Why aren't there more medical schools in the US?
Acceptance to medical school is so ridiculously competitive - if people feel so strongly that we need to be seen by an MD, the only answer is to train more MDs.
So what's the hold up with more medical schools?

Anonymous wrote:

Anonymous wrote:Op made an appointment with a doctor, months in advance, and then the office switched it to an NP a few days in advanced. That’s not cool and I can understand why she is upset.

Sometimes I prefer NPs - I find they have better personalities and are less arrogant a lot of times.

It's infuriating. I've had the exact same thing happen several times with a gastroenterologist in Arlington, even though I specifically state I do not want to see his NP. They agree, make the appointment with the doc (supposedly) and then when I show up I'm stuck with the NP.

I have an IBD. If I made an appointment to see a gastroenterologist and was shuttled off to an NP when I took a day off of work to see the gastroenterologist I would be angry.

Anonymous wrote:It is horrifying to me how many people are unaware of how poorly trained the far majority of NP's are. They can get their degrees from 100% online programs (AKA degree mills). They may be absolutely lovely in person, but the bottom line is that they don't know what they don't know. It is an absolute travesty what they have done to the field of medicine. Primary care is one of the most difficult things because 99% of the time, everything is fine. But you need to see thousands of cases of normal in order to detect the abnormal.

Check the bio of your PA just like you check the bio of your MD

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The devolution of the US medical system to increasingly poor quality levels is the fruit of corporatization, abetted by the appalling power insurance companies have been permitted to amass over what constitutes “appropriate” care. Corporate-owned practices (which increasingly are the only thing you can find if you want to use your preposterously overpriced insurance) hire non-physicians to do what properly is physician’s work because the non-physicians are more readily available, are significantly cheaper and allow vastly increased financial leverage and a concomitant increase in profit. People say that their non-physician “provider” is great and will refer them if anything is “serious.” The problem is that few patients have even the slightest ability to determine how “serious” their condition is; regardless of their misplaced self confidence, non-physicians lack the training to avoid mistakes that a physician would catch. Given the rate of physician error, it is terrifying to think how much non-physicians may be missing. I am alive today because a physician noticed a deadly skin cancer when I was in for something else entirely. I have very little confidence that a non-physician would have caught that.

I caught my husband’s melanoma, so pretty sure an NP could as well.

+1

The people who don't like "anyone except a full MD" seem to not realize that you can deal with a bad MD just as much as a Bad NP/BadPA/Bad whatever other medical staff.

By and large, NP/PA take more time and get to know their patients and often provide a higher level of care, freeing up time for the full MD to see the patients with more urgent cases, who need surgery, etc.

A NP/PA can do my yearly exam/gyn exam. If they see any issues, they will always get me in to see the Gyn for follow up. But there is typically no need to see a Gyn if you don't have issues. Seeing the same NP/PA each year means they get to know you, know your minor issues and can send you for more tests/refer to MD as needed.
I have never dealt with a PA/NP that isn't highly qualified. OTOH, I've dealt with a few incompetent MDs, and plenty with no bedside manner and no recollection of me from my last visit even if it was 4 weeks ago, which is almost as bad as incompetent

(new poster) No. I am a specialist MD and routinely get patients who have received poor/inappropriate care from mid levels - way more than those who have gotten poor care from MDs. [i][u]In my professional discussion groups, we routinely trade horror stories about mid level overmedication, dangerous medication interactions that were overlooked, grossly inappropriate dosing, missed diagnoses that were obvious, and overall quite a lot of intervention that led to more harm than if they had done nothing at all. It's not like these things never happen with an MD, but it's orders of magnitude less frequent. The scope creep is scary to me not just as a provider, but as a patient like everyone else.

Could that possibly be because NPs actually DO refer out to an MD when they need the assistance, unlike MDs, who will be convinced of their own knowledge and competence even when they really should be referring to someone else?
So you just never know about your fellow MDs who are also providing poor care.

I will never forget my PCP when I first moved to the area. She was an MD and was convinced she could handle everything herself. She never would give me a referral to a dermatologist, and required two visits before I could get her to write the referral to a cardiologist for a life long congenital defect.
Fortunately I was able to change both PCP and insurance at the next open enrollment. I now see an NP who is wonderful and happy to work with MD specialists.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I find that the NP’s and the PA’s in the practice I go to are excellent. They seem to be much more thorough and take more time with the patients than the Md’s. If there is something drastically wrong they consult immediately with the MD’s.

