PA granted independent practice right in North Dakota

[Black Coffee 24/7]

Anecdotes are not data. If you can show me data showing that it's <20% I will happily consider it. And just because you and people who live in more rural areas don't consider it to be "BFE" doesn't mean most medical students don't and would be willing to live/practice there. I've heard multiple people in my class describe towns with a population of ~50k as "the middle of nowhere" and seen it on SDN as well.

My anecdotes and the confirmation by @VA Hopeful Dr tell you that the stratification of the data for BFE % is flawed. There isn't going to be a paper that contradicted the ivory lord points. However, I'm happy for the continued misconception to exist.

But yeah, I don't want to get too far off topic here. Ithink the debt discussion is for another thread. But we can definitely agree on the fact that it's a major issue and addressing it might encourage a handful more people every year to go into lower paying specialties. But I have yet to talk to a single person who has said something to the effect of "well if it weren't for that darn debt I would do FM in North Dakota." And the fact that rural positions already tend to pay more hasn't helped much. There are way, way more factors that drive people away from shortage specialties and areas than just money, and none of these issues can be easily or quickly fixed. So in the meantime, are people in North Dakota just supposed to go without any care whatsoever?

No, those people that live in those areas that can't support a daily caseload of min 10 pts/day for a PCP can drive 3-4 hrs to the nearby location to see a real physician.

Otherwise, I fully support telecare by a physician rather than destroying the whole profession with this camouflaged attack on physician practicing rights that have been earned after 7-10 years of training and an accumulated 300-500K of debt after interest.

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[stayathomemom]

North Dakota Department of Health
In case this hasn't been brought up yet, physicians in rural North Dakota can apply to have up to $150K per year of loan repayment. 2 year commitment required.

 

[Black Coffee 24/7]

North Dakota Department of Health
In case this hasn't been brought up yet, physicians in rural North Dakota can apply to have up to $150K per year of loan repayment. 2 year commitment required.

150K of total loan forgiveness after a 5 yr commitment when places like Cali offer similar deals with same number of $$$/yr. No wonder why they're having trouble recruiting docs to that region. Nobody in their right minds is going to choose ND over Cali when the money is similar.

 

[RNthenDoc]

Meanwhile, in Canada.....

 

[VA Hopeful Dr]

My anecdotes and the confirmation by @VA Hopeful Dr tell you that the stratification of the data for BFE % is flawed. There isn't going to be a paper that contradicted the ivory lord points. However, I'm happy for the continued misconception to exist.

Actually my anecdote isn't confirmation of anything in terms of rural percentages

 

[Black Coffee 24/7]

If you read a bit more carefully, it's actually 150k PER YEAR for up to 5 years or when your loan is paid off. The commitment is just for the year that you apply for the repayment, not 5 years total. Incidentally, for most people that's pretty darn close to the total loan repayment in 4 years you suggested be done. And you still haven't answered where the money is supposed to come from.

Thanks, I read it just fine. OP misquoted the number from the website. It's a total of 150K of forgiveness for a 5 year commitment. Not competitive with the market rate.

Don't worry about those farmers that can't drive 3-4 hrs to the closest physician. Automated driving technology will be a reality in the next 5-10 years. They can load themselves into a self-driving car and await care in the next 3-4 hours. There's no need for us to butcher our field for these ridiculous reasons.

 

[Ho0v-man]

I don't disagree that they ought to have supervision in an ideal world. But that's not the world we live in. Saying "sorry rural folks, no healthcare for you" is NOT a solution.

If they have to be without supervision, I'd say they should be restricted to basic primary care, maybe EM (enough to stabilize and ship them out) where the need is greatest, have someone remotely reviewing their charts, and only PAs with a certain number of years in experience in that field. I'd be much more comfortable with PAs than NPs just because their education is more standardized and within the medical model, often training alongside med students on clinical rotations (at least in my area).


So no data. Got it.


That's a super great idea if you (a) can take an entire day off work every time you need to go to the doctor (b) have transportation that's reliable for a 3-4 hour drive (c) can afford the gas for 6-8 hours of driving every time you need to go to the doctor (d) aren't too sick to do 6-8 hours of driving every time you need to go to the doctor and (e) are not an old person who's not allowed to drive anymore.


