Is being replaced by mid levels a legitimate concern in peds?

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Parents aren’t getting a choice. You are assigned a “provider” who “specializes in pediatric cardiology” who the schedulers will pressure you into, and if you don’t like it good luck trying to switch in a city that used to have 10 pediatric cardiologists but now has 4. This is not a rarity only occurring in rural areas, it’s everywhere, including major academic centers.

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These places make it sound like both are the same. The MD is booked out 3 months. Np can see you in two weeks. What do you think more people will do?
Advertising NPs as "the same as MDs" is highly unethical and health systems should be called out on it. If a patient is in a major metro area, hopefully they look around and go see someone else (an actual MD pediatric cardiologist) that can see them sooner. Funny (actually, not funny) how I needed to add the "MD" in there. Who would have ever thought that when using the term "cardiologist" that would be necessary.

Yes, if in a rural area, maybe you're stuck with the NP....and so further contributing to the myriad of reasons why patients in some rural areas have poor healthcare outcomes.
 
Advertising NPs as "the same as MDs" is highly unethical and health systems should be called out on it. If a patient is in a major metro area, hopefully they look around and go see someone else (an actual MD pediatric cardiologist) that can see them sooner. Funny (actually, not funny) how I needed to add the "MD" in there. Who would have ever thought that when using the term "cardiologist" that would be necessary.

Yes, if in a rural area, maybe you're stuck with the NP....and so further contributing to the myriad of reasons why patients in some rural areas have poor healthcare outcomes.
Nps advertise themselves as better than physicians.
 
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Advertising NPs as "the same as MDs" is highly unethical and health systems should be called out on it. If a patient is in a major metro area, hopefully they look around and go see someone else (an actual MD pediatric cardiologist) that can see them sooner. Funny (actually, not funny) how I needed to add the "MD" in there. Who would have ever thought that when using the term "cardiologist" that would be necessary.

Yes, if in a rural area, maybe you're stuck with the NP....and so further contributing to the myriad of reasons why patients in some rural areas have poor healthcare outcomes.
Health systems actively promote equivalence. They see physicians and midlevels as interchangeable cogs who provide a service which is billed. There is no incentive to acknowledge one billable asset is inferior to the other, quite the opposite. They actively promote the idea that one should not acknowledge a physicians superior knowledge/ability, doing so would be rude and against a team healthcare culture, one’s experience cannot be objectively compared to anothers. This culture is good for business and ensures they only need to retain the minimum amount of physicians to keep the department and other midlevels afloat.
 
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Health systems actively promote equivalence. They see physicians and midlevels as interchangeable cogs who provide a service which is billed. There is no incentive to acknowledge one billable asset is inferior to the other, quite the opposite. They actively promote the idea that one should not acknowledge a physicians superior knowledge/ability, doing so would be rude and against a team healthcare culture, one’s experience cannot be objectively compared to anothers. This culture is good for business and ensures they only need to retain the minimum amount of physicians to keep the department and other midlevels afloat.
When will physicians get some backbone and collectively bargain and / or use their money to lobby for stronger restrictions on what NP's can do and to put restrictions on how they can be utilized, identified, promoted, etc. ? I know doctors are cheap, and the senior ones don't want to rock the boat, and of course the new ones have loans to worry about.....but geez, have some respect for your profession and defend it.
 
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Nps advertise themselves as better than physicians.
That should be illegal if they're actually documenting this falsehood on websites or in literature. In what world is an NP better than a physician ? Cheaper, yes. Better ? The public is so gullible / ignorant.
 
That should be illegal if they're actually documenting this falsehood on websites or in literature. In what world is an NP better than a physician ? Cheaper, yes. Better ? The public is so gullible / ignorant.

Public is only thinking what they are told to. NP lobby advertises constantly. Our own leadership just sits back in the ivory tower and counts cash.
 
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Public is only thinking what they are told to. NP lobby advertises constantly. Our own leadership just sits back in the ivory tower and counts cash.
Ummm... no one in an ivory tower counts cash...

In fact... it's quite the opposite compared to the private practice counterparts.
 
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Ummm... no one in an ivory tower counts cash...

In fact... it's quite the opposite compared to the private practice counterparts.

