I'm a nurse who has NPs in the family.

This is a downstream effect of caps to medical school admissions, driving costs of getting those degrees leading to student loans that can't be paid off by the low salaries your primary care doctor makes.

So, to fill those gaps, you get mid-level providers (NPs and PAs) who can do the primary care work.

It's fine if you only want to see a MD - but those will be increasingly filled by NPs and PAs as time goes on.

I'm lucky in that I've had excellent care delivered by the mid-level providers. I've had some duds, too. But I've had duds in the medical profession, too.

Anonymous wrote:This is also discouraging because I wouldn’t know what to tell a young person that wants to do primary care medical care. Doctors doing primary care don’t make enough to cover their med school loans. 10 years ago a lot of people were telling those kids to get a NP degree, which I understood to be a six year program (4undergrad plus 2 masters) with a significant clinical component. By cheapening that field, they’ve left bright young people interested in primary care without any real good options.

Something that would be nice is if Bloomberg and others, when giving billions to medical schools for free tuition, instead give free tuition only for those who go into primary care/family practice.

There is no need to cover the tuition for those who go into high-paying specialties, where they will quickly make enough to repay their medical school loans and go on to be millionaires.

Anonymous wrote:This is also discouraging because I wouldn’t know what to tell a young person that wants to do primary care medical care. Doctors doing primary care don’t make enough to cover their med school loans. 10 years ago a lot of people were telling those kids to get a NP degree, which I understood to be a six year program (4undergrad plus 2 masters) with a significant clinical component. By cheapening that field, they’ve left bright young people interested in primary care without any real good options.

I disagree with the idea that the salary is not enough. I’m a pcp and it’s enough. It’s not the money it’s really the demands it places on your life and the horrible work flow with mychart in basket and lack of support. Money is fine in my opinion. Maybe not specialist money but it’s fine. It is more that it is not sustainable job. If they actually supported primary care and made it a more tolerable job then maybe people would do it. And btw- NP and PAs don’t want to do primary care either. It’s a major issue that will get worse.

Anonymous wrote:The schools are trying to make money and the health care system trying to save money.

It is the logical endpoint of capitalism (which is why we should not allow for profit health care).

But if you vote for Trump, the trend will be towards eliminating the regulations which are in place to protect patients.

+1
And didn't we have a thread about med schools AMA capping and limiting access to the "prestigious doctor" world?
We'll either get NPs, foreign trained doctors, or very very long waits to see anyone for care at all. And plus what PP said- unregulated care, billing practices, insurance companies making absolute bank if you vote R.

Anonymous wrote:This is also discouraging because I wouldn’t know what to tell a young person that wants to do primary care medical care. Doctors doing primary care don’t make enough to cover their med school loans. 10 years ago a lot of people were telling those kids to get a NP degree, which I understood to be a six year program (4undergrad plus 2 masters) with a significant clinical component. By cheapening that field, they’ve left bright young people interested in primary care without any real good options.

These young people can still go through a 6 year program with a significant clinical component. The key is to look for well regarded programs that can be undertaken affordably-- look for in-state programs at flagship schools with strong nursing programs that are attached to teaching hospitals. Or investigate programs with tuition reimbursement if you go to work in places or specialties that really need medical professionals-- rural hospitals or pediatrics or mental health, for instance.

Just don't do a quickie online degree with no clinical experience because it sounds easy and cheap. That's the advice.

This is what happens when you start focusing more on credentials than actual experience. It's happening in other fields too though I agree it's scary to see it in medicine.

It's interesting to see how common this is in "pink" fields that are dominated by women. See also:

More places (including DC) requiring degrees in early childhood development for childcare jobs, where these degrees are more valued than years of direct experience.

Higher salaries and promotional potential for professionals in marketing and communications fields if you have a masters, even when the non-masters candidates have vastly more experience.

I think women in these fields started seeking out higher credentials because they knew their work was often undervalued and that inherent bias was leading to lower pay and less respect in workplaces. But now we have reached a weird point of credentialism where a 20-something with a one or two year degree (often from programs with no practical requirements) will be deemed more qualified than a 20 year veteran without that degree. This is stupid. And likely also reflects a misogynistic reflex to devalue both the work of women generally but also the "soft skills" that one develops when working in a field for a long time, including good judgment, bedside manner or collegiality, and time management/organizational skills.

We need better ways to value real world experience in the workforce. It would also help with age discrimination.

I also try to not see NPs or PAs. But recent experience example - had to cancel a gyn appointment as I have irregular cycles and it started and is too heavy for exam. I was told I can see next available dr in four months or PA in three weeks. So I have to either delay my mammo and Pap smear four months or see a less trained professional. I have family histories that make a four month delay - assuming it even happens then since I’m irregular - very concerning. I feel forced into seeing a less trained professional.

Anonymous wrote:This is also discouraging because I wouldn’t know what to tell a young person that wants to do primary care medical care. Doctors doing primary care don’t make enough to cover their med school loans. 10 years ago a lot of people were telling those kids to get a NP degree, which I understood to be a six year program (4undergrad plus 2 masters) with a significant clinical component. By cheapening that field, they’ve left bright young people interested in primary care without any real good options.

Wouldn't a PA program be the other option for people who want primary care?

This is also discouraging because I wouldn’t know what to tell a young person that wants to do primary care medical care. Doctors doing primary care don’t make enough to cover their med school loans. 10 years ago a lot of people were telling those kids to get a NP degree, which I understood to be a six year program (4undergrad plus 2 masters) with a significant clinical component. By cheapening that field, they’ve left bright young people interested in primary care without any real good options.

The schools are trying to make money and the health care system trying to save money.

It is the logical endpoint of capitalism (which is why we should not allow for profit health care).

But if you vote for Trump, the trend will be towards eliminating the regulations which are in place to protect patients.

Retired NP here. I am also concerned. Back in my day,LOL, you had to have a BSN and two years in the real world of nursing before applying to an MSN program. I believe now you can be a full on “Doctor” of Nursing without ever even working in the real world of healthcare delivery. Back then, doctors preferred NPs to PAs because of their experience working with patients with many needs other than medical ones. Now I personally would see recent PA grad over a recent NP grad because the education and training is much more rigorous for PAs.

^many co-morbidities

Anonymous wrote:As a patient, the vast majority of my healthcare interactions are not complicated at all. This seems like more than enough training for a lot of healthcare roles.

This is not true! As we learn more about diseases and have more treatment options, the amount you have to know has drastically increased. Add to that how unhealthy everyone is - leading to my comorbities- health care interactions are super complex. The response to this on the MD side is to increase training.

I’m in primary care and I did tons of icus time and complex care in order to train (3 year residency in internal medicine) and I still felt like I needed more time!

I do not understand how the NP world is doing the opposite and rushing people out. Makes no sense.

As a patient, the vast majority of my healthcare interactions are not complicated at all. This seems like more than enough training for a lot of healthcare roles.

That’s still one year longer than PA school..