What will all the PA's, RNP's, DNPs etc do to rural medicine?

[Trail Boss]

Don't get me wrong, rural people care no matter what letters are after the providers name, I am just wondering what effect people think all of these mid-level providers will have on an MDs ability to have a sustainable practice in a rural area?

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[Chronic Student]

I'm pretty sure that is one of the reasons they came into existence in the first place, because they could not get doctors to practice in rural areas. I also think they have been in the rural areas for something like thirty years now.

As an example, there are numerous counties in south and west Texas without a single healthcare practicioner, be it MD, PA or NP. So it is still quite a problem.

-Mike

 

[sophiejane]

I'm pretty sure that is one of the reasons they came into existence in the first place, because they could not get doctors to practice in rural areas. I also think they have been in the rural areas for something like thirty years now.

As an example, there are numerous counties in south and west Texas without a single healthcare practicioner, be it MD, PA or NP. So it is still quite a problem.

-Mike

Mike is exactly right. FM is still lagging way behind in our numbers for the projected and current need in underserved areas. Not all PA's and NP's practice in rural areas, though a larger proportion do. They are filling a desperate need in some areas, and allow physicians to extend the area and number of patients they can treat.

They do not practice alone--they need to have a physician's oversight. I can't imagine that any physician wanting to practice rural medicine will have trouble finding a job...at least not in my lifetime!

 

[primadonna22274]

We help fill in the gaps. Sheesh. We're not taking jobs away from docs...we're taking jobs docs won't take, or helping the docs who are there who are overburdened and worn out. Do a little research.

 

[iatrosB]

We help fill in the gaps. Sheesh. We're not taking jobs away from docs...we're taking jobs docs won't take, or helping the docs who are there who are overburdened and worn out. Do a little research.

 

[Trail Boss]

We help fill in the gaps. Sheesh. We're not taking jobs away from docs...we're taking jobs docs won't take, or helping the docs who are there who are overburdened and worn out. Do a little research.

Oh knock the chip of your shoulder. I was doing research, that was the nature of the question. Or is not okay to ask questions in a forum anymore? Alot of people I know med students and doctors think the rise of mid-levels will change they way they practice, so I think I have asked a fair question. I also think I qualified my question by saying that the treatment of patients is the primary concern, not anyones ego.

 

[primadonna22274]

Eh, no chip on my shoulder, although my shoulder does hurt after 12hr in the ED...(tension, typical for me). I was a primary care PA for 6 yr, got bored, moved to ED, not bored anymore, just tired and sore.
There are lots of studies that have been done and more being done all the time investigating this very question. A literature search on Medline with the terms "physician assistant", "nurse practitioner", "mid-level provider", "non-physician provider", "rural medicine", "undereserved area", "primary care", etc. will give you lots of hits. Most of these studies using quantitative measures have showed a positive impact on health care delivery when PAs, NPs, CNMs etc. are introduced into an underserved/health professional shortage area and thereby we continue to exist. There are still way too many places with no healthcare provider of any kind where the people who live there would probably be ecstatic to not drive 50 miles or more when they're sick or injured...and there are not enough physicians to fill all those (potential) jobs.
For at least a year a rural clinic in Fossil, Oregon has been trying to find someone, anyone, to come to work there. The nearest hospital that I know of is at least an hour away. It's a nice little clinic in a beautiful part of the state but there is next to no support network and any true emergency requires Life Flight. The pay also sucks because there's no money there. There are thousands of places just like this all over the US just waiting for someone to step into the job. The burnout factor is high and it's often difficult for highly educated people to live without the niceties we take for granted in more suburban places (restaurants, shopping, culture, other educated people to hobnob with, etc.)
I've worked in semi-rural family practice (pop. 28000). It was pleasant. I myself don't think I could go much less rural than that, but I'm glad I have colleagues who do.
So, are you gonna be one of 'em?
Lisa PA-C

 

[Trail Boss]

