It's official: Physician Associate (not Assistant).

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jhmmd said:
5. I think I've said enough already--as I stated above, physicians need to use all five senses when examining/tx'ing a pt.
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I am NOT tasting any patients.
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jhmmd said:
1. The point is to streamline healthcare. Cutting through red tape eliminates the need for midlevels, who already spend most of their time doing paperwork, as was alluded to above
2. "All-in-one-outpt centers" are large healthcare facilities where you can "one stop shop"--e.g. see the endocrinologist, the cardiologist, and the orthopedic surgeon all in one day
3. Evidence that trying to eliminate the middleman is a lost cause??
4. This is the way it's been done since the Whipple has been around
5. I think I've said enough already--as I stated above, physicians need to use all five senses when examining/tx'ing a pt. It's just common sense. Telemedicine works in a pinch but it's not ideal. I don't feel like typing out the rest of what I wrote above so please just skim up and read it
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Isn't the entire point of this post venting/being upset with midlevels diagnosing, ordering, and treating independently? No one seems to really care about midlevels doing paperwork. I still fail to see how tort reform and protecting the people practicing medicine, not doing paperwork, will make midlevels disappear. Even if they're 'less needed' they're still objectively cheaper at the end of the day. If you suddenly protect us more (and again, tort reform would almost certainly extend to them), systems would not have less incentive to use them. The opposite.

As to your last point, maybe twenty or even ten years ago. But physicians growing up in the last decade are much less reliant on the physical exam. I know very few residents whom graduated in the last five years who would not require and rely on objective data. The physical exam changes management <10% of the time for most of us, and in that 10% the physical exam is almost always a targeted process with a specific question and can be done by anyone on the healthcare team pretty reliably. It is not just that we suck at the physical exam more than those that came before us (we do, no doubt), but there is better objective data that is more far more sensitive and specific and really not that expensive anymore. Telehealth+good history+labs+imaging and the fact that most patients touch multiple providers in a chain these days makes it not unreasonable to coordinate the vast majority of care remotely, should a patient desire it.

Most patients don't actually want telehealth, and neither do providers. But I disagree that it is inferior for at least 95% of what we do now.
 
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Lem0nz said:
Isn't the entire point of this post venting/being upset with midlevels diagnosing, ordering, and treating independently? No one seems to really care about midlevels doing paperwork. I still fail to see how tort reform and protecting the people practicing medicine, not doing paperwork, will make midlevels disappear. Even if they're 'less needed' they're still objectively cheaper at the end of the day. If you suddenly protect us more (and again, tort reform would almost certainly extend to them), systems would not have less incentive to use them. The opposite.

As to your last point, maybe twenty or even ten years ago. But physicians growing up in the last decade are much less reliant on the physical exam. I know very few residents whom graduated in the last five years who would not require and rely on objective data. The physical exam changes management <10% of the time for most of us, and in that 10% the physical exam is almost always a targeted process with a specific question and can be done by anyone on the healthcare team pretty reliably. It is not just that we suck at the physical exam more than those that came before us (we do, no doubt), but there is better objective data that is more far more sensitive and specific and really not that expensive anymore. Telehealth+good history+labs+imaging and the fact that most patients touch multiple providers in a chain these days makes it not unreasonable to coordinate the vast majority of care remotely, should a patient desire it.

Most patients don't actually want telehealth, and neither do providers. But I disagree that it is inferior for at least 95% of what we do now.
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Lem0nz said:
OK BOOMER.

~tldr physical exam is not necessary 95% of the time, you're wrong about telehealth.
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I would be extremely interested in seeing this published in a peer-reviewed journal lol
 
jhmmd said:
I would be extremely interested in seeing this published in a peer-reviewed journal lol
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It would be too long for your tired old eyes to read friend, I'll spare you. Also - how tf would that help make less independent practice of midlevels either? Its literally counterproductive to your argument of making healthcare more efficient.
 
jhmmd said:
As a matter of fact, here you go
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That article about teaching medical students a core physical exam and omitting older parts of it did absolutely nothing to convince me that objective testing is not superior to the physical exam. lolol.

Yes, you should still teach medical students a core physical exam.
 
