Comments on: Do mid-levels want to take over primary care? http://www.kevinmd.com/blog/2008/11/do-mid-levels-want-to-take-over-primary.html medical blog Sun, 22 Nov 2009 07:50:13 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/11/do-mid-levels-want-to-take-over-primary.html/comment-page-1#comment-88007 Anonymous Sat, 08 Nov 2008 22:45:00 +0000 http://clients.emmense.com/kevinmd/2008/11/do-mid-levels-want-to-take-over-primary-care.html#comment-88007 Why must this always be an either or situation?<br/><br/>re: "higher pay and better hours"<br/><br/>Most specialists think PCP's should be payed more but believe it or not not all subspecialists are rolling in dough. Talk with you local ID doc or rheum. CMS a few years ago stopped the markup for oncologists on their drugs (which I don't agree with ethically) but did they make up for it any way? No. Talk with your consultant oncologist Dr. Val/Kevin, their practice's are often crashing into the red. The global fee for general surgeons on their procedures such as chole's is a friggen joke. About hours, believe or not guys your tyical surgeon/medical subspecialist puts in a hell of a lot of hours. IMO usually more than PCP's. We are not talking lifestyle fields here. <br/>Most general surgeons and many medical subspecialists also spent 2-5 more years on in training at indentured servants wages. I agree we need to get away from paying for procedures and more for time. But a bigger issue is the health care pie is not going to grow in size. What we should be talking about is reasonable expectations in care. Maybe we shouldn't abuse people in the ICU to prolong their deathes. Maybe 90 year old's with comorbidities shouldn't get CABG's of dialysis. Maybe we shouldn't give 5th line chemo in a terminal situtaton. But in all honesty these are not just MD discussions, these are SOCIETY discussions. IMO Americans have shown no interstr in having these honest discussions (see the absence in the latest election). We want everything an we want it now...or we will call a lawyer. Until American society realizes that more isn't better and healthcare is not limitless for all nothing will change. Why must this always be an either or situation?

re: “higher pay and better hours”

Most specialists think PCP’s should be payed more but believe it or not not all subspecialists are rolling in dough. Talk with you local ID doc or rheum. CMS a few years ago stopped the markup for oncologists on their drugs (which I don’t agree with ethically) but did they make up for it any way? No. Talk with your consultant oncologist Dr. Val/Kevin, their practice’s are often crashing into the red. The global fee for general surgeons on their procedures such as chole’s is a friggen joke. About hours, believe or not guys your tyical surgeon/medical subspecialist puts in a hell of a lot of hours. IMO usually more than PCP’s. We are not talking lifestyle fields here.
Most general surgeons and many medical subspecialists also spent 2-5 more years on in training at indentured servants wages. I agree we need to get away from paying for procedures and more for time. But a bigger issue is the health care pie is not going to grow in size. What we should be talking about is reasonable expectations in care. Maybe we shouldn’t abuse people in the ICU to prolong their deathes. Maybe 90 year old’s with comorbidities shouldn’t get CABG’s of dialysis. Maybe we shouldn’t give 5th line chemo in a terminal situtaton. But in all honesty these are not just MD discussions, these are SOCIETY discussions. IMO Americans have shown no interstr in having these honest discussions (see the absence in the latest election). We want everything an we want it now…or we will call a lawyer. Until American society realizes that more isn’t better and healthcare is not limitless for all nothing will change.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/11/do-mid-levels-want-to-take-over-primary.html/comment-page-1#comment-88001 Anonymous Sat, 08 Nov 2008 16:03:00 +0000 http://clients.emmense.com/kevinmd/2008/11/do-mid-levels-want-to-take-over-primary-care.html#comment-88001 In relative terms physicians assistants and nurse practitioner are still the best set up to fill primary care needs. Yes its hard for someone to go back to school for a couple years and pay tuition of $100,000. But compare that to physician who are accumulating $350,000 of medical school debt and take 8 years to train for the same job. Most doctors have little to no work experience and often have 4-5 years of undergraduate debt and living expenses. Where NPs often have several years work experience earning good money and may have savings to pay for NP training. Physicians may also be bearing additional $10-100k debt in the form of small business loans for office equipment and practice overhead before they start to earn any real money. PA/NPs are most often salaried out school and bear little to no administrative burden. Bottom line, when you look at the larger financial picture it can take decades for a doctor to reach the same wealth level as a NP/PA for the same work. PA/NP do have a relative financial advantage for them to assume the primary care role. In relative terms physicians assistants and nurse practitioner are still the best set up to fill primary care needs. Yes its hard for someone to go back to school for a couple years and pay tuition of $100,000. But compare that to physician who are accumulating $350,000 of medical school debt and take 8 years to train for the same job. Most doctors have little to no work experience and often have 4-5 years of undergraduate debt and living expenses. Where NPs often have several years work experience earning good money and may have savings to pay for NP training. Physicians may also be bearing additional $10-100k debt in the form of small business loans for office equipment and practice overhead before they start to earn any real money. PA/NPs are most often salaried out school and bear little to no administrative burden. Bottom line, when you look at the larger financial picture it can take decades for a doctor to reach the same wealth level as a NP/PA for the same work. PA/NP do have a relative financial advantage for them to assume the primary care role.

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