DrMetal

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lol, the implication from this thread and past ones like it is that medicine as a whole is being sold away piece by piece. I can only feel sorry for those high schoolers starting premed. There really will be nothing left by then.

I took a history/econ course once in college---mainly to hit on this girl. When I realized she wanted nothing to do with me (and maybe after the threat of a light restraining order, hey it was the 90s!)---I stopped pursuing her and paid more attention in class. As it turns out: American history is full of examples where a highly skilled individual is first glorified and paid lots of money to do a job (in a particular industry), but then the industry realizes it's paying too much for this individual, and finds an alternative. If/when the alternative works just as well, it becomes the standard.

When automobiles first came out, only a PhD/MS mechanical engineer was allowed to fix one if it broke. When they realized there weren't enough of them (and they were too costly), and a belt could be changed by a 'common man', hence the birth of your local mechanic.

In a creepy way, medicine is now following this pattern (it only took a 100 years to catch up to the automotive industry).

Don't take my word for it. Ask your favorite local econ/history professor, this is classic.

The ultimate blame for this should still rest with the hematologist, who is doing their part in selling out medicine to midlevels. They could instead try to hire an actual heme onc doctor to help cover the consult load..

Yeah, you could pay a Heme/Onc $400K a year to do this, or a mid-level $150k/year. Economically, the choice is clear. What's crazy is: Heme/Onc was one of the specialties that vehemently vowed to never allow mid-level encroachment. (And I don't mean to pick on Heme/Onc, they're not the worst offenders. Don't get me started on Neurology!)
 
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chessknt

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I took a history/econ course once in college---mainly to hit on this girl. When I realized she wanted nothing to do with me (and maybe after the threat of a light restraining order, hey it was the 90s!)---I stopped pursuing her and paid more attention in class. As it turns out: American history is full of examples where a highly skilled individual is first glorified and paid lots of money to do a job (in a particular industry), but then the industry realizes it's paying too much for this individual, and finds an alternative. If/when the alternative works just as well, it becomes the standard.

When automobiles first came out, only a PhD/MS mechanical engineer was allowed to fix one if it broke. When they realized there weren't enough of them (and they were too costly), and a belt could be changed by a 'common man', hence the birth of your local mechanic.

In a creepy way, medicine is now following this pattern (it only took a 100 years to catch up to the automotive industry).

Don't take my word for it. Ask your favorite local econ/history professor, this is classic.



Yeah, you could pay a Heme/Onc $400K a year to do this, or a mid-level $150k/year. Economically, the choice is clear. What's crazy is: Heme/Onc was one of the specialties that vehemently vowed to never allow mid-level encroachment. (And I don't mean to pick on Heme/Onc, they're not the worst offenders. Don't get me started on Neurology!)
Im surprised you haven't figured this out yet but people aren't machines that follow consistent patterns. You take 100 people with 'sepsis' pattern recognition diagnosis and I'll bet at least 20% actually have something else going on that, if treated like sepsis, will get worse. People don't give a crap if their BMW was built with a machine or an artisan welder, they do care if their tumor is being diagnosed by the weekend course jockey or someone who has seen hundreds and hundreds of similar tumors from start to finish and knows what they are doing.
 
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VA Hopeful Dr

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Maybe even 1 year is too excessive (for pain)

Poster below suggests that even with learning on the job, can get the bread and butter down in 6 weeks.

Practicing pain as general anesthesiologist
From that post: "He's not doing surgical procedures, implanting stimulators or pumps"

Those are things that pain management physicians do. That's part of why the training is needed.

That's like saying that if I read a good procedure book I can inject most of the same joints that sports medicine trained physicians do. That's true, but their training lets them do significantly more than that which is why it's an extra year.
 
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No, it's not utter nonsense. What it does require is some forward and out-of-the-box thinking, which most academic physicians aren't capable of.

