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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

#71

Post by pen2l »

FireBeyond wrote: post #60
pen2l wrote: post #18

In a very meaningful way the line between physician and non-physician had been blurring anyway. There's a software called Epic which is used by virtually all large healthcare centers, and while most know it as a database system to store patient history and health records (problems and conditions they've been diagnosed for, lab work results, medicine they're currently taking or have taken in the past), it also has a l…

Having worked in healthcare IT, and as a prehospital provider who has seen and interacted with many EHR systems, including Epic, Meditech, and ESO (moreso for prehospital)... the sooner Epic dies in a fire the better. Keyword-driven differentials should be, if anything, the baseline, bottom rung, pattern matching to inspire and drive critical thinking, focused assessment, and diagnostic skills. Not to "easy mode" the…

Epic very much is poised to take over and every week it appears a new large healthcare center makes the switch to it.

I think the hard lesson everyone must learn eventually is that they have to take control of/become deeply involved with their healthcare as much as possible, because dragons are everywhere. For the average person acute care is not needed when they're thinking of reaching out to the doctor, and they shouldn't because elevating level of intervention can quickly result in shit: got a headache or a hip injury? The doctors will give you a plethora of CT scans and you end up with cancer. Got pain? They'll give you opioids so you end up with crippling addiction.

It's true on a national level: https://www.wesh.com/article/us-health-care-worst-outcomes-h... and at a local level iatrogenesis is seen abound.

Indeed, of paramount importance for us is to learn how to take care of ourselves by going back to the basics (avoid processed diets, increase fibre-intake, etc, exercise (for the strength gains, for the endorphins and cardio/conditioning, for better bone density so that the body can whether through injuries better), cultivate your link to a positive community so it is there for you in your time of need). And download Epic and learn about healthcare/medicines and take charge as much as possible of your own fate. But when faced with a truly acute problem, see a specialist doctor and follow their commands.

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

#72

Post by coryrc »

syedkarim wrote: post #63
outlace wrote: post #28

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…

Why do you include your undergraduate degree as part of your medical training? I've asked dozens of doctors (and lawyers) about the relevance of their college/undergraduate education to their day-to-day work and none have said it was critical, most have said it was not relevant, and some have had completely non-medical majors (music and physics). Of course, maybe it's different for you, which is why I ask.

Anatomy and many other highly relevant undergraduate courses in biology and chemistry are mandatory for the postgraduate degrees.

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

#73

Post by lumost »

outlace wrote: post #28

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…

Isn’t this the natural outcome of the American medical associations license cap? A growing country will always need more medical professionals , if MDs cannot be accessed - then an alternative will emerge.

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

#74

Post by russdill »

outlace wrote: post #28

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…

I argued with a PA because they were convinced that the most likely reason for a high white blood cell count in my sample was that it was contaminated post collection. It was a very frustrating discussion that seemed to have gone around in circles many times. I eventually just had to agree to retest. I feel like this would not be an issue talking to an MD.

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

#75

Post by konschubert »

lumost wrote: post #73
outlace wrote: post #28

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…

Isn’t this the natural outcome of the American medical associations license cap? A growing country will always need more medical professionals , if MDs cannot be accessed - then an alternative will emerge.

Is there such a cap?

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

#76

Post by hn_throwaway_99 »

jdsleppy wrote: post #59
hn_throwaway_99 wrote: post #6

Honestly, I don't have any problem with this, and I see it as a great thing. 95% of the time when I go to the doctor it's something routine and basic, e.g. I just need someone to diagnose my cold/flu/infection etc. My question, though, is where are all the "savings" going if so many visits are now seen by lower paid professionals? I was referred to a sleep study, where a PA or nurse practitioner just proceeded to ask…

Why go to the doctor to be told it's a flu or a cold? There's nothing to do but treat yourself well and wait, right? I wonder what portion of visits are for common viruses.

Because if it's flu and it's early enough there is treatment (Tamiflu), and it's helpful to differentiate from things like strep, where there is also treatment.

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

#77

Post by underseacables »

It's getting harder to see a doctor, they only let you see a physicians assistant, Who acts like a doctor, but isn't. I understand they meet with a doctor later to discuss the case, but… It's just not the same. A physicians assistant is not a doctor

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

#78

Post by underseacables »

pen2l wrote: post #18

In a very meaningful way the line between physician and non-physician had been blurring anyway. There's a software called Epic which is used by virtually all large healthcare centers, and while most know it as a database system to store patient history and health records (problems and conditions they've been diagnosed for, lab work results, medicine they're currently taking or have taken in the past), it also has a l…

A few years ago I saw a young doctor and all she did was put stuff into an iPad that told her what to do next. I could not run from her fast enough. Medical care by iPad app is not the way to go

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

#79

Post by junofan »

konschubert wrote: post #75
lumost wrote: post #73

Earlier quoted context omitted.

Isn’t this the natural outcome of the American medical associations license cap? A growing country will always need more medical professionals , if MDs cannot be accessed - then an alternative will emerge.

Is there such a cap?

AMA lobbied for a cap on CMS residency funding, and I believe you need to do a residency to get a license, so effectively yes.

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

#80

Post by lionsdan »

konschubert wrote: post #75
lumost wrote: post #73

Earlier quoted context omitted.

Isn’t this the natural outcome of the American medical associations license cap? A growing country will always need more medical professionals , if MDs cannot be accessed - then an alternative will emerge.

Is there such a cap?

"In 1997, Congress passed the Balanced Budget Act, a bipartisan effort to cut back on spending. The act put a cap on the number of annual residencies CMS would support, and froze the funding at 1996 levels. . . . Since 2007, a bill to increase the number of residencies has been introduced in every Congress . . . but never passed."

https://www.washingtonian.com/2020/04/13/were-short-on-healt...

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