Thanks. You seem to have very good perspective on this issue. And Condon is a long ways from fossil isn't it. I personaly have though that more PAs in rural places would make it a lot easier for a physician to practice medicine. I know there are many rural practitoners, doctors and dentist, that travel huge distances to see multiple population bases. Having PA's, RNP's in more places hopefully will make a doctors visits more productive for communties. How all this all affects the rural physicians bottom line is a conern though, I still don't know if it will make it easier to have a sustainable practice or not. I know some towns barely have the patient base to sustain a single provider, and well I'll have nearly 200,000 dollars in educational debt when I'm done here. I hope that there are some good models for how to practive in a really rural area and still manage this burden, I know lots of states have loan repayment programs, but they are still kind of small when you consider the difference in salry between an urban and rural practitioner of the same speciality. But I don't think any of us interested in rural medicine are planning to make it rich, I would just like to know what I am getting into. The money keeps many MD's out of rural areas--even those of us that know the culture of rural places very well.

 

[sophiejane]

If I was going to be a PA, I'd definitely work in ER. You'd likely see fast track patients primarily, and at least have some suturing and casting to break up the endless barrage of gastroenteritis, sniffles, and coughs.

I think ERs and urgent care are ideal settings for using PAs and NPs to their fullest potential.

By the way...the primary care docs I know who hire PAs are going gangbusters with their practices and making a lot more money than those who go it alone, even when you subtract the PA's salary.

 

[Tn Family MD]

Precisely, sophiejane. I think allied health provideers are more ally than adversary. The practices that I have seen that use mid levels are making bank. I plan on having at least one mid level for every doc in my future office.

 

[deleted6669]

"If I was going to be a PA, I'd definitely work in ER. You'd likely see fast track patients primarily, and at least have some suturing and casting to break up the endless barrage of gastroenteritis, sniffles, and coughs."

actually the suturing, sniffles, and coughs help break up the pattern of mi's, cva's, traumas, and overdoses that we spend a lot of time on....
last night I admitted multiple pts:
symptomatic overdose on adderall to the icu
esophageal fb to peds gi
new onset gi bleed with probable malignancy in elderly woman
new onset tia sx(resolved by my exam) in a htn/dm elderly male

em pa's see a lot more than just sniffles.....yes, many places do use pa's just in fast track but those of us with a passion for em get lots of extra training and seek out jobs with higher levels of autonomy. for instance although I spend most of my time at a busy trauma ctr I also do solo coverage several nights a month at a facility that sees around 25-30k pts/yr. I intubate there, run codes, cardiovert, etc

here is a recent ad for such a job:

SOUTHWEST GEORGIA RURAL ER!
Rural Southwest Georgia Hospital has IMMEDIATE opening for Physician Assistant in the emergency room. Join team of two other PAs in sharing coverage duties. Must have at least three years experience in an emergency room and be capable of independent practice. acls/atls/pals required. Solo position requires comfort with a full range of medical and trauma patients.
Great quality of life in rural, agricultural based community with easy access to larger cities. Excellent hospital system with long history of physician assistant utilization. Salary $85-90K to start with bonus structure. exceptional cafeteria-style benefit package including paid CME, professional memberships, licensure, malpractice insurance, retirement and relocation!

 

[deleted6669]

Precisely, sophiejane. I think allied health provideers are more ally than adversary. The practices that I have seen that use mid levels are making bank. I plan on having at least one mid level for every doc in my future office.

agree- most of us make at least 3 times the cost of employing us. that's big bucks for the md/do partners. I'm fortunate that where I work there is also a performance/productivity incentive so if I make the group more I also get a larger bonus.

 

[sophiejane]

actually the suturing, sniffles, and coughs help break up the pattern of mi's, cva's, traumas, and overdoses that we spend a lot of time on....

I stand corrected! Thank you!

 

[DeanWormer]

What do these patients do who just have a PA, midlevel nonphysician provider do when they need chronic specialty care. A ALS or PD patient that must see a neurologist routinely for example.