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A fourth of U.S. health visits now delivered by non-physicians

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Re: A fourth of U.S. health visits now delivered by non-physicians

#21

Post by Spivak »

fnfjfkdngh wrote: post #5

Because PA time is cheaper to the provider than MD time. Give it a few years and a trip to the doctor's office will mean using a touch screen a-la-mcdonalds to describe your symptoms and then the first-line medication pops out of a drawer. I'm pretty jaded with our (US) healthcare system. As long as you stay on the happy path it's fine, but if you stray from that, good luck. Over the last few years I was given antibi…

There's nothing actually stopping you from getting a fungal culture yourself. The turnaround time is over a month though. Unless you're at a huge hospital they just farm it out to Labcorp and the like and you can buy direct. Like it makes sense, if it's high-probability bacterial you might as well try the z pack first. It's faster to just treat it and see than to test if it's bacterial.

Also for SSRIs there's nothing to test, you just try them under medical supervision and if they help they help. There is an experimental DNA test that might be able to narrow down the antidepressant options but unless you're struggling to find one that works for you it's usually not worth bothering.

Medicine is crazy advanced in some specific areas but for the long tail we're not that far from leeches.

Re: A fourth of U.S. health visits now delivered by non-physicians

#22

Post by Waterluvian »

A month ago my kids had pink eye. One resolved within days, the other got worse. Instead of a doctor’s appointment the next day, we went to the pharmacy where the pharmacist evaluated him and prescribed an antibiotic. Whole thing took 15 minutes. Really made sense for “a parent could diagnose this” kinds of minor ailments.

Also: if it’s the pharmacist determining a med and immediately administering it, is she really “pre-scribing” anything?

Re: A fourth of U.S. health visits now delivered by non-physicians

#23

Post by mips_r4300i »

j-bos wrote: post #14

It wouldn't be so bad, except so many MDs, PAs, and NPs are just bad. This is coming from someone who has been traveling with a sick family member for a few years. There are great (read: skilled, thoughful, patient, investigative, this.patient data driven) professionals out there, but they are badly outnumbered and booked for months near a year into the future. A huge bunch display the interest, skill, or attention o…

This was my experience going through a half dozen doctors. I found a great one finally, but they didn't even bother taking insurance, and it was very expensive.

Re: A fourth of U.S. health visits now delivered by non-physicians

#24

Post by monero-xmr »

mips_r4300i wrote: post #23
j-bos wrote: post #14

It wouldn't be so bad, except so many MDs, PAs, and NPs are just bad. This is coming from someone who has been traveling with a sick family member for a few years. There are great (read: skilled, thoughful, patient, investigative, this.patient data driven) professionals out there, but they are badly outnumbered and booked for months near a year into the future. A huge bunch display the interest, skill, or attention o…

This was my experience going through a half dozen doctors. I found a great one finally, but they didn't even bother taking insurance, and it was very expensive.

Excluding emergency situations, the biggest issue IMO is diagnosis. So many tests, scans, listening, observation, etc. is all about understanding what the problem actually is. Once you accurately identify the problem, treatment can be effectively given (if one exists) via the current system.

For mysterious problems that elude a simple diagnosis you can really be stuck. Most doctors don’t have the time for complex cases. It’s worth becoming your own health researcher if no one else can identify the issue.

Re: A fourth of U.S. health visits now delivered by non-physicians

#25

Post by diogenescynic »

If you go to urgent care, you most likely won't get a physician. 9/10 visits are urgent care you only see a PA or NP and they can't even really do much. Urgent care seems to also provide really poor results--every time I've gone it's a long wait, the workers seem over-stressed, you barely get any time with the doctor, and usually they just do a strep test or give you a Zithromax pack and hope you'll go away.

Re: A fourth of U.S. health visits now delivered by non-physicians

#26

Post by subharmonicon »

Related: I was shocked when I tried to get a COVID booster in NY State and they told me they didn’t have a registered nurse on staff that day so they couldn’t do any vaccinations.

In California, all of my vaccinations have come from phlebotomists, and it seems that pharmacists can also do them here.

Why does NY State require an RN?

Re: A fourth of U.S. health visits now delivered by non-physicians

#27

Post by rcpt »

vsskanth wrote: post #12

The number of new physicians in the US are restricted because you need to go through residency and the number of residency slots are limited because they have to be funded by Medicare (why ?). There's a huge lobby (AMA) to keep it that way, to ensure their members salaries remain high. PAs and NPs don't have the same restriction so hospital systems are pushing to have them handle office visits as much as possible. Th…

AMA stopped lobbying for that around ten years ago

Re: A fourth of U.S. health visits now delivered by non-physicians

#28

Post by outlace »

MD here. I'm of two minds about this. On the one hand, obviously there's a bit of defensiveness since I went through 12 years of school and training to be an independent physician (4 years college, 4 years medical school, 4 years residency) and I've definitely seen subpar care from other "providers" (not a fan of the term) with less training. The wide variety of different "providers" is also confusing to patients who have little idea the differences in training and scope. The training for non-MD "providers" seems very variable, unlike the quite standardized MD training. I definitely think residency training is a much more robust and you need to have that critical feedback from supervising physicians to improve, which I think can be lacking in non-residency based training. Overall, nothing against PAs/NPs, I know some great ones.

On the other hand, a lot of what I do doesn't require 12 years of training, so I am sympathetic to making health care more accessible. I am also a bit jealous that my non-MD colleagues can easily switch from e.g. being a primary care PA to being dermatology PA, whereas as an MD I'm pretty much stuck in my specialty unless I go through another 4+ year residency. Instead of MD-training getting shorter to compete, it's actually getting longer in many cases. Residency trainings are getting longer not shorter for a number of specialties (e.g. neurosurgery, interventional cardiology, pediatric hospitalist).

Re: A fourth of U.S. health visits now delivered by non-physicians

#29

Post by Afforess »

rcpt wrote: post #27
vsskanth wrote: post #12

The number of new physicians in the US are restricted because you need to go through residency and the number of residency slots are limited because they have to be funded by Medicare (why ?). There's a huge lobby (AMA) to keep it that way, to ensure their members salaries remain high. PAs and NPs don't have the same restriction so hospital systems are pushing to have them handle office visits as much as possible. Th…

AMA stopped lobbying for that around ten years ago

Which given the 8-10 year pipeline to become a physician, means we have yet to see the effects. It will take years more.

Re: A fourth of U.S. health visits now delivered by non-physicians

#30

Post by robomartin »

penjelly wrote: post #20
robomartin wrote: post #16

Earlier quoted context omitted.

> Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. This is the problem with all of these systems that try to violate the laws of physics (aka: free market economics). They invariably results in substandard care, if you receive care at all. Keeping people alive isn't the same thing as actually solving problems with quality care. This is my b…

i already understand the economics, these types of systems exist everywhere, usually to the detriment of everyone. However, all they need to do is not deflect me from specialist care, so im not sure it applies 100% here. Check back in a month when i go to the office again and insist on seeing a specialist.

Mine was more of a general comment on these types of systems rather than an explanation for what you are going through. I have no clue why they are treating you in the way you describe. It might be interesting if you could ask them why they haven't referred you. Even more interesting if they gave you an honest answer.

Good luck.

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