Good luck providing care to somebody who's been injured in a farming accident from 4 hours away. Telecare is great for some kinds of care, not so much for others.


If you read a bit more carefully, it's actually 150k PER YEAR for up to 5 years or when your loan is paid off. The commitment is just for the year that you apply for the repayment, not 5 years total. Incidentally, for most people that's pretty darn close to the total loan repayment in 4 years you suggested be done. And you still haven't answered where the money is supposed to come from.

I don’t think you’re totally unreasonable, but there’s a reason it’s considered unsafe for a doc to do primary care without a residency. There’s no way I’ll ever agree that someone without the education necessary to enter residency in any field is magically qualified to practice in any field they so choose.

Can’t wait for 10 years from now when they’re addressing the interventional cardiologist shortage...

 

[Ho0v-man]

Yeah, I really don't disagree with you. I think our point of contention here is not whether midlevels are qualified to practice independently, but rather whether some care is better than none while we're in the process of making changes that will improve access to physician-provided and/or physician-led care.

Agreed. I would only ever get on board with this if the leash was much tighter and only related to primary care in specific areas. Instead, any and all fields are open regardless of experience and will likely be exclusive to the areas physicians are already concentrated.


This legislation was a bad call.

 

[Taddy Mason]

Thanks, I read it just fine. OP misquoted the number from the website. It's a total of 150K of forgiveness for a 5 year commitment. Not competitive with the market rate.

Don't worry about those farmers that can't drive 3-4 hrs to the closest physician. Automated driving technology will be a reality in the next 5-10 years. They can load themselves into a self-driving car and await care in the next 3-4 hours. There's no need for us to butcher our field for these ridiculous reasons.

There are other state and federal loan forgiveness programs that you can qualify for in most of ND and you can qualify for more than one simultaneously. I have a job offer to go back there which is more than double the starting salary for my specialty where I’m currently training plus at least $200K in loan forgiveness for a 2 year commitment. Between that, state and federal loan forgiveness programs, and the MUCH lower cost of living I could easily wipe out my debt in 2-3 years and put a fair amount into savings/investments/retirement etc. while still living comfortably, however it’s very unlikely I will go that route or return to ND. UND also offers total tuition forgiveness for up to 8 med students per class who agree to return to practice FM or GS in rural communities for at least 5 years, however that program has filled all spots maybe once since it started. Much more money is being thrown at the problem than you suggest, and it clearly isn’t fixing it.

 

[Little Green Mensch]

The problem with midlevels in rural medicine is that rural primary care is, if anything, more demanding than primary care in a city. When you're the only physician available within a 3-hour drive, you are a lot more likely to be practicing at the top of your license/training. Throwing people who haven't completed a residency into a practice environment where you can't just reflexively send the complicated stuff to a specialist is a recipe for disaster.

The payer mix is better in big cities, because that's where the highly-paid jobs are; consequently, rural hospitals are too cash-strapped to finance the kind of incentives that would reliably attract physicians to rural practice. That problem doesn't disappear just because midlevels are cheaper to employ than physicians (for now).

I don't know if giving admissions preference to students from rural areas would help, but there has to be some way to recruit medical students who are more willing to do rural primary care.

 

[SLC]

The problem with midlevels in rural medicine is that rural primary care is, if anything, more demanding than primary care in a city. When you're the only physician available within a 3-hour drive, you are a lot more likely to be practicing at the top of your license/training. Throwing people who haven't completed a residency into a practice environment where you can't just reflexively send the complicated stuff to a specialist is a recipe for disaster.

The payer mix is better in big cities, because that's where the highly-paid jobs are; consequently, rural hospitals are too cash-strapped to finance the kind of incentives that would reliably attract physicians to rural practice. That problem doesn't disappear just because midlevels are cheaper to employ than physicians (for now).

I don't know if giving admissions preference to students from rural areas would help, but there has to be some way to recruit medical students who are more willing to do rural primary care.

Nailed it!

The only quibble I have with your post is the second to last paragraph. For primary care at least, pay is higher in rural locales. And for some of us, practicing at (or near) the upper end of our scope, combined with higher pay and the rural lifestyle is all the incentive we need.

