Future of Midlevels in EM and Implications For Attending Workload

[857770]

I just had to say this: it really is true that patients do know when they are not seeing a doctor. Just the other day a patient complained about an NP that saw him. He referred to her as a nurse QUACKtioner! The attending physician in the room laughed. I looked rather shocked, although it was hilarious!

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[WilcoWorld]

I just had to say this: it really is true that patients do know when they are not seeing a doctor. Just the other day a patient complained about an NP that saw him. He referred to her as a nurse QUACKtioner! The attending physician in the room laughed. I looked rather shocked, although it was hilarious!

While it's a good story, it's an n=1, and some doubt is cast on it by the fact that the NP was a woman. Patients regularly assume that female doctors are nurses, and that male nurses/APPs are doctors. We have a white-haired male PA at my shop that just about everybody loves. In the PG patient comments that get sent out to the entire staff it is very common for patients to write something like "Dr. Whitehair was fantastic!"

 

[857770]

Yes it is ancedotal. But, I knew who I was seeing before I even started college. My family and friends (none in medicine) all know they are seeing doctors. In fact, they won't go to practices were midlevels are employed. Although, this is ancedotal, they represent a large group of people.

 

[Old_Mil]

Disagree. As we've touched on before.

Senior Anesthesia residents I know who are looking for jobs say the market is TOUGH right now. Many are forced to do a fellowship to latch on in certain markets.

Spend some time in the Anesthesia forum and come back and tell me that Mid-Levels are NOT negatively affecting their jobs, now and in the future.

I realize that I'll likely be in the MINORITY on this one (for now, at least)....And that is the saddest part.

In addition to being a small profession that lacks political power, the normalcy bias is strong in medicine.

The end result is that a lot of people end up doing nothing about foreseeable bad outcomes and bitch about it later.

If you start comparison shopping most physician salaries today FP, Peds, General IM, (1099 EP - (0.5*(medicare+social security)) + retail benefits + costs of maintaining certification/CME) against what's available in other industries they don't look very good, particularly given the malpractice risks doctors face today. There are a whole lot of understaffed EDs that want to hire ABEM guys for 125-200 an hour without any benefits. When you consider that's maybe a third of what the lawyer who sues you charges, or half what pilot that flies you to your CME conference gets it is an eye opener.

In my opinion, as a physician you shouldn't be looking at any position where you see over 1.5pph for under $250. As that number rises towards 2, that rate should rise to or above $300.

 

[deleted109597]

There are a whole lot of understaffed EDs that want to hire ABEM guys for 125-200 an hour without any benefits.

Most of those are in the cities that people just can't be pulled away from. Philadelphia? $110. DC? $150. Central Texas? $325. And because the high COL low demand places pay so low, any extra shifts are taken at base rate. In TX? There's nobody waiting to work it. So it jacks up the price even further.