I much prefer NPs for my annual GYN exam. If it's a serious illness or condition, sure, I'd like a doctor, but for routine stuff I find that they are willing to take more time and ask more questions. And if something is wrong, they consult the doctor.

+100

I like NPs I feel like they're more down to earth, easily approachable, and more relatable.. Doctors have the textbook knowledge, but the nurses have the clinical skills bc it's so routine for them.

NPs and PAs are middle class providers for middle class people.

Doctors are upper class providers for upper class people.

Um, no. What a strange take.

Well we do know that the uber wealthy have their own personal doctors and probably would consider themselves above an NP. So if she considers "upper class" only the .001%, then she's right. However, those who have their own doctors and consider those doctors to be the medical equivalent of a server in a restaurant often have worth health outcomes because they demand unnecessary interventions.

High net worth person here. Believe me, I've been subject to the bait and switch. I make an appointment with the doctor and an unknown PA comes in to do the appointment. I have nothing against PA's but people of all income levels should be expect the person who they made the appointment with to see them.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The devolution of the US medical system to increasingly poor quality levels is the fruit of corporatization, abetted by the appalling power insurance companies have been permitted to amass over what constitutes “appropriate” care. Corporate-owned practices (which increasingly are the only thing you can find if you want to use your preposterously overpriced insurance) hire non-physicians to do what properly is physician’s work because the non-physicians are more readily available, are significantly cheaper and allow vastly increased financial leverage and a concomitant increase in profit. People say that their non-physician “provider” is great and will refer them if anything is “serious.” The problem is that few patients have even the slightest ability to determine how “serious” their condition is; regardless of their misplaced self confidence, non-physicians lack the training to avoid mistakes that a physician would catch. Given the rate of physician error, it is terrifying to think how much non-physicians may be missing. I am alive today because a physician noticed a deadly skin cancer when I was in for something else entirely. I have very little confidence that a non-physician would have caught that.

I caught my husband’s melanoma, so pretty sure an NP could as well.

+1



The people who don't like "anyone except a full MD" seem to not realize that you can deal with a bad MD just as much as a Bad NP/BadPA/Bad whatever other medical staff.

By and large, NP/PA take more time and get to know their patients and often provide a higher level of care, freeing up time for the full MD to see the patients with more urgent cases, who need surgery, etc.

A NP/PA can do my yearly exam/gyn exam. If they see any issues, they will always get me in to see the Gyn for follow up. But there is typically no need to see a Gyn if you don't have issues. Seeing the same NP/PA each year means they get to know you, know your minor issues and can send you for more tests/refer to MD as needed.
I have never dealt with a PA/NP that isn't highly qualified. OTOH, I've dealt with a few incompetent MDs, and plenty with no bedside manner and no recollection of me from my last visit even if it was 4 weeks ago, which is almost as bad as incompetent

(new poster) No. I am a specialist MD and routinely get patients who have received poor/inappropriate care from mid levels - way more than those who have gotten poor care from MDs. In my professional discussion groups, we routinely trade horror stories about mid level overmedication, dangerous medication interactions that were overlooked, grossly inappropriate dosing, missed diagnoses that were obvious, and overall quite a lot of intervention that led to more harm than if they had done nothing at all. It's not like these things never happen with an MD, but it's orders of magnitude less frequent. The scope creep is scary to me not just as a provider, but as a patient like everyone else.

Another buzzword: “mid-level.” Where did that come from? What’s “entry level?” The receptionist?

Be very leery of seeing any PA's that graduated from the UMES program. It was actually discontinued for a number of years
due to scandal.

Mom's experience. She is usually prescribed 250 mg cipro twice a day for UTI. The UMES PA grad prescribed 1000 mg twice a day for UTI. Mom had severe psychosis from this over prescribing. The PA was affiliated with her regular PCP so the PA had access to her dosing records.

I've been seen once a year to monitor for MGUS. I go to a cancer specialist at a Cancer Center.

Ideally I would see a doctor who specializes in Multiple Myeloma Cancer but there are no specialists in my area so I see a Hematologist/Cancer Specialist.

My wonderful Hematologist that I'd been seeing since 2017 retired. I also saw the P.A. a couple of times and liked her too.

I got a call that I was assigned to a new doctor for my screening this year and made the appointment with the new doctor after looking up new doctors bio.

My appointment with my new doctor was yesterday. I was shocked when an unknown P.A. trounced in the room and did my appointment. She was somewhat dismissive. I flat out asked her if Dr. ______ would
be reviewing my bloodwork. She said yes. I was really upset when I left the office as I felt I was subject to bait and switch.

