You guys should do DO, NP and PA over Carib MD

[Unzbuzzled]

I see now that my initial post was written a bit too hastily and may not adequately capture my intentions. All this talk is simply about optimizing one's chances of becoming a doctor in one's desired specialty. If you're a doctor who attended medical school in the Caribbean and are now a practicing, licensed physician, I view you as a total equal to any other physician on the wards. Learning basic science in the Caribbean is only 2 years out of 7+ years of training. Yes it can potentially give you obstacles at the beginning, and there might be a few tools that might give you flack (most likely due to their small corpora cavernosas), but at the end of the day, you're a physician practicing medicine, and once you get a few years under your belt and hone your skills, you'll be just fine. I'm just concerned with getting people to that point in the first place, which is the most difficult obstacle to overcome as a FMG. So going back to the OP, being a NP, PA, CRNA, DNP ect will not allow you to practice medicine so much as it allows you to work as a midlevel practitioner in a medical career. I understand your concern about NPs and PAs assuming more autonomy and scope of practice, but I don't see a threat to primary care physicians. Instead, I'm guessing PCPs will just focus mostly on the most relevant aspects of the CC, and allow midlevels to do the more basic and preparatory aspects of patient visits. Anyone else think the same?

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[Aphtalyfe]

I understand your concern about NPs and PAs assuming more autonomy and scope of practice, but I don't see a threat to primary care physicians. Instead, I'm guessing PCPs will just focus mostly on the most relevant aspects of the CC, and allow midlevels to do the more basic and preparatory aspects of patient visits. Anyone else think the same?

It would appear to me that NPs are most definitely pushing to have more autonomy and practice nearly independently. In many states they can function as a PCP which means they see their own patients and write their own scripts. My personal stance on it is that the 2,000 clinical training hours a NP has does not compare to the 20,000 a family practice physician has... but hey who am I to judge?

 

[Top Gun]

It would appear to me that NPs are most definitely pushing to have more autonomy and practice nearly independently. In many states they can function as a PCP which means they see their own patients and write their own scripts. My personal stance on it is that the 2,000 clinical training hours a NP has does not compare to the 20,000 a family practice physician has... but hey who am I to judge?

Not to mention the greater depth of basic science knowledge a family physician has as well. But yeah, with NP's pushing for greater autonomy and prescription privileges, there is going to be encroachment on the practices of PCP's.

 

[Skip Intro]

I understand your concern about NPs and PAs assuming more autonomy and scope of practice, but I don't see a threat to primary care physicians.

I see it as a threat. They want the "easy" cases at the same reimbursement rate. They believe they don't need a physician's help to do their job... until they need a physician's help. This is the "pick the low hanging fruit" that a lot of us object to.

It's really hard in the real world to quantify near misses. They want the ability to practice "independently" (if you can call it that) until there is a complication. Then they want us to step in. Also, until they can get away from the "shift mentality" (i.e. their job is to work from 7 AM to 3 PM, take no call, and expect someone to handle the after hours stuff), there will never be parity. This is why malpractice insurers, for example, still make the distinction and haven't yet caught up to this changing tide.

Instead, I'm guessing PCPs will just focus mostly on the most relevant aspects of the CC, and allow midlevels to do the more basic and preparatory aspects of patient visits. Anyone else think the same?

This is kind of the model in the current supervision system. The physician becomes part of the team approach and oversees the overall plan of care for the patient. This system works. One where there is complete autonomy of the midlevel with no oversight is, in this practitioner's opinion, a colossal social experiment with potentially disastrous consequences.

Until the day that, to share your analogy, physicians actually and collectively grow a pair and say, "deal with your own complications", we will continue to see this mismatch in ultimate responsibility to the patient... and malpractice rates will continue to favor the midlevel. When that changes, the entire game changes.

-Skip Intro

 

[Unzbuzzled]

I see it as a threat. They want the "easy" cases at the same reimbursement rate. They believe they don't need a physician's help to do their job... until they need a physician's help. This is the "pick the low hanging fruit" that a lot of us object to.

It's really hard in the real world to quantify near misses. They want the ability to practice "independently" (if you can call it that) until there is a complication. Then they want us to step in. Also, until they can get away from the "shift mentality" (i.e. their job is to work from 7 AM to 3 PM, take no call, and expect someone to handle the after hours stuff), there will never be parity. This is why malpractice insurers, for example, still make the distinction and haven't yet caught up to this changing tide.



This is kind of the model in the current supervision system. The physician becomes part of the team approach and oversees the overall plan of care for the patient. This system works. One where there is complete autonomy of the midlevel with no oversight is, in this practitioner's opinion, a colossal social experiment with potentially disastrous consequences.

Until the day that, to share your analogy, physicians actually and collectively grow a pair and say, "deal with your own complications", we will continue to see this mismatch in ultimate responsibility to the patient... and malpractice rates will continue to favor the midlevel. When that changes, the entire game changes.

-Skip Intro

So what you're saying is that when PCPs assume a more specialist role and see only the toughest cases, there are bound to be more misses, where a patient with a serious condition is treated for something more benign because the midlevel's training was too subpar to recognize the more serious condition. This makes sense. Do you think that this is an inevitability anyway, because doctors are spending less and less time with each patient as the physician shortage increases in this country? Or let me put it this way. The physician shortage is growing and the physician to patient ratio is getting smaller and smaller as the boomers age. So, unless we significantly increase the number of practicing physicians (very hard considering what it takes to train a resident), we have two choices: either allow midlevels to increase their scope and autonomy and have PCPs assume a more specialist role, or jam in more and more patients the doc has to see, so that, although the doc will see everyone, he will be more rushed and therefore less likely to catch everything. which is the lesser evil? Or is there a better way? I'm just curious, because I really have no idea what we are going to do. We haven't increased the number of residency positions in years, so I don't see the number of physicians increasing significantly in the US any time soon.

 

[Skip Intro]

Do you think that this is an inevitability anyway, because doctors are spending less and less time with each patient as the physician shortage increases in this country?

It's a tough problem, no doubt.

We have increased the number of medical school spots in the U.S. (MD and DO) over the past 15 years by both opening new schools and increasing the number of matriculants in already-established schools. Essentially, this means that the "leftover" spots for IMGs will shrink.

I think a three-prong approach will have to happen: (1) there will be a need for more doctors in primary care (FP, gen IM, peds, OB/Gyn) and there will have to be some sort of additional financial incentive to go into those fields; (2) there will have to be some sort of differentiation in reimbursement, essentially treating any physician consultation as a consultation with commensurate increase in reimbursement, and; (3) we will somehow have to reduce the administrative burden on everyone.

I don't know how you make that work. There will be perhaps more misses and misdiagnoses, and the system will have to figure out a way to deal with that (e.g., tort reform, medmal reform, etc.). Having bureaucrats sitting behind desks mandating things, though, is not part of that reform. The trend and focus as of late has been less on the patient's problem and more on completing the paperwork properly... and that is bad for all involved.

-Skip

 

[Gfliptastic]

The 2% Medicare/Medicaid decrease and spending hold will really put a damper on an already poor situation.

I've always said that if any government official put forth a PCP scholarship, I would have signed the papers long ago. And so many of my classmates I've offered a similar idea would choose the same thing.

Good enough incentive, as opposed to knowing I leave med school w/ the same amount of debt as a classmate looking into surgery or oncology, but having lower yearly income every year because I want to be a PCP.