I'm not delusional, I don't expect us to create a bunch of 'apprenticeships' and weekend courses, I know that wont happen. If anything: we're very much going towards the side of 'fellowshipizing' everything. We now have a Peds Hospitalist fellowship, Internal Medicine will soon follow suit, we'll have fellowships in Obesity, Addiction, Women's Health, Men's Health, HIV, etc etc. Most of us will be grandfathered in if we're already involved in these things, but the next generation of physicians will have to be PGY10+ trained in order to touch a patient.

And so . . .don't be surprised when mid-levels encroach in your specialty, b/c there aren't enough quadruple-board-certified physicians to do the work.




Define 'easy'. I just consulted hematology for a patient that's floridly pancytopenic (and has been > 10 days, with no obvious reason), I thought for sure warrants a BM biopsy. I get a call back from an NP on the service, who tells me nothing to do. It would be nice if the hematologist could look at the smear and weigh in, but he's not reachable; he has a full clinic, and he's using his NP to do his scut consult work at the hospital. Such is life in 2021.
That's a nice straw man you've constructed, but I've never said we need to increase the length of any existing fellowships nor add any new ones. I also think that hospitalist fellowships for pediatrics are a bad idea. Most of the others you mentioned are completely optional, and I do not see them as being necessary for primary care since I'm guessing that's who they're supposed to be appealing to. If someone wants to take an extra year to get better at addiction, or women's health, I have no objection to it existing. and if 10 years down the line those things are required to treat those kinds of patients, feel free to point this out as evidence of how naive and wrong I was.
 

bronx43

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Im surprised you haven't figured this out yet but people aren't machines that follow consistent patterns. You take 100 people with 'sepsis' pattern recognition diagnosis and I'll bet at least 20% actually have something else going on that, if treated like sepsis, will get worse. People don't give a crap if their BMW was built with a machine or an artisan welder, they do care if their tumor is being diagnosed by the weekend course jockey or someone who has seen hundreds and hundreds of similar tumors from start to finish and knows what they are doing.
Except it's literally happening as we speak... across most of the country. Numerous posters here are currently working in areas where midlevel expansion is unabated and speeding up. I'm in academia in a large metro, and I've seen midlevels go from rare to EVERYWHERE over the past decade. Even if what you're saying is true that patients want only the most qualified (and that's even debatable), that doesn't mitigate soft replacement - the fact that one physician is now supervising multiple midlevels.

You want the doc who has seen hundreds or thousands of similar tumors? Sure. He/she will come say hi for five minutes, answer a few questions, then off they go to the next room. At some point, this will saturate every market. Then, the older docs (haves) will hold onto their positions for dear life, while the young docs (have nots) will be SOL.
 
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chessknt

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Except it's literally happening as we speak... across most of the country. Numerous posters here are currently working in areas where midlevel expansion is unabated and speeding up. I'm in academia in a large metro, and I've seen midlevels go from rare to EVERYWHERE over the past decade. Even if what you're saying is true that patients want only the most qualified (and that's even debatable), that doesn't mitigate soft replacement - the fact that one physician is now supervising multiple midlevels.

You want the doc who has seen hundreds or thousands of similar tumors? Sure. He/she will come say hi for five minutes, answer a few questions, then off they go to the next room. At some point, this will saturate every market. Then, the older docs (haves) will hold onto their positions for dear life, while the young docs (have nots) will be SOL.
And numerous posters also make 7 figures in the stock market and get paid $800/hr. Doctors used to be able to handwrite progress notes that were 2 sentences long, now we have onerous documentation requirements and patients are reading the notes in real time. It is an evolution to address the preposterous nonsense being perpetrated against the medical field, not a replacement but by all means continue to run in circles proclaiming the end of the MD.
 
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bronx43

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And numerous posters also make 7 figures in the stock market and get paid $800/hr. Doctors used to be able to handwrite progress notes that were 2 sentences long, now we have onerous documentation requirements and patients are reading the notes in real time. It is an evolution to address the preposterous nonsense being perpetrated against the medical field, not a replacement but by all means continue to run in circles proclaiming the end of the MD.
Like I said, it's a soft replacement. I don't think all MDs will be replaced. But one does not need all MDs to be replaced for the market to get wrecked.
 