I called my RN friend as to how to handle. She said to make another appointment with Dr. _____, once my bloodwork is posted online and make if clear that you want to meet Dr. _____ to "meet" him and to review your bloodwork.

This bait and switch also happened to my boyfriend. I called my Dr. Derm to make a cancer check appmt for my boyfriend. The receptionist said they could get him in in 2 days. I was shocked he could see my doctor that quick as it usually took me 45 days.

Same bait and switch. A PA flounced in to his appmt.

I have nothing against PA's but a patient should no up front who they are seeing and not be subject to bait and switch.

I'm not against PA's. I've seen the same Gyn PA for 35 years and am very happy with her.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It is horrifying to me how many people are unaware of how poorly trained the far majority of NP's are. They can get their degrees from 100% online programs (AKA degree mills). They may be absolutely lovely in person, but the bottom line is that they don't know what they don't know. It is an absolute travesty what they have done to the field of medicine. Primary care is one of the most difficult things because 99% of the time, everything is fine. But you need to see thousands of cases of normal in order to detect the abnormal.

At least an NP sees actually patients all throughout 4 yrs of nursing school and even if getting NP online, is likely working as a nurse seeing patients concurrently.

PAs see zero patients during all of undergrad while they major in biology or whatever science (or sometimes not even science) they pick as their major. During their 2 yrs of PA school, they have a couple clinal rotations for a portion of that time. If anyone is vastly undertrained, it is PAs

Such BS. Please do some research before you spout untruths.
PAs are required to have over 1K HOURS of clinical experience before they can even apply to PA school.

Wow! Six WHOLE MONTHS as a gofer and hang-around! My concerns are assuaged.

MD later or NP sooner. Pick up. Nobody gives F which one you pick.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That's your right OP. If that's what you want and willing to wait, insist on it. DW is a cardiology NP and had a patient like you. Rather than seeing DW, wanted to wait 6 weeks for a doctor. The idiot died of heart attack while waiting. DW could've saved his life by catching his problems but what can you do.

Pretty shocking that you refer to your wife’s deceased patient as, “an idiot.” Such compassion.

Since I assume you heard the tale from her, that is even more appalling.

Another take on this might be that it was highly irresponsible (malpractice?) for the office to put off a patient with a life-threatening condition for six weeks, when all he wanted was to see his doctor. But still they found no way to move up his appointment.

Some practices might have felt awful about this turn of events. The incident might have caused them to investigate how the case was handled…but your wife and her colleagues just wrote this poor caller off as “an idiot. “

Please do share the name of the practice , if you think they operate to such a high standard.

yeah, no. that's not how it works. when you are a patient of the practice you are a patient of the practice, and you need to agree to how they manage cases. if you don't like it you should find another practice. But it's simply not a thing to insist on "I want to see the doctor and nothing else is acceptable." The practice decides how to triage cases. If this guy had come to his scheduled appt the NP would certainly have been able to coordinate his care and get him what he needed, but the patient refused. Patients have agency in their care. This was an unfortunate outcome but hardly the fault of the practice.

This is incorrect. “The practice” does not set the standard of care.

Not sure what you think “ standard of care” means. Patient refused appointment. Had a deadly outcome. The practice had no obligation to let him pick his provider, they gave him an inroad to care and he declined. As unfortunate as this situation is, nobody who knows the first thing about healthcare would call this “malpractice.”

Says who?

Anonymous wrote:

Anonymous wrote:The devolution of the US medical system to increasingly poor quality levels is the fruit of corporatization, abetted by the appalling power insurance companies have been permitted to amass over what constitutes “appropriate” care. Corporate-owned practices (which increasingly are the only thing you can find if you want to use your preposterously overpriced insurance) hire non-physicians to do what properly is physician’s work because the non-physicians are more readily available, are significantly cheaper and allow vastly increased financial leverage and a concomitant increase in profit. People say that their non-physician “provider” is great and will refer them if anything is “serious.” The problem is that few patients have even the slightest ability to determine how “serious” their condition is; regardless of their misplaced self confidence, non-physicians lack the training to avoid mistakes that a physician would catch. Given the rate of physician error, it is terrifying to think how much non-physicians may be missing. I am alive today because a physician noticed a deadly skin cancer when I was in for something else entirely. I have very little confidence that a non-physician would have caught that.

I caught my husband’s melanoma, so pretty sure an NP could as well.

