DNPs will eventually have unlimited SOP

[evilbooyaa]

Docs that are currently set in their ways will not be on board of eliminating the DNP or NP profession, or to stop hiring them. They get to take a cut from the NPs work for supervising. They'll be retired by the time DNPs manage to get nationwide unlimited SOP.

It's the young doctors that you need to convince to band together. Doesn't help that all specialties talk **** on each other, and that the AMA seems weaker than every individual subspecialty association.

---

Members don't see this ad.

 

[SpecterGT260]

where is the outward pressure coming from? and what can we do to change the mindset of these docs who just don't care? we've been talking about it forever.. but what action can we actually take now??

societal and political pressure establishes a "need" for these training programs. I believe Vandy just made one where cardio docs will train DNPs to do.... something. Add in the other things I listed and suddenly you have a viable program producing fauxcters and endangering the public (parts of this statement bay be somewhat editorial in nature....)

What can we do? uh.... Implement a system which hinders such things. I'm not sure exactly how it could go or if it would even be legal, but board sanctions for participating would seriously hurt the DNP ability to train. This is more relevant for the DNP specialist programs that are trying to gain traction. Otherwise lobbying, PR, and research is about all that can be done. The problem is the patient cares more about the subjective feel of the care than the actual quality. So patients respond to things that are actually an artifact and direct result of limited scope and lower work load which makes them feel "more taken care of". Doesn't matter if they aren't managed appropriately....

 

[badasshairday]

Change starts with you. Don't train dNP's, don't hire dnp's. Do hire PA's.

 

[rog411]

Change starts with you. Don't train dNP's, don't hire dnp's. Do hire PA's.

I've found that a lot of doctors don't know that DNPs are regulated by their own board, not ours and PAs are... We should spread the word.

 

[eject]

Change starts with you. Don't train dNP's, don't hire dnp's. Do hire PA's.

I heard a lecture by physician recently about new models for healthcare that include midlevels. I'm sure this has been discussed before, perhaps in this thread, but the idea in a primary care practice makes a lot of sense. Midlevels see most patients, overseen by a physician who spends most of his/her time with the most difficult cases. Apparently, this model is working well on many measures in places like MA, including both patient and physician satisfaction, and objective measures of outcomes and $ (in this explanation, the physicians are paid as much or more--in some cases, where outcomes and efficiency are best, much more than under the "old" model where the doc sees everyone).

I'm too removed from the actual practice of medicine to say whether it's an idea that can be scaled up to the whole country (or if it even works the way it was explained). But this guy made a strong case, and I see some reason for optimism.

 

[evilbooyaa]

I heard a lecture by physician recently about new models for healthcare that include midlevels. I'm sure this has been discussed before, perhaps in this thread, but the idea in a primary care practice makes a lot of sense. Midlevels see most patients, overseen by a physician who spends most of his/her time with the most difficult cases. Apparently, this model is working well on many measures in places like MA, including both patient and physician satisfaction, and objective measures of outcomes and $ (in this explanation, the physicians are paid as much or more--in some cases, where outcomes and efficiency are best, much more than under the "old" model where the doc sees everyone).

I'm too removed from the actual practice of medicine to say whether it's an idea that can be scaled up to the whole country (or if it even works the way it was explained). But this guy made a strong case, and I see some reason for optimism.

This is exactly where the situation is now. Most, if not all doctors are OK with a midlevel ACTING as a midlevel. It's when they (a subset within the field of midlevels, specifically DNPs, start thinking they are "just as good" as the person supervising them and want to practice on their own. That's when MDs/DOs go, "hey, let's back off that idea".

 

[rog411]

This is exactly where the situation is now. Most, if not all doctors are OK with a midlevel ACTING as a midlevel. It's when they (a subset within the field of midlevels, specifically DNPs, start thinking they are "just as good" as the person supervising them and want to practice on their own. That's when MDs/DOs go, "hey, let's back off that idea".

That's the thing though, they will always want to do this. No one wants to stay in the middle when they see a path up. We allowed this to happen to us by being OK with midlevels in the first place. I don't understand how any sane doctor thought we can teach these people to do what we do and get them to do most of our work while we relax on the golf course (actually seen this happen) and they won't start thinking they can just get rid of us and do their own thing.