I’m making specialist pay, in a location where I can practice as full-spectrum as I choose, and a location that’s within 100 miles drive of 5 national parks, and endless outdoor recreation opportunities. My only issue is that my REI expenditures have gone way way up. Gonna get a serious dividend this year though!!

 

[hurtem&healem]

Nailed it!

The only quibble I have with your post is the second to last paragraph. For primary care at least, pay is higher in rural locales. And for some of us, practicing at (or near) the upper end of our scope, combined with higher pay and the rural lifestyle is all the incentive we need.

I’m making specialist pay, in a location where I can practice as full-spectrum as I choose, and a location that’s within 100 miles drive of 5 national parks, and endless outdoor recreation opportunities. My only issue is that my REI expenditures have gone way way up. Gonna get a serious dividend this year though!!

I don't think he's saying pay isn't better in rural areas, just that it's not so high as to "reliably attract" enough physicians. Earlier on this thread someone suggested like $500k plus 3 months of vacation. That is not even remotely feasible.

 

[MerYangBey]

NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals

“An editorialist, favoring different approaches to primary care, writes that "it is time to stop calling NPs and PAs 'midlevel' providers."

I just thought this was funny considering the two mid level threads going on right now.

 

[GoldenFish]

I don't think he's saying pay isn't better in rural areas, just that it's not so high as to "reliably attract" enough physicians. Partially on this thread someone suggested like $500k plus 3 months of vacation. That is not even remotely feasible.

I don't even know that pay would solve it, even if it were somehow feasible. I really don't think there's any amount of money that would get me to live and work in rural north dakota. There are some people that love it (and I can see the appeal myself) but they're few and far in between. Additionally, the likelihood that someone either raised in a city or is not white will go rural is exceedingly small.

 

[235009]

I don't know if giving admissions preference to students from rural areas would help, but there has to be some way to recruit medical students who are more willing to do rural primary care.

To add to the comment directly above which was posted while I was typing...

Pre-meds will say anything to get into med school. Shocker I know. And a significant proportion of those who are recruited from states that have a large rural area/population don't go back after they finish med school and residency because they've acquired a spouse and had children or have put together social networks and mad new friends who they don't want to leave behind and move somewhere that's hours away from an airport.

Look no further than DO schools to see the complete failure of recruiting med students with the purpose of filling the rural primary care shortage. As evident by the lack of substantive arguments in this thread, there is no good solution to the problem. You can't just be against this without providing a viable alternative.

 

[deleted938090]

What specialties have the lowest possibility of mid-level encroachment?

 

[nimbus]

What specialties have the lowest possibility of mid-level encroachment?

Pathology and radiology because they’ll have AI encroachment instead.

 

[deleted938090]

Seriously though, are there specialties that require more competency than NP training allows?
Neurosurgery and plastics come to mind, anything else?

 

[RNthenDoc]

Seriously though, are there specialties that require more competency than NP training allows?
Neurosurgery and plastics come to mind, anything else?

Surgery, in my experience.

 

[DubbiDoctor]

Seriously though, are there specialties that require more competency than NP training allows?
Neurosurgery and plastics come to mind, anything else?

Surgery. NPs have the right to diagnose and prescribe medicine in most States, but they do not have the right to practice surgery independently. And there isn't any active campaign to grant nurses or physician assistants that right. The most nurses can do is become certified registered nurse first assistants, where they assist the surgeon. Surgical PAs also work as first assistant to the surgeon. Surgery is also projected to have the largest physician shortage by the AAMC, partially because it's considered the least vulnerable to midlevel encroachment.

 

[SLC]

I don't think he's saying pay isn't better in rural areas, just that it's not so high as to "reliably attract" enough physicians. Earlier on this thread someone suggested like $500k plus 3 months of vacation. That is not even remotely feasible.

I’ve got 3/5ths of that salary, and 2 months of vacation.

 

[stayathomemom]

I’ve got 3/5ths of that salary, and 2 months of vacation.

