Where have all the doctors gone?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

Until that strep test was really just a red herring and the patient really had pulmonary hypertension. Or that third round of antibiotics is causing resistance that will lead to a real pneumonia later.

It isn’t until you or a family member actually has an issue with superficial training leading to an issue that you regret it.

Yes, most of the time a AI program or an NP could go through an algorithm and spit out a lab order or test and it will be fine for a healthy patient. But we all get sick and die at some point and I would rather be taken care of by astute well trained physicians.

To each their own

I think you overestimate how much an urgent care doctor really investigates when presented with a positive strep test

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

I think it may be bias on a patient’s end to think this is all a pcp does. In my practice, I see really sick patients with many comorbities. For example, a cancer survivor with diabetes and hypertension. I need to know what kinds of chemo my patient has been on since there will be life long risks associated. I also need to know all the diabetes drugs and their interactions with her other meds. I need to know that she is more likely to have recurrence of cancer and also potential blood clots, PE etc. I need to understand that if she walks into my office with low blood pressure and tachycardia that it may be sepsis. All of these things I learned with brute repetition in residency - caring for patients who are super sick day in and day out. Before you say anything most specialist will not handle a cancer patients diabetes and hypertension - esp if they are a survivor and in remission. That’s in primary care land. Just an example.

Those patients probably nee you. There is no reason that a healthy family needs your level of expertise.

Yes and that’s what most MDs see. There are many many many patients that fall into this category. Not sure who will take care of them in the future. I feel bad for the inevitable push to have NPs and PAs take care of these patients with little training and half the salary but with no one going into primary care that will be the situation.

You could pay PCPs like specialists, but I don't think most people would accept what that would do to their insurance rates

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

I think it may be bias on a patient’s end to think this is all a pcp does. In my practice, I see really sick patients with many comorbities. For example, a cancer survivor with diabetes and hypertension. I need to know what kinds of chemo my patient has been on since there will be life long risks associated. I also need to know all the diabetes drugs and their interactions with her other meds. I need to know that she is more likely to have recurrence of cancer and also potential blood clots, PE etc. I need to understand that if she walks into my office with low blood pressure and tachycardia that it may be sepsis. All of these things I learned with brute repetition in residency - caring for patients who are super sick day in and day out. Before you say anything most specialist will not handle a cancer patients diabetes and hypertension - esp if they are a survivor and in remission. That’s in primary care land. Just an example.

Those patients probably nee you. There is no reason that a healthy family needs your level of expertise.

Yes and that’s what most MDs see. There are many many many patients that fall into this category. Not sure who will take care of them in the future. I feel bad for the inevitable push to have NPs and PAs take care of these patients with little training and half the salary but with no one going into primary care that will be the situation.

You could pay PCPs like specialists, but I don't think most people would accept what that would do to their insurance rates

I speak for myself and it’s not about the money (again this is just for myself)- pcps make about 250-350k and that’s pretty good without having to deal with 3-4 more years of fellowship. To me I’m okay with this, it’s more the lack of support , the system, prior authorizations, double booking, notes, etc. I really feel like AI should be handling these issues and writing my notes or answering some of the request / calling pharmacies etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

I think it may be bias on a patient’s end to think this is all a pcp does. In my practice, I see really sick patients with many comorbities. For example, a cancer survivor with diabetes and hypertension. I need to know what kinds of chemo my patient has been on since there will be life long risks associated. I also need to know all the diabetes drugs and their interactions with her other meds. I need to know that she is more likely to have recurrence of cancer and also potential blood clots, PE etc. I need to understand that if she walks into my office with low blood pressure and tachycardia that it may be sepsis. All of these things I learned with brute repetition in residency - caring for patients who are super sick day in and day out. Before you say anything most specialist will not handle a cancer patients diabetes and hypertension - esp if they are a survivor and in remission. That’s in primary care land. Just an example.

Those patients probably nee you. There is no reason that a healthy family needs your level of expertise.

Yes and that’s what most MDs see. There are many many many patients that fall into this category. Not sure who will take care of them in the future. I feel bad for the inevitable push to have NPs and PAs take care of these patients with little training and half the salary but with no one going into primary care that will be the situation.

You could pay PCPs like specialists, but I don't think most people would accept what that would do to their insurance rates

Nonetheless, having PCPs for high risk patients the way there are OBs for high risk pregnancies is a useful idea.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

Until that strep test was really just a red herring and the patient really had pulmonary hypertension. Or that third round of antibiotics is causing resistance that will lead to a real pneumonia later.

It isn’t until you or a family member actually has an issue with superficial training leading to an issue that you regret it.

