Comments on: My take: Mid-levels, cost-shifting, IMGs http://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83792 Anonymous Thu, 21 Feb 2008 03:00:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83792 Considering MD/DO schools are opening in droves, and expanding (MD, anyway) per AAMC demands @ 30% above existing levels, I believe very soon that foreign med grads will be shoved out of the equation, and AMG's will dominate primary care...because they wont have a choice to go elsewhere. <br/><br/>At that point, the DNP nurses who are crying for residencies will effectively be shut down. The ripple effect will trickle down to decreased enrollment in DNP, with massive closures as funding dries up. PA schools will become more competitive, and for the first time, we will see MD's who can't find residency slots. <br/><br/>We'll see MD's go into mid-level positions as a sort of "resume building" exercise. This will all be the death of nurse practioners, who often fancy themselves as doctors. PA's and MD's will rule the day, at least for a while. Considering MD/DO schools are opening in droves, and expanding (MD, anyway) per AAMC demands @ 30% above existing levels, I believe very soon that foreign med grads will be shoved out of the equation, and AMG’s will dominate primary care…because they wont have a choice to go elsewhere.

At that point, the DNP nurses who are crying for residencies will effectively be shut down. The ripple effect will trickle down to decreased enrollment in DNP, with massive closures as funding dries up. PA schools will become more competitive, and for the first time, we will see MD’s who can’t find residency slots.

We’ll see MD’s go into mid-level positions as a sort of “resume building” exercise. This will all be the death of nurse practioners, who often fancy themselves as doctors. PA’s and MD’s will rule the day, at least for a while.

]]> By: Health Punkhttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83791 Health Punk Thu, 21 Feb 2008 02:45:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83791 Regarding IMG's:<br/><br/>http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50511<br/><br/>And we thought they'd be satisfied with their "60 acres and a mule"....<br/><br/>Take a look at the ethical implications. Western exploitation continues in many different ways:<br/><br/>http://www.annfammed.org/cgi/content/full/5/6/486#T1<br/><br/>It's so hard to find good, submissive help. Regarding IMG’s:

http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=50511

And we thought they’d be satisfied with their “60 acres and a mule”….

Take a look at the ethical implications. Western exploitation continues in many different ways:

http://www.annfammed.org/cgi/content/full/5/6/486#T1

It’s so hard to find good, submissive help.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83790 Anonymous Thu, 21 Feb 2008 01:22:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83790 This is interesting:<br/><br/>http://www.nationalpost.com/news/canada/Story.html?id=319808 This is interesting:

http://www.nationalpost.com/news/canada/Story.html?id=319808

]]> By: IVF-MDhttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83788 IVF-MD Wed, 20 Feb 2008 23:28:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83788 My previous comment should have read "what you propose would work, IN A FREE MARKET WORLD". This is yet another example of how, as Kevin has pointed out numerous times, the artificial non-free environment that medicine is today, contributes greatly to our present day mess. My previous comment should have read “what you propose would work, IN A FREE MARKET WORLD”. This is yet another example of how, as Kevin has pointed out numerous times, the artificial non-free environment that medicine is today, contributes greatly to our present day mess.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83787 Anonymous Wed, 20 Feb 2008 23:12:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83787 Americans also think they need antibiotics scans for colds, but that doesn't mean it's the best use of resources.<br/><br/>Perhaps the customer oriented nature of American medicine needs to be clipped back. Not every ache or pain needs an MD, no matter how important the potential patient is. Americans also think they need antibiotics scans for colds, but that doesn’t mean it’s the best use of resources.

Perhaps the customer oriented nature of American medicine needs to be clipped back. Not every ache or pain needs an MD, no matter how important the potential patient is.

]]> By: DermDochttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83785 DermDoc Wed, 20 Feb 2008 20:36:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83785 Its true Kevin. Derm PAs make more money (~100K here in California) and more PAs and NPs are trying to get derm jobs. Its true Kevin. Derm PAs make more money (~100K here in California) and more PAs and NPs are trying to get derm jobs.

]]> By: IVF-MDhttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83784 IVF-MD Wed, 20 Feb 2008 20:21:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83784 To the anonymous PA above, what you propose would work. The patient can make a choice of what to do with his own funds. Pay less for a PA (and be seen faster) or wait longer and pay more for a ER MD/DO. However, it doesn't work that way, because they are making that decision with someone ELSE footing the bill. Given no financial incentive and no sacrifice out of their own pocket, the tendency is to say "I want all that I can get for free". To the anonymous PA above, what you propose would work. The patient can make a choice of what to do with his own funds. Pay less for a PA (and be seen faster) or wait longer and pay more for a ER MD/DO. However, it doesn’t work that way, because they are making that decision with someone ELSE footing the bill. Given no financial incentive and no sacrifice out of their own pocket, the tendency is to say “I want all that I can get for free”.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83783 Anonymous Wed, 20 Feb 2008 19:35:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83783 I've been a PA for 30 years. I have had only one or two patients refuse to see me for that entire time. I work at an Urgent Care on weekends and routinely see 30 patients a day, none of whom seems to be upset to see a PA. There are plenty of MDs/DOs in the community, but they are generally doing something more entertaining on a Sunday afternoon. Or, someone could pay quadruple (or more) what they pay me and see a boarded EM physician for their influenza, but fortunately they have the sense to not do that. I’ve been a PA for 30 years. I have had only one or two patients refuse to see me for that entire time. I work at an Urgent Care on weekends and routinely see 30 patients a day, none of whom seems to be upset to see a PA. There are plenty of MDs/DOs in the community, but they are generally doing something more entertaining on a Sunday afternoon. Or, someone could pay quadruple (or more) what they pay me and see a boarded EM physician for their influenza, but fortunately they have the sense to not do that.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83776 Anonymous Wed, 20 Feb 2008 17:54:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-cost-shifting-imgs.html#comment-83776 If a US citizen finds a certain rural community undesirable, why would a Pakistani or Filipino or Asian Indian find the area any better?<br/><br/>In fact, they will often feel even less comfortable. Somebody from New York may feel like an outsider in a certain rural area. Somebody from Manila or New Delhi or Karachi even more so.<br/><br/>So yes, the IMG's have a practice geographic pattern that matches US graduates, and their preference for specialty practice is greater than US graduates.<br/><br/>If you want physicians to practice in rural America, you admit medical students who are from those rural areas. Then you make it worthwhile for the doc to practice there. You certainly don't pay them less, which is the current situation. If a US citizen finds a certain rural community undesirable, why would a Pakistani or Filipino or Asian Indian find the area any better?

In fact, they will often feel even less comfortable. Somebody from New York may feel like an outsider in a certain rural area. Somebody from Manila or New Delhi or Karachi even more so.

So yes, the IMG’s have a practice geographic pattern that matches US graduates, and their preference for specialty practice is greater than US graduates.

If you want physicians to practice in rural America, you admit medical students who are from those rural areas. Then you make it worthwhile for the doc to practice there. You certainly don’t pay them less, which is the current situation.

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