Comments on: My take: Mid-levels, PCP summit http://www.kevinmd.com/blog/2008/02/my-take_05.html medical blog Sun, 22 Nov 2009 22:50:49 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Nurse Practitioner http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83443 Nurse Practitioner Fri, 08 Feb 2008 03:27:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83443 Kevin, you mention anecdotes of NP-rendered patient staisfaction and "appropriate" care. Well, I'd just like to provide you with some peer-reviewed evidence to perhaps shift your mindset a little: http://www.cochrane.org/reviews/en/ab001271.html, http://jama.ama-assn.org/cgi/content/abstract/283/1/59, http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=16282871&cmd=showdetailview&indexed=google (I have more if you'd like to see them). The fact is that NP's have been providing high-qulaity cost-effective care for years. <br/><br/>NP's will be willing and able to fill these voids in primary care. Kevin, you mention anecdotes of NP-rendered patient staisfaction and “appropriate” care. Well, I’d just like to provide you with some peer-reviewed evidence to perhaps shift your mindset a little: http://www.cochrane.org/reviews/en/ab001271.html, http://jama.ama-assn.org/cgi/content/abstract/283/1/59, http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=16282871&cmd=showdetailview&indexed=google (I have more if you’d like to see them). The fact is that NP’s have been providing high-qulaity cost-effective care for years.

NP’s will be willing and able to fill these voids in primary care.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83380 Anonymous Wed, 06 Feb 2008 05:30:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83380 "What a joke. The academic setting is precisely the wrong place to start if you want solutions."<br/><br/>100% true. Which is precisely why the politicians are avoiding dealing with real clinical physicians like the plague. The sorry excuses for Presidential candidates, third rate hacks like Tom Menino, the insurance companies, and various power-hungry bureaucracies are instead busy scheming on various ways to (excuse my language) screw us royally. <br/><br/>There are many, many billions of dollars to be made by unscrupulous insurance companies with government monopoly contracts. There's big money also to corrupt politicians (Think Bill Clinton's recent influence peddling for mega-millions).<br/><br/>Ed Sodaro MD “What a joke. The academic setting is precisely the wrong place to start if you want solutions.”

100% true. Which is precisely why the politicians are avoiding dealing with real clinical physicians like the plague. The sorry excuses for Presidential candidates, third rate hacks like Tom Menino, the insurance companies, and various power-hungry bureaucracies are instead busy scheming on various ways to (excuse my language) screw us royally.

There are many, many billions of dollars to be made by unscrupulous insurance companies with government monopoly contracts. There’s big money also to corrupt politicians (Think Bill Clinton’s recent influence peddling for mega-millions).

Ed Sodaro MD

]]> By: ERP http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83376 ERP Wed, 06 Feb 2008 01:50:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83376 Hmmm. Interesting. I know several PCP's who use midlevels to do a lot of their work in the office. I am sure that most patients are happy with them since they have been working there for many years. Some people however, are just snooty and refuse to even be examined by PA. I guess as they encounter more good ones, that attitude may change. Hmmm. Interesting. I know several PCP’s who use midlevels to do a lot of their work in the office. I am sure that most patients are happy with them since they have been working there for many years. Some people however, are just snooty and refuse to even be examined by PA. I guess as they encounter more good ones, that attitude may change.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83375 Anonymous Wed, 06 Feb 2008 01:18:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83375 I think using mid-levels for primary care is an inexorable trend, particularly as it seem that prpimary care will continue to decline in numbers and influence.<br/><br/>What I see is the efficacious use of mid-levels in specialists' offices to perform primary care. The added advantage is that if a true specialty need arises the specialist is on the premises available for prompt consultation. It's pretty hard to argue against instant access.<br/><br/>That does not take the place of comprehensive health care, but since patients are self-referring for a specific problem anyway, the comprehensive part of it is not a concern of the specialist. I think using mid-levels for primary care is an inexorable trend, particularly as it seem that prpimary care will continue to decline in numbers and influence.

What I see is the efficacious use of mid-levels in specialists’ offices to perform primary care. The added advantage is that if a true specialty need arises the specialist is on the premises available for prompt consultation. It’s pretty hard to argue against instant access.

That does not take the place of comprehensive health care, but since patients are self-referring for a specific problem anyway, the comprehensive part of it is not a concern of the specialist.