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chessknt

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I'm pretty sure pain docs don't do surgical procedures or place pumps.
They definitely put pain pumps/stimulators in. I don't know if you consider lesi or myelography surgical procedures buy they do those too.
 
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The demands I see on social media to increase residency spots concern me just as much as midlevel encroachment.
 
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Bobblehead

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They view us physicians as a total PITA: we take too long to educate and train (sometimes true: do I really need a sleep physician, PGY7+, to tell me someone's too fat to breath well at night?), we're expensive (to pay, to insure), and we're high maintenance. In any other industry, the economic mechanisms at hand will find a way to circumvent such a PITA commodity, and that's exactly what's happening in medicine.
Well you can feel free to manage their sleep apnea yourself. I'm sure you'll be fine with a national home testing company and auto-PAP for the majority of them and many sleep physicians don't really need more referrals since there's seemingly an unlimited pool of sleep apnea patients. There's other parts of sleep medicine that take the rest of the year to teach though.
 
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DrMetal

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but people aren't machines that follow consistent patterns.

Oh we're not? What do you think the entire Artificial Intelligence field is predicated on?

they do care if their tumor is being diagnosed by the weekend course jockey or someone who has seen hundreds and hundreds of similar tumors from start to finish and knows what they are doing.

Yeah? So why am I getting a NP today when I consult Heme/Onc? I have no doubt that the patient cares. But the question is: does the system care enough to pay a real Hematologist $400K/year to tend to consults in the hospital, or would it rather pay an NP $150K to do the same. Unfortunately the latter seems to be more and more the case.
 
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blue.jay

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Im surprised you haven't figured this out yet but people aren't machines that follow consistent patterns. You take 100 people with 'sepsis' pattern recognition diagnosis and I'll bet at least 20% actually have something else going on that, if treated like sepsis, will get worse. People don't give a crap if their BMW was built with a machine or an artisan welder, they do care if their tumor is being diagnosed by the weekend course jockey or someone who has seen hundreds and hundreds of similar tumors from start to finish and knows what they are doing.
Radiologist and Pathologist are the ones diagnosing cancer. Oncologist plans the chemo regimen. At least in most places after the initial visit, follow-up chemo visits are done by midlevels. Oncology is team based care and midlevels are encroaching more day by day.
 

blue.jay

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Just be like the local hospital here: start an IM program, get cheap labor, and dump the midlevels.

That is the expectation anyway. I don’t think there’s enough work to warrant adding 45 residents (15 per year) without cutting somebody.
Increased medical school enrollment and residency expansion is going to be a problem in a decade. EM is a good example, this will be followed by other specialties or increased difficulty getting jobs in metro areas for most specialties. This is a win situation for hospitals/employers when the supply goes up. Probably good for patients and rural areas when grads are forced to move to rural areas to get jobs.
 
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VA Hopeful Dr

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It would be nice if (for once) we could stop the crazy train before it leaves the station.
Sure, and by all means try and stop additional things from becoming required fellowships. I'm completely on board with that.

What I'm not on board with is taking things that have been established fellowships for a fairly long time and trying to undo that.
 
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Radiologist and Pathologist are the ones diagnosing cancer. Oncologist plans the chemo regimen. At least in most places after the initial visit, follow-up chemo visits are done by midlevels. Oncology is team based care and midlevels are encroaching more day by day.
The oncologist just reads off the nccn guidelines anyway, who needs them in the first place! Amirite??!!

@gutonc
 
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BorntobeDO?

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No, it's not utter nonsense. What it does require is some forward and out-of-the-box thinking, which most academic physicians aren't capable of.

