I just realized Physician Assistants (PAs) and Nurse Practitioners (NPs) have been forgotten in this equation. 126,000 practicing PAs [0] 325,000 licensed NPs [1] 985,000 practicing physicians (MDs and DOs) [2] I know that nurse practitioners are not under the same artificial residency constraints of MDs/DOs. I'm not sure about physician assistants. For someone not in the U.S., NPs and PAs often do the same role as g…
PA/NA education is a complete joke compared to what your average MD gets. They are not qualified to practice as general doctors at all. However, they are really cheap, which is why corporations are pushing them so hard. Substandard care in the name of profits.
If only we could have stopped doctor salary inflation instead, like other developed countries :)
> the restricting of doctor supply via the residency bottleneck Assuming that you're referring to the AMA here, their role is pretty unclear to me. They appear to have played a lobbying role to get Congress to freeze residency funding in 1997 to avoid having lots of doctors [1], but for several years now, the AMA has at least publicly claimed that they've been lobbying congress to increase funding for residency slots…
AMA is a bad actor. They refuse to allow junior doctors (doctors who are MD school graduates but who have not completed residency) to practice medicine in ANY capacity. Common sense says that junior doctors should have the same practice rights as physician assistants - but the AMA refuses to let that happen. They are a medical cartel. A few states have allowed junior doctors to start practicing medicine in a limited…
The AMA also argues against prescription rights for other health professionals like pharmacists (who often have much more in-depth education on drugs)
I worked in a hospital for 13 years. The economic incentives for the current system are quite perverse. The FDA has no cost constraints and so maximizes safety instead of QALYs. Medical equipment and drug manufacturers maximize profit and so fill the highest margin niches first instead of maximizing QALYs. Radiology and lab services are lucrative and separate themselves from clinical providers to maximize profits ins…
Well, that's because Americans have an aversion to QALYs. It might be related to the idea that the country is fundamentally Christian in a deep way. A common accusation of anyone attempting to do a QALY based system would be that they are "sacrificing grandma for the dollar". The recent COVID crisis is an example where QALY based evaluations (which may well have gone either way) were summarily considered "putting a n…
are you saying Christians are against quality life?
> the restricting of doctor supply via the residency bottleneck Assuming that you're referring to the AMA here, their role is pretty unclear to me. They appear to have played a lobbying role to get Congress to freeze residency funding in 1997 to avoid having lots of doctors [1], but for several years now, the AMA has at least publicly claimed that they've been lobbying congress to increase funding for residency slots…
AMA is a bad actor. They refuse to allow junior doctors (doctors who are MD school graduates but who have not completed residency) to practice medicine in ANY capacity. Common sense says that junior doctors should have the same practice rights as physician assistants - but the AMA refuses to let that happen. They are a medical cartel. A few states have allowed junior doctors to start practicing medicine in a limited…
Does the AMA want that or is that the purview of state medical boards? AMA doesn't set practice laws. The people who lobby against new grad MDs having the same practice rights as NPs/PAs are NPs and PAs (more NPs). NPs lobby against assistant-physician laws because why would you want someone who has had 500 hours of clinical shadowing while completing their part-time online, direct-entry, 100% acceptance, diploma-mill school (NP) vs. a new-grad physician who's had 2 years of physiology, anatomy, and pharmacology and 2 years with 5000 clinical hours where there's actually an expectation that you contribute treatment plans and care to the team. The fact that the AMA has been asleep at the wheel and unable to stop NPs from getting independent practice in 20+ states show that they don't have any real influence on who practices where.
I just realized Physician Assistants (PAs) and Nurse Practitioners (NPs) have been forgotten in this equation. 126,000 practicing PAs [0] 325,000 licensed NPs [1] 985,000 practicing physicians (MDs and DOs) [2] I know that nurse practitioners are not under the same artificial residency constraints of MDs/DOs. I'm not sure about physician assistants. For someone not in the U.S., NPs and PAs often do the same role as g…
PA/NA education is a complete joke compared to what your average MD gets. They are not qualified to practice as general doctors at all. However, they are really cheap, which is why corporations are pushing them so hard. Substandard care in the name of profits.