If you are in 100 miles of 5 national parks, though, that's a completely different situation than rural ND. Your location sounds like a place people would choose to vacation, while in ND you can drive 100 miles in any direction and you'll see nothing more than cows, farms, and empty highways. Unless you have an affinity for hunting, fishing, or snowmobiling, you are going to have to drive 6-8 hours or more to find something that mainstream America would define as "fun," or take at least two planes anywhere if you are flying commercially. It's just too much of a sacrifice for the vast majority of people, no matter the salary or benefits.

 

[Black Coffee 24/7]

What specialties have the lowest possibility of mid-level encroachment?

Anything that has surgeries in them or management of difficult pts who could die at any moment. To get into these fields, it will take 4-6 years of training. The 6 years of training is usually for those with a medicine background.

 

[Taddy Mason]

... or take at least two planes anywhere if you are flying commercially. It's just too much of a sacrifice for the vast majority of people, no matter the salary or benefits.

Plus the cost of flying out of ND because of having to make connections. I averaged 900-2000 per flight for CS and interview season. I actively looked for the best deals and was not flying first class.

 

[Taddy Mason]

... or management of difficult pts who could die at any moment.

There are plenty of NPs in MICUs and SICUs.

 

[hurtem&healem]

I’ve got 3/5ths of that salary, and 2 months of vacation.

I can only speak from where I'm sitting, but the difference between 300k and the proposed $500-700k is pretty massive.

Let me dial the snark back and ask a serious question. Do you have coverage during your vacation? How much can you realistically take in a single block? And, do you actually use it all? If not, by choice or by circumstance (ie, no coverage)?
Where are you located? Your posts made me think of Idaho, your name obviously implies Utah. Either is vastly more alluring than ND.

And just because I'm starting to feel bad about everyone talking down on the state, I will say that ND has the most amazing sky I've ever seen. Super low light pollution combined with the unobstructed view in all directions make for some pretty gazing.

 

[stayathomemom]

Plus the cost of flying out of ND because of having to make connections. I averaged 900-2000 per flight for CS and interview season. I actively looked for the best deals and was not flying first class.

Not to mention, first class is rarely offered when flying out of ND even if you wanted it. Usually it's smaller commuter planes or even prop planes (I've been on a few flights like that).

Getting through TSA is a breeze though

I can only speak from where I'm sitting, but the difference between 300k and the proposed $500-700k is pretty massive.

Massive, but there's not much to spend it on out there, even if it was viable. I guess this would only appeal to someone who loves getting rich but is basically a recluse, or someone who spends like a celebrity when vacationing and puts up with the ND lifestyle the other 10 months out of the year.

 

[medschoolzombie]

Yes.

I don’t think anyone wants the people of North Dakota to go without primary care. But these people aren’t qualified to deliver it without supervision. There’s no system in place to verify that they are qualified to do so. Their entire education revolves around doing their job with a doc acting as a safety net. There’s no check in place to verify that they’re qualified to work alone. FFS, assisting a physician is in the title of the frickin’ degree!

If they can practice without supervision, then what’s the point of med school?

I wonder if that would reduce the demand for a medical education too? If people can do the same things with a PA/NP degree there's no reason for anyone to become a doctor. That sounds like the beginning of the end for the title of doctor

I don’t think you’re totally unreasonable, but there’s a reason it’s considered unsafe for a doc to do primary care without a residency. There’s no way I’ll ever agree that someone without the education necessary to enter residency in any field is magically qualified to practice in any field they so choose.

Can’t wait for 10 years from now when they’re addressing the interventional cardiologist shortage...

Is interventional cardiology really going to be facing a shortage? If so, I'd imagine the competitiveness of that fellowship would go down to compensate no?

Yeah, I really don't disagree with you. I think our point of contention here is not whether midlevels are qualified to practice independently, but rather whether some care is better than none while we're in the process of making changes that will improve access to physician-provided and/or physician-led care.

As someone else mentioned, a big issue that they would face is the diversity of cases they'd have to deal with. They're more likely to be even more unprepared in a rural area where they have to be even more flexible in their skills. The chance for error is a lot higher

To add to the comment directly above which was posted while I was typing...