 

[SpecterGT260]

That's the thing though, they will always want to do this. No one wants to stay in the middle when they see a path up. We allowed this to happen to us by being OK with midlevels in the first place. I don't understand how any sane doctor thought we can teach these people to do what we do and get them to do most of our work while we relax on the golf course (actually seen this happen) and they won't start thinking they can just get rid of us and do their own thing.

shift them equal liability . From what I understand much of the issue is that there are always physicians involved in patient care and very often physicians are required to sign off on orders. So guess who get's sued when things go south, the person with a master's level education who labels it with the wrong letters simply because it is a terminal degree who makes ~80-100k or the guy making nearly 3x that?

 

[yoyostring]

So it is important that we all stay active on this, in the form of keeping up on what the mutants in D.C. are doing and contacting congress when they are going to pass ******ed legislation that puts patients at risk.

We are all patients in the end. I for one am going to be pretty pissed when I'm 80 in the ICU and can't actually get a doctor (the real kind) to see me, because everybody took the path of least resistance and became an over-zealous nurse.

This could get really scary.

 

[Textbookversion]

http://www.kevinmd.com/blog/2013/02/destroying-family-physician-aafp-member-responds.html

 

[evilbooyaa]

shift them equal liability . From what I understand much of the issue is that there are always physicians involved in patient care and very often physicians are required to sign off on orders. So guess who get's sued when things go south, the person with a master's level education who labels it with the wrong letters simply because it is a terminal degree who makes ~80-100k or the guy making nearly 3x that?

I would imagine that if they get unlimited SOP they would have to get their own malpractice insurance. Only reason physicians cover them currently is because it adds to the physicians' bottom line.

 

[SpecterGT260]

I would imagine that if they get unlimited SOP they would have to get their own malpractice insurance. Only reason physicians cover them currently is because it adds to the physicians' bottom line.

as it stands they will have their own insurance, but it is often kind of like the appendix..... My point (and I think maybe we are agreeing) is that they enjoy a reduced amount of liability compared to the scope they want.

 

[sharklasers]

I wish I had seen this thread earlier. As someone who wants to do private practice internal medicine, would someone mind quickly summarizing what the future risks are by going into this field now? Thank you!

EDIT: By the way, the only reason I made this post because one of the first posts I saw on the first page said that internal medicine is still a good choice for people who want to work in a hospital, but not for those who want to work in the community with a private practice. I'm not sure if any other comments were made regarding that statement. Thanks!

 

[jackets5]

All of that may be true, but the fact still remains that you will never win a battle in the statehouse or congress if the other side is offering a more cost effective solution and has data to back it up. You just won't. So whatever excuses there are for not doing those studies, they need to get over them, or accept the fact that it's going to happen and deal with it.

How do you exactly design a study like this. The only way it is possible is to give mid-levels the more complex cases which you really cant do because you put patients lives and safety at risk.

Also, your right its about money and prestige. I didnt go to medical school and about to start residency to make 150k/year. While less educated, less trained, less qualified people make 135k to work less hours with zero liability.

Physicians need to stop being so short sighted when dealing with the mid-levels.

 

[rog411]

How do you exactly design a study like this. The only way it is possible is to give mid-levels the more complex cases which you really cant do because you put patients lives and safety at risk.

Also, your right its about money and prestige. I didnt go to medical school and about to start residency to make 150k/year. While less educated, less trained, less qualified people make 135k to work less hours with zero liability.

Physicians need to stop being so short sighted when dealing with the mid-levels.

If the salary is really that close and the workload & liability are so much less for PAs, why did you go to med school? Why would anyone? It seems like a very foolish thing to do from a cost-benefit perspective.

 

[jackets5]

If the salary is really that close and the workload & liability are so much less for PAs, why did you go to med school? Why would anyone? It seems like a very foolish thing to do from a cost-benefit perspective.

Im was talking about more of the direction we are heading.

 

[rog411]

Im was talking about more of the direction we are heading.

Fair enough.

On a related note, i keep hearing that malpractice insurance is really cheap for NPs, even if they're practicing solo. How can this be?

 

[JourneyAgent]

Fair enough.

On a related note, i keep hearing that malpractice insurance is really cheap for NPs, even if they're practicing solo. How can this be?

