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

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Lem0nz said:
Resident salaries are woefully inadequate so we're going to make a pseudo incomplete training path that continues to pay garbage and probably will cap at whatever PGY-10 is, which is like 80k at best? I can definitely see them also having 80 hour work weeks if used ubiquitously. They're physicians after all, so they should take call like physicians.

And what are we going to do with them in five or ten years when they're telling us they've been doing the same job as an MD, *with* an MD, for 5+ years - why can't they bill and function as an independent MD? They've essentially 'done' residency right? As long as they just do the job they were trained?

Why would we not give them the same independent practice as we already have to NPs and PAs (and by we I mean the country, not doctors. Because we're already against independent practice, but we obviously do not control all the levers of power). Here is an ultra cheap solution to the 'doctor shortage'. But they take call.

I'm imaging some worst case scenarios, sure. But independent practice of NPs and PAs directly out of school is a worst case scenario and that's what we're talking about. So it CAN happen.
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1.) I think 60K for 3 years, maybe 80K for the next two, then 100K if they stay past 5. Most will not stay past 5. Therefore, it will be cheaper. Just an idea/example.

2.) They're physicians with an unrestricted license (which I personally believe med students should be eligible after graduation: My Ideal Medical School Curriculum 2022&Beyond: Critiques? How about yours? ), but no board certification. They still will have supervision as PAs do, unless we are in an area with limited resources (like PAs). They will not encroach out of desire for more privileges because if they want to, they can just apply for residency.

3.) Keep in mind they're not residents. They're working on a specific unit (i.e. transplant rotation) for 12 months. They're going to need Trauma, SICU, and all the other constituents of a gen surg residency you graduated from.
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@Redpancreas Sorry, just going back and I don't want to multi quote but you're proposing letting people who left their programs do this too. Most people who leave training got fired, and if they got fired there's also always a REALLY good reason. These are NOT safe doctors or normal humans 9/10. Sure, the tenth is a medical education screw up, but the other 9 were not. And while a great many IMGs who didn't match are probably fine, a great many of them also would not acclimate or do well in American medicine.

This seems like an incredibly cheap source of abusive labor to me. I get where M935 is coming from by saying we aren't all in it for the money, but there are enough doctors who are in it for the money and those are EXACTLY who you should be afraid of by giving them an unlimited supply of 60k+ laborers with prescribing/treatment power. You see an alternate path and a second chance. I see the thing that really scares me and that M935 and I are arguing about in another thread - doctors using midlevels maliciously for profit. Ya'll can think what you want of me but I'm not for that. I'm very, very much against that. It is very easy to picture some guy hanging up a sign saying he has a ten physician practice where its one physician and nine associate physicians practicing medicine under his license where they get paid 60k and he gets paid much, much more. And he would not be lying, technically.

On top of that, this is a quote from you RP: "They still will have supervision as PAs do, unless we are in an area with limited resources." This is the exact same slippery slope that started all of this.
 
Lem0nz said:
@Redpancreas Sorry, just going back and I don't want to multi quote but you're proposing letting people who left their programs do this too. Most people who leave training got fired, and if they got fired there's also always a REALLY good reason. These are NOT safe doctors or normal humans 9/10. Sure, the tenth is a medical education screw up, but the other 9 were not. And while a great many IMGs who didn't match are probably fine, a great many of them also would not acclimate or do well in American medicine.

This seems like an incredibly cheap source of abusive labor to me. I get where M935 is coming from by saying we aren't all in it for the money, but there are enough doctors who are in it for the money and those are EXACTLY who you should be afraid of by giving them an unlimited supply of 60k+ laborers with prescribing/treatment power. You see an alternate path and a second chance. I see the thing that really scares me and that M935 and I are arguing about in another thread - doctors using midlevels maliciously for profit. Ya'll can think what you want of me but I'm not for that. I'm very, very much against that. It is very easy to picture some guy hanging up a sign saying he has a ten physician practice where its one physician and nine associate physicians practicing medicine under his license where they get paid 60k and he gets paid much, much more.

