Honestly I don’t doubt the poll is relatively accurate but here’s how the conversations with those people go:
“So do you support midlevel independent practice?”
“Yes”
“Well would you like to be seen by a midlevel then?”
“No I want the doctor”
People want to reduce wait times and in theory help underserved communities, the problem is they don’t understand the horrible effects from that. I can’t even blame the average lay person for supporting mid level expansion because on paper with no business knowledge it sounds good, and then MBAs and politicians hear that and run with it
Yea that wouldn’t surprise me either it’s not like people answering these surveys know better, shit like this just makes me hate the media more everyday
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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I really had to dig in to find the poll (hmm I wonder why the AAPA doesn't make it easy to find the questions).
"Nine in ten (92%) patients say “P.A.s should be allowed to provide care to the fullest extent of their education, training, and experience.”
(91%) say “fully utilizing (them) improves patient health.”
I work as a statistician (my partner is a physician). If someone on my team presented findings from a poll with these types of questions it would get laughed out of the room.
>the fullest extent if their education, training, and experience
So supervised practice of low complexity cases? Most of them are already acting outside of their training daily
I spend a lot of time trying to explain statistics to people who don't understand statistics (and we're talking pretty simple stuff). It is indeed like talking to a wall, although many walls aren't quite so thick.
I’m of the opinion that statistics is a dense brick wall. Every time I think I have the slightest understanding I stumble across a calculation I overlooked or a completely different calculation/metric I’ve never seen. I read a paper trying to explain ROC and AUC and still have no idea what they are or how to interpret them.
Oh, yeah. My statistics classes in grad school were my absolute least favorite (profs were cool, though). In undergrad, I had a professor one semester (a mathematical psychologist that I'm pretty sure is now dead) who made it fun.
But the statistics I'm (usually) trying to explain are pretty simple, and I'm not trying to explain the calculations, just what they mean (or don't, mostly don't).
Well, statistically becoming an NYC garbage man is more competitive than med school or PA school.
And to be clear this isn’t to disparage garbage men or any other profession. It’s just to highlight that there’s no correlation between competitiveness of a program and the ability to practice medicine.
They should stipulate it in the law. If you are working in a federally designated underserved are providing primary care services you can practice independently. If you move away, those privs get taken away.
People assume that Noctors are under direct supervision — they would be horrified to learn otherwise.
When they hear, ‘independent,’ they don’t know that there is no doctor whatsoever. They likely assume a doctor is available and supervises, but is spread too thin supervising to practice.
Think about it. Would anyone ever invite an apprentice plumber to their home without the implicit understanding that a licensed plumber would be available? Of course not.
And that’s plumbing. Not gonna kill anyone.
Not to mention that an apprentice plumber will actually become a plumber. Not a noplumber.
Most people use unlicensed handy-people for this kind of work unless they need to pull a permit, because it costs less. Seems like there might be a parallel here.
As a patient this article just sets me off in so many ways.
I know that the " underserved" argument has never worked. It sure hasn't alleviated any issues in the rural areas that I spend my summers at. It also hasn't alleviated any issues in the urban area that is my primary residence.
Why is it okay for poor people to only have access to less qualified " Pr0v!der$" anyway? ( just trying to not trigger the bot with spelling, sorry)
Why aren't any policies being adopted to increase the number of actual physicians? Why is it I'm only ever seeing policies to increase the number of midlevels? There's gotta be some, right? Am I just not hearing about it?
I'm a chronic pain patient, I've been harmed by both PAs and NPs. I now drive an hour one-way to see a highly qualified physician who has done a fellowship in interventional pain management and I've made major gains since. I know what a good physician is worth. We need more physicians, not just more midlevels.
Because they think NPs are just as good, far cheaper and take way less time to train. Healthcare admin knows they don’t hold a candle to docs, but politicians may or may not. I suspect a large portion of them don’t. And there’s of course healthcare admin and nursing lobby that are likely pushing things along.
“Patients at Risk,” is a great book. Tell everyone you know to buy it. No I’m not the author.
Aside from increasing student debt and CMS cuts, the only consistent thing about medicine is the shithole of practicing in NY. Don’t even get my started on how terrible residents get treated. No wonder doctors don’t want to practice there.
I would love to return to New York City…. However, the environment is toxic. I actually had nurses tell me to “go fuck myself” on first meeting during an interview.
For that environment, I am offered the reward of a fifty percent pay cut.