Someone who knew something about actuarial science on here explained the phenomenon as relating to propensity to get sue and rewards for suing. In other words, if an NP working for a doc f's up and the patient wants to sue. The plaintiff's attorney will sue the deeper pocketed name on the chart.

The insurance people run the math on this across the board and charge accordingly for insurance.

Something like that.

The free ride NP's are getting off of us is a Russian doll of surreptitiousness. It really is ingenuous. We're the mules in this scenario while they've convinced themselves and the rest of the world that they're oppressed.

Bravo ladies.

 

[rog411]

Someone who knew something about actuarial science on here explained the phenomenon as relating to propensity to get sue and rewards for suing. In other words, if an NP working for a doc f's up and the patient wants to sue. The plaintiff's attorney will sue the deeper pocketed name on the chart.

The insurance people run the math on this across the board and charge accordingly for insurance.

Something like that.

The free ride NP's are getting off of us is a Russian doll of surreptitiousness. It really is ingenuous. We're the mules in this scenario while they've convinced themselves and the rest of the world that they're oppressed.

Bravo ladies.

So let's say all the NPs become autonomous, then there won't be any more MDs associated with them, and their malpractice insurance costs would shoot up, right? Because in that situation they're the only ones that can get sued.

In that case giving them all the autonomy they want is a good thing- no more free rides from MDs. They can't try to be heroes while standing on our backs anymore.

 

[JourneyAgent]

So let's say all the NPs become autonomous, then there won't be any more MDs associated with them, and their malpractice insurance costs would shoot up, right? Because in that situation they're the only ones that can get sued.

In that case giving them all the autonomy they want is a good thing- no more free rides from MDs. They can't try to be heroes while standing on our backs anymore.

Yeah. That's the way I feel about it. I want open competition as opposed to parasitic shell games.

If they strike out on their own in large enough numbers and insurance companies start having the same risk of loss then they will certainly charge them for it. Which will run up their costs some.

The HMO's could care less though. So it might not be the biggest deal. PP is getting difficult for everyone. NP's so far as I can tell are setting up independently only when other options are scarce.

 

[xenotype]

The HMO's could care less though. So it might not be the biggest deal. PP is getting difficult for everyone. NP's so far as I can tell are setting up independently only when other options are scarce.

NPs hanging their own shingles in the current climate of integration is not a threat. They won't make much money and it'll be a huge uphill battle for them in most places. ACOs will further eliminate that.

The threat is that the HMO like ACOs will hire NPs instead of MDs to save $.

 

[KnuxNole]

Way overrated

This. I've never really needed to ask a professor for much, since almost all of the learning requires memorizing the facts. Classmates sadly ask way too many questions, which is a negative part about lectures(and rounds!).

Besides, I'd rather interact with classmates outside of school. In school, I'm a zombie in the morning(with coffee!), people talk about school-related things, etc. Outside of school, that's where the more entertaining stuff happens

 

[JourneyAgent]

NPs hanging their own shingles in the current climate of integration is not a threat. They won't make much money and it'll be a huge uphill battle for them in most places. ACOs will further eliminate that.

The threat is that the HMO like ACOs will hire NPs instead of MDs to save $.

Right I agree.

That's why I'm increasingly interested in creating my own specialized niche in PP.

Whatever I end up doing I'm always going to be scheming to do something on my own. Even if it's part time. The thought of going through all of this and then be ordered by an MBA to sign off on an NP's work for patients I don't see would give me stomach cancer.

Primary care fields won't have this option unless they're extremely creative. I read an article about a doc who would take the subway to your apartment. Diagnose you. And help you find resourceful ways of getting cheap scripts. You booked appointments with him yourself. You paid as you go for his services. He had zero overhead.

My debt load makes this paratrooper style practice unlikely for a while. But there are still some niches out there that can be obtained for a higher pay scale. I'm about figuring them out and getting after them. With a day job or without.

When you put yourself directly to the public selling your training is proof positive in the quality of your services. There I will be able to go head to head with anyone and find the exact limit of my talent in earnest as demonstrated by my ability to be successful.

