Which specialties will survive the rush of mid-levels?

[Future_Bone_Docta]

Of course they all require direct knowledge, however the breadth of knowledge needed for radiology makes it near impossible to "wing it" as some midlevels can in other fields, even though their clinical knowledge and care is generally subpar. In radiology and pathology, incompetence quickly stands out. Images and reports don't change and can always be reviewed in the future.

Between the complexity barricading from encroachment, and it being a ROADS specialty, no wonder diagnostic radiology is becoming as competitive as surgical subs.

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[collegestud2013]

Midlevels aren't held to physician standards and never will be.. hospitals love them as they order more tests and any errors end up with the patient right back in their hospital. $$$

They can be held to similar standards as physicians if they are practicing independently (which some states are allowing), as in those cases no physician is signing their notes and orders.

Ordering more tests in an inpatient setting just loses the hospital more money since admissions are paid by insurance as bundled patients (ie DRGs).

Increased errors in a hospital environment will get both the midlvel and the hospital named in more malpractice lawsuits (remember the hospital has the most money so they are the biggest target in just about any lawsuit that involves care in a hospital setting).

High readmission rates from errors nowadays will just get the hospital penalized more by CMS (which has been cutting reimbursements to hospitals with excessively high readmission rates).

However, midlevels are still valuable from a financial standpoint for an organization trying to save money, since they can, in many settings, provide maybe 70-90% of the care of their respective physician but at maybe 30-50% of the cost.

 

[deleted1139416]

Midlevels aren't held to physician standards and never will be.. hospitals love them as they order more tests and any errors end up with the patient right back in their hospital. $$$

20 years ago, sure. But in 2022, patients staying at the hospital too long are causing hospitals to lose money.

 

[PikminOC]

They can be held to similar standards as physicians if they are practicing independently (which some states are allowing), as in those cases no physician is signing their notes and orders.

Ordering more tests in an inpatient setting just loses the hospital more money since admissions are paid by insurance as bundled patients (ie DRGs).

Increased errors in a hospital environment will get both the midlvel and the hospital named in more malpractice lawsuits (remember the hospital has the most money so they are the biggest target in just about any lawsuit that involves care in a hospital setting).

High readmission rates from errors nowadays will just get the hospital penalized more by CMS (which has been cutting reimbursements to hospitals with excessively high readmission rates).

However, midlevels are still valuable from a financial standpoint for an organization trying to save money, since they can, in many settings, provide maybe 70-90% of the care of their respective physician but at maybe 30-50% of the cost.

I'm looking at it from an outpatient angle. And they are held to np standards in those states they practice independently. Not physician standards.

 

[ProReduction]

Ehh, I work in one of the regions you name in a practice with many APPs, and I would say the statement that a neurology APP is filling a general neurology position is equivalent to saying a PA that manages uncomplicated hypertension all day is filling a fellowship-trained cardiology position.

APPs are excellent at dealing with uncomplicated migraine, uncomplicated neuropathy, uncomplicated memory loss ("worried well" or pseudodementia). You could argue that a neurologist could see all of those and bill for them, but could also argue that a PCP could (and should) be able to manage basic headache, diabetic neuropathy, etc.

I enjoy working with APPs and they do see a lot of patients, and at least where I work do a good job of it. But there's zero competition between us. They couldn't do my job, and any place that's using an APP instead of paying a neurologist is probably having a ton of trouble attracting a neurologist in the first place. I'm sure you've seen the job postings these days.

I think we are making the same point here. I am not saying they can do our job. I am saying that Admin at Small-Town-Hospital-X does not care if they can or cannot do our job. If a mid-level can crank through the volume of consults, that is all Admin wants. I've done TeleNeuro for national groups, and I get to see scope of practice across the entire country in every possible setting. In the South and Midwest, I am already seeing NPs "replace" Neurologists, not in skill or expertise, but in who is providing outpatient and inpatient general neurology consults. I think what you are arguing is that it is not actually a "replacement" because this is a job that no Neurologist wants, hence why a mid-level fills it. I understand that, but you are not focusing on what it does with respect to supply and demand equilibrium for Neurologists. Yes, no Neurologist wants that job at 400k, but what about for 600k? 700k? If there was true supply/demand equilibration within Neurology without the pay being degraded by Telehealth (I am part of the problem) and soon, mid-levels, Neurologists would be making 600k uniformly in the Midwest and South instead of the 400k-ish we average now.

 

[Choсolate]

Considering what I have been reading here, should I then switch to considering becoming an MD/DO and drop the idea of going to PA school?

 

[Putkernerinthehall]

Considering what I have been reading here, should I then switch to considering becoming an MD/DO and drop the idea of going to PA school?

How much confidence do you have in yourself to handle the rigors of medical school and residency? Can you afford to go to medical school?

If you go the PA route, would you forever be working with doctors and thinking to yourself "I could be doing that job better than he/she is doing it" ?

 

[wholeheartedly]

Considering what I have been reading here, should I then switch to considering becoming an MD/DO and drop the idea of going to PA school?

The biggest thing about being a PA ( or any healthcare worker) is knowing your limits. Know your knowledge base doesn’t come close to a physician and work within those limits, but continually work to learn more. It’s the people who think they know so much, are as smart as anyone and everyone else, don’t ask questions, and don’t seek out help etc who really screw up and hurt people. Always be humble and willing to learn.

the rest of that question is a matter of finances, logistics, and time.

 

[Choсolate]

How much confidence do you have in yourself to handle the rigors of medical school and residency? Can you afford to go to medical school?