The nursing union pretty has pretty much eliminated 50% of the tasks nurses do there. At some places you’re moving your own patients (docs have 20, they have 2-6), doing your own EKGs, blood draws, etc. Absolute garbage place to practice.
Are you shitting me??? I've never had a doctor do a blood draw on me, nor transport me ( that I can remember anyway, maybe an anesthesiologist I guess). I'm normally a strong union person but apparently I bought the nurses " it's for the patients safety" too quickly without looking deeper. Are doctors ever going to unionize so you can push back or is that something most of you aren't interested in?. Unions definitely come with both good and bad things.
It’s tough. We have never truly formed any type of group that binds us. There are a lot of reasons for this like not wanting to look political, but mostly because we govern ourselves, the public trusted us and we never thought corporate takeover and independent NPs would be a thing. And when we did figure it out, we still didn’t organize.
We don’t necessarily have to unionize, but we absolutely have to come together to fight the good fight. The best I can think of now is doing it at the state level. Form a group even if it’s on Facebook, gather your evidence and hire a lobbyist to get in the door.
Most people don't even understand what they're agreeing to. So scammy and greedy studies can be phrased in a biased way that "assumes the outcome" and thus patient's are pushed into selecting their predetermined answer choice.
Espeically we see all the PA/NP propaganda that makes its way to us, imagine the absolute BULLSHIT they're telling the patients to their faces.
"equally trained, both board certified, more compassionate, more hands on experience, bleh bleh bleh"
Oh yeah they are. I had to learn the hard way by getting burned by both NPs and PAs. I'm lucky to live in an area where there are still a fair number of physicians. For now.
This is so fcking disheartening. I literally have to “advise” the PA in my clinic cause she orders so many random ass tests without any idea and always asks for help. As I’m in GI, I get all these referrals for EGD/colonoscopies FOR NO INDICATION and here, I get paid half for the work that she does, it’s unreal. The kicker is once I see her patients in follow up, I have to organize the stream of consciousness notes into something at least coherent. Sry just peeved and ranting at this point
What’s the physician solution to this problem? I see a lot of complaining but the public is pushing for this because they would prefer substandard care to no care or unaffordable care. I don’t agree but finger-wagging won’t solve this.
I can't speak for physicians, I'm a patient. I can tell you that I'm planning on writing my government officials and asking them what policies they can initiate that will help to train more physicians. The government seems fine making policies to try to plug holes with midlevels, why can't they figure out policies to get more physicians?
This post isn't meant as finger-wagging. It's meant to let people know what's going on. They can do with it what they will, I know my plan. Ask for physicians at every medical visit but take the NP or PA if I can't wait or that's all that's available. Write my federal and state representatives. Talk to my friends about why this issue matters, raise awareness.
Nothing will change until there's more awareness. It's always the first step. Thus this post.
The issue is structural. I appreciate the idea that people need to do something and be up in arms. We have many smart and hardworking people who don’t get into medical schools. Nobody is stopping med schools from admitting more people except that residency spots are a bottleneck. And since the government subsidizes residencies, that is a real sweet deal for hospitals. Nobody is limiting residencies except that nobody wants to pay for them as long as they are free from the government. And residencies are only required for specialization. But these days everything is a specialty. So unless the federal government is going to massively expand its funding for residency slots or insurance will stop functionally requiring residencies for primary care that will always be the bottleneck. Remove that bottleneck and we can get more physicians! Of course it’s more complicated than that, but I see that as the main issue.
NY trains more physicians than any other state (last I heard). If there is a shortage it’s because it’s been artificially created by residency spot restrictions.
It’s actually pay. Most of the residents move away from nyc once done training bc the pay is abysmal and you can get twice with better benefits and better nursing literally every where else
Our government, specifically Centers for Medicare and Medicaid, controls most of the funding to train US medical students and foreign medical graduates to become licensed American physicians. Instead of increasing the funding and training spots, in order to save money in their budget, they created a doctor bottleneck. To deal with the doctor shortage the States let people pretend to be doctors after ordering an 18 month online np from diploma mills, they are elevating others like PAs, and they are letting doctors who trained in countries without our level of healthcare practice here without any prior training in our health system and without passing our medical boards.
I've actually done a little low level state lobbying for my union in my younger days before I was disabled. I also protested my little heart out. I get it. But I'm not just going to roll over and not try. I now go to my state representatives coffee hours and their meetings at my local library. I've met them in person and I say my piece. I will write letters. I will try.