F@ck HMO's, f@ck MBA middling managers, f@ck insurance companies, f@ck patients who expect everything and give nothing to their own health, f@ck my medical school, and all my bosses and attendings who nitpick the work of others while risking nothing for their position to do so.

At least...when I am able to say that...then yeah...until then...fantasies and schemes are at least better that resigning to being a debt laden tool competing with other less trained tools for same lot of mule's work.

 

[CDI]

Primary care fields won't have this option unless they're extremely creative. I read an article about a doc who would take the subway to your apartment. Diagnose you. And help you find resourceful ways of getting cheap scripts. You booked appointments with him yourself. You paid as you go for his services. He had zero overhead.

Damn, that might be the most bootleg thing I have ever heard.

I'm going into primary care (someday)...solo private practice or bust.

 

[JourneyAgent]

Damn, that might be the most bootleg thing I have ever heard.

I'm going into primary care (someday)...solo private practice or bust.

Bootleg never bothered me. It's called hustlin.

 

[CDI]

If the salary is really that close and the workload & liability are so much less for PAs, why did you go to med school? Why would anyone? It seems like a very foolish thing to do from a cost-benefit perspective.

Most people going into med school don't outright say they want to do primary care. Who doesn't want to become a CT surgeon, Neurosurgeon, or Cards?

Many of the 'weaker' are eventually weeded into primary care. Others who are good, just want to start their life and are tired of all the years of training/making no money and then choose primary care (even if they are capable of the more lucrative specialties.) And there's those few others who just wanted to do primary care all along and never really cared about the money aspect. Then there's the smart ones who married rich by telling someone they're a doctor.

 

[KnuxNole]

Most people going into med school don't outright say they want to do primary care. Who doesn't want to become a CT surgeon, Neurosurgeon, or Cards?

Many of the 'weaker' are eventually weeded into primary care. Others who are good, just want to start their life and are tired of all the years of training/making no money and then choose primary care (even if they are capable of the more lucrative specialties.) And there's those few others who just wanted to do primary care all along and never really cared about the money aspect.

I never wanted to be a surgeon in my life. My rotation made the thought from 90% to 100%. Cardiology I never ruled in or out, lol

 

[rog411]

Most people going into med school don't outright say they want to do primary care. Who doesn't want to become a CT surgeon, Neurosurgeon, or Cards?

Many of the 'weaker' are eventually weeded into primary care. Others who are good, just want to start their life and are tired of all the years of training/making no money and then choose primary care (even if they are capable of the more lucrative specialties.) And there's those few others who just wanted to do primary care all along and never really cared about the money aspect.

so primary care is basically a dumping ground, lol

 

[CDI]

so primary care is basically a dumping ground, lol

In the MD track, sure, unless that's what you were truly aiming for all along.

After all, DO is the probably the dumping ground for like 75% of MD rejects.

DNP/PA probably dumping ground for 30-40% of DO rejects.

 

[JourneyAgent]

so primary care is basically a dumping ground, lol

Well. You could go with a primary care field and take a specialized route within it. But regardless if dumped or chosen or called by voices, all signs are that it's going to be a crowded provider market.

The midlevels--I could care less if they don't like the term--have made their case loud, clear, and pretty damn irrefutable to stake a claim as primary providers. Much, much, less so as specialists unless supervised.

Even if the dominoes do fall all over the place. The primary care ones have already.

If I liked supervising other people I would be less concerned about it. And would just hone my management skills and get ready to do business leading a team or working the administrator path. But I hate that stuff. Always wanted a direct clinical career. But if your's or whoever's concerns are different you can still plan a good career in primary care.

 

[rog411]

In the MD track, sure, unless that's what you were truly aiming for all along.

After all, DO is the probably the dumping ground for like 75% of MD rejects.

DNP/PA probably dumping ground for 30-40% of DO rejects.

PA is the dumping ground for med school rejects. DNP is just a path for overzealous nurses to feed their egos and their wallets. No one else wants "nurse" anywhere in their title.

 

[JourneyAgent]

Another thought.

Why should we fight for a public that...likes Beyonce and Justin Beiber. How can we convince them longer harder trading is better for them. Why should we?

What is the ethical problem with going along with the current towards a multi-tiered health care system instead of fighting against it?

Why don't we just charge more stay focused on quality and let the McDonald's workers of medicine serve up happy medicine meals to the masses?

