Ever schedule an appointment with a physician only to see a mid-level provider instead?
Patients better get used to it, as the doctor shortage, especially in primary care, is leading hospitals and practices to staff mid-level providers like nurse practitioners and physician assistants instead.
A retired doctor reminisces about the old days, and notes that “it is really all about economics,” and that the doctors patients really want “cannot realistically exist under the current economic situation.”
Financial trends are causing the system to evolve to one where doctors are in supervisory role, delegating direct patient care to surrogate mid-levels.
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- Informed consent is central to the doctor-patient relationship
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{ 6 comments }
I will seeing doctod every 3 months. Lastly i saw a doctor is on october 2008. I will doing the same schedule this year.
Not me. I pay for my own care. When I go to a restaurant and order steak. I will get a steak on my plate or walk out.
When I schedule with a doctor, I get a doctor–and would walk out otherwise.
If I go to the soup kitchen, I have to take what they offer me.
Docters in supervisory roles only? Silly. We don’t have nearly one doc for every 300 people. Plenty to provide all the patient care that is needed.
Besides, the “supervision” of mid-levels is a Big Lie, a farce. You can’t supervise care that is predicated on an exam you haven’t done. Fancy word for mindlessly countersigning to rent out your professional standing for a fee–almost always done long after the patient is long gone and thrived on, merely survived, or succumbed to the treatment anyway.
yes, i agree, we also need to be honest: the greed of many Primary Care Doctors , at least in our suburbs, is why mlp’s flourish! there are financial incentives to the 2 parties, and i have witnessed some doctors are just lazy. would rather “supervise” than provide direct care..
Your posts have such a constant theme of trying to maximize profits for doctors at the same time you bemoan the loss of relationships.
There are other options that let you have both. Qliance in Seattle is a practice that only has 800 patients per provider, 30 to 60 minute office visits but opts out of insurance and charges a flat fee of about $50 a month for unlimited access.
Since up to 40% of all health care dollars are wasted on billing and administration you don’t need as many admin staff. The doctor comes out to get the next patient. you gross over 480,000 a year
Stop complaining. Most people only make $45,000 a year so I am pretty sure you could cover your overhead with 1/2 a million a year? If not you need to go take a course in finance.
I really dislike the arguement “stop complaining, you make much more than others.” It’s a stupid and senseless arguement. People want ot be paid what they deserve. If you think a physician should be paid $45k per year, then by all means go the to neighborhood free clinic. But if you think I busted my ass for 12 years in school pulling A grades, spent 14 hour days toiling over other peoples problems, deal with death on a daily basis, I thinkwe desrve good pay. In England a PCP makes $250,000-$300,000 without worrying about any of the BS we have to. Before I started a practice similar to Qliance, I would never have remained a PCP. It just isn’t worth the cost, tension, and hassle.
Please do not just blame the greed of physicians for the growth of midlevels.
How about consumerism in medicine? Patients view their health care as a commodity they are paying for, like steak at a restaurant. They think they have a right to be seen when and where they want. What is urgicare anyway? At least 75% of cases at an urgicare are viral URI’s; these people should either be waiting for their doctors office to open or they do not need to be seen at all.
Consumerism in medicine drrives up cost because it increases utilization.
A family practitioner, who does not have a NP or PA in his office
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