I'm not delusional, I don't expect us to create a bunch of 'apprenticeships' and weekend courses, I know that wont happen. If anything: we're very much going towards the side of 'fellowshipizing' everything. We now have a Peds Hospitalist fellowship, Internal Medicine will soon follow suit, we'll have fellowships in Obesity, Addiction, Women's Health, Men's Health, HIV, etc etc. Most of us will be grandfathered in if we're already involved in these things, but the next generation of physicians will have to be PGY10+ trained in order to touch a patient.

And so . . .don't be surprised when mid-levels encroach in your specialty, b/c there aren't enough quadruple-board-certified physicians to do the work.




Define 'easy'. I just consulted hematology for a patient that's floridly pancytopenic (and has been > 10 days, with no obvious reason), I thought for sure warrants a BM biopsy. I get a call back from an NP on the service, who tells me nothing to do. It would be nice if the hematologist could look at the smear and weigh in, but he's not reachable; he has a full clinic, and he's using his NP to do his scut consult work at the hospital. Such is life in 2021.
That’s a service that no longer deserves a consult. Sorry, I am not interested in a mid level being my only point of contact for a service.
 
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Siggy

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Least Safe:
Pulm/Critical Care - already tons of mid-levels. At my institution they grab procedures from residents.

The problem with crit care is if it's anything but routine then the midlevels will miss it. The amount of times I've seen transfer orders in from my service's NPs and thought, "Damn, I'm happy I'm not cosigning that order" has been way too high.

I also don't remember the last time they've actually started an SBT without being explicitly told to. Once the vent days start coming up, admin is going to be looking for the first physician that understands that the standard of care is a daily SBT/SAT.
 
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DrMetal

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"Damn, I'm happy I'm not cosigning that order" has been way too high.

You don't have to cosign anything, b/c the NP lobby has advocated for them to work independently! (Maybe not in CC just yet, but I'm sure that day will come!)

I also don't remember the last time they've actually started an SBT without being explicitly told to. Once the vent days start coming up, admin is going to be looking for the first physician that understands that the standard of care is a daily SBT/SAT.

So when the hospital admin realizes this, what are they most likely to do? a) fire the NPs and hire more CC physicians or b) ask the current CC physicians to train the NPs more (teach them the importance of daily SBTs etc) and then continue the practice of hiring/utilizing NPs.

I think choice b) wins.
 
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blue.jay

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You don't have to cosign anything, b/c the NP lobby has advocated for them to work independently! (Maybe not in CC just yet, but I'm sure that day will come!)



So when the hospital admin realizes this, what are they most likely to do? a) fire the NPs and hire more CC physicians or b) ask the current CC physicians to train the NPs more (teach them the importance of daily SBTs etc) and then continue the practice of hiring/utilizing NPs.

I think choice b) wins.
I agree. I see some critical care folks talk as if they won’t be touched by all this midlevel issues. i have great respect for CCM folks and they won’t be replaced in tertiary centers where they are dealing with ECMO, balloon pumps etc but majority of the critical care jobs in the country could have the same fate as anesthesia or EM.
Why pay 400k for a doc to cover 14 bed unit when you can make them do tele ICU and take the responsibility of 3 ICUs staffed by midlevels? That’s what is happening.
Regarding refusing to co-sign charts is silly as we hospital employed physicians have any say in that matter. You are paid that much and that expectation includes cosigning. Of course if there is a rogue midlevel you can go to higher ups and try to get them fired. on the other hand if you have a decent midlevel with significant experience I doubt the employer will get rid of such a valuable cheap worker whether you like working with them or not.
 
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CCM-MD

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I agree. I see some critical care folks talk as if they won’t be touched by all this midlevel issues. i have great respect for CCM folks and they won’t be replaced in tertiary centers where they are dealing with ECMO, balloon pumps etc but majority of the critical care jobs in the country could have the same fate as anesthesia or EM.
Why pay 400k for a doc to cover 14 bed unit when you can make them do tele ICU and take the responsibility of 3 ICUs staffed by midlevels? That’s what is happening.
Regarding refusing to co-sign charts is silly as we hospital employed physicians have any say in that matter. You are paid that much and that expectation includes cosigning. Of course if there is a rogue midlevel you can go to higher ups and try to get them fired. on the other hand if you have a decent midlevel with significant experience I doubt the employer will get rid of such a valuable cheap worker whether you like working with them or not.