On top of that, this is a quote from you RP: "They still will have supervision as PAs do, unless we are in an area with limited resources." This is the exact same slippery slope that started all of this.
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1.) Sure. Let's circle back. ACGME distinguishes between resignation, non-renewal of training, and termination. I unfortunately have some experience some of this stuff so I know this stuff more than I would if I didn't go through this. The entry process into this path should be based off a letter from the program's PD. The latter probably shouldn't be hired unless there are extenuating circumstances and won't be. I believe the former deserves to be put in a situation where they can succeed.

2.) Regarding the cheap use of labor, there would be an 80 hr cap. This would be a path for MDs/DOs to continue their training and for IMGs to increase their profile so they could match so YOG 2016 doesn't look as bad. There are plenty who would take that as opposed to sitting at home trying to figure out other ways to gain clinical experience. They're basically equivalent to residents, but are not currently working to clinical training. Residents currently are physicians but hospitals are not saying this is a 1000-physician led hospital.

3.) It isn't because this would be under the same governing bodies that govern physicians. They would not have their own AP governing body.
 
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Redpancreas said:
1.) Sure. Let's circle back. ACGME distinguishes between resignation, non-renewal of training, and termination. I unfortunately have some experience some of this stuff so I know this stuff more than I would if I didn't go through this. The entry process into this path should be based off a letter from the program's PD. The latter probably shouldn't be hired unless there are extenuating circumstances and won't be. I believe the former deserves to be put in a situation where they can succeed.

2.) Regarding the cheap use of labor, there would be an 80 hr cap. This would be a path for MDs/DOs to continue their training and for IMGs to increase their profile so they could match so YOG 2016 doesn't look as bad. There are plenty who would take that as opposed to sitting at home trying to figure out other ways to gain clinical experience. They're basically equivalent to residents, but are not currently working to clinical training. Residents currently are physicians but hospitals are not saying this is a 1000-physician led hospital.

3.) It isn't because this would be under the same governing bodies that govern physicians. They would not have their own AP governing body.
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I really don't see the benefit in why you wouldn't just put those resources into creating more non-competitive FM/IM residency programs. All this will do is inflate the number of applicants re-entering the match without changing the number of slots and it will build on itself over time. AZ's program (last I looked) even capped their associate physician program at 3 years. Why would we not just make another residency? I don't understand the value here.
 
Lem0nz said:
I really don't see the benefit in why you wouldn't just put those resources into creating more non-competitive FM/IM residency programs. All this will do is inflate the number of applicants re-entering the match without changing the number of slots and it will build on itself over time. AZ's program (last I looked) even capped their associate physician program at 3 years. Why would we not just make another residency? I don't understand the value here.
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Residency positions would be paid for through Medicare which would cost more in taxes. These AP positions would be funded via different means. Nonprofit hospitals could pay salaries using their hospitals. Obviously so could for-profits, etc.
 
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Redpancreas said:
1. The PA/NP was never meant to replace physicians, but they are gradually attempting to out of regret that at some point there is a cap to their privileges/ability as there should be. They have created these shortpaths, etc. without even basic understanding of what medical training should entail. Medicine is learning the evidence based mechanisms which dictate the human body and applying those mechanisms and insights to treating humans in the most effective way. Physicians go to medical school knowing the committment at hand. Wanna hear the most common argument you get out of college students planning to go the NP/PA route? "It's shorter"...that has real life consequences. Is a patient in trouble, but it's 4:58 PM on a Friday? Guess who wants to sign out per hospital policy?

