Why don't IM's work with a ton of midlevels? Ala Derm?

[Strength&Speed]

What is the big stopping point here. Not enough reimbursement to cover the salary of the midlevels? It seems there is a relative dearth of offices utilizing multiple midlevels. I would think this would be an ideal spot for an IM. Be available for difficult cases and see some patients on the side.

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[Myostatin]

In an office setting, not enough reimbursment. In a full-time hospitalist set up, attending can/do hire PAs and NPs.

 

[Soundwave]

these days a midlevel pulls in almost as much as an internist. So its not that surprising that internists frequently just hire other internists to join them in their group instead of a pa or np. You have to supervise pa's and np's and you are liable for any crazy thing they decide to do with a patient. It makes more sense for people like dermatologist, who make their money doing procedures and who make much more then the midlevel people, to hire someone to field their skin cancer screening and post-biopsy patients rather then highering another dermatologist to do the scut work. ALso, there is a shortage of np's and pa's, one of the reasons their salaries are being driven so highly. So the more highly reimbursed specialties get first picks because they can pay them more.

 

[elwademd]

as with many things in medicine, in medical school we're taught how to do the medicine part... but not how to translate that into good business sense/decisions. same with residency... we're taught the medicine, but not necessarily the business aspect.

sure there's a role for mid levels. but do we know how to incorporate them?

patients need to be educated on certain topics... does it have to be the physician doing it?

does every young patient with few to no comorbidities who presents with a cough/rash/fever need to be seen by the physician?

i'm sure there are other roles, but i think more im offices could utilize mid level help, but there's probably a lack of understanding (in general) about how to go about doing it so that its an effective and beneficial partnership.