Agree. Major midlevel threat exists for CCM. People have a hard time accepting this because things are so damn good right now. Everywhere I work that has had mid levels, they function like my little scut monkeys. But with more mid level independence in the ICU and potential overtraining of intensivists, we could end up just like EM in a few years or worse.
 
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Siggy

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Agree. Major midlevel threat exists for CCM. People have a hard time accepting this because things are so damn good right now. Everywhere I work that has had mid levels, they function like my little scut monkeys. But with more mid level independence in the ICU and potential overtraining of intensivists, we could end up just like EM in a few years or worse.
My site has been consistently averaging around 35-40 patient encounters (between continuing patients and new consults) for the last several months. We only have a handful of COVID patients. Out staffing is 1 doc during the day with 3 midlevels.

I honestly have a hard time believing that we wouldn't be better off in terms of better documentation (better reimbursement for the hospital) and better patient turnaround by going to 2 physicians and 0-1 NPs.
 
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blue.jay

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My site has been consistently averaging around 35-40 patient encounters (between continuing patients and new consults) for the last several months. We only have a handful of COVID patients. Out staffing is 1 doc during the day with 3 midlevels.

I honestly have a hard time believing that we wouldn't be better off in terms of better documentation (better reimbursement for the hospital) and better patient turnaround by going to 2 physicians and 0-1 NPs.
I am sure the way your hospital administration sees this as a cost of doing business. They will eat us this cost for take the time it takes these midlevels to be well seasoned and bill well. Most places are downsizing docs in favor of more midlevels. Big academic centers even have so called “fellowship“ to train midlevels for much lower market rate. If there is a conflict between a seasoned midlevel and a doc the employer most likely will hold on to the midlevel. It’s not that hard for them to hire another fresh out of fellowship grad for the same pay/quality. The same is not true with midlevels. This is the sad state is every hospital based employed speciality unlike like cardiology or oncology.
 
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CCM-MD

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My site has been consistently averaging around 35-40 patient encounters (between continuing patients and new consults) for the last several months. We only have a handful of COVID patients. Out staffing is 1 doc during the day with 3 midlevels.

I honestly have a hard time believing that we wouldn't be better off in terms of better documentation (better reimbursement for the hospital) and better patient turnaround by going to 2 physicians and 0-1 NPs.

35-40 encounters in one day for 1 intensivist is ridiculous. That sounds like a farm your license out and supervise NPs kind of a gig. Looks like midlevel encroachment on CCM is much worse than I anticipated.
 

Siggy

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35-40 encounters in one day for 1 intensivist is ridiculous. That sounds like a farm your license out and supervise NPs kind of a gig. Looks like midlevel encroachment on CCM is much worse than I anticipated.

Our problem is that we literally can't find intensivists right now. Hence why one site doesn't have night time coverage half the time (we're supposed to be in house 24/7) and the other site has a high reliance on PRN and part time coverage to maintain 24 hour coverage.
 

RadsWFA1900

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I have not been practicing for very long but it did not take me long to realize that there is no actual safe field in medicine. Not even the surgical sub specialties. You think medical school/residency expansion is bad but there are so many mid levels it isnt even funny. they permeate every area of medicine and they will not be content with just doing your notes and scut they will and are making major life and death medical decisions.

Expertise and experience are practically despised in the system now. They want cogs following algorithms. Its really naive to designate any field as safe from this.

I absolutely cannot stand MLPs but they are everywhere and I have no control over it.
 
