SoCal_PA Posted November 1, 2014 Share Posted November 1, 2014 I've heard this from several of our MD and PA lecturers but I cannot find anything online to back it up. Having MDs work at the top of their license and focus on all the difficult cases would be great for the PA profession. Anyone? Link to comment Share on other sites More sharing options...
DiggySRNA Posted November 1, 2014 Share Posted November 1, 2014 Having MDs work at the top of their license and focus on all the difficult cases would be great for the PA profession. How so? Can you explain a little bit :)? Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted November 1, 2014 Moderator Share Posted November 1, 2014 My question would be who's stopping them? Link to comment Share on other sites More sharing options...
Guest Paula Posted November 1, 2014 Share Posted November 1, 2014 I've heard this from several of our MD and PA lecturers but I cannot find anything online to back it up. Having MDs work at the top of their license and focus on all the difficult cases would be great for the PA profession. Anyone? What the heck does that mean? They should say having PAs work at the top of their license and focus on our abilities will be great for patient care. I am not liking what I think your statement means........I take it that MDs only get difficult cases so PAs can stop telling the public we see difficult cases and then we only are allowed to see the snotty noses. Link to comment Share on other sites More sharing options...
SoCal_PA Posted November 1, 2014 Author Share Posted November 1, 2014 My question would be who's stopping them? I would guess that it would quite difficult to take the bread and butter cases away from the docs and let the PAs handle them. What the heck does that mean? They should say having PAs work at the top of their license and focus on our abilities will be great for patient care. I am not liking what I think your statement means........I take it that MDs only get difficult cases so PAs can stop telling the public we see difficult cases and then we only are allowed to see the snotty noses. Having the doctors focus all their time and energy on the zebras and complex cases would allow the PAs to operate at the highest of their license as well and basically take over all the "normal" cases, comprehensively. The doctors should do all the highly skilled tasks that is beyond the scope of the PAs and delegate the rest. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 1, 2014 Share Posted November 1, 2014 How much hunting would a doctor need to do to find a Zebra? How would anyone determine what is beyond the scope of the PA? The PA works in the SAME SCOPE AS THE DR. They both would have their eyes on the scope of the gun looking for Zebras and if found the Dr. gets the case, I guess. Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 1, 2014 Share Posted November 1, 2014 I do not see a model like this becoming standard. for example I have been caring for a patient 3-4 years ... i know his/her history well ... but now another diagnosis comes where "it is more complicated" so I refer to someone who does not know the patient and essentially the work up over to some extent during a complex time ? There is one clinic that has a policy in effect where physicians serve as consultants for a number of PA/APRN and then get extended visits with the sickest of the patients among those providers panels. It was discussed on this board awhile back and I thought it was a pretty decent set up. I forget the name of the clinic/hospital sorry. I will relay another scenario .... I was part of a busy practice a number of years. I would see many roll over patients from a physician. It got to the point where he was only seeing patients for follow up, physical, chronic complaints. He was not providing vaccinations, urgent care, etc. In theory this sounds like a dream job for an internist... but that lack of variety in a normal 15 min appt schedule can make for a very complicated day. Also the economics of things. I actually heard someone say that the PA should spend the long period with a complicated patient so the physician can bill MD hours and see a larger number. Link to comment Share on other sites More sharing options...
db_pavnp Posted November 2, 2014 Share Posted November 2, 2014 It is not too hard to imagine a near future where primary care is almost entirely NP/PA driven and all MDs hyperspecialize. Link to comment Share on other sites More sharing options...