Cheaper salary and they order more unnecessary tests, imaging, and consults, which, what do you know, the hospital system also makes money off of. It's a win-win for the hospital, but patients and the healthcare system lose.
Agreed. Entrenched institutions are the general problem with America. It's the police unions protecting bad policing, the restricting of doctor supply via the residency bottleneck, and local governments preventing new building for burgeoning populations. They're all the same problem really. Beneficial to the incumbent group at the expense of those they service. It's kind of amazing.
> the restricting of doctor supply via the residency bottleneck Assuming that you're referring to the AMA here, their role is pretty unclear to me. They appear to have played a lobbying role to get Congress to freeze residency funding in 1997 to avoid having lots of doctors [1], but for several years now, the AMA has at least publicly claimed that they've been lobbying congress to increase funding for residency slots…
Is there any reason the slots can't be privately funded?
Like, could minting more doctors drive down costs for hospitals (that need doctors for services)?
PA/NA education is a complete joke compared to what your average MD gets. They are not qualified to practice as general doctors at all. However, they are really cheap, which is why corporations are pushing them so hard. Substandard care in the name of profits.
Wow I was about to gush about how much I LOVE my NP compared to my old crappy, braindead MDs. I could share stories of how bad MDs are...and the horrors of insurance. She is sharp as a whip. Smarter and more motivated than ANY MD I've EVER had. Anything she doesn't know about, she researches (on her own time/dime). She prescribes everything - dirt cheap. Lets me text/call/email ANY time. Refers me to a specialist for…
Your access to care is the result of the direct primary care model not your NP necessarily. Your NP might be good, but I'm willing to bet on average the people who have a minimum of 15,000 hours of clinical training (MDs/DOs) before independent practice are more competent than the ones who only are required to get 500.
More motivated? Why wasn't she more motivated to go to school for four years, get in-depth training in residency, and become an expert in her field rather than taking the easy "route" to practice "medicine"? I guarantee the IM docs and surgeons slugging it for 80+hour work weeks in residency to become experts are more dedicated and motivated to care for patients than the NPs who train part-time and online.
Their solution in the TFA is to focus on straight-through billing through standardization of payment mechanisms, arguing that each physician is paying $100K / year. Of course, this also puts the lie to the insurance companies, who are the other side of the transaction and essentially add another 20% in cost just to pay the bill! (Their loss ratios due to medical costs are about 80%.) Insurance companies are basically…
Cut out the insurance company and drop 20% out of the system.
Hope it fixes medical inflation (it won’t) or you’ll be back to the same place in 3-4 years.
Well, that's because Americans have an aversion to QALYs. It might be related to the idea that the country is fundamentally Christian in a deep way. A common accusation of anyone attempting to do a QALY based system would be that they are "sacrificing grandma for the dollar". The recent COVID crisis is an example where QALY based evaluations (which may well have gone either way) were summarily considered "putting a n…
> The recent COVID crisis is an example where QALY based evaluations (which may well have gone either way) were summarily considered "putting a number on the value of a life". I think a clarification is that a lot of U.S. citizens agree with putting a number on the value of a life but they value lives by the amount of wealth a particular life owns. What they actually don't like is the perception of having to pay thei…
You know, I'd agree, except that the criticisms were directed at people who claimed that there may be some balance of kick-starting the economy (saving some number of QALYs) and allowing some number of people to die (losing other QALYs).
AMA is a bad actor. They refuse to allow junior doctors (doctors who are MD school graduates but who have not completed residency) to practice medicine in ANY capacity. Common sense says that junior doctors should have the same practice rights as physician assistants - but the AMA refuses to let that happen. They are a medical cartel. A few states have allowed junior doctors to start practicing medicine in a limited…
The AMA also argues against prescription rights for other health professionals like pharmacists (who often have much more in-depth education on drugs)
What do you have to do before you prescribe a drug? Make a diagnosis, which is what is taught in medical school and not in pharmacy school. Pharmacists are frequently embedded in care teams in hospitals and primary care clinics where they make medication recommendations and know how to get drugs approved by insurance companies (sad that this has to happen...).