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Renal_Prometheus

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The paradigm has changed, but dialysis remains by far the most profitable part of nephrology care. I have worked within both systems, physician owned and with DaVita, and both systems have pros and cons. On the one hand, a practice can be more responsible for the logistics of the unit and reap more of a financial benefit, and on the other hand, a practice can relinquish that responsibility and spend its time elsewhere. Dialysis is very territorial; the companies cannot just establish their own dialysis clinic down the road and bully out the already established doctors. Number and range of dialysis clinics is tightly regulated. A need has to be established. If dialysis patients are already being served, there is not a need for a new unit. Historically, DaVita and others bought out practices who crunched the numbers and found it beneficial to let it go. I would liken it to IR taking over many procedures. Sometimes it's not worth the hassle.

However, DaVita and practices have joint ventures all the time. Practices will often own the property, and DaVita rent space to perform dialysis. These companies' business models are really focused on the dialysis component. They do not necessarily want to buy property. They do not want to hire their own doctors. They are happy to work with practices and rent space. There are also medical directorships that can be lucrative.

So it's a nice setup. Bill for the patient care. Bill for the medical directorship. Possibly collect rent on top of that.

Now, I'll be clear and say that working with a large health care entity is not all rainbows and butterflies, but my complaints are about other things and not what was just discussed.

Reimbursement is controlled by Medicare primarily, not DaVita. Coincidentally, reimbursement for nephrology is expected to go up quite a bit with changes to how dialysis compensation works, efforts to promote home modalities, etc.

It remains to be seen if the current fellowship load is still too much or enough for the specialty. The number of spots filled has not changed much over the years. There might have been slightly more over this past year. The lower end programs continue to run half full. There is a world where the field may be contracting, and good graduates will be in high demand. Anecdotally, it may take a practice a couple of years to find a good candidate. That has been the experience in my region.

That was probably more than you wanted! The above does not have much to do with midlevels. We use midlevels to help with dialysis rounding. Each patient needs to be seen four times monthly (3 quicker visits and 1 comprehensive visits) for maximum billing so docs will do the comprehensive visit and maybe a limited visit while the midlevels do the rest. That frees us docs up to be more productive in clinic (or maintain our 4-day work weeks).

I think nephrology is safe from midlevel takeover for a while. There is not more money in regular clinic visits...more complicated patients with similar billing to everyone else (unless they are transplants or GNs). They cannot handle the complexity. They cannot treat GN. We have to teach them how to manage hypertension for Pete's sake. Midlevels would have to go after dialysis and see patients independently for it to be worthwhile, but dialysis is so tightly regulated by the government/Medicare that I think it is going to be a long time before we see anything like that. I'm sure DaVita would like to make a buck, but dialysis patients are complicated, and we provide a lot of oversight. Outcomes would be poor. Midlevels don't learn any nephrology in their training so if there is not a nephrologist, DaVita would have to train them, and they have not shown much interest in doing that at this time.

Just do what you want. As long as you do private practice, you have a lot of control as far as midlevels go. You have less say if you are employed.
I don’t understand why this guy keeps talking up his specialty when in reality nephrology is a dumpster fire right now. He cant let go of his ego and admit that the reason people avoid this specialty is because it’s very bad. Many nephrologists end up as hospitalsits.
 
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DrMetal

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I don’t understand why this guy keeps talking up his specialty when in reality nephrology is a dumpster fire right now. He cant let go of his ego and admit that the reason people avoid this specialty is because it’s very bad. Many nephrologists end up as hospitalsits.

I don't think he's 'talking it up', it sounds like @Chemist0157 is just giving an honest account.

We should all be weary of what's happening in Nephrology, many other specialties are following suit. For instance, the cash grab (or attempted cash grab) that we've seen with dialysis centers is now also being attempted with cath labs, new ones of which are popping up, some attempting to be outpatient centers (the only limiting reagent is not enough IC trained cardiologists . . .but give it 10 years, we'll have NPs doing PCI). This could easily throw cardiology into the same tailspin we now see Nephrology in.