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Lem0nz said:
It would be too long for your tired old eyes to read friend, I'll spare you. Also - how tf would that help make less independent practice of midlevels either? Its literally counterproductive to your argument of making healthcare more efficient.
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I am not going to keep repeating myself. If you didn't comprehend what I said the first time, go back and re-read my posts. I don't know what you mean by "make less independent practice of midlevels" and my argument is not about making healthcare more efficient--it's about making it more effective. But do go on making inappropriate comments like "hard agree," "hard disagree," and creating straw man arguments like calling me old. You don't even know me.
Adios my friend

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Lem0nz said:
That article about teaching medical students a core physical exam and omitting older parts of it did absolutely nothing to convince me that objective testing is not superior to the physical exam. lolol.

Yes, you should still teach medical students a core physical exam.
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What exactly is "objective testing" if not part of a physical exam??
 
jhmmd said:
I am not going to keep repeating myself. If you didn't comprehend what I said the first time, go back and re-read my posts. I don't know what you mean by "make less independent practice of midlevels" and my argument is not about making healthcare more efficient--it's about making it more effective. But do go on making inappropriate comments like "hard agree," "hard disagree," and creating straw man arguments like calling me old. You don't even know me.
Adios my friend

View attachment 337825
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...what? Hard agree and hard disagree are my way of saying "strongly". How on earth is that inappropriate? I did read your posts and took the time to give a counter argument which you couldn't be bothered with.

If you don't know what I mean by independent practice of midlevels you... you're in the wrong freaking thread dude. So yes, I agree, move on. lol
 
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Lem0nz said:
...what? Hard agree and hard disagree are my way of saying "strongly". How on earth is that inappropriate? I did read your posts and took the time to give a counter argument which you couldn't be bothered with.

If you don't know what I mean by independent practice of midlevels you... you're in the wrong freaking thread dude. So yes, I agree, move on. lol
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That's not what I said. YOU said
Lem0nz said:
"Also - how tf would that help make less independent practice of midlevels either?"
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This is a non-starter. Goodnight.
 
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VA Hopeful Dr said:
Labs, imaging, pathology
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My point was not that these kinds of things are irrelevant; on the contrary I am arguing that the patient should be seen in-person so that these kinds of things can happen
 
Mass Effect said:
Pretty sure you're confusing academics with community. The academic institutions I'm familiar with don't have any midlevels. It's attendings, med students, and residents. The community attendings however....
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Definitely not confusing the two. I’ve seen way more midlevels in academic institutions than community.
 
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jhmmd said:
Well it's better than NO physical exam lol
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Umm, no. If you listen to a patients lungs and don't hear anything abnormal and so miss the pneumonia that is very often not identifiable from auscultation that is in fact worse since you now have a false sense of security about it not being pneumonia.
 
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Chads2 said:
I am NOT tasting any patients.
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I mean, smelling them happens. It just does. Knowing the smell of a melena vs uremia is expected in my line of work. And pretty much everyone knows what EtOH intoxication smells like.
 
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Matthew9Thirtyfive said:
Definitely not confusing the two. I’ve seen way more midlevels in academic institutions than community.
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Same. My institution uses them mostly for the things that an Attending wants to put off doing. Surgical services use mid levels to answer consults, usually with “No acute surgical intervention. Admit to medicine to manage multiple medical issues. Will continue to follow” built into consult template. It helps the surgeons spend more time in the OR and gets the upper level residents more cases. Which is great. Endocrinology uses a DNP to handle uncontrolled DM, to see more complex consults. (I never consult endocrinology for DM myself...I’m an internist, after all). The trouble is when, again, a midlevel doesnt know what they don’t know. Similar to a resident who doesn’t know what they don’t know. Dangerous.
 
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Lawpy said:
Why is that in every single midlevel thread, there's always attendings, fellows, residents and med students simping for midlevels and attributing that casually to corporate medicine?
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Really? All of the threads I've seen bash mid levels all the time. Very rarely do I see anything postive about them.

Like there is a reason why midlevel creep is a thing, if there weren't so many problems with physicians (medical school and residencies) then people would still want to become a Physician. You can thank the boomers for enabling the environment that makes it extremely undesirable to become a Physician. When I worked at my local hospital I met so many doctors who were over worked and miserable and told me that medical school isn't worth it. Just become a PA and enjoy your life. My aunt who is a doctor had a much easier time getting into medical school and the speciality she wanted than all of my friends.
 