Look no further than DO schools to see the complete failure of recruiting med students with the purpose of filling the rural primary care shortage. As evident by the lack of substantive arguments in this thread, there is no good solution to the problem. You can't just be against this without providing a viable alternative.

I'd argue that it isn't a total failure. Nearly half of DO students still end up going into primary care fields. Maybe as the stigma against DOs goes away and with the upcoming merger, we may see these numbers go down, but so far they're not doing that badly.

What specialties have the lowest possibility of mid-level encroachment?

Anything surgery related or with complex procedures seems to be a good bet

Surgery. Surgery is also projected to have the largest physician shortage by the AAMC, partially because it's considered the least vulnerable to midlevel encroachment.

How does this make sense? If they're considered the least vulnerable to midlevel encroachment then doesn't that mean there should be a lot more people going into it? I'm sure the grueling residency has something to do with the shortage

 

[SLC]

If you are in 100 miles of 5 national parks, though, that's a completely different situation than rural ND. Your location sounds like a place people would choose to vacation, while in ND you can drive 100 miles in any direction and you'll see nothing more than cows, farms, and empty highways. Unless you have an affinity for hunting, fishing, or snowmobiling, you are going to have to drive 6-8 hours or more to find something that mainstream America would define as "fun," or take at least two planes anywhere if you are flying commercially. It's just too much of a sacrifice for the vast majority of people, no matter the salary or benefits.

Touche’ I guess I didn’t think about desirable rural vs tundra. I always just see people talk about rural vs non-rural.

 

[Ho0v-man]

I wonder if that would reduce the demand for a medical education too? If people can do the same things with a PA/NP degree there's no reason for anyone to become a doctor. That sounds like the beginning of the end for the title of doctor



Is interventional cardiology really going to be facing a shortage? If so, I'd imagine the competitiveness of that fellowship would go down to compensate no?



As someone else mentioned, a big issue that they would face is the diversity of cases they'd have to deal with. They're more likely to be even more unprepared in a rural area where they have to be even more flexible in their skills. The chance for error is a lot higher


I'd argue that it isn't a total failure. Nearly half of DO students still end up going into primary care fields. Maybe as the stigma against DOs goes away and with the upcoming merger, we may see these numbers go down, but so far they're not doing that badly.



Anything surgery related or with complex procedures seems to be a good bet




How does this make sense? If they're considered the least vulnerable to midlevel encroachment then doesn't that mean there should be a lot more people going into it? I'm sure the grueling residency has something to do with the shortage

I was being facetious. Basically saying midlevels go for high compensation just like docs. Difference being that there’s no barrier to entry for them like there is for doctors.

 

[medschoolzombie]

I was being facetious. Basically saying midlevels go for high compensation just like docs. Difference being that there’s no barrier to entry for them like there is for doctors.

Oh that's pretty on point. It really sucks that this is an actual issue. There's another mid level thread that's gaining traction right now. People are suggesting that in a decade's worth of time, surgical physician contracts will probably require surgeons to start teaching mid levels there too

 

[SLC]

I can only speak from where I'm sitting, but the difference between 300k and the proposed $500-700k is pretty massive.

Sure the difference represents a lot of money, but I mainly mention it to point out that hospitals in rural areas can pay higher than primary care average salaries. I’ve got a lot of other benefits too (I’m not paying any of my own student loans for example).

Let me dial the snark back and ask a serious question. Do you have coverage during your vacation? How much can you realistically take in a single block? And, do you actually use it all? If not, by choice or by circumstance (ie, no coverage)?
Where are you located? Your posts made me think of Idaho, your name obviously implies Utah. Either is vastly more alluring than ND.

I have coverage, I work for a large hospital system and share my office with 1.5 other docs and a part time PA. I can take as much vacation as I choose, so far have gone 8 days in one stint, 4-5 in others.

I’m located in Southern Utah near Capitol Reef National Park. Yes it’s vacationland. But my town has 6k residents, and not a lot going on unless you like to spend your time outside (I do).

And just because I'm starting to feel bad about everyone talking down on the state, I will say that ND has the most amazing sky I've ever seen. Super low light pollution combined with the unobstructed view in all directions make for some pretty gazing.

It sounds nice TBH, though I’d probably not enjoy the type of winter you get there. And I need mountains in my life.