If you go the PA route, would you forever be working with doctors and thinking to yourself "I could be doing that job better than he/she are doing it" ?

Affording to go to medical school is not a problem because one could easily remediate one's debt by doing locums tenens after graduating.

With your latter point, that could very certainly become the case; however, it is to my understanding that one cannot have one's cake and eat it too as a PA. I acept that I would have to give up some significant things in order to have things that doctors are not able to take advantage of, such as giving up the privilege of always having the final voice, even if I am confident in my abilities as a PA but am working with a physician 20 years younger than me.

 

[Putkernerinthehall]

I accept that I would have to give up some significant things in order to have things that doctors are not able to take advantage of, such as giving up the privilege of always having the final voice, even if I am confident in my abilities as a PA but am working with a physician 20 years younger than me.

What things would you have (as a PA) that doctors are not able to take advantage of ?

 

[greatnt249]

What things would you have (as a PA) that doctors are not able to take advantage of ?

The ability to hop specialties on a whim, but that's a whole separate discussion.

 

[VA Hopeful Dr]

The ability to hop specialties on a whim, but that's a whole separate discussion.

And significantly shorter training.

 

[PikminOC]

And significantly shorter training.

Which the pas couch as being smarter than physicians as they can finish what we know in less time.

 

[FeedMeSeymour]

Which the pas couch as being smarter than physicians as they can finish what we know in less time.

If your main claim to fame is the length of medical school over PA/NPs, you have to realize you have very little added value.

1) A large percentage of what you learn in medical school will be irrelevant to the particular specialty you end up choosing (if relevant to the clinical practice of medicine at all).

2) A good portion of the basic science and clinical best practice you learn will be outdated by the time you are an attending.

3) New medical students are generally almost useless, despite +++ hours of training. Your real training is on the job learning in internship and residency.

4) Although the education aspect isn’t prioritized for PA/NPs early in their career, they get on the job training too. They just get paid an appropriate wage for it (instead of relying on GME funding).


There are idiots with MDs and geniuses with NPs, which path you end up on has as much to do with finances and life choices as any actual difference in ability.

Stop worrying so much about midlevels and start focusing on the real enemies - administrators and private equity/corporations.

 

[PikminOC]

If your main claim to fame is the length of medical school over PA/NPs, you have to realize you have very little added value.

1) A large percentage of what you learn in medical school will be irrelevant to the particular specialty you end up choosing (if relevant to the clinical practice of medicine at all).

2) A good portion of the basic science and clinical best practice you learn will be outdated by the time you are an attending.

3) New medical students are generally almost useless, despite +++ hours of training. Your real training is on the job learning in internship and residency.

4) Although the education aspect isn’t prioritized for PA/NPs early in their career, they get on the job training too. They just get paid an appropriate wage for it (instead of relying on GME funding).


There are idiots with MDs and geniuses with NPs, which path you end up on has as much to do with finances and life choices as any actual difference in ability.

Stop worrying so much about midlevels and start focusing on the real enemies - administrators and private equity/corporations.

I'm in private practice. I'm not worried about those other things

 

[FeedMeSeymour]

I'm in private practice. I'm not worried about those other things

🤷‍♂️

Depending on your specialty you still should be concerned about the private equity/corporate side of things if you care about the sustainability of your profession.

If already a partner you might get a payout, but those coming up after you wouldn’t.

Bigger threat than midlevels in many specialties.

 

[PikminOC]

🤷‍♂️

Depending on your specialty you still should be concerned about the private equity/corporate side of things if you care about the sustainability of your profession.

If already a partner you might get a payout, but those coming up after you wouldn’t.

Bigger threat than midlevels in many specialties.

Solo private practice

 

[Slack3r]

Maybe dermatology…

Lol, have you been to a dermatology office?

 

[voxveritatisetlucis]

Lol, have you been to a dermatology office?

Obviously physicians won’t be replaced for for Mohs and cancer stuff but for run of the mill stuff, there are a lot of midlevels in dermatology

 

[Bloobury]

Considering what I have been reading here, should I then switch to considering becoming an MD/DO and drop the idea of going to PA school?

IDK my dude. During first year of med school I periodically had thoughts of "damn, I bet the PA students don't have to memorize this ****".

 

[collegestud2013]

Affording to go to medical school is not a problem because one could easily remediate one's debt by doing locums tenens after graduating.

With your latter point, that could very certainly become the case; however, it is to my understanding that one cannot have one's cake and eat it too as a PA. I acept that I would have to give up some significant things in order to have things that doctors are not able to take advantage of, such as giving up the privilege of always having the final voice, even if I am confident in my abilities as a PA but am working with a physician 20 years younger than me.

PAs/NPs are basically permanent residents in most cases (except in states that allow independent practice), since attendings have to sign off everything they do just like with residents. At least they usually get paid about twice as much as a resident. They will seem happier in their 20s when they are making twice as much as their peers who went to med school and are currently residents while doing similar work, and have less educational debt. But in their 40s-50s they won't make much more and still require their notes to be signed off by an attending (sometimes by an attending who is much younger than them.

 

[Future_Bone_Docta]

PAs/NPs are basically permanent residents in most cases (except in states that allow independent practice), since attendings have to sign off everything they do just like with residents. At least they usually get paid about twice as much as a resident. They will seem happier in their 20s when they are making twice as much as their peers who went to med school and are currently residents while doing similar work, and have less educational debt. But in their 40s-50s they won't make much more and still require their notes to be signed off by an attending (sometimes by an attending who is much younger than them.

And then they will pull the "WhY aM I dOiNg aN MDs JoB AnD MaKiNg HaLf ThE SaLaRy"