]]> By: Greg Kelly http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83370 Greg Kelly Tue, 05 Feb 2008 22:50:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83370 So right Dr. Kev. It's the docs in the trenches who have their finger on the pulse—literally and figuratively. When it comes to any meaningful change in American medicine, if you don’t get their buy in, it’s really not going to happen. Just as it should be.<br/><br/>And you do great work representing that group. Keep up the outrage.<br/><br/>Greg Kelly<br/>Physicians’ Financial News<br/>www.pfnlive.com So right Dr. Kev. It’s the docs in the trenches who have their finger on the pulse—literally and figuratively. When it comes to any meaningful change in American medicine, if you don’t get their buy in, it’s really not going to happen. Just as it should be.

And you do great work representing that group. Keep up the outrage.

Greg Kelly
Physicians’ Financial News
http://www.pfnlive.com

]]> By: Anonymous http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83369 Anonymous Tue, 05 Feb 2008 22:04:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83369 When I did a number on my ankle playing basketball I was quite satisfied to see a PA. Had the bone been sticking out of my skin I probably would have gone to the ER. Since I could hobble home I did, and called my health plan. <br/><br/>I got in with a PA promptly, saving me the indignity of the ER. He wiggled it around in a gentle way and send me on for an Xray. Nothing broken, wrap it up and stay off of it. <br/><br/>Had it been broken I would have expected to see an MD. Had it not improved in a few days I would have called back and seen an MD.<br/><br/>All in all I'd rather see and NP or PA promptly at my health center where my records are than sit among the unwashed in the ER. When I did a number on my ankle playing basketball I was quite satisfied to see a PA. Had the bone been sticking out of my skin I probably would have gone to the ER. Since I could hobble home I did, and called my health plan.

I got in with a PA promptly, saving me the indignity of the ER. He wiggled it around in a gentle way and send me on for an Xray. Nothing broken, wrap it up and stay off of it.

Had it been broken I would have expected to see an MD. Had it not improved in a few days I would have called back and seen an MD.

All in all I’d rather see and NP or PA promptly at my health center where my records are than sit among the unwashed in the ER.

]]> By: Christine-Megan http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83368 Christine-Megan Tue, 05 Feb 2008 21:56:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83368 I have no problem seeing an NP once in awhile. They definitely serve a purpose. I want to be an NP eventually. <br/><br/>However, if I never saw the doctor, I'd be pissed. NPs were never meant to replace doctors, nor do they want to in my experience.<br/><br/>I think Dr. Crippen was way off the mark when he said that they don't know when to get the doctor involved though. That hasn't been my experience at all. I have no problem seeing an NP once in awhile. They definitely serve a purpose. I want to be an NP eventually.

However, if I never saw the doctor, I’d be pissed. NPs were never meant to replace doctors, nor do they want to in my experience.

I think Dr. Crippen was way off the mark when he said that they don’t know when to get the doctor involved though. That hasn’t been my experience at all.

]]> By: Happyman http://www.kevinmd.com/blog/2008/02/my-take_05.html/comment-page-1#comment-83367 Happyman Tue, 05 Feb 2008 21:51:00 +0000 http://clients.emmense.com/kevinmd/2008/02/my-take-mid-levels-pcp-summit.html#comment-83367 very well put Kevin.<br/><br/>My feeling about the expansion of e.g. minute-clinics as the answer to primary care: It's a RIDICULOUS stretch to say that NPs & PAs treating "simple stuff" like URI's, strep throat, etc. will fill the primary care void that will grow as the elderly medicare population grows. <br/><br/>The majority of those folks using minute-clinics will inevitably be young & healthy overall, between jobs & therefore uninsured. These guys will get over their colds within a few days anyway, with or without the z-pak & robitussin.<br/><br/>For the 75-yr-old on 10 meds with chf, uncontrolled diabetes, and pneumonia, it'll be a different story, and the minute-clinic will only be a useless $50 stopover on the way to the ER (hopefully). very well put Kevin.

My feeling about the expansion of e.g. minute-clinics as the answer to primary care: It’s a RIDICULOUS stretch to say that NPs & PAs treating “simple stuff” like URI’s, strep throat, etc. will fill the primary care void that will grow as the elderly medicare population grows.

The majority of those folks using minute-clinics will inevitably be young & healthy overall, between jobs & therefore uninsured. These guys will get over their colds within a few days anyway, with or without the z-pak & robitussin.

For the 75-yr-old on 10 meds with chf, uncontrolled diabetes, and pneumonia, it’ll be a different story, and the minute-clinic will only be a useless $50 stopover on the way to the ER (hopefully).

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