 

[hurtem&healem]

Not to mention, first class is rarely offered when flying out of ND even if you wanted it. Usually it's smaller commuter planes or even prop planes (I've been on a few flights like that).

Hey, GFK is an "international" airport

Massive, but there's not much to spend it on out there, even if it was viable. I guess this would only appeal to someone who loves getting rich but is basically a recluse, or someone who spends like a celebrity when vacationing and puts up with the ND lifestyle the other 10 months out of the year.

Off topic, but having some fun with the thought experiment. If I were going into FM, at $700k/yr and 3 months vacation, I could buy a prop plane and fly to Minneapolis to catch a commercial flight every few weeks to visit my wife at our northern New England mountain cabin. I could do that for a year and still be ahead by several hundred thousand dollars. I couldn't stand it for 2 years, but I could do pretty much anything for one year.

 

[hurtem&healem]

It sounds nice TBH, though I’d probably not enjoy the type of winter you get there.

Windchill of -60*F is a real thing. And it is brutal.

 

[Goro]

Windchill of -60*F is a real thing. And it is brutal.

Indeed. In that part of the country. Winter makes a serious attempt to kill you from Dec to Mar

 

[Winged Scapula]

Seriously though, are there specialties that require more competency than NP training allows?
Neurosurgery and plastics come to mind, anything else?

All. Of. Them.

There are no medical specialties in which NPs have the depth and breadth of training required to practice independently safely. There may be SITUATIONS in which they are competent but not entire medical specialties.

 

[DubbiDoctor]

How does this make sense? If they're considered the least vulnerable to midlevel encroachment then doesn't that mean there should be a lot more people going into it? I'm sure the grueling residency has something to do with the shortage

Because midlevels are projected to reduce the demand for physicians, since they can perform some, if not all, of their responsibilities. But midlevels can't really be used to alleviate the shortage of surgeons, unlike other primary care and anesthesia, so the shortage is projected to be worse than for other specialties. The grueling residency may lead to some attrition, but surgery is still an attractive field for med students. More US students applied to gen surgery in 2018 than ever before, more than there are residency spots available.

 

[Matthew9Thirtyfive]

All. Of. Them.

There are no medical specialties in which NPs have the depth and breadth of training required to practice independently safely. There may be SITUATIONS in which they are competent but not entire medical specialties.

What is the org you are part of that is trying to get the word out? I want to bookmark it so I can participate as soon as I’m able.

 

[Winged Scapula]

What is the org you are part of that is trying to get the word out? I want to bookmark it so I can participate as soon as I’m able.

I'm in the private group, but there are public resources:

http://www.physiciansforpatients.org/home

Physicians for the Protection of Patients - Public

Log into Facebook | Facebook (this one you have to be vetted and invited by a member)

 

[Matthew9Thirtyfive]

I'm in the private group, but there are public resources:

http://www.physiciansforpatients.org/home

Physicians for the Protection of Patients - Public

Log into Facebook | Facebook (this one you have to be vetted and invited by a member)

Lol. I read one of the articles on the second site and all the NPs flocked to the comment section about how they earned the right to be called doctor. That’s all they care about—being called a doctor without going through the training.

 

[Winged Scapula]

Lol. I read one of the articles on the second site and all the NPs flocked to the comment section about how they earned the right to be called doctor. That’s all they care about—being called a doctor without going through the training.

Yep.

Some days I have to "take a KitKat break" because I cannot stand all the ignorance and entitlement from them. Its really scary.
Former nurses are our best allies; I've never met or heard of one who didn't realize, often in horror, how little they knew or understood.

 

[medschoolzombie]

Because midlevels are projected to reduce the demand for physicians, since they can perform some, if not all, of their responsibilities. But midlevels can't really be used to alleviate the shortage of surgeons, unlike other primary care and anesthesia, so the shortage is projected to be worse than for other specialties. The grueling residency may lead to some attrition, but surgery is still an attractive field for med students. More US students applied to gen surgery in 2018 than ever before, more than there are residency spots available.