And for those of us who like managing McDonald's and running a stable of mid levels, then you play for that team.

Is quality difference achievable at all.

Because if it's not then we are all epic suckers.

 

[JShephard]

Another thought.

Why should we fight for a public that...likes Beyonce and Justin Beiber. How can we convince them longer harder trading is better for them. Why should we?

What is the ethical problem with going along with the current towards a multi-tiered health care system instead of fighting against it?

Why don't we just charge more stay focused on quality and let the McDonald's workers of medicine serve up happy medicine meals to the masses?

And for those of us who like managing McDonald's and running a stable of mid levels, then you play for that team.

Is quality difference achievable at all.

Because if it's not then we are all epic suckers.

I try to stay positive, but it's clear that the public and govt don't value what doctors do anymore. The incomes and training level for our profession are going to drop substantially in the next few decades.

I've seen the argument that, as long as we have people applying to med school then we can lower the reimbursements. It's crazy. This job doesn't make sense to do 80 hr weeks and a decade of training with 300k in debt and malpractice, call, 30 hr shifts, etc. only to come out making 50% of what we should. Or even to be compared to nurses.

Doctors neglected politics far too long. Anesthesiologist trained those that are destroying their field.

I think many people will move to other fields in 10 years. I feel bad for people with 300k+ in debt and 5 year residencies. They money will be gone by then and they will be sitting on a half million in debt with an average income.

 

[rog411]

I try to stay positive, but it's clear that the public and govt don't value what doctors do anymore. The incomes and training level for our profession are going to drop substantially in the next few decades.

I've seen the argument that, as long as we have people applying to med school then we can lower the reimbursements. It's crazy. This job doesn't make sense to do 80 hr weeks and a decade of training with 300k in debt and malpractice, call, 30 hr shifts, etc. only to come out making 50% of what we should. Or even to be compared to nurses.

Doctors neglected politics far too long. Anesthesiologist trained those that are destroying their field.

I think many people will move to other fields in 10 years. I feel bad for people with 300k+ in debt and 5 year residencies. They money will be gone by then and they will be sitting on a half million in debt with an average income.

We need a revolution. We all need to stand together and say we're not going to do this anymore. Only then will the system change. Patients may suffer, but if that's what it's gonna take, that's what needs to happen.

 

[JShephard]

We need a revolution. We all need to stand together and say we're not going to do this anymore. Only then will the system change. Patients may suffer, but if that's what it's gonna take, that's what needs to happen.

I agree. I'll be interested to see if this giant group of competitive "do it on my own" people can follow leadership and sacrifice some independence for the greater good.

Reality, there are a lot of individuals and a lot of people without foresight. The group without foresight thinks everything is ok as long as they can earn a decent income - they will be shocked in 15 years when they are competing w/ nurses to even HAVE a job. Tips could easily happen in primary care. Brushing off the idea isn't wise.

 

[JourneyAgent]

I try to stay positive, but it's clear that the public and govt don't value what doctors do anymore. The incomes and training level for our profession are going to drop substantially in the next few decades.

I've seen the argument that, as long as we have people applying to med school then we can lower the reimbursements. It's crazy. This job doesn't make sense to do 80 hr weeks and a decade of training with 300k in debt and malpractice, call, 30 hr shifts, etc. only to come out making 50% of what we should. Or even to be compared to nurses.

Doctors neglected politics far too long. Anesthesiologist trained those that are destroying their field.

I think many people will move to other fields in 10 years. I feel bad for people with 300k+ in debt and 5 year residencies. They money will be gone by then and they will be sitting on a half million in debt with an average income.

Yeah I'm in the future shock category of debt load. I'm also going to be middle aged when I start my career. Loveliness abides.

So yeah. I got a **** hand in a high stakes game.

I want to believe that I can escape the downward pressure of Medicare reimbursement by establishing a boutique/consultant/high-demand-specialist's gig. But I just don't know if that's real or just my comic book script I spin to avoid a sinking feeling I have.

Are the economics of scale to lopsided?

What if it was like the current vegan/health/organic food market? Absent a short decade ago, expanding ferociously, even in a country of fat sedentary f@cks.

