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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

#91

Post by ip26 »

mips_r4300i wrote: post #54
monero-xmr wrote: post #24

Earlier quoted context omitted.

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 cas…

The first doctor I had wanted to send me to get my thyroid nuked because it was inflamed after a viral infection. After 2 years and 6 doctors I found I basically had long covid years before it was recognized. Probably from a low grade garden variety viral infection. My gut developed food sensitivities and I started to develop autoimmune problems from that. After finding the right doctor who could handle researching c…

Did you do anything to directly address the autoimmune problems etc, or simply managed your chronic conditions and everything eventually cleared up?

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

#92

Post by Shekelphile »

Some states have weaponized this. In Florida for example a huge amount of offices are staffed by NPs but they have passed legislation to lock certain groups of people out from receiving care from them as they are the target of the current political hot button issue. Being told you need to find an MD when most offices won't let you see one and may not even have one in the building at the time is laughable.

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

#93

Post by exhilaration »

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

Is that because they won? This comment explains the history: https://news.ycombinator.com/item?id=38063504

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

#94

Post by kortilla »

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…

The system is completely broken with you taking 12 years to train.

It means that:

- you are expected to learn way too much and only have a surface understanding of a lot of things (see tick example from sibling comment)

- your time is very valuable so you can’t put any time effort into patients at all to try to deeply understand anything that doesn’t pass your “known expertise” classifier.

My son has back pain that most closely matches descriptions of sciatica.

The 3 MDs he has been given a cumulative exposure time of maybe 15 minutes to have resulted in prescriptions for various muscle relaxers and steroids based on a single xray. No attempt to look at any soft tissues and none of it has helped.

The industry is an absolute dumpster fire of ineffective care unless you land in the top 20 issues for each sub category.

No offense, but the job of diagnosing one of the thousands of possible issues should not be yours. This is what computers are ripe to disrupt. ChatGPT isn’t there yet but something like it that can just crunch data and known results for every obscure thing is going to blow you out of the water. We can both only hope…

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

#95

Post by imagainstit »

russdill wrote: post #74
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.

I have experienced the flip of this: a less experienced MD specialist not recognizing a lab error, and wanting to act on it, which was recognized (correctly) as an error by PA primary care and confirmed in retesting. In this case the MD was significantly younger/less total years of experience and maybe that had to do with it?

PA experience isn't the equivalent of training as a resident (and I think we should be training more MDs) but the MD isn't always right either.

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

#96

Post by gustavus »

dukeofdoom wrote: post #51

I hope AI replaces most of them. My experience in the ER, at least in Canada. You're not getting a doctor. You're getting a doctor's 10 minutes attention, while they're running around from patient to patient. Don't expect your diagnosis to be anything more then the most obvious, A -> B diagnosis. When your problems conflate from the drugs they just wrongly gave you, and add in random screw ups, staff and equipment sh…

Sounds like you're getting what you pay for in Canada.

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

#97

Post by kortilla »

WirelessGigabit wrote: post #66
syedkarim wrote: post #63

Earlier quoted context omitted.

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.

It could be more of explaining the total duration and cost of how long they went to college. If it's required to have an undergrad I believe one can mention it, even if the undergraduate isn't required. Like in Belgium you need to have a masters for certain government jobs, but it's not relevant in which field.

Then why not include high school?

Unless the degree was exclusive to medicine, including it is bullshit.

MDs have a glorified 4 year masters and an on the job training program not significantly different than what it takes to become a PE.

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

#98

Post by mattkrause »

coryrc wrote: post #72
syedkarim wrote: post #63

Earlier quoted context omitted.

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.

I think the standard pre-reqs in the US are two semesters of biology, math, and physics, four of chemistry (general and organic).

I doubt that any of this is directly relevant to patient care and honestly, I’m skeptical that it’s either necessary or sufficient background for the stuff that is.

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

#99

Post by nextaccountic »

kortilla wrote: post #97
WirelessGigabit wrote: post #66

Earlier quoted context omitted.

It could be more of explaining the total duration and cost of how long they went to college. If it's required to have an undergrad I believe one can mention it, even if the undergraduate isn't required. Like in Belgium you need to have a masters for certain government jobs, but it's not relevant in which field.

Then why not include high school? Unless the degree was exclusive to medicine, including it is bullshit. MDs have a glorified 4 year masters and an on the job training program not significantly different than what it takes to become a PE.

what's PE?

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

#100

Post by nextaccountic »

lolinder wrote: post #81
lionsdan wrote: post #80

Earlier quoted context omitted.

"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...

But why aren't more residencies paid for through other channels? I wasn't under the impression that medical residents were solely a drain on hospital resources—my sense was they did a lot of the smaller tasks to free up licensed physicians to do more. At some point, if there aren't enough CMS-funded residencies and there aren't enough licensed doctors, wouldn't hospitals just start hiring more residents? The article…

maybe it's because the industry isn't really interested in having more MDs?
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