I don't expect to see that in my career (I've got at least 23 years left).
True. What I mean to say is, "I am fine with them adding spots to FM, IM, and Peds"
I don't disagree, but I think another key difference here is the need for an OR/general anesthesia for this type of stuff vs. office-based procedures. Most FM docs are not going to want to screw around with hospital credentialing and that sort of thing but are perfectly happy to do whatever procedures can be easily done in the office.
But that goes more into thinking what we’re owed vs what is actually good for patients.
Why not specialists too? Midlevels are widely used in derm due to wait times (area dependent obviously)
I think the thought only becomes dangerous if (when) FPA becomes a thing.
Because I am in a specialist field and I prefer my salary to be propped up.
Oh yeah. I’m only for it if they’re given the same volume in training as physicians.
Orrrr they can go to med school, match academic IM, and get a GI fellowship. I don't think you would want to get scoped or other loved ones to get scoped by an NP. I have no interest in GI but I respect them for protecting their turf. Instead of minimizing and putting down other specialties, you all could learn something from GI. And for those saying wait times are insane, go call a local private practice GI and they'll get you in within a couple of weeks if not sooner; the same could be said for any specialty in pp.
Because in employed setting, it doesn’t matter. In PP, if you have enough private insurance patients, most physicians limit the number of Medicaid. If they don’t, they pretty much have to take it.
Agree with DarkHorizon above, and also because it is the right thing to do for those patients. 20-25% of Americans are on Medicaid.
Especially in pp, you can fill your panel with no Medicaid or straight medicare with no supplemental. Psychiatry is leading the way with how practices should be run with a cash-only model. Hope other specialties can adopt a similar system. Medicaid/care are abysmal payers, especially Medicaid.
Good for them, they know their worth.
I'm not disagreeing by any means that Medicaid reimbursement is terrible and it's a system-level issue, but the policy of these practices also directly harms my patients so it's tough for me to be quite so flippant about it.
So due to poor policy docs should voluntarily take a massive pay cut (and often lose money on Medicaid patients) and assume the same liability? This is why docs get walked over
Interesting how our gov can spend billions on a country 99% of Americans doesn't know exists yet they lowball docs and docs just take it
That works great in theory, but FQHCs and teaching facilities CANNOT just stop taking Medicaid by law, which is where the bulk of these patients end up for primary care. This also couldn't happen without ENORMOUS harm to patients on Medicaid, which as I said make up about a quarter of Americans and are often those in greatest need of care. So they don't have access to care, they end up in the ER for everything from a snotty nose to a stroke due to uncontrolled pick your favorite chronic disease, and we end up paying for their care anyway. I think the right answer is to advocate for better Medicaid reimbursement, among other policies to support good access to good quality care for this patient population.
That's....not even close to what I said. I think there are numerous potential policy solutions to fix this issue that we as physicians should be advocating for. In the meantime, we should do the right thing for our patients.
We do not share the same view point so I am going to leave this conversation.
LOL. Yeah, if you don't share the view that we should advocate for better health policy and do the right thing for our patients then I don't see this conversation being productive.
No, I don't believe physicians should take being ripped off. Physicians are under no obligation to take Medicaid. And "advocating" for increased reimbursements will, and has, accomplished nothing.
You seem to be responding to a lot of points that (1) I never made, and (2) I don't even agree with. I don't believe physicians should take being ripped off either. I never said physicians are under any obligation to take Medicaid, and I can certainly understand why some physicians don't. That doesn't change the fact that making that choice directly harms patients who are often in greatest need of care. Regardless of your position on whether physicians should take Medicaid, I think we can all acknowledge the fact that it hurts patients when they don't. And thanks to physician advocacy, there have actually been some big changes to outpatient billing criteria recently that monetarily incentivize taking care of patients with more complex social situations, which of course boosts reimbursement for many Medicaid patients.
And yet they still lag significantly behind private insurance and cash pay with the same liability on more complex patients
...which is why we need to continue to advocate for better policy. I'm like genuinely confused what you think you disagree with me about???
I mean if you have an argument that shows you really need 10 years of training after undergrad (7 of which have nothing to do with colonoscopies) to do this procedure, I’m happy to hear it. But it sounds like your argument is that GI docs are entitled to it because they’re GI docs.
I think there's a nuanced argument to be made here for scope techs, but there has to be very strict guidelines as to what patients they care for. Colonoscopies are both diagnostic and therapeutic. Completing both identification and treatment of an abnormality requires you to have a foundation in clinical reasoning, pathology, and decision making that takes years to master. Sure, a tech might be able to identify a polyp, remove it, biopsy a lesion, but you still need a GI to make decisions about potential treatment/follow up. The GI would probably need to do another scope to make sure nothing was missed. Would you make a clinical decision about a pathology without actually looking at it yourself? The only people who should be seen by techs are those with basically no risk factors or symptoms. If there is a positive result they should be scoped by a GI. This is obviously attainable because there are a LOT of people with no risk factors who need routine screening. But I can't help but feel this is a slippery slope if we are unable to define exactly what they should and should not be allowed to do. And we know that with the whole NP autonomy situation that those established bounds are inevitably going to be removed/crossed at some point...
Yeah. I imagine it purely for screening purposes. Not diagnostic or therapeutic. On paper, you’re paying someone $150-$200k to just perform a screening exam instead of a physician $600k+. That’s huge savings for admin and allows additional revenue to expand services to more patients.
I think you have a poor understanding of what PCPs do. This may not be your fault - in many locations PCPs are glorified referral techs. But in plenty of other places you see a pattern of only referring for procedures or problems that are significantly complex.
I'm a lowly med student; my perception on my FM rotation was the pcps constantly bad-mouthing specialists. They were far more than technicians, many were great clinicians, but it came off as sour grapes and made me 100% want to be a specialist.
I think you have a poor perception of what referrals specialists get from PCPs.
I definitely have less than what specialists do, there's no denying that.
It's my favorite SDN trope: "I am not a primary care physician and have never trained in it but I know you guys have too much training time."
This thread is "I am a primary care doctor and nps and PAs can do specialist procedures"
| What you can do now |
| Contact your members of Congress and ask them to stop the Medicare physician payment cuts before the end of the year. The AMA is urging Congressto do the same—and to reform the system overall so we aren’t facing yearly cuts. Congress is taking notice: Reps. Bera, MD (D-CA) and Bucshon, MD (R-IN) recently introduced bipartisan legislation, the “Supporting Medicare Providers Act of 2022,” to stop the cuts; and 46 senators on Nov. 2 cosigned a bipartisan letter spearheaded by Senators Stabenow (D-MI) and Barrasso (R-WY) to Senate leadership urging them to address cuts—and supporting bipartisan long-term Medicare payment reform. |
Yes because that's simply a repeating of things that are already happening.
As I don't refer for medicolegal purposes...
Probably not if going by the book, but in real world, in the outpatient setting your reputation matters (including your rating on any of the physician review websites out there which patients can easily post on). Patients frequently request specialist referral since they are seen as the experts the issue at hand. And as long as if they have a decent insurance, they specialists probably want the business as well.
Yes, I do it all the time.
