throwaway1000000
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- May 14, 2019
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Thank you for the insight.I realize this is an old topic, but one I feel continues to push ahead and become more and more pertinent over time. I do not wish to discourage but rather make aware of what reality is at least from my experiences.
Some Background:
Undergrad BSN, work ICU RN for 6 years ( last three of those 6 yrs took night course to obtain my pre requisites for med school and sitting for MCAT.
Advised by many specialists Surgeons Nephrologists, Intensivists, Cardiologist, and alike that if you want to fly the plane you go to Pilot school.
I did my IM residency at 2 large inner city level 2 trauma centers in Philadelphia which were part of our residency.
After residency I worked as a Hospitalist / pseudo intensivist running an ICU and managing vent patients in a small Hospital for about 1 yr. From there I moved to Florida where joined Private practice doing in patient and outpatient care.
Since my time in nursing and medicine, I have witnessed the evolution ( or de evolution depending on your view ) of Medical care in the USA.
Managed care ( HMO's) and the advancement and struggles of the field of NP vs PA battling for dominance in a similar market for jobs, the results of which can be summed up of bad mouthing each other, and pseudo higher degrees to try to justify their training over the other.
I have known ICU RN's who have gone onto get their NP degree and then state to my face their training and knowledge is equal to any Doctors without any provocation for this statement ( ie I am here hear me roar). I attended a Physician recruitment seminar in Las Vegas, NV of whic the ABIM sent a female rep to address the recruiters, and them not knowing a Internist in the crowd stated, " we happy to see so many NP's taking up the shortage of PCP and specialists in medicine, our data shows the shortage is NOT do to not enough medical school spots, Not lower reimbursement for Insurers, not more red tape and paper work bogging down physicians but rather a shift of most medical school graduates preferring to become specialists" I raised my hand for the speaker was called on and I stood up and replied to the speaker, " I am an internist and I don't care nor agree with what your data tells you I can assure you, that I and many of my colleagues all share the same sentiment, Low reimbursement, red tape to get reimbursement, red tape and barriers to treat our patients, and bureaucracy, killing practices, along with medical malpractice costs on the primary care providers salary is nearly impossible. I proceeded to advise her the acceptance and lack of support for PCP will undo decades of time proven practices of medicine leading to the collapse of the medical field as we know it and they might as well get ready to change their name to the ABNP's"
The speaker was silent and dumb founded to say the least.
Watching the events going on in different states and across the USA even in my home state, I predict that the less then Medical training of ARNP PhD's will only deteriorate the remaining scope of practice across multiple medical specialists in the USA. When I am old and retired I have no doubt I will go to a Doctors office expecting to see an MD or DO only to find out at a later time it was a ARNP PhD who not wrongfully called herself Doctor as MOST patients are totally unaware of today.
It honestly, makes me wonder why I spent 3 yrs after my bachelors to get my pre med requirements ( and took difficult sciences) to get into med school then busted my hump to do well in Medical school let alone the $250K price tag of this education, I am still paying on and will be until I am 70. And then to consider my 3 yrs of IM residency on call every 3rd night, and 120 hrs per week on the job ( yes before they limited residency hrs even with limits its still alot of time). Only to be told or have someone who has a BSN, then 2 yrs for Masters and 1-2 yrs to get their PhD and clinical time which doesn't even come close to our residency time or clinical time in Medical school. tell me they our my equal and just as good and some claiming to be even better then an Physician??? ( Hmmm ok so if thats the case guess all that was just one big expensive waste of resources and time).
It has been noted that their is programs under development where NP can attend for one yr and get their MD degree, Great a short cut..........Love it.
I believe they already have a program like this....its called Medical school and residency???
To sum it up I sincerely hope that someone ( Politician, Medical association, finally speaks up and stops this craziness other wise I feel the Medical field will continue to dwindle as lower cost, less trained individuals, enter the market spurred by Insurers, Lobbyists, and Politicians).
One last tid bit, I at one time owned my practice I started from scratch, on call at 2 hospitals admitted > 50% uninsured as high as 70% which never got paid by those patients, Insurance company's played games and jerked me around, billing company's screwed up and jerked me around at times, and patients even one's who claimed to love me I had to chase them to pay, co-pays or deductibles.
In 6 years of running my Practice in Palm beach county ( rishest county in FL) from 2006 until 2012 I brought in $1.8 million GROSS ( ie before all expenses,Taxes, salary's, med mal, electric, rent, etc ) In the same 6 years I ate in unpaid services for uninsured, Insurance companies stiffing me and patients who were insured stiffing me OVER $2.8 million. I finally gave up and closed the practice as did 3 other local IM PCP's I know did do to the same issues.
I now work for Urgent Care as a medical director and still do direct pt care being an employee is better then owning ones own solo practice, but even then most Doctors at my clinics are concerned corporate owners may get rid of Doctors altogether and replace all of us with cheaper ARNP's or PA's that is the future we have to look forward to.
I am happy to hear and get opposing views and comments, but if you think these obstacles won't happen to you; you are fooling yourself until you get out in the real world
Lot of graduating physicians like me are concerned about this exact thing especially the ones going into primary care fields: IM, FM, EM.
Makes sense why PCPs are not able to run their own offices.
Hope more physicians are get together and lobby for our rights and educate the public on the differences in training.