2. Yes it is. A PAs job is to assist a physician. Not replace one. If we have 3 fields trying to do the same thing, it's inefficient. Let's divide the labor appropriately.
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1. Didn't answer the question
2. No one is against dividing labor. That's why I said that medicine is about teamwork. I am sick of repeating myself in this thread lol
 
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Redpancreas said:
Residency positions would be paid for through Medicare. These AP positions would be funded via different means. Nonprofit hospitals could pay salaries using their hospitals. Obviously so could for-profits, etc.
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Either I’m being obtuse (super possible) or you’re just not explaining this to me well. What you’re proposing is just a stop gap to get back to residency. This is not a solution to needing a permanent assistant who can do physician scut while not costing as much. And HCA has demonstrated that you don’t need Medicaid money to make residency positions so... again, why not just more residency positions?
 
jhmmd said:
1. Didn't answer the question
2. No one is against dividing labor. That's why I said that medicine is about teamwork. I am sick of repeating myself in this thread lol
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1. Medicine was designed to heal people. I acknowledged that in my initial response. We seem to disagree on the most effective way to do that.

2. By suggesting we have MD/DOs, but then NPs and PAs effectively looking to do the same thing means we are not appropriately designating roles (which is important because roles have standards) and we are creating confusion. I am sorry if you feel you're repeating yourself but I did answer your point #1 originally! I hope I'm not upsetting anyone in this discussion. I can stop here.
 
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Lem0nz said:
Either I’m being obtuse (super possible) or you’re just not explaining this to me well. What you’re proposing is just a stop gap to get back to residency. This is not a solution to needing a permanent assistant who can do physician scut while not costing as much. And HCA has demonstrated that you don’t need Medicaid money to make residency positions so... again, why not just more residency positions?
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This is in the works
 
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Lem0nz said:
Either I’m being obtuse (super possible) or you’re just not explaining this to me well. What you’re proposing is just a stop gap to get back to residency. This is not a solution to needing a permanent assistant who can do physician scut while not costing as much. And HCA has demonstrated that you don’t need Medicaid money to make residency positions so... again, why not just more residency positions?
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The system would be staggered. Some people would use it as a stop-gap to residency. Some people would just stay on and do the job. Those who stay on are essentially the permanent assistants.

The HCA (model) is one way to do it. You can create APs too though. I just think residency spots should be limited because we already have limited people willing to teach residents officially. We don't need as much effort to supervise them doing work. I think expanding residencies would dilute the quality. Also, it would increase the supply of physicians without increasing their allocation to desired areas.
 
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Redpancreas said:
The system would be staggered. Some people would use it as a stop-gap to residency. Some people would just stay on and do the job. Those who stay on are essentially the permanent assistants.

The HCA is one way to do it. You can create APs too though. I just think residency spots should be limited because we already have limited people willing to teach residents officially. We don't need as much effort to supervise them doing work. I think expanding residencies would dilute the quality. Also, it would increase the supply of physicians without increasing their allocation to desired areas.
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1. Physicians are naturally very hardworking. It's not as much about expending effort to supervise new trainees as it is about finding the right way to delegate work.
2. Regarding your second point, I agree that simply increasing the number of residency positions does not automatically mean that people work where they're most needed. This is why a number of incentives are in place to recruit doctors to rural areas and to work with underserved populations.

Redpancreas said:
I think expanding residencies would dilute the quality
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People made the same argument when we instituted the 80 hour work week rule. Now regardless of whether or not people follow it (officially), the fact is that doctors are still being trained appropriately. People find ways to make it work. Have some faith in the process. :)
 
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Lem0nz said:
Thank you captain obvious, proceed to the next two sentences and explain why you would hire this person and not simply start a residency or host residents for rotations.
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I mean I’ve never started a residency before, but I imagine it’s not as simple as “simply starting a residency.” And hosting residents for rotations does nothing to aid unmatched medical school graduates. You seem to have difficulty understanding that some people aren’t just looking to maximize profits as much as possible.
 
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Matthew9Thirtyfive said:
I mean I’ve never started a residency before, but I imagine it’s not as simple as “simply starting a residency.” And hosting residents for rotations does nothing to aid unmatched medical school graduates. You seem to have difficulty understanding that some people aren’t just looking to maximize profits as much as possible.
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We all have limits on what we will and won't do to make more money, but money is still a very large factor for the vast majority of physicians
 
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VA Hopeful Dr said:
We all have limits on what we will and won't do to make more money, but money is still a very large factor for the vast majority of physicians
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Not saying it shouldn’t be. But his response to almost every suggestion or critique is from a lens of how it will or won’t maximize your income. Sometimes people do things because it’s better for other people. Like helping unmatched grads have a job while they try to match again. Or keeping patients from having to get ****ty care from unsupervised midlevels with fewer clinical hours than a barber.
 