Maybe a high-dollar/high quality counter stream is possible. Will the middle class be so gutted that purchasing power may not make it feasible?

Damn. All I can do is keep studying and keep renting federally distributed money.

F@ck. I suck wheel barrels of cocks. For free.

 

[rog411]

Yeah I'm in the future shock category of debt load. I'm also going to be middle aged when I start my career. Loveliness abides.

So yeah. I got a **** hand in a high stakes game.

I want to believe that I can escape the downward pressure of Medicare reimbursement by establishing a boutique/consultant/high-demand-specialist's gig. But I just don't know if that's real or just my comic book script I spin to avoid a sinking feeling I have.

Are the economics of scale to lopsided?

What if it was like the current vegan/health/organic food market? Absent a short decade ago, expanding ferociously, even in a country of fat sedentary f@cks.

Maybe a high-dollar/high quality counter stream is possible. Will the middle class be so gutted that purchasing power may not make it feasible?

Damn. All I can do is keep studying and keep renting federally distributed money.

F@ck. I suck wheel barrels of cocks. For free.

I love the way you talk. awesome

 

[CDI]

Yeah I'm in the future shock category of debt load. I'm also going to be middle aged when I start my career. Loveliness abides.

So yeah. I got a **** hand in a high stakes game.

I want to believe that I can escape the downward pressure of Medicare reimbursement by establishing a boutique/consultant/high-demand-specialist's gig. But I just don't know if that's real or just my comic book script I spin to avoid a sinking feeling I have.

Are the economics of scale to lopsided?

What if it was like the current vegan/health/organic food market? Absent a short decade ago, expanding ferociously, even in a country of fat sedentary f@cks.

Maybe a high-dollar/high quality counter stream is possible. Will the middle class be so gutted that purchasing power may not make it feasible?

Damn. All I can do is keep studying and keep renting federally distributed money.

F@ck. I suck wheel barrels of cocks. For free.

Hahahahahaha! Awesome.

 

[valkener]

Doom on SdN as usual.

Yes salaries might go down, even though in some specialties they have actually slightly gone up. Physicians will continue to have one of the best job-security in the economy. They continually rank among the top 3 (if not 1) of "Best Jobs."

Yes specialties matter but things aren't going to hell at all. I'm all for increased lobbying but panicking is not the answer. When salaries decrease, people are not willing to work as much anymore. A neurosurgeon might be willing to do 90-hour weeks for $500k but if that salary get's slashed in half, that person will claim a 50-hour work week.

 

[xenotype]

You don't have to worry about having a job. Nobody will hire a nurse for the price of a physician, that much is certain.

I have a solution to the DNP problem, and it'll be very unpopular among the established older docs.

Let them have independence now. Stop fighting it. Let them have it in every state, and let their scope be whatever they want it to be. Then, refuse to work with them. Refuse to sign paperwork for them. Refuse to hire them. Refuse to consult for them. Refuse to train or precept them. Publicly claim that you have serious misgivings about their training.

500 clinical hours and independent practice is a lethal combination, and as long as you make it impossible for them to hide from public scrutiny for their bad outcomes and half assed training they will fail pretty quickly.

But you have to make it so they cannot muddy the water or shift the blame to physicians for bad outcomes or take the credit when things run smoothly.

If you make one system with MDs and PAs, and force them to have their own system (NOT on medical staff, with their own clinics and patients) they will implode.

 

[blazer123]

You don't have to worry about having a job. Nobody will hire a nurse for the price of a physician, that much is certain.

I have a solution to the DNP problem, and it'll be very unpopular among the established older docs.

Let them have independence now. Stop fighting it. Let them have it in every state, and let their scope be whatever they want it to be. Then, refuse to work with them. Refuse to sign paperwork for them. Refuse to hire them. Refuse to consult for them. Refuse to train or precept them. Publicly claim that you have serious misgivings about their training.

500 clinical hours and independent practice is a lethal combination, and as long as you make it impossible for them to hide from public scrutiny for their bad outcomes and half assed training they will fail pretty quickly.

But you have to make it so they cannot muddy the water or shift the blame to physicians for bad outcomes or take the credit when things run smoothly.

If you make one system with MDs and PAs, and force them to have their own system (NOT on medical staff, with their own clinics and patients) they will implode.

