Some approaches come to mind. My sense is that the senior docs are the only ones that can move the needle on this. They may not have a lot of clout but the top dogs have more than everyone else. I've heard the excuses, too cheap, too busy, etc. I think it's apathy and lack of organization.
1) Attendings should specifically document when midlevels mis-manage patients. Docs need to make sure to write in their notes that the PCP is a NP or PA. And due to the CARES Act, patients can see doctors' notes which will help educate patients. Docs are also obligated to tell their patients why a screw-up happened. Eventually the risk management department will start to get the message.
2) Docs could push back on contracts that mandate mid-level supervision for what they perceive as low/nominal compensation. Docs should push back on the volume / numbers of mid-levels they agree to supervise.
3) ED attendings, when discharging patients and you're asked about locating a good doctor -- you need to take the opportunity to educate. Give them a list of doctors and say something like "for your next appointment, ask to be seen by a physician." Many patients have no idea they are being seen by a PA or a nurse and assume the man/woman walking into the room with a long white coat is a physician.
4) If the situation is as dire as it sounds, physician groups need to bargain collectively. Maybe this isn't unionization but there needs to be some level of pushback on the MBAs that are running the show. Residents and recently minted attendings with $300k debt aren't going to lead this. Has to be the senior, strongest docs leading the charge. Make demands, negotiate, challenge. This is where the problem lies, IMO. The docs who have all the brains, training, and talent are not collectively working together to improve their profession by pushing back on ownership / PE. The senior docs are probably too comfortable to rock the boat.
5) Public shaming - utilize the all too willing world of journalism to "out" the excessive use of mid-levels, the mismanaged care from mid-levels when it happens, and the money grubbing MBAs who are taking an enormous cut from your salaries and don't respect your training. Big healthcare systems "HATE" bad press.
6) Professional lobbying ---- if the AMA sucks, why don't the senior docs get together and do something about it ? Why don’t doctors collectively hire lobbying firms that will advocate for their interests? Again, the senior, most powerful docs have to lead the way here. If you don't have time, hire firms to do this. As someone noted upthread, perhaps even throwing in some exorbitant performance bonuses (ie. for every successful state effort to ban independent mid level practice, you get a 1m dollar bonus). If resources were pooled, it would cost little.