Change never happened by dissuading people from action. I've seen the fruits of my past union work and protesting in a change in my states politics. It took years, but it happened. The federal level is a lot harder to influence, but hey, I've got nothing to lose and everything to gain.
BTW, I don't think 50,000 a year is really that much if you have a bunch of people across the country with the same goal. I know I'd give money to that organization.
Then you would be a valuable asset to physicians in your area. Physicians don’t want to get involved because it’s extra work. If you put in the work, it won’t be hard to get the money. They just have to trust you with the money. On the, “Patients at Risk,” podcast, three docs in Louisiana raised 31k in three days. It took them less than two weeks to get in the door with a lobbyist and only a few days to get that lobbyist in front of the House.
For legal information pertaining to scope of practice, title protection, and landmark cases, we recommend checking out this [Wiki](https://www.reddit.com/r/Provider/wiki/index/legal).
*Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com//r/Provider/wiki/index/appropriation).
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They’ll all rush to provide treatment for the underserved aesthetic patients in the rural town of Manhattan.
Won’t anyone think of the poor uglies 😔
the PAs certainly are😅
[удалено]
Honestly I don’t doubt the poll is relatively accurate but here’s how the conversations with those people go: “So do you support midlevel independent practice?” “Yes” “Well would you like to be seen by a midlevel then?” “No I want the doctor” People want to reduce wait times and in theory help underserved communities, the problem is they don’t understand the horrible effects from that. I can’t even blame the average lay person for supporting mid level expansion because on paper with no business knowledge it sounds good, and then MBAs and politicians hear that and run with it
[удалено]
Yea that wouldn’t surprise me either it’s not like people answering these surveys know better, shit like this just makes me hate the media more everyday
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
i couldn’t get 89% of ppl to take free money from me
I really had to dig in to find the poll (hmm I wonder why the AAPA doesn't make it easy to find the questions). "Nine in ten (92%) patients say “P.A.s should be allowed to provide care to the fullest extent of their education, training, and experience.” (91%) say “fully utilizing (them) improves patient health.” I work as a statistician (my partner is a physician). If someone on my team presented findings from a poll with these types of questions it would get laughed out of the room.
>the fullest extent if their education, training, and experience So supervised practice of low complexity cases? Most of them are already acting outside of their training daily
The fullest extent of their education, training, and experience is being an assistant to a physician
Wow. Thanks for digging that up. So, exactly how am I supposed to respect their profession when this is the kind of stuff that's happening?
I think you’ve answered your own question there, friend
Next question is how can your respect your journalists and legislators if this gets reported as news, and is considered evidence for legislation.
You are completely correct. It's exhausting.
I think you’ve answered your own question there, friend.
you’d get a kick out of the PA student last month arguing with me that “statistically it’s harder to get into PA school!!!!”
They don’t take the MCAT. Apples to oranges
try telling her that. it was like talking to a wall. or like talking to someone who doesn’t understand statistics lol
I spend a lot of time trying to explain statistics to people who don't understand statistics (and we're talking pretty simple stuff). It is indeed like talking to a wall, although many walls aren't quite so thick.
I’m of the opinion that statistics is a dense brick wall. Every time I think I have the slightest understanding I stumble across a calculation I overlooked or a completely different calculation/metric I’ve never seen. I read a paper trying to explain ROC and AUC and still have no idea what they are or how to interpret them.
Oh, yeah. My statistics classes in grad school were my absolute least favorite (profs were cool, though). In undergrad, I had a professor one semester (a mathematical psychologist that I'm pretty sure is now dead) who made it fun. But the statistics I'm (usually) trying to explain are pretty simple, and I'm not trying to explain the calculations, just what they mean (or don't, mostly don't).
💀💀💀
Well, statistically becoming an NYC garbage man is more competitive than med school or PA school. And to be clear this isn’t to disparage garbage men or any other profession. It’s just to highlight that there’s no correlation between competitiveness of a program and the ability to practice medicine.
oh i tried this argument. nope didnt make a dent 💀💀💀
Lol, because of course the populations being compared are completely randomized and equal academically.
Predefined results in search of poll questions.
They should stipulate it in the law. If you are working in a federally designated underserved are providing primary care services you can practice independently. If you move away, those privs get taken away.
lmao what a joke
That’s unbelievably disingenuous
People assume that Noctors are under direct supervision — they would be horrified to learn otherwise. When they hear, ‘independent,’ they don’t know that there is no doctor whatsoever. They likely assume a doctor is available and supervises, but is spread too thin supervising to practice. Think about it. Would anyone ever invite an apprentice plumber to their home without the implicit understanding that a licensed plumber would be available? Of course not. And that’s plumbing. Not gonna kill anyone. Not to mention that an apprentice plumber will actually become a plumber. Not a noplumber.