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Rhorn said:
Really? All of the threads I've seen bash mid levels all the time. Very rarely do I see anything postive about them.

Like there is a reason why midlevel creep is a thing, if there weren't so many problems with physicians (medical school and residencies) then people would still want to become a Physician. You can thank the boomers for enabling the environment that makes it extremely undesirable to become a Physician. When I worked at my local hospital I met so many doctors who were over worked and miserable and told me that medical school isn't worth it. Just become a PA and enjoy your life. My aunt who is a doctor had a much easier time getting into medical school and the speciality she wanted than all of my friends.
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Lmao. Yeah medicine is so undesirable there are thousands of applicants every year, far more than seats....
 
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DOVinciRobot said:
Lmao. Yeah medicine is so undesirable there are thousands of applicants every year, far more than seats....
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Most of those applicants probably don't know about the realities of medicine and the direction its headed in.
 
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The funniest part to me is that right after the AAPA announced this they had to put out a statement to PAs to tell them not to refer to themselves as 'physician associates' until legislative and regulatory changes occur (which will take years according to them) because "this could mislead patients and may be interpreted as stepping beyond the scope of the current PA licensure." It really makes you just want to beat your head into a wall. So apparently them setting an arbitrary date in the future will all of a sudden no longer confuse patients..... yeah sure. It's just the beginning of the lobbying efforts for independent practice.
 
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Rhorn said:
Really? All of the threads I've seen bash mid levels all the time. Very rarely do I see anything postive about them.

Like there is a reason why midlevel creep is a thing, if there weren't so many problems with physicians (medical school and residencies) then people would still want to become a Physician. You can thank the boomers for enabling the environment that makes it extremely undesirable to become a Physician. When I worked at my local hospital I met so many doctors who were over worked and miserable and told me that medical school isn't worth it. Just become a PA and enjoy your life. My aunt who is a doctor had a much easier time getting into medical school and the speciality she wanted than all of my friends.
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Midlevel creep is a thing because medical school is difficult to get into, it costs a lot to create physicians (both time and money), and people want cheaper healthcare. Everyone wanna be a doctor etc...
 
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Rhorn said:
Really? All of the threads I've seen bash mid levels all the time. Very rarely do I see anything postive about them.

Like there is a reason why midlevel creep is a thing, if there weren't so many problems with physicians (medical school and residencies) then people would still want to become a Physician. You can thank the boomers for enabling the environment that makes it extremely undesirable to become a Physician. When I worked at my local hospital I met so many doctors who were over worked and miserable and told me that medical school isn't worth it. Just become a PA and enjoy your life. My aunt who is a doctor had a much easier time getting into medical school and the speciality she wanted than all of my friends.
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I guess you haven't been reading these threads in detail. There's a lot of defense for midlevels in these discussions. Yes there's the anti-midlevel sentiment but this isn't universal.
 
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Rhorn said:
Really? All of the threads I've seen bash mid levels all the time. Very rarely do I see anything postive about them.

Like there is a reason why midlevel creep is a thing, if there weren't so many problems with physicians (medical school and residencies) then people would still want to become a Physician. You can thank the boomers for enabling the environment that makes it extremely undesirable to become a Physician. When I worked at my local hospital I met so many doctors who were over worked and miserable and told me that medical school isn't worth it. Just become a PA and enjoy your life. My aunt who is a doctor had a much easier time getting into medical school and the speciality she wanted than all of my friends.
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What lol?
 
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My favorite part about this is that the AAPA released a statement saying PAs are not authorized to call themselves physician associates right now until state legislation changes, because it will be confusing to patients.

What planet are these people living on? Like in some random, arbitrary time in the future it will suddenly not be confusing?
 
