I mean, if it's anything like my current area I'll take being able to have a PA look at a likely melanoma in 2 weeks versus the current wait for dermatologists at around 6 months
Nice thing is, most derms if you say "Hey this really worries me for melanoma" will find a way to get that person in pretty darned fast. Or at least that's the case outside of academic medicine. Most of us out in the world will do our best to accommodate if another doctor calls asking for something.
"In addition to an alarming high worker death rate in the oil and gas industry, life-altering injuries can also occur. In 2016 alone, at least 20 workers a month were hospitalized or lost a body part while on the job. Oilfield workers can also experience major burns and fractures, among other injuries. The Labor Department speculates that employers under report injuries by as much as 60 percent. The former head of the Occupational Health and Safety Administration (OSHA) pointed out that a culture of not reporting these incidents in the oil and gas industry is common, so even more workers are probably hurt or injured on the job."
We've tried, believe me. The trouble is I'm in the sticks and there are literally only two derm practices in a 90 mile radius, and they are booked up to the point that if they took every "this is probably melanoma" they got referred to them they would be working 24/7. They would love to, certainly, but they just can't.
Send it to a surgeon for a wide excision
Well, they did open another forensic path lab after the oil “boom”.
No, of course not. I do wonder if some of the firms out there have a physician or two on retainer, though. If they can avoid lost productivity by providing some care (read, pain meds) they may come out ahead on that deal.
ND literally did fund another forensic path lab because of the ancillary effects of the oil “boom”.
That's probably inappropriate.
While shadowing in FM over the summer, an internist asked the doc to look at a skin lesion bc he referred the pt to derm, got seen by an NP who said they didn’t know and referred it back.
I had something suspicious that just got sent to a GS for biopsy back in the day, might be a more safe way to go considering that we've got way more surgeons than dermatologists. Not really my problem after this year though, given that I'm a psych intern
So, basically in ND, attending a 3-year PA school for a masters degree is the same as going to medical school for 7+ years...excellent!
This a big blow to all those EM docs (and other primary care areas) in ND who went through Meds school and are probably in crazy-debt, just so that a PA can take their jobs!
I'm not going to look everywhere, but at the 2 programs in my state both have full schedules during the summer so realistically more like 2.5+ years (one of them for classroom stuff starts in May but ends in August of the next year, so 4 semesters-ish).
ND is the low hanging fruit. Next comes SD and Iowa. Outside of the Twin Cities, the case will be made for MN. By then, bills will be on the table in Maine, NH, VT. Now they've got momentum and precedence on their side. Appalachia, Mississippi, Nevada...
Well we can quibble about whether it’s “two academic years“ versus two full years. I assumed the latter since PA students often brag that they learned everything medical students do but in half the time. Regardless there are very few, if any “three-year programs“ which is what I was responding to
Fair enough.
Was there ever a 3rd year? I am unaware of that ever being the standard for physician assistant training.
I was told that at some point, but I don't recall much past that so easily could be wrong.
The problem is the physician shortage, not enough trained physicians to meet the demand. The obvious solution is to train more physicians and to offer inducements for medical students to go to school and residency in rural areas and practice there after for at least a few years. But that would have required expanding residency positions, necessitating government spending. Politicians have used midlevel expansion because it's cheap and easy - midlevels finance their own education - not because it's in the best interest of patients. Most midlevels do not practice in rural areas. While independent practice may induce PAs to work in SD, NPs have independent practice in most States. The PA lobby and leadership is clear that want independent practice in all States as well. Once that happens midlevels will be no more incentivized to work in underserved areas than physicians, so midlevel expansion in place of physician expansion for the reason that midlevels will work in rural areas is nonsensical. Letting providers with a fraction of the training that physicians receive autonomously function as physicians because it's cheaper than expanding residency positions is detrimental to both the physician profession and, I believe, patients' welfare.
That wasn't your question. "Show of hands in this thread how many extra special snowflake physician students were planning on working in North Dakota when they were done."
It’s a maldistrinution not a shortage. ND offers monitory incentives (both tuition free education for med students and generous loan reimbursement for new attendings with much higher salaries in a lower COL region) and has expanded residency spots which has not been successful thus far in ameliorating the problem (see my initial post in this thread).
Yes, and training an abundance of midlevel of providers in the hope that some of them will work in areas with a relative shortage is short-sided. We're creating an army of second class providers who will continue to demand the same independent practice rights of physicians, despite having far less training. Of course some of them will go to the underserved areas, but if we trained more physicians some of them would as well. I've yet to see evidence that midlevels are more likely to practice in underserved areas.
As I mentioned previously in this thread, UND has been doing this for several years and it has largely been fruitless.
Aside from the fact that tuition waivers/reimbursement ARE monetary incentives...
Its currently 8 per class not 22 - 22 refers to the total number of students who have enrolled in the program since it began. I’m only aware of one class where all spots filled since the program started. Also, several students who were accepted into the program opted out prior to graduating.
I realized that after re-reading it. The rest of it's still true, though. The school is putting in the effort.
This really hurts the physician-centric side of the argument here, imo. UND is really trying here, from admissions onward, and they still can't get 8 people per class to commit to practicing in rural ND.
My point is, monitary incentives aren’t fixing the issue. I never implied that UND wasn’t trying...at least to some degree...
And what does this tell you?
I think it's far more pertinent to ask if the medical students here have spoken with the state politicians??????
The only point I have has been made a few times, and as far as I've seen is the only viable compromise. Giving midlevels unrestricted licenses statewide is not a good solution. Yes, it will give the rural folks more access, but, as has already happened with NP's in many states, there is a disproportionate number who will continue to congest already saturated markets. That doesn't help anybody and directly hurts physicians and patients. I personally agree that something is better than nothing in these rural areas (there are clearly some here who disagree with that), but that doesn't preclude advocating for limiting the places midlevels are given such freedom.
No... This isn't even close to representative. Look at the source. This data is from the AAMC, which excludes osteopathic medical schools. Osteopathic schools are nearly universally private and cost more, so by only including MD schools this data can't reasonably assess average debt of all medical students.
Most of my family grew up in a rural part of the midwest and we have lived on the same land for 5 generations. When my grandmother got sick she got really Crappy care at the local rural hospital. Her "psych" and "cardiologist" were MLPs and she pretty much never saw a physician. It seems that the argument has already devolved to where we accept that it's better for these rural people to see someone close to them that is a MLP than travel 50+ miles to see a doctor. Low and behold when she started making appointments in the nearest metro area with physicians we got her on a medical regimen where her quality of life significantly improved.
Such a dearth that the current model of supervision isn't feasible?
Truth. Reminds me of that Tracy Chapman song: "You got a fast car, I got a plan to get us out of here...won't have to drive too far, just cross the border and into the city. You and I can both get jobs, and finally see what it means to be living."