Of course you did. Of course you did.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The devolution of the US medical system to increasingly poor quality levels is the fruit of corporatization, abetted by the appalling power insurance companies have been permitted to amass over what constitutes “appropriate” care. Corporate-owned practices (which increasingly are the only thing you can find if you want to use your preposterously overpriced insurance) hire non-physicians to do what properly is physician’s work because the non-physicians are more readily available, are significantly cheaper and allow vastly increased financial leverage and a concomitant increase in profit. People say that their non-physician “provider” is great and will refer them if anything is “serious.” The problem is that few patients have even the slightest ability to determine how “serious” their condition is; regardless of their misplaced self confidence, non-physicians lack the training to avoid mistakes that a physician would catch. Given the rate of physician error, it is terrifying to think how much non-physicians may be missing. I am alive today because a physician noticed a deadly skin cancer when I was in for something else entirely. I have very little confidence that a non-physician would have caught that.

I caught my husband’s melanoma, so pretty sure an NP could as well.

+1

The people who don't like "anyone except a full MD" seem to not realize that you can deal with a bad MD just as much as a Bad NP/BadPA/Bad whatever other medical staff.

By and large, NP/PA take more time and get to know their patients and often provide a higher level of care, freeing up time for the full MD to see the patients with more urgent cases, who need surgery, etc.

A NP/PA can do my yearly exam/gyn exam. If they see any issues, they will always get me in to see the Gyn for follow up. But there is typically no need to see a Gyn if you don't have issues. Seeing the same NP/PA each year means they get to know you, know your minor issues and can send you for more tests/refer to MD as needed.
I have never dealt with a PA/NP that isn't highly qualified. OTOH, I've dealt with a few incompetent MDs, and plenty with no bedside manner and no recollection of me from my last visit even if it was 4 weeks ago, which is almost as bad as incompetent

(new poster) No. I am a specialist MD and routinely get patients who have received poor/inappropriate care from mid levels - way more than those who have gotten poor care from MDs. In my professional discussion groups, we routinely trade horror stories about mid level overmedication, dangerous medication interactions that were overlooked, grossly inappropriate dosing, missed diagnoses that were obvious, and overall quite a lot of intervention that led to more harm than if they had done nothing at all. It's not like these things never happen with an MD, but it's orders of magnitude less frequent. The scope creep is scary to me not just as a provider, but as a patient like everyone else.

Another buzzword: “mid-level.” Where did that come from? What’s “entry level?” The receptionist?

Anonymous wrote:Medical offices are now being sneaky. I call to make an appointment and it goes like this:

Me: I would like to make an appointment with Dr.----.
Receptionist: I can get you in to our office in a next week. So next Tuesday at 2.
Me: So that is with Dr. -----?
Receptionist: Well it is with one of our providers. So you are all set.
Me: Wait, no I am asking if it is with Dr.-----?
Receptionist: He is booked for a while so I have you down with another provider.
Me: Who is the other provider? Another Dr. or is it a PA, or NP?
Receptionist: They all are great. We are going to fit you in. See you next Tuesday.

“Provider” is the dead giveaway. The moment they mentioned that word, I’d have been on them like stink on [expletive deleted.]. If a medical office gave me the runaround you’re describing that would be that.

Anonymous wrote:Medical offices are now being sneaky. I call to make an appointment and it goes like this:

Me: I would like to make an appointment with Dr.----.
Receptionist: I can get you in to our office in a next week. So next Tuesday at 2.
Me: So that is with Dr. -----?
Receptionist: Well it is with one of our providers. So you are all set.
Me: Wait, no I am asking if it is with Dr.-----?
Receptionist: He is booked for a while so I have you down with another provider.
Me: Who is the other provider? Another Dr. or is it a PA, or NP?
Receptionist: They all are great. We are going to fit you in. See you next Tuesday.

It must be a PE-owned practice. Leave a review on Healthgrades. Those scare away new patients, which makes the practice change its tune fast.

Medical offices are now being sneaky. I call to make an appointment and it goes like this:

Me: I would like to make an appointment with Dr.----.
Receptionist: I can get you in to our office in a next week. So next Tuesday at 2.
Me: So that is with Dr. -----?
Receptionist: Well it is with one of our providers. So you are all set.
Me: Wait, no I am asking if it is with Dr.-----?
Receptionist: He is booked for a while so I have you down with another provider.
Me: Who is the other provider? Another Dr. or is it a PA, or NP?
Receptionist: They all are great. We are going to fit you in. See you next Tuesday.