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Lawpy said:
There is one problem though. Midlevels are useful because they stay longer as opposed to transient nature of unmatched IMGs who will be reapplying in the match
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How about all the American med grads who don't match? They should be higher than mid-levels
 
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Angus Avagadro said:
Like so many things, it is a noisy minority of "Advocates" who push for any changes. I don't believe a significant majority of CRNAs want independent practice as most are smart enough to recognize their limitations. My daughter in law is a PA, and very smart. I asked her to be one of my med students on several occasions and she declined stating she was happy just where she was. I also think we use mid levels incorrectly. I think the Dr should see patients first and the midlevel utilized for follow up. My sister in law had a navicular fracture missed by the PA. Plain films normal, but the Orthopedist would have a higher index of suspicion with continued pain and ordered a ct sooner.
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My local hospital system went apoplectic went I mentioned what u said years ago. They were like oh so you want to use them as Physician extenders?
 
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thatchemguy said:
Most of those applicants probably don't know about the realities of medicine and the direction its headed in.
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If that’s what you want to tell yourself lol. Everyone wants to be a doctor without actually, you know, going through doctor training.
 
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Lawpy said:
They are but they're even more transient since they're very likely going to match the following year. Pure repeated umatched US grads are rare
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There should be stats on this. And at least they won't waste time if they can work in between
 
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Lem0nz said:
Isn't the entire point of this post venting/being upset with midlevels diagnosing, ordering, and treating independently? No one seems to really care about midlevels doing paperwork. I still fail to see how tort reform and protecting the people practicing medicine, not doing paperwork, will make midlevels disappear. Even if they're 'less needed' they're still objectively cheaper at the end of the day. If you suddenly protect us more (and again, tort reform would almost certainly extend to them), systems would not have less incentive to use them. The opposite.

As to your last point, maybe twenty or even ten years ago. But physicians growing up in the last decade are much less reliant on the physical exam. I know very few residents whom graduated in the last five years who would not require and rely on objective data. The physical exam changes management <10% of the time for most of us, and in that 10% the physical exam is almost always a targeted process with a specific question and can be done by anyone on the healthcare team pretty reliably. It is not just that we suck at the physical exam more than those that came before us (we do, no doubt), but there is better objective data that is more far more sensitive and specific and really not that expensive anymore. Telehealth+good history+labs+imaging and the fact that most patients touch multiple providers in a chain these days makes it not unreasonable to coordinate the vast majority of care remotely, should a patient desire it.

Most patients don't actually want telehealth, and neither do providers. But I disagree that it is inferior for at least 95% of what we do now.
Click to expand...

Im of 2 minds on this because with the explosion of telehealth more and more I see PCPs putting people on antibiotics and crap sight unseen and then refer them to me and then I have to try and be tactful and tell the patient their PCP is an idiot and theres no infection.

On the other hand, half the time the PCPs have no idea what theyre looking at on physical exam anyway so it is kind of useless. Though the answer in an ideal world is for them to learn a physical exam which as we can see from this thread people seem to want to throw away.
 
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Wordead said:
Im of 2 minds on this because with the explosion of telehealth more and more I see PCPs putting people on antibiotics and crap sight unseen and then refer them to me and then I have to try and be tactful and tell the patient their PCP is an idiot and theres no infection.

On the other hand, half the time the PCPs have no idea what theyre looking at on physical exam anyway so it is kind of useless. Though the answer in an ideal world is for them to learn a physical exam which as we can see from this thread people seem to want to throw away.
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I was waiting for one of y'all to chime in here. ENT exams are actually quite valuable (and eye exams with the proper tools). That's not always true of the rest of the body however.
 
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VA Hopeful Dr said:
I was waiting for one of y'all to chime in here. ENT exams are actually quite valuable (and eye exams with the proper tools). That's not always true of the rest of the body however.
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I don’t think the “physical exam is useless” sentiment applies to a lot of the surgical subs. ENT, urology, etc.
 
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Matthew9Thirtyfive said:
I don’t think the “physical exam is useless” sentiment applies to a lot of the surgical subs. ENT, urology, etc.
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Agreed, but they also have the advantage of getting the patients for a specific issue. Its much more useful in a targeted sense like that.
 
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VA Hopeful Dr said:
Agreed, but they also have the advantage of getting the patients for a specific issue. Its much more useful in a targeted sense like that.
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Yeah I was going to say that a lot of those specialties aren’t doing a global physical exam, they are often looking for very specific things.
 
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