Thursday, April 16, 2009

Internist shortages.....

I love this.

From Happy's blog...

So, midlevels aren't good enough.....blah, blah, blah. If Happy is only referring to practicing with complete independence, I would completely agree with him. But he's not.

I cannot speak for NP's, but PA's ARE educated in the medical model. We recieve between 2000-2600 clinical hours during school. NP's recieve far less. Like 600-800 for many programs. We are dependent providers that practice with a fair amount of autonomy, but not complete independence. We complete board examinations every 6 years, and 100 hours of CME every two years.

If Happy had his way, ONLY MD's/DO's would be able to practice medicine....too bad it's not possible.

HERE is a link from an article for the NY Times....

A little snippet for ya.

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

Hmmm, 35-45000 fewer providers than needed. Per the ACP.....Where are these mythical MD's going to magically appear from? Who is going to pay for them?

PA's and NP's can manage a great deal of what comes through an ER or clinic on their own. I am working today. I've seen 12 patients, I've only involved the consultant on three of them, WHY?? Cause the others did not need physician evaluation.

OH, and BTW...the PA profession has 49 residencies, including Hospital Medicine, in fact, there are two!



B. said...

Happy and Internist X and their ilk don't believe that comprehensive care can be provided by anyone other than a residency trained, board certified internist. Fair enough.

But what do they propose for the rural hospitals and small towns of America, which consistently have difficulty recruiting family practice physicians, let alone boarded internists?

Should the patients have to travel to the nearest Big City Hospital for routine procedures and care? What about emergencies? Tough cookies for those who choose to live outside an urban region?

My hospital, until recently, had no IM trained physicians on staff. (We now have a cardiologist, who is on courtesy staff, and does not admit at all, nor consult outside the hours of 8 a.m. to 5 p.m.)

Our single hospitalist is a family physician...assisted by a nurse practitioner.

Whether Happy likes it or not, this is the reality in rural America. My ED is staffed 24/7 by PAs. We consult when needed. We transfer complicated cases to the Big City Hospital. I suppose Happy would consider many of these transfers inappropriate.

However, in many of the cases the issue is not that I don't know how to care for the patient, but rather the FPs who manage the inpatient service are "uncomfortable" or don't want to admit for fear of a bad outcome.

So where are these internists to save the day in rural America? Answer: not to be found. Yet PAs and NPs are incapable of providing comprehensive care, according to some. So what is the solution?

Anonymous said...

I will be starting a PA program in January of 2010, but reading Happy's blog really brought me down, for two reasons- the first is their stance on PA's, NP's, and nurses. Having worked in a team oriented setting, where every member of a team was valuable, I am very shocked that anyone feels that way- that basically, everyone else is beyond the high rank of "Dr".
In fact, every PA I have ever seen has been top notch- extremely dedicated and knowledgable. And...some doctors didn't make the grade.
It really left me in a really bad mood. I saw the way they responded to your comment, too- that really pissed me off.

Reality Rounds said...

Found your blog through the Happy Hospitalist of all places. You must thank him for that. There is a strong need for primary and preventative care in this country, you are thankfully filling this need. I am very pro NP and CNM because I have worked with them for many years, and have seen fantastic patient care. It seems this whole PA, NP vs. MD is just a big turf war. The MD's who complain the most are usually not confident in their own skills.

JosephinesMountain said...

Yeah Phys, the little bit about "I'd sooner have a fresh-out-of-residency n00b over an experienced PA/NP every time" (loosely quoted) was short sighted.

I've worked with PA's I'd choose any day over a number of MD's I've worked with. And vice versa of course.

And, I've worked with top notch MD's, that laud the skill and knowledge of diligent PA's.

The Happy Hospitalist said...

For B:

There is a shortage of internists because the Medicare National Bank fails to pay appropriately for their service.

Pay appropriately, and the shortage disappears.

It's amazing how that works.

Perhaps, by your conclusion, America doesn't require internists to take care of their chronic medical conditions. If not them, I have no idea who has the education to handle this task.

I have a different educational experience than you, something you can't even being to appreciate without first experiencing it. I don't blame you for a moment for not understanding where I gain my perspective. It's something I don't expect you to understand.

For you to understand my perspective you have to know what I know. And that would only happen if you completed medical school and residency and passed your internal medicine boards.

Until then, I'll just have to be your ilk.

I don't have any ill will towards you. I'm just telling you that what you know pales in comparison to what I know. Perhaps you must assume I simply know a lot of stuff that doesn't need to be known. Perhaps you are correct. Perhaps you aren't. I would much rather error on the side of too much information than just enough information.

This does not make you less of a person. It's the nature of educational tracks which are less in depth in time, experience and education than the medical school and residency experience.

And that extra training shows up daily when you least expect it. And I can attest to that on a daily basis.

Anonymous said...

There are actually a very clear practice boundaries. Physicians practice medicine, Nurses practices nursing, Dentist practice dentistry, Psychologist practice psychology, Opometrist practice optometry, Physical Therapist practice physical therapy, Podiatrist practice podiatry and PA are supervised health care workers to help with the Internist shortage we have presently.

physasst said...

Happy, there simply isn't the money to train and supply all of the internal medicine needs solely from physicians. They will need to be augmented with PA's and NP's. Simple reality. Now you can continue to pursue your utopian vision, but simply wishing for it, isn't going to make it come true.

The Happy Hospitalist said...

Physsast interesting position. How do you suppose we pay for all cardiology needs as well. PA cardiologists?

. said...

Oh my, no one can appreciate! lol Us little peons simply CAN'T wrap our teensy eensy little minds around the scope of MD/DO training. I'm guessing that someone hasn't taken their Psych classes! Us who have, understand where it's alll coming from. Incidentally, I had a clinic appointment the other day and said "no problem" when I was asked if I minded an MD student observe. This kid (yes, kid, trying so hard to be a Big Bad Doctor) actually GIGGLED during our discussion about rectal bleeding. And this is the "noob" that you want seeing a patient over an experienced PA/NP? Talk about inferior training, it was pathetic. And by the way, Happy, you need to do your research on cardio PAs. You are extremely ignorant.

Anonymous said...

It isn't that you can't, its just that you haven't had the full scope of MD/DO training yet nor will you in the future. To do so you would have to actually attend medical school not just "medical school model" program or whatever.