Yes, most of the time a AI program or an NP could go through an algorithm and spit out a lab order or test and it will be fine for a healthy patient. But we all get sick and die at some point and I would rather be taken care of by astute well trained physicians.

To each their own

Not just for a healthy patient. What you're describing is a perfect use for an AI algorithm on complicated patients that have too many comorbidities for a doctor to keep in their head.

AI software wouldn't perform perfectly, and might make mistakes in different cases than physicians, but overall you'd expect an algorithm to be able to outperform a humanz

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

I think it may be bias on a patient’s end to think this is all a pcp does. In my practice, I see really sick patients with many comorbities. For example, a cancer survivor with diabetes and hypertension. I need to know what kinds of chemo my patient has been on since there will be life long risks associated. I also need to know all the diabetes drugs and their interactions with her other meds. I need to know that she is more likely to have recurrence of cancer and also potential blood clots, PE etc. I need to understand that if she walks into my office with low blood pressure and tachycardia that it may be sepsis. All of these things I learned with brute repetition in residency - caring for patients who are super sick day in and day out. Before you say anything most specialist will not handle a cancer patients diabetes and hypertension - esp if they are a survivor and in remission. That’s in primary care land. Just an example.

Those patients probably nee you. There is no reason that a healthy family needs your level of expertise.

Yes and that’s what most MDs see. There are many many many patients that fall into this category. Not sure who will take care of them in the future. I feel bad for the inevitable push to have NPs and PAs take care of these patients with little training and half the salary but with no one going into primary care that will be the situation.

You could pay PCPs like specialists, but I don't think most people would accept what that would do to their insurance rates

Not the same, but close the gap. And some of that should involve lowering the compensation for some specialists. Anesthesiologists, particularly those assisting in basic procedures (e.g., colonoscopies) should not be making the money they are.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

Get rid of the first bachelor degree? I don't understand someone with a four year CS or English degree being able to apply. Why not require a year of applicable sciences then straight into medical school. That's how other countries do it

Pretty med school requires you to have pre-med studies and a degree in one of the sciences.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

Get rid of the first bachelor degree? I don't understand someone with a four year CS or English degree being able to apply. Why not require a year of applicable sciences then straight into medical school. That's how other countries do it

Pretty med school requires you to have pre-med studies and a degree in one of the sciences.

Pre-med studies, yes. Science major, no. In fact, liberal arts majors have an edge as there is a view that they have spent more time thinking about the human condition.

I once read that music majors have the highest MCATs. Pretty sure too that the number of music majors who go to med school is very small.

[Anonymous]

the best have gone concierge.

[Anonymous]

Anonymous wrote:Insurance and politicians who get donations are the problem.

If I told you average income for X job was 170k in 2010, what do you expect that income to be today? Does 179K sounds normal 14 yrs later? Guess what, that is the average salary of a dentist in the US from 2010 vs Today!!! How in the world are we supposed to not squeeze in a ton of patients and work fast and brush over the complaints when we have lives that we have to pay for too?? explain this to me!!

I’ll send you some expensive cheese for your wine. Enjoy!

[Anonymous]

Being bought out by Inova and no longer being as responsive bc it’s all a numbers game.

[Anonymous]

It’s not just insurance companies now driving profits. Private equity firms are buying out ER physician groups. What could possibly go wrong?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

Until that strep test was really just a red herring and the patient really had pulmonary hypertension. Or that third round of antibiotics is causing resistance that will lead to a real pneumonia later.

It isn’t until you or a family member actually has an issue with superficial training leading to an issue that you regret it.

Yes, most of the time a AI program or an NP could go through an algorithm and spit out a lab order or test and it will be fine for a healthy patient. But we all get sick and die at some point and I would rather be taken care of by astute well trained physicians.

To each their own

Not just for a healthy patient. What you're describing is a perfect use for an AI algorithm on complicated patients that have too many comorbidities for a doctor to keep in their head.

AI software wouldn't perform perfectly, and might make mistakes in different cases than physicians, but overall you'd expect an algorithm to be able to outperform a humanz

Well, then there is no physician shortage problem anymore! Great to know.

[Anonymous]

How about we build more medical schools and train more doctors?
We’ve had the same number of schools and graduates for decades but our population has surged. 🤷‍♀️

[Anonymous]

The problem is that really extremely intelligent people are no longer going into medicine and we need that for the millions of less common illnesses than diabetes and high blood pressure. America used to be a leader in finding new treatments but now the only treatments that are coming out are me2 drugs for the most common and therefore most sellable illnesses.