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Matthew9Thirtyfive said:
Not saying it shouldn’t be. But his response to almost every suggestion or critique is from a lens of how it will or won’t maximize your income. Sometimes people do things because it’s better for other people. Like helping unmatched grads have a job while they try to match again. Or keeping patients from having to get ****ty care from unsupervised midlevels with fewer clinical hours than a barber.
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I'm not sorry that my lens has been crafted from years of money dictating where and how I will work as a resident, and as a physician, and on what terms. I'm trying to impart a view of experience. It isn't just about how much money I'm going to make, its that money is the motivation for 95% of what is happening around you in the world of medicine. I don't really agree with it. I think I'd be pretty happy in a completely socialized system. But I'm very pragmatic. Its the world we live in, its US healthcare. It is what it is.

None of these plans will work if the people in charge cannot be persuaded that it has a value to the institution. That value does not always have to be dollars, but it usually is. Education is rarely valued as highly as... well, really anything else in medicine. Certainly not physician education which is taken for granted time and time again.
 
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Lem0nz said:
None of these plans will work if the people in charge cannot be persuaded that it has a value to the institution. That value does not always have to be dollars, but it usually is. Education is rarely valued as highly as... well, really anything else in medicine. Certainly not physician education which is taken for granted time and time again.
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Certainly don’t disagree with you here. And you don’t have to apologize for prioritizing how you can maximize your income. Where we get into disagreements is that it often seems like as long as you can get yours, it doesn’t matter what midlevel orgs and physicians who are inappropriately using midlevels are doing to patients and the profession.
 
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Matthew9Thirtyfive said:
Certainly don’t disagree with you here. And you don’t have to apologize for prioritizing how you can maximize your income. Where we get into disagreements is that it often seems like as long as you can get yours, it doesn’t matter what midlevel orgs and physicians who are inappropriately using midlevels are doing to patients and the profession.
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I believe (though I might be wrong) that we don't actually disagree on the utility of midlevels. My world view is that they should be used in some fashion of 1:2 1:4 model that anesthesia does with CRNAs. I argue pretty adamantly for their existence because the scope of what we have to do as physicians has increased over the last couple decades and seems to be getting worse. I do think we should be teaching students that this exists and how to work in that model so they're prepared. Not because I think every physician needs to do that - far from it - but because in my mind that's the only viable way to actually stop scope creep and independent practice.

They simply aren't going anywhere. The best case scenario in my opinion is to reincorporate them. I recognize others don't share that view and that's fine but some of the proposed alternatives often seem insane to me so I argue against them. Inside of that model I also feel there's a lot of strengths to be had for increasing the structure of their education and that by doing so we're more likely to limit their scope, at least by limiting the likelihood that they'll swap fields on a whim, than the other direction. Again, I recognize a lot of people don't feel like that but so many anti-midlevels say "they had no formal education and are garbage" and then bash them trying to formalize their education.

If they're going to do some of what physicians do, and they definitely are - that is not going away we should do our best to make it in a way that is physician led, safe, and efficient. This doesn't mean you HAVE to supervise midlevels. But if you want them to be physician led SOMEONE has to.
 
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Matthew9Thirtyfive said:
Not saying it shouldn’t be. But his response to almost every suggestion or critique is from a lens of how it will or won’t maximize your income. Sometimes people do things because it’s better for other people. Like helping unmatched grads have a job while they try to match again. Or keeping patients from having to get ****ty care from unsupervised midlevels with fewer clinical hours than a barber.
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I am convinced he has a significant other who is an NP...


My issue with NP is that the education is NOT rigorous and standardized. Was an RN (AS degree) and planning to become an NP. Took a health assessment for my BSN, which was just regular class. After class was over, > 50% + of the students went to administration and have the professor (an older NP) removed to teach the class again because the class was too hard. Really!. All they had to do was read a 350+ pages of a book and got A, but they weren't willing to do that.

