option is the fact that midlevels (NPs especially) want to get paid the same. They are actively pushing this in state legislatures across the country, and have already passed a law in Oregon. Once the incentive to hire them is gone, they will be too. I don't really have a huge problem with the work/training that most PAs do/get, but NPs are another story

I have no desire to push for equal pay for PAs and physicians in the same specialty. I think we both need to make a good income, but it's fair that a residency trained/boarded EM doc will always make more money than I do.

 

[masaraksh]

Our hospital was a stroke center and a nuero NP came down from the neuro floor to the ED for every stroke activation.

Uhhh, you don't need much to 'run' a stroke - either tPA or ride it out with some aspirin and hope the FNDs don't end up being too bad.

 

[David Mitchell]

rad onc needs to worry about computer encroachment

 

[masaraksh]

rad onc needs to worry about computer encroachment

Rad onc needs to worry about jobs.

 

[Rekt]

Uhhh, you don't need much to 'run' a stroke - either tPA or ride it out with some aspirin and hope the FNDs don't end up being too bad.

Never said it did. He just posed what he thought only neuro NPs did. What they did was really easy. Neuro exam: tPA yes or no. Pretty simple. The EM docs didn't care as it put more liability on the neurologist.

 

[username456789]

rad onc needs to worry about computer encroachment

Rad Onc needs to worry about having hitched their wagon to a treatment modality rather than an organ/physiologic system.

 

[NeuResurgens]

Our best option is the fact that midlevels (NPs especially) want to get paid the same. They are actively pushing this in state legislatures across the country, and have already passed a law in Oregon. Once the incentive to hire them is gone, they will be too. I don't really have a huge problem with the work/training that most PAs do/get, but NPs are another story

I've never understood the logical fallacy some of these people employ by thinking they deserve the same compensation as someone who was trained much more thoroughly than they were. Some of them seem to think that they've found an educational holy grail that allows them to get the same training in 6+ fewer years and the doctors are just too dumb to realize it.

Obviously I don't speak of most NPs but a few outspoken people in the nursing world think this way.

 

[Warderino92]

Rad Onc needs to worry about having hitched their wagon to a treatment modality rather than an organ/physiologic system.

Out of curiosity, what would happen 20-50 years down the road if rad onc becomes phased out due to new therapies in cancer treatment? Would interventional radiology take them in under a 2-3 year transitional fellowship?

 

[FBurnaby]

I've never understood the logical fallacy some of these people employ by thinking they deserve the same compensation as someone who was trained much more thoroughly than they were. Some of them seem to think that they've found an educational holy grail that allows them to get the same training in 6+ fewer years and the doctors are just too dumb to realize it.

Obviously I don't speak of most NPs but a few outspoken people in the nursing world think this way.

Exactly. What CFO would hire an NP over a physician if they had to pay out the same salary?

 

[deafdealer]

I've never understood the logical fallacy some of these people employ by thinking they deserve the same compensation as someone who was trained much more thoroughly than they were. Some of them seem to think that they've found an educational holy grail that allows them to get the same training in 6+ fewer years and the doctors are just too dumb to realize it.

Obviously I don't speak of most NPs but a few outspoken people in the nursing world think this way.

They argue that their outcomes are better than ours. They're not exactly a clever or logical bunch

 

[DrBowtie]

Out of curiosity, what would happen 20-50 years down the road if rad onc becomes phased out due to new therapies in cancer treatment? Would interventional radiology take them in under a 2-3 year transitional fellowship?

There is very little overlap. Not going to trim 2-3 years off of training.

 

[NeuResurgens]

They argue that their outcomes are better than ours. They're not exactly a clever or logical bunch

Maybe some of them are comparing their overall outcomes (not taking into account the condition treated or the severity of the case) to physicians at large (still not taking into account these factors). Wouldn't be hard to get better outcomes than physicians when you're treating colds and stomach flus when PCPs see all that, plus sicker patients.