I bolded the part that I'm focusing on. If surgery is such an attractive field for med students, and mid levels can't take it over, then shouldn't we see a lot more med students flocking to surgery? Why would there be a shortage in that case? Are more surgeons retiring then are coming in?

 

[VA Hopeful Dr]

I bolded the part that I'm focusing on. If surgery is such an attractive field for med students, and mid levels can't take it over, then shouldn't we see a lot more med students flocking to surgery? Why would there be a shortage in that case? Are more surgeons retiring then are coming in?

Because surgery is a hard residency and life.

 

[medschoolzombie]

Because surgery is a hard residency and life.

Which is what I said too.
DubbiDoctor's logic doesn't make sense to me

 

[medschoolzombie]

Going into a primary care field isn’t the same as going into primary care. I’ll be applying to a primary care field but I will not be going into primary care.

IM?

 

[Ho0v-man]

I bolded the part that I'm focusing on. If surgery is such an attractive field for med students, and mid levels can't take it over, then shouldn't we see a lot more med students flocking to surgery? Why would there be a shortage in that case? Are more surgeons retiring then are coming in?

The bottleneck is available residency spots.

 

[hurtem&healem]

I bolded the part that I'm focusing on. If surgery is such an attractive field for med students, and mid levels can't take it over, then shouldn't we see a lot more med students flocking to surgery? Why would there be a shortage in that case? Are more surgeons retiring then are coming in?

Only so many people want the life of a surgeon. Only so many residency slots. And, I would venture the biggest factor, only so many surgeons willing to live outside of cities. From what I've read, there is a huge dearth of young surgeons going into rural areas to replace what aging/retiring surgeons there currently are. Add in the push towards greater and greater specialization of surgeons and, seriously, how could a subspecialist fill the shoes of those old, truely general surgeons?

 

[DubbiDoctor]

I bolded the part that I'm focusing on. If surgery is such an attractive field for med students, and mid levels can't take it over, then shouldn't we see a lot more med students flocking to surgery? Why would there be a shortage in that case? Are more surgeons retiring then are coming in?

I'm getting impatient because I clearly answered your question. More US students apply to surgery residencies than there are spots available. The number of people going into a field isn't only determined by student interest but by also by other factors including supply and demand. Look at the 2018 charting outcomes, general surgery, the least competitive surgical residency, maintains an above average USMLE step 1 score and an 84% match rate. There are not enough residency spots available to fill projected physician shortage, which is one of the reasons we've seen midlevel expansion in recent years. The government has to pay for residency spots but not to train midlevels, since they don't require residency. But midlevel expansion does less to alleviate a surgery shortage than shortages for other specialties, since midlevels can perform fewer responsibilities than surgeons can, compared to other specialists. This is straight from the AAMC's annual report on the physician shortage:

"For modeling purposes, the “high use” scenario assumes that each additional APRN or PA beyond the supply needed to maintain current staffing patterns will ease demand for physicians in their specialty as follows: anesthesiology (60%), women’s health (40%), primary care (50%), medical specialties (30%), surgery (20%), and other medical specialties (30%). The “moderate use” scenario assumes that the adjustment in physician demand is half the above amounts. The above percentages imply nothing about the value of services provided by APRNs and PAs relative to physicians. Instead, they allow for the examination of the role these providers will play in the future health care system and whether that role fills a currently unmet need (see Section V) or reduces demand for physicians."

Mod staff: The content of this post has been edited due to unprofessional personal attacks. Let's please keep the conversation civil.

 

[stayathomemom]

Indeed. In that part of the country. Winter makes a serious attempt to kill you from Dec to Mar

That range is inaccurate because it's too narrow
Just for the record (pun intended):
North Dakota record high: 121*F, 1936
North Dakota record low: -60*F, also 1936 (not including windchill)
Any takers?

 

[hurtem&healem]

That range is inaccurate because it's too narrow
Just for the record (pun intended):
North Dakota record high: 121*F, 1936
North Dakota record low: -60*F, also 1936 (not including windchill)
Any takers?

February 1995, on the 15th it was the standard -30*, on the 21st it was 57*, then by 28th we were back to -30*. Something about a "continental climate zone," and no large bodies of water to help regulate the temperature. idk. It was crazy, though.