Word, once the public feels the consequences of this idea, the government will change it back.

Are there any field right now not affected by midlevels?

 

[JourneyAgent]

You don't have to worry about having a job. Nobody will hire a nurse for the price of a physician, that much is certain.

I have a solution to the DNP problem, and it'll be very unpopular among the established older docs.

Let them have independence now. Stop fighting it. Let them have it in every state, and let their scope be whatever they want it to be. Then, refuse to work with them. Refuse to sign paperwork for them. Refuse to hire them. Refuse to consult for them. Refuse to train or precept them. Publicly claim that you have serious misgivings about their training.

500 clinical hours and independent practice is a lethal combination, and as long as you make it impossible for them to hide from public scrutiny for their bad outcomes and half assed training they will fail pretty quickly.

But you have to make it so they cannot muddy the water or shift the blame to physicians for bad outcomes or take the credit when things run smoothly.

If you make one system with MDs and PAs, and force them to have their own system (NOT on medical staff, with their own clinics and patients) they will implode.

Love the idea. Will sign for it now!

The only problem is we would need tight, military organization. And a few hundred goons to break a thumb or twos when we need them.

And for docs in general to not be self-interested pricks. But a team with some balls. Hmmmm. I'm lookin around here boss and ..... .... Idk?

 

[AlmostAnMD]

Xenotype, seriously you've got one of the worst attitudes towards fellow healthcare professionals I've seen on these boards. I've worked with many competent NP's/PA's. Some I'd sooner trust than you, certainly.

And about your idea. What happens if that backfires, hmm? What happens if you give them the autonomy to do as they please, and then, counter to your deepest desires, they don't kill anyone in large volumes or have significantly different outcomes from MD treatments (which seem to be the case).

At that point, because you've given them everything and they've done quite well...you're out of a job.

I never bought the whole "We're smarter than they are" argument. They're going to have practically none of the debt, fewer work hours, half the training and most of the pay we do. And THEY'RE supposed to be the dumb ones....

 

[SpecterGT260]

Xenotype, seriously you've got one of the worst attitudes towards fellow healthcare professionals I've seen on these boards. I've worked with many competent NP's/PA's. Some I'd sooner trust than you, certainly.

And about your idea. What happens if that backfires, hmm? What happens if you give them the autonomy to do as they please, and then, counter to your deepest desires, they don't kill anyone in large volumes or have significantly different outcomes from MD treatments (which seem to be the case).

At that point, because you've given them everything and they've done quite well...you're out of a job.

I never bought the whole "We're smarter than they are" argument. They're going to have practically none of the debt, fewer work hours, half the training and most of the pay we do. And THEY'RE supposed to be the dumb ones....

The best research that THEY have put out suggests that they have similar rates of negative outcomes within THEIR scope as physicians do within a PHYSICIANS scope. So at the very least we can assume they will be the same after a split, but in all likelihood they will rise. Truly autonomous work without the physician malpractice net overhead will make their model non-viable unless somehow they suddenly drop to zero cases with potential for suit. As has been suggested, insurance companies will adjust rates accordingly in order to not lose money and physicians will no longer be named in DNP overseen cases. They will either have to contract their scope to avoid suits or raise their prices. Either way physician babysitting is the only thing making them a threat.

To the bold part: you attempting to correlate the things you do here to intelligence makes a stronger point than anything you actually said

 

[CDI]

Xenotype, seriously you've got one of the worst attitudes towards fellow healthcare professionals I've seen on these boards. I've worked with many competent NP's/PA's. Some I'd sooner trust than you, certainly.

And about your idea. What happens if that backfires, hmm? What happens if you give them the autonomy to do as they please, and then, counter to your deepest desires, they don't kill anyone in large volumes or have significantly different outcomes from MD treatments (which seem to be the case).

At that point, because you've given them everything and they've done quite well...you're out of a job.

I never bought the whole "We're smarter than they are" argument. They're going to have practically none of the debt, fewer work hours, half the training and most of the pay we do. And THEY'RE supposed to be the dumb ones....

Question is...what really differntiates us and allows us to demand a higher pay? (The time invested, and loans aren't what I'm referring to.)