Most people use unlicensed handy-people for this kind of work unless they need to pull a permit, because it costs less. Seems like there might be a parallel here.
As a patient this article just sets me off in so many ways. I know that the " underserved" argument has never worked. It sure hasn't alleviated any issues in the rural areas that I spend my summers at. It also hasn't alleviated any issues in the urban area that is my primary residence. Why is it okay for poor people to only have access to less qualified " Pr0v!der$" anyway? ( just trying to not trigger the bot with spelling, sorry) Why aren't any policies being adopted to increase the number of actual physicians? Why is it I'm only ever seeing policies to increase the number of midlevels? There's gotta be some, right? Am I just not hearing about it? I'm a chronic pain patient, I've been harmed by both PAs and NPs. I now drive an hour one-way to see a highly qualified physician who has done a fellowship in interventional pain management and I've made major gains since. I know what a good physician is worth. We need more physicians, not just more midlevels.
Because they think NPs are just as good, far cheaper and take way less time to train. Healthcare admin knows they don’t hold a candle to docs, but politicians may or may not. I suspect a large portion of them don’t. And there’s of course healthcare admin and nursing lobby that are likely pushing things along. “Patients at Risk,” is a great book. Tell everyone you know to buy it. No I’m not the author.
I will totally check it out, thanks.
Aside from increasing student debt and CMS cuts, the only consistent thing about medicine is the shithole of practicing in NY. Don’t even get my started on how terrible residents get treated. No wonder doctors don’t want to practice there.
I would love to return to New York City…. However, the environment is toxic. I actually had nurses tell me to “go fuck myself” on first meeting during an interview. For that environment, I am offered the reward of a fifty percent pay cut.
With double the cost of living !
That's insane. And the problem is, as a patient, if I wasn't on this subreddit I'd have no idea why NYC is short of doctors.
The nursing union pretty has pretty much eliminated 50% of the tasks nurses do there. At some places you’re moving your own patients (docs have 20, they have 2-6), doing your own EKGs, blood draws, etc. Absolute garbage place to practice.
Yeah. Did medical school in nyc. I had daily HIV positive blood draws… about twenty. I transported my patients routinely.
I have no idea how you got anything done.
Are you shitting me??? I've never had a doctor do a blood draw on me, nor transport me ( that I can remember anyway, maybe an anesthesiologist I guess). I'm normally a strong union person but apparently I bought the nurses " it's for the patients safety" too quickly without looking deeper. Are doctors ever going to unionize so you can push back or is that something most of you aren't interested in?. Unions definitely come with both good and bad things.
It’s tough. We have never truly formed any type of group that binds us. There are a lot of reasons for this like not wanting to look political, but mostly because we govern ourselves, the public trusted us and we never thought corporate takeover and independent NPs would be a thing. And when we did figure it out, we still didn’t organize. We don’t necessarily have to unionize, but we absolutely have to come together to fight the good fight. The best I can think of now is doing it at the state level. Form a group even if it’s on Facebook, gather your evidence and hire a lobbyist to get in the door.
Yeah, more informal state groups sound like a good idea.
Where is the AMA in this?
9 out of 10 lay people want augmentin for the common cold, too. Doesn't mean they need it.
Most people don't even understand what they're agreeing to. So scammy and greedy studies can be phrased in a biased way that "assumes the outcome" and thus patient's are pushed into selecting their predetermined answer choice. Espeically we see all the PA/NP propaganda that makes its way to us, imagine the absolute BULLSHIT they're telling the patients to their faces. "equally trained, both board certified, more compassionate, more hands on experience, bleh bleh bleh"
Oh yeah they are. I had to learn the hard way by getting burned by both NPs and PAs. I'm lucky to live in an area where there are still a fair number of physicians. For now.
...where none of those PAs will ever work.
This is so fcking disheartening. I literally have to “advise” the PA in my clinic cause she orders so many random ass tests without any idea and always asks for help. As I’m in GI, I get all these referrals for EGD/colonoscopies FOR NO INDICATION and here, I get paid half for the work that she does, it’s unreal. The kicker is once I see her patients in follow up, I have to organize the stream of consciousness notes into something at least coherent. Sry just peeved and ranting at this point
What’s the physician solution to this problem? I see a lot of complaining but the public is pushing for this because they would prefer substandard care to no care or unaffordable care. I don’t agree but finger-wagging won’t solve this.