I reference this:


ABP literally just slapped every pediatrician in the face by pushing PHM to become a fellowship, and yet here their executives are making almost 3x what a practicing PHM doc makes (My home institution starts PHM docs at 150k). This push was a boon to hospitals + will ultimately lead to more midlevels being employed in the hospital.

These guys are literally making money and just pushing extra busy work on practicing docs. So I do think these guys are counting $$$ while not seeing patients and just making the life of pediatricians harder.
 
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I reference this:


ABP literally just slapped every pediatrician in the face by pushing PHM to become a fellowship, and yet here their executives are making almost 3x what a practicing PHM doc makes (My home institution starts PHM docs at 150k). This push was a boon to hospitals + will ultimately lead to more midlevels being employed in the hospital.

These guys are literally making money and just pushing extra busy work on practicing docs. So I do think these guys are counting $$$ while not seeing patients and just making the life of pediatricians harder.
Exactly. You hit the nail on the head. Where are the established physicians in all of this ? I don't think I've ever seen a professional group so lackadaisical about the future of their trade. Where is the collective bargaining effort, the intense / aggressive lobbying ? For goodness sake, physicians are the brains of the whole operation and yet they allow their profession to be undermined and treated like crap.
 
Health systems actively promote equivalence. They see physicians and midlevels as interchangeable cogs who provide a service which is billed. There is no incentive to acknowledge one billable asset is inferior to the other, quite the opposite. They actively promote the idea that one should not acknowledge a physicians superior knowledge/ability, doing so would be rude and against a team healthcare culture, one’s experience cannot be objectively compared to anothers. This culture is good for business and ensures they only need to retain the minimum amount of physicians to keep the department and other midlevels afloat.
Honest question here.....why do insurance companies / medicare reimburse NP service at the same dollar level as an MD ? I'm assuming they do and that's what provides the financial incentive for the health systems to use NP's.

Is that not where the point of attack should be ? Stop reimbursing NPs at the same rate. No ?
 
Exactly. You hit the nail on the head. Where are the established physicians in all of this ? I don't think I've ever seen a professional group so lackadaisical about the future of their trade. Where is the collective bargaining effort, the intense / aggressive lobbying ? For goodness sake, physicians are the brains of the whole operation and yet they allow their profession to be undermined and treated like crap.
The AAP has been historically weak in lobbying for pediatricians and proper reimbursement. Poor leadership. Same for the ABP - fleecing its members and doing next to nothing for us. At least you don't have the join the AAP; good luck getting a good job without being board certified.
 
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The AAP has been historically weak in lobbying for pediatricians and proper reimbursement. Poor leadership. Same for the ABP - fleecing its members and doing next to nothing for us. At least you don't have the join the AAP; good luck getting a good job without being board certified.
Who decides who leads the AAP and ABP ? Aren't they elected by the physician membership they represent ? If so, why don't physicians install people / doctors that aggressively support their profession ?
 
The AAP has been historically weak in lobbying for pediatricians and proper reimbursement. Poor leadership. Same for the ABP - fleecing its members and doing next to nothing for us. At least you don't have the join the AAP; good luck getting a good job without being board certified.

Will say thankfully my hospital system in a major metro area now accepts NBPS certification. Unaware of the status of insurance as I imagine that is the issue, but at least its progress. Hopefully we break the board certification monopoly.

Who decides who leads the AAP and ABP ? Aren't they elected by the physician membership they represent ? If so, why don't physicians install people / doctors that aggressively support their profession ?

I imagine, much like with politics, those who would actually be good leaders are turned away from these positions. These positions are mostly filled with toxic people. They are working to benefit themselves.
 
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Will say thankfully my hospital system in a major metro area now accepts NBPS certification. Unaware of the status of insurance as I imagine that is the issue, but at least its progress. Hopefully we break the board certification monopoly.



I imagine, much like with politics, those who would actually be good leaders are turned away from these positions. These positions are mostly filled with toxic people. They are working to benefit themselves.
But are they "elected" by the physician membership ? If so, the physician population needs to collectively nominate suitable candidates and then vote them in. I go back to lackadaisical behavior on the part of the profession. Or maybe I just don't understand. Seems simple though.
 
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