The Step 1 material is what we know "extra" about and which differentiates us 'physician scientists'. Half the time we're learning those subjects from PhDs, even though we don't even need to in order to be PCPs. If something goes wrong with a patient are we going to stop and draw out a physiological diagram on the spot or recite a biochem pathway to understand what went wrong, or are we just going to fix it instinctively and based on the clinical training? That's what the PA/DNP would probably do, and they'd probably have the same end result.

Unfortunately, we put 2 years worth of our time into that material and then PDs (including the ones for PCP residencies) put virtually all their decision on that one exam. Seems like a serious system flaw.

When we drastically reduce the emphasis on Step 1 and instead focus more on the clinical knowledge (CK), that will make an actual difference. After all, many people go into the Match with only their Step 1 scores, which makes very little sense to me.

 

[JourneyAgent]

Xenotype, seriously you've got one of the worst attitudes towards fellow healthcare professionals I've seen on these boards. I've worked with many competent NP's/PA's. Some I'd sooner trust than you, certainly.

And about your idea. What happens if that backfires, hmm? What happens if you give them the autonomy to do as they please, and then, counter to your deepest desires, they don't kill anyone in large volumes or have significantly different outcomes from MD treatments (which seem to be the case).

At that point, because you've given them everything and they've done quite well...you're out of a job.

I never bought the whole "We're smarter than they are" argument. They're going to have practically none of the debt, fewer work hours, half the training and most of the pay we do. And THEY'RE supposed to be the dumb ones....

A teamsters (from the 1930's) could be born right here. Me and xenotype break dis guys f@ckin thumbs with a hammer. And then asks the rest of you soft mf'ers if you have any questions about bidness is gonna get handled.

We start stufiin some pockets. A lil intimidation here, a lil persuasion there. Badaboom. Slingin some ol school doctor d!ck and handin out bubble gum.

Who's in.....

 

[JourneyAgent]

See Xeno....that's what I mean. Nobody's in. Instead your a scary pooty head for not ducktaping your nutsack to your asscrack every morning like they taught you to.

These are not the types to organize. We will remain an isolated, spoiled group of boarding school brats. Even those that aren't are doped into aspiring to that kind of uselessness. That cannot and will not conceive of us getting our lunch money taken by those who are up to it. And who are organized and willing.

I'm not waiting around for this bunch to get wise.

I'll be looking for systemic indpendence from them or die tryin.

Good luck for those that try.

If you ever get something real together let me know.

 

[KLycos]

Xenotype, seriously you've got one of the worst attitudes towards fellow healthcare professionals I've seen on these boards. I've worked with many competent NP's/PA's. Some I'd sooner trust than you, certainly.

And about your idea. What happens if that backfires, hmm? What happens if you give them the autonomy to do as they please, and then, counter to your deepest desires, they don't kill anyone in large volumes or have significantly different outcomes from MD treatments (which seem to be the case).

At that point, because you've given them everything and they've done quite well...you're out of a job.

I never bought the whole "We're smarter than they are" argument. They're going to have practically none of the debt, fewer work hours, half the training and most of the pay we do. And THEY'RE supposed to be the dumb ones....

lol I'd sooner trust someone like xenotype who can use his brain and think logically than you, "certainly". Just because NPs are good at their role in healthcare doesn't mean that they'd be able to work autonomously at the same level of a physician. If you don't buy the "we're smarter than they are" argument, then why can't they pass a watered down version of our licensing exams more than 50% of the time? Xeno is just using logic which seems like anathema to some people .___.

 

[Zedor]

http://www.bloomberg.com/news/2013-...-doctors-as-30-million-insured-seek-care.html

 

[DocVapor]

http://www.bloomberg.com/news/2013-...-doctors-as-30-million-insured-seek-care.html

My favorite quote from the article:

"Doctors are under a lot of pressure financially and feel like they are losing some of their patient volumes and traditional position as captain of the ship," said John W. Rowe, former chief executive officer of Aetna Inc. and of Mount Sinai NYU Health. At the same time, "nurses find it demeaning and unprofessional to be in a situation where they are restricted from doing what they know they can do," he said."

Give me a break.

My buddy has taken me up in his small airplane a couple times and let me take over the controls for a little bit each time. I know I can fly a plane. So why can't I become an airline pilot?