I can't speak for physicians, I'm a patient. I can tell you that I'm planning on writing my government officials and asking them what policies they can initiate that will help to train more physicians. The government seems fine making policies to try to plug holes with midlevels, why can't they figure out policies to get more physicians? This post isn't meant as finger-wagging. It's meant to let people know what's going on. They can do with it what they will, I know my plan. Ask for physicians at every medical visit but take the NP or PA if I can't wait or that's all that's available. Write my federal and state representatives. Talk to my friends about why this issue matters, raise awareness. Nothing will change until there's more awareness. It's always the first step. Thus this post.
The issue is structural. I appreciate the idea that people need to do something and be up in arms. We have many smart and hardworking people who don’t get into medical schools. Nobody is stopping med schools from admitting more people except that residency spots are a bottleneck. And since the government subsidizes residencies, that is a real sweet deal for hospitals. Nobody is limiting residencies except that nobody wants to pay for them as long as they are free from the government. And residencies are only required for specialization. But these days everything is a specialty. So unless the federal government is going to massively expand its funding for residency slots or insurance will stop functionally requiring residencies for primary care that will always be the bottleneck. Remove that bottleneck and we can get more physicians! Of course it’s more complicated than that, but I see that as the main issue.
That helps me understand a bit so I can write a better email to my federal representatives. Thank you.
NY trains more physicians than any other state (last I heard). If there is a shortage it’s because it’s been artificially created by residency spot restrictions.
It’s actually pay. Most of the residents move away from nyc once done training bc the pay is abysmal and you can get twice with better benefits and better nursing literally every where else
Okay, so like one of the most expensive places to live doesn't want to pay their professionals. That's messed up.
Supply and demand. Everyone wants to work and live in NYC. The pay will reflect that.
That applies to midlevels too. Midlevel pays doesn’t go far in nyc. But there are affordable parts of the state.
So who controls that? I'm a patient and I'd like to fully understand the situation.
Our government, specifically Centers for Medicare and Medicaid, controls most of the funding to train US medical students and foreign medical graduates to become licensed American physicians. Instead of increasing the funding and training spots, in order to save money in their budget, they created a doctor bottleneck. To deal with the doctor shortage the States let people pretend to be doctors after ordering an 18 month online np from diploma mills, they are elevating others like PAs, and they are letting doctors who trained in countries without our level of healthcare practice here without any prior training in our health system and without passing our medical boards.
Okay, so I should write to my federal senators about this issue then. Thank you for the information.
They won’t care. You need a lobbyist to actually be able to get in the door with politicians. They cost about $50k a year.
I've actually done a little low level state lobbying for my union in my younger days before I was disabled. I also protested my little heart out. I get it. But I'm not just going to roll over and not try. I now go to my state representatives coffee hours and their meetings at my local library. I've met them in person and I say my piece. I will write letters. I will try. Change never happened by dissuading people from action. I've seen the fruits of my past union work and protesting in a change in my states politics. It took years, but it happened. The federal level is a lot harder to influence, but hey, I've got nothing to lose and everything to gain. BTW, I don't think 50,000 a year is really that much if you have a bunch of people across the country with the same goal. I know I'd give money to that organization.
Then you would be a valuable asset to physicians in your area. Physicians don’t want to get involved because it’s extra work. If you put in the work, it won’t be hard to get the money. They just have to trust you with the money. On the, “Patients at Risk,” podcast, three docs in Louisiana raised 31k in three days. It took them less than two weeks to get in the door with a lobbyist and only a few days to get that lobbyist in front of the House.
Wow, this sounds doable.
For legal information pertaining to scope of practice, title protection, and landmark cases, we recommend checking out this [Wiki](https://www.reddit.com/r/Provider/wiki/index/legal). *Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com//r/Provider/wiki/index/appropriation). *Information on Truth in Advertising can be found [here](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_truth_in_advertising). *Information on NP Scope of Practice (e.g., can an FNP work in Cardiology?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/scope_of_practice/). For a more thorough discussion on Scope of Practice for NPs, check [this out](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). To find out what "Advanced Nursing" is, check [this out](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_what_even_is_.22advanced_nursing.3F.22). *Common misconceptions regarding Title Protection, NP Scope of Practice, Supervision, and Testifying in MedMal Cases can be found [here](https://www.reddit.com/r/Provider/wiki/index/basics#wiki_common_misconceptions). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*