After that, I had to take an in depth look at the NP curriculum at every single state school in my state. And it was all fluff. The following semester I decided to take med school prereqs and complete my BSN concurrently.

What was strange about the whole thing is that my first bio class (BIO 101) was harder that the Health Assessment class that nurses were complaining about.

I am mad because I could have been practicing as a NP for 5+ years now, but these people forced me to go to med school because I wanted to do things the right way. Boy! I am glad they did.

I looked into PharmD as well, but the market was already going downhill at that time.


/rant over.
 
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Splenda88 said:
I am convinced he has a significant other who is an NP...


My issue with NP is that the education is NOT rigorous and standardized. Was an RN (AS degree) and planning to become an NP. Took a health assessment for my BSN, which was just regular class. After class was over, > 50% + of the students went to administration and have the professor (an older NP) removed to teach the class again because the class was too hard. Really!. All they had to do was read a 350+ pages of a book and got A, but they weren't willing to do that.

After that, I had to take an in depth look at the NP curriculum at every single state school in my state. And it was all fluff. The following semester I decided to take med school prereqs.

What was strange about the whole thing is that my first bio class (BIO 101) was harder that the Health Assessment class that nurses were complaining about.

I am mad because I could have been practicing as a NP for 5+ years now, but these people forced me to go to med school because I wanted to do things the right way. Boy! I am glad they did.


/rant over.
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I'm divorced and my SO was a teacher. So, no. I'm pretty convinced you're projecting your salt over that surgery attending giving you a high pass onto me but, it is what it is. If you had just cut the suture better independent practice probably wouldn't be an issue. *shrug*
 
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Lem0nz said:
I'm divorced and my SO was a teacher. So, no. I'm pretty convinced you're projecting your salt over that surgery attending giving you a high pass onto me but, it is what it is. If you had just cut the suture better independent practice probably wouldn't be an issue. *shrug*
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Any family member who is a NP?
 
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I'm an only child and my family is my Dad, my daughter, me. We can stop going over my personal details now though. My viewpoint is from working in an institution for the last two years that had no residents on pretty much every service, and from working in a surgical residency where the services that had NPs helping do the scut were amazingly more pleasant than the services that didn't. I have not concealed this.
 
jhmmd said:
1. Physicians are naturally very hardworking. It's not as much about expending effort to supervise new trainees as it is about finding the right way to delegate work.
2. Regarding your second point, I agree that simply increasing the number of residency positions does not automatically mean that people work where they're most needed. This is why a number of incentives are in place to recruit doctors to rural areas and to work with underserved populations.


People made the same argument when we instituted the 80 hour work week rule. Now regardless of whether or not people follow it (officially), the fact is that doctors are still being trained appropriately. People find ways to make it work. Have some faith in the process. :)
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Thanks to weekly SDN emails of hot topics/threads, I'm one of those pre-med students who is actually open to said incentive like say... living in Montana or something, should residencies open up. I personally just want to be near a body of water though because I grew up in California and near the beach.

But to stay on topic about the change in title for PAs: "Medical care practitioners" or "primary care health associates" may have been more accurate and less misleading. If I somehow get the privilege of getting into medical school in a couple of years and manage to graduate from medical school, I don't think it's wrong for me to not want to be confused with a "Physician's Associate" because my patient couldn't distinguish who helped them first or who followed up with them, based on similar titles.

I can already see myself cringing if I'm mistaken for being a nurse on account of me being (1) female and (2) a Filipina-American potentially working in healthcare, so yeah. Like I already am expecting that, since when I tell people I'm doing pre-med as a non-trad student, one of the first things people ask me is: "What? Why don't you just become an NP? It's shorter and you get to make money faster and work in healthcare anyway?"

The issue is I feel like @Splenda88 where I've been around nursing students (friends and family) so I've seen the different paths to get into nursing... But I don't want to go into healthcare or trying to heal/help people without paying my dues with the time and effort it takes to learn what's necessary to do that. From what I can tell, people who become physicians have way more clinical hours and the curriculum is harder...