I sometimes wonder how dumb our profession really is. We physicians live in an ocean of higher education/training but have not an ounce of common or business sense.
 
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wamcp

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I don't think he's 'talking it up', it sounds like @Chemist0157 is just giving an honest account.

We should all be weary of what's happening in Nephrology, many other specialties are following suit. For instance, the cash grab (or attempted cash grab) that we've seen with dialysis centers is now also being attempted with cath labs, new ones of which are popping up, some attempting to be outpatient centers (the only limiting reagent is not enough IC trained cardiologists . . .but give it 10 years, we'll have NPs doing PCI). This could easily throw cardiology into the same tailspin we now see Nephrology in.

I sometimes wonder how dumb our profession really is. We physicians live in an ocean of higher education/training but have not an ounce of common or business sense.
Anyone think even GI will succumb within ten years? Right now a big supply demand mismatch...but what’s the likelihood of government slashing procedure reimbursement rates, midlevels being trained by private equity to scope, new/refined imaging technology that reduces endosocpy usage all within the next decade
 
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Chemist0157

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I don't think he's 'talking it up', it sounds like @Chemist0157 is just giving an honest account.

We should all be weary of what's happening in Nephrology, many other specialties are following suit. For instance, the cash grab (or attempted cash grab) that we've seen with dialysis centers is now also being attempted with cath labs, new ones of which are popping up, some attempting to be outpatient centers (the only limiting reagent is not enough IC trained cardiologists . . .but give it 10 years, we'll have NPs doing PCI). This could easily throw cardiology into the same tailspin we now see Nephrology in.

I sometimes wonder how dumb our profession really is. We physicians live in an ocean of higher education/training but have not an ounce of common or business sense.
Oh, we undoubtedly have little idea what we are doing with money as a profession. We have to self teach, though I guess that's not terribly unusual compared to other self teaching we do. Financial literacy is terribly low in the US across the board too, not just in medicine.

I would reiterate though there is not a lot of cash grabbing in the dialysis business. It's tightly regulated. I cannot decide to just start a dialysis clinic somewhere. Even Davita cannot. A need has to be shown to the government for a new clinic to be allowed. Any midlevel rounding in dialysis is because a nephrologist put him or her there. They are not there on their own. They are currently there at the service of practices. That could change. If the government allowed dialysis companies to have patients only be seen by midlevels, I'm sure the dialysis companies would consider such a model. They like money. Still, that would be an 180 of current policy. It may very well happen, but I think that is years away.
 
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Wow. Johns Hopkins always at the forefront of selling out to midlevels

while i don’t disagree with you, scoping has been on the radar for a bit: What are the clinical outcome and cost-effectiveness of endoscopy undertaken by nurses when compared with doctors? A Multi-Institution Nurse Endoscopy Trial (MINuET) - PubMed i known it’s a garbage article in some throwaway rag.

im not gi and don’t know if it is a legitimate issue or not. i can see some suit coming up with an idea of mid levels scoping and the video getting recorded, then sent to a GI at 2x speed for review. throw in some buzzwords like AI and customer service- baby you got a stew going.
 

Osteoth

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The greed of someone teaching an NP to scope. For 10 years after that the GI salaries are going to balloon, boomers will cash out and the field forever more will be dead.

Greed and ego pure and simple.

And this was the golden age of medicine?
 
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Man, ya'll just leaving crumbs for poor old me. What am I going to leave for the high schoolers thinking of medicine?
 
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DrMetal

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And this was the golden age of medicine?

It is for the consumer. In 1930, there were two major automotive dealers. In 1980, there were several. It was much easier/cheaper to buy a car in in 1980 vs 1930. It's just basic economics that we're ignoring (or that we're refusing to accept is affecting our own profession now).

The first colonoscopies were done in the early 70s. Now some 50 years later (same delta, 1930 to 1980), we're finding cheaper and more efficient ways of doing them. Are they equal quality? Who knows.
 
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