andersenpa Posted November 3, 2014 Share Posted November 3, 2014 I do not see a model like this becoming standard. for example I have been caring for a patient 3-4 years ... i know his/her history well ... but now another diagnosis comes where "it is more complicated" so I refer to someone who does not know the patient and essentially the work up over to some extent during a complex time ?What you've described is a routine consult and not at all uncommon. Confidence in your own ability is knowing when to refer out. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted November 6, 2014 Share Posted November 6, 2014 It is not too hard to imagine a near future where primary care is almost entirely NP/PA driven and all MDs hyperspecialize. That is more of a far future thing than near future. In order for that to happen, primary care residency programs would need to close in large numbers. Not going to happen anytime soon. There are hundreds of thousands of primary care doctors out there -- they arent just going to hand over their patients to NP/PAs. I can see a long term gradual takeover IF primary care residency programs start closing, but we're talking 25-30 years at least. FYI primary care residency programs in IM, FP, and peds increased by 15% over the last 5 years. I dont see them going anywhere anytime soon. Even if American grads abandon primary care, there are MILLIONS of FMGs out there just waiting to take these spots, even at bad residency programs in crappy locations. Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 6, 2014 Share Posted November 6, 2014 What you've described is a routine consult and not at all uncommon. Confidence in your own ability is knowing when to refer out. I described something different. The institution had protocols where a patient would have primary care managed by an MD. I am not talking about referral to a specialist PA or MD. Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 6, 2014 Share Posted November 6, 2014 The lack of primary care conversation among PAs is wrongly fueled by popular media, PA programs, and AAPA. The shortage is not as real as these people suggest and healthcare does not need another 100 PA programs. Period. If anyone wants to make financial bets on this I am willing to go as high as 10,000 USD and we can place the money is escrow this week. Link to comment Share on other sites More sharing options...
primadonna22274 Posted November 6, 2014 Share Posted November 6, 2014 Primary care physicians aren't going away. Yes we are trained to work at the top of our license, but in real life there is a lot of bread and butter medicine too. Honestly after a few train wrecks I'm grateful to have a couple easy patients peppered in my schedule--I need the mental break. And so do you. Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted November 6, 2014 Share Posted November 6, 2014 The lack of primary care conversation among PAs is wrongly fueled by popular media, PA programs, and AAPA. The shortage is not as real as these people suggest and healthcare does not need another 100 PA programs. Period. If anyone wants to make financial bets on this I am willing to go as high as 10,000 USD and we can place the money is escrow this week. 100% agree with this. I will bet any amount of money that in 10 years there are going to be MULTIPLE articles and studies out there showing a glut of NPs, PAs, and MDs Medical schools alone have almost doubled over the last 10 years. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 7, 2014 Moderator Share Posted November 7, 2014 I don't think there will be a glut we will see a HUGE # of retirements of PCPs is going to a exodus of establish docs, many of who are carrying large panels http://www.reportingonhealth.org/2014/03/10/whether-it%E2%80%99s-retire-or-flee-doctors-are-leaving-health-care In practical terms, we doctors are a fairly elderly bunch. Nationwide, despite churning out roughly 20,000 newly-minted medical school graduates a year, one in three doctors is over 50, and one in four is over 60. One reason doctors are older than you think -- the training alone takes so many years. Or, as one uber-specialized colleague of mine said, “It’s hard to explain to your five-year-old son, without making him petrified to start kindergarten, that you’re actually in thirty-fifth grade.” Knowing that one in four doctors will reach retirement age in five years is cause for enough concern. Then, there’s the well-documented doctor shortage coming down the pipe simply because not enough new doctors are being trained to meet the needs of the U.S. population. But do impending changes within the medical industry stand to drive doctors into early retirement? There’s evidence to indicate that it will. if the economy has a great run, then I can see a lot of the docs that are fed up with the changes in health care, simply retiring..... Link to comment Share on other sites More sharing options...