Splenda88 said:
I am convinced he has a significant other who is an NP...


My issue with NP is that the education is NOT rigorous and standardized. Was an RN (AS degree) and planning to become an NP. Took a health assessment for my BSN, which was just regular class. After class was over, > 50% + of the students went to administration and have the professor (an older NP) removed to teach the class again because the class was too hard. Really!. All they had to do was read a 350+ pages of a book and got A, but they weren't willing to do that.

After that, I had to take an in depth look at the NP curriculum at every single state school in my state. And it was all fluff. The following semester I decided to take med school prereqs and complete my BSN concurrently.

What was strange about the whole thing is that my first bio class (BIO 101) was harder that the Health Assessment class that nurses were complaining about.

I am mad because I could have been practicing as a NP for 5+ years now, but these people forced me to go to med school because I wanted to do things the right way. Boy! I am glad they did.

I looked into PharmD as well, but the market was already going downhill at that time.


/rant over.
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^ I feel this on a cellular level. I have family who are nurses and CNAs and while that was good enough for them, we're all built differently. I'm in the boat where I just think it would be more worth my time to learn more than clock in and out knowing that I could've learned more about something and helped someone more efficiently - maybe even had more authority to do so, if I were to be a doctor.

So I don't know whether the change in title for PAs matters, as much as having the humility to know that you only did so much schooling or clinical hours to get a job than be liable enough to practice the way a doctor has to be. I don't care about the title we give them, but I do care about the perception and blatant, potential disrespect that may be given when there are people who are NPs and Physicians who give up more time and money to earn their titles.

Time will tell though how it all plays out. In the meantime, let's not be at each others' throats should conflict arise over the tediousness that comes with arbitrary titles... which could more/less bleed into the way we all end up practicing in HC in the future. We still all have to work together, anyhow.
 
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Lem0nz said:
I believe (though I might be wrong) that we don't actually disagree on the utility of midlevels. My world view is that they should be used in some fashion of 1:2 1:4 model that anesthesia does with CRNAs. I argue pretty adamantly for their existence because the scope of what we have to do as physicians has increased over the last couple decades and seems to be getting worse. I do think we should be teaching students that this exists and how to work in that model so they're prepared. Not because I think every physician needs to do that - far from it - but because in my mind that's the only viable way to actually stop scope creep and independent practice.

They simply aren't going anywhere. The best case scenario in my opinion is to reincorporate them. I recognize others don't share that view and that's fine but some of the proposed alternatives often seem insane to me so I argue against them. Inside of that model I also feel there's a lot of strengths to be had for increasing the structure of their education and that by doing so we're more likely to limit their scope, at least by limiting the likelihood that they'll swap fields on a whim, than the other direction. Again, I recognize a lot of people don't feel like that but so many anti-midlevels say "they had no formal education and are garbage" and then bash them trying to formalize their education.

If they're going to do some of what physicians do, and they definitely are - that is not going away we should do our best to make it in a way that is physician led, safe, and efficient. This doesn't mean you HAVE to supervise midlevels. But if you want them to be physician led SOMEONE has to.
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Yes we actually agree on all this.
 
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They can do what they want. I'm an RN that chose to go to medical school for the knowledge I would obtain rather than go for my NP. Even if the roles become even more similar as the years go on, the knowledge can't be replaced. That holds true for NP and PA.
 
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Redpancreas said:
Hmmm. Yeah I'm not sure what it is about your medical school that allows it to do this but it probably has something to do with the 1000 other things you say happens at your medical school that doesn't seem to happen elsewhere.
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perhaps because it's a military school? :thinking:
 
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DO_or_Die said:
They can do what they want. I'm an RN that chose to go to medical school for the knowledge I would obtain rather than go for my NP. Even if the roles becomes even more similar as the years go on, the knowledge can't be replaced. That holds true for NP and PA.
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Yes. I’m an RN and made the same choice. Just graduated medical school. I didn’t want to be thrust into a position without the appropriate education and training.
 