Guest Paula Posted November 7, 2014 Share Posted November 7, 2014 There is a shortage of docs in rural areas too. In my area it is difficult to recruit a physician so more and more PA/NP jobs open up. I just interviewed for a job today in a group practice and they are hiring 2 ACPs. Three of their physicians are retiring in the next 18 months, one just retired, and they need help. BTW: This particular group is pro PA/NP and treat us like colleagues. I was impressed. The medical director/administrator told me she had gone to a national medical management meeting for physician managers and was shocked at how some physicians and physician groups spoke poorly of PA/NPs. She felt that the wave of the future is the PA/NP as the PCPs with less physicians available. It was an interesting conversation, to say the least. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted November 7, 2014 Moderator Share Posted November 7, 2014 Primary care physicians aren't going away. Yes we are trained to work at the top of our license, but in real life there is a lot of bread and butter medicine too. Honestly after a few train wrecks I'm grateful to have a couple easy patients peppered in my schedule--I need the mental break. And so do you. This. I don't know why this doesn't get more play- you can't see complicated train-wrecks all day and not be exhausted. We all love a good case, but interspersed with some simple lac or an ankle sprain where someone is genuinely grateful for your help really does help break up the day and increase your job satisfaction. At least, it does for me. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 8, 2014 Moderator Share Posted November 8, 2014 Primary care physicians aren't going away. Yes we are trained to work at the top of our license, but in real life there is a lot of bread and butter medicine too. Honestly after a few train wrecks I'm grateful to have a couple easy patients peppered in my schedule--I need the mental break. And so do you. What??? you mean the EMR system does not simplify the train wrecks down to simple algorithmic medicine with a simple yes/no answers? Geez that's what all the EMR reps were selling me, oh yeah, and I would get $44,000 for using them.......... tongue in cheek - wrong on both points..... Link to comment Share on other sites More sharing options...
Gordon, PA-C Posted November 8, 2014 Share Posted November 8, 2014 There is a shortage of docs in rural areas too. In my area it is difficult to recruit a physician so more and more PA/NP jobs open up. I just interviewed for a job today in a group practice and they are hiring 2 ACPs. Three of their physicians are retiring in the next 18 months, one just retired, and they need help. BTW: This particular group is pro PA/NP and treat us like colleagues. I was impressed. The medical director/administrator told me she had gone to a national medical management meeting for physician managers and was shocked at how some physicians and physician groups spoke poorly of PA/NPs. She felt that the wave of the future is the PA/NP as the PCPs with less physicians available. It was an interesting conversation, to say the least. Rural areas are ALWAYS going to be shortchanged. You could dump 20 milliion doctors, PAs, and NPs into this country and they will all run to the big cities; very few of them will practice rurally. The medical director you spoke to is misinformed. I'm going to question her premise that there will be "less physicians available" in the future. Where is he/she getting their data? Medical schools have increased by 75% over the last 10 years. Existing medical schools have increased their enrollment by 50% over hte last 10 years. Primary care residency programs have increased their slots by 10-15% over the last 5-7 years. So where is this "drop" in physicians they are referring to? It's true that american-trained MDs are shifting towards subspecialties, but that is irrelevant considering that primary care residency programs have access to hundreds of thousands of FMGs who will literally jump at any chance at an american residency program, even if it's a crap family medicine program in hicktown arkansas. Some primary care programs fail to fill in the match, but again this is irrelevant because after the match they get bombarded with inquiries from thousands of FMGs who want to come practice in the states. There's literally a whole world full of doctors who want nothing more than to come to the USA. In rural areas there will be areas where doctors refuse to practice, but in terms of a nationwide takeover of primary care by NP/PAs, that's never going to happen as long as there are so many primary care residency programs that are still open, and as long as they have access to tens of thousands of foreign doctors who want to come to the USA. Link to comment Share on other sites More sharing options...
Febrifuge Posted November 8, 2014 Share Posted November 8, 2014 Gordon has a good point. Anecdotally, my brother lives in an exurb that was a small farming community as recently as 20 years ago, and which has kind of exploded with McMansions in the past 5-10 years. They built a brand-new clinic building 3 or 4 years back, and while they were in the process of completing the construction, they cast a wide net looking for docs to staff it. They wound up importing a couple of MDs originally from India. This is more than 25 but less than 50 miles outside a major metro area; I was surprised no one from the suburbs wanted to just drive the other direction, away from the city, and claim the gig. Link to comment Share on other sites More sharing options...
db_pavnp Posted November 8, 2014 Share Posted November 8, 2014 I read that as they didn't want to pay enough to convince someone to drive. Probably advertised poorly, too. Link to comment Share on other sites More sharing options...
Febrifuge Posted November 9, 2014 Share Posted November 9, 2014 This is very likely also part of it, yes. Link to comment Share on other sites More sharing options...
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