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sunshinefl said:
Yes. I’m an RN and made the same choice. Just graduated medical school. I didn’t want to be thrust into a position without the appropriate education and training.
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Proud of you, always love to hear of other RN's turned med student (Well in your case, turned Doctor!) Congrats.
 
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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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I dont really understand the point here - only the surgical subs need to learn the physical exam? How are the PCPs supposed to diagnose and send the patients to the appropriate surgical sub if they have no idea how to do an exam? Or are you an advocate of "has penis, send to urology with zero workup", because great now there really is no difference between a MD and a NP/PA. You can't advocate for MDs over PAs while simultaneously advocating for the same level of care between the two. Does that not make sense?
 
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Wordead said:
I dont really understand the point here - only the surgical subs need to learn the physical exam? How are the PCPs supposed to diagnose and send the patients to the appropriate surgical sub if they have no idea how to do an exam? Or are you an advocate of "has penis, send to urology with zero workup", because great now there really is no difference between a MD and a NP/PA. You can't advocate for MDs over PAs while simultaneously advocating for the same level of care between the two. Does that not make sense?
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That’s not what I said.
 
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Wordead said:
I guess I'm not understanding why people are advocating tossing out the physical exam then.
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I mean, all I am saying is that for most fields, the physical exam is superfluous the majority of the time, as you should be able to get to the diagnosis or an appropriate ddx from the history alone. That doesn’t mean you should completely throw it out. But it has fairly poor test characteristics, so it needs to be taken with a grain of salt.
 
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Splenda88 said:
What the heck is going on in the healthcare industry?

Advanced Practice RT!

www.aarc.org

Ohio State Graduates First Class of Advanced Practice RTs - AARC

The first class to earn the Master of Respiratory Care, Advanced Practice degree received their diplomas. Read more.
www.aarc.org www.aarc.org
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Wtf. What a crock. Shame on that school for taking money from people for a “position” that doesn’t exist. And why do we keep having physicians who are hell bent on eroding this profession as much as possible?
 
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Matthew9Thirtyfive said:
Wtf. What a crock. Shame on that school for taking money from people for a “position” that doesn’t exist. And why do we keep having physicians who are hell bent on eroding this profession as much as possible?
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I already lost hope when it's feared that joining PPP as a med student can be viewed as a red flag by some PDs
 
Lawpy said:
I mean agreed but that's really the problem here. Joining the PPP is a good thing and any PD taking offense to that is destroying the profession
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Oh, sorry. Thought you meant it had to be mentioned.
 
Redpancreas said:
Oh, sorry. Thought you meant it had to be mentioned.
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I personally think it should be mentioned but i get the fears of not listing it. Its just sad. Nursing and midlevel students joining their lobbying organizations and unions are viewed as a huge plus but med students doing the same for PPP can be a potential red flag for sell out PDs
 
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Matthew9Thirtyfive said:
I mean, all I am saying is that for most fields, the physical exam is superfluous the majority of the time, as you should be able to get to the diagnosis or an appropriate ddx from the history alone. That doesn’t mean you should completely throw it out. But it has fairly poor test characteristics, so it needs to be taken with a grain of salt.
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But Im saying it guides you. Yes it's not 100% even in an expert's hands but a history is definitely not definitive in the least as much as UWORLD makes you think that. For example, take "ear pain". Extremely common primary care or ED complaint. You know how many I see on a weekly basis? Treated with multiple courses of antibiotics for "ear infection"? Dozens. You know how many actually have an ear infection? Like 5%. All it would take to save these patients multiple trips, multiple courses of antibiotics, random other medications, would be the referring person having any idea of what a normal ear looks like. That's it. It's ALWAYS documented "bulging erythematous TM" or some nonsense. Ill see them a day later or same day and it's invariably pristine.

Other examples - "nasal polyps" = turbinate. "lymphadenopathy" = submandibular gland. Coming in with CTs and some treatment for normal exam findings. All the time. Waste of everyone's time and money.
 
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