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Why go through the costly process of training a physician, when in most healthcare a midlevel practitioner would provide appropriate evaluation and treatment? A

Why go through the costly process of training a physician, when in most healthcare a midlevel practitioner would provide appropriate evaluation and treatment? Also it seems that not all stakeholders in medicine are into restricting physician training[1]. (I come into the discussion with a physician’s perspective.) [1] https://www.modernhealthcare.com/article/20140730/NEWS/307309954/iom-report-on-medical-education-questions-doc-shortage-fears https://www.modernhealthcare.com/article/20140730/NEWS/30730...

chimi 7y ago
We should go through the process of training more physicians, because every day in the USA many people are harmed, up to death, due to there not being enough physicians. We need more midlevels too, I agree, though midlevels are not allowed to do everything doctors can do and are required to have many things approved by a doctor as well. So to increase midlevels would naturally require an increase in physicians. I come to this from the perspective of someone being harmed by the way it is right now and I don't like being harmed.
- vo2maxer 7y ago
  I don’t mean to underestimate what you’re going through and those in similar situations, but consider the significant harm being done by unnecessary procedures and medications which add no value to a patient’s life. A lot of it is being done by a glut of avaricious physicians in metropolitan areas, particularly those with large elderly populations. Witness end-of-life care with its outrageous in-hospital costs, which again adds little to the quality of someone’s life. This is one of the great scandals in U.S. healthcare. Edit: For whatever reason, I was downvoted on this comment. I’m truly curious to know why. Is it too alarmist? Is it betrayal of my colleagues from someone in the trenches of our inefficient healthcare? Am I just restating the well known? Is it believable? Here is an article which should stimulate continuing discussion[1]. As far as I know, this hasn’t changed. I’m not sure how increasing the amount of medical school graduates and residency spots will deal with the issue described. [1] https://www.propublica.org/article/unnecessary-medical-care-is-more-common-than-you-think https://www.propublica.org/article/unnecessary-medical-care-...
  - snagglegaggle 7y ago
    That is an issue, but I don't think preventing the training of physicians will help. If anything it shows our training is inadequate.
  - saghm 7y ago
    > I don’t mean to underestimate what you’re going through and those in similar situations, but consider the significant harm being done by unnecessary procedures and medications which add no value to a patient’s life. A lot of it is being done by a glut of avaricious physicians in metropolitan areas, particularly those with large elderly populations. Witness end-of-life care with its outrageous in-hospital costs, which again adds little to the quality of someone’s life. This is one of the great scandals in U.S. healthcare. I wasn't one of the downvoters (and in fact didn't read this comment until after your edit), but I think part of the issue people might have had with it is that it does across as a bit dismissive of GP's complaints. Yes, you've also correctly identified a problem that's tangentially related to the one under discussion, but you haven't given any insight to why that solving that problem will have any effect in what people were already discussing. It's sort of like jumping into a discussion about people starving due to inadequate food supplies and saying "Yeah, but what about people dying from eating food that should have been recalled due to contamination?" Both issues are about food, but there's no apparent context for the sudden shift in topic.
    - vo2maxer 7y ago
      You’re right. I appreciate your comment. I allowed my own frustration with the obvious problems around me to cloud my comments. Here, hoping to clarify my original argument: Adding healthcare services by producing more physicians, costly in training and by their later contribution through a perverse incentive system, does not appear to be the simple answer. In addition, is there a physician shortage [1] or not [2]? I recommended more midlevel providers, who are capable of handling a vast majority of medical problems. To suggest that only professionals with years of training and paid an exorbitant rate can do this, is not to understand what physicians do or midlevel providers’ capability. It is another way of buying into the self-serving mantra promulgated by medical boards and organizations: Only a doctor knows and, furthermore, needs to be board certified. Depending on the state, multiple nurse practitioners and physician assistants can be supervised remotely by one physician. Add telemedicine and other online tools to this partnership and you’ve got a pretty robust team able to care for a much larger population than one physician could. A zillion other tweaks to the system, and all of a sudden efficiency starts to make an impact. But some artificial barriers must be broken in the process (e.g., coordinated information dissemination between health professionals). [1] https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage https://www.aamc.org/news-insights/press-releases/new-findin... [2] https://www.ncbi.nlm.nih.gov/pubmed/26177529 https://www.ncbi.nlm.nih.gov/pubmed/26177529 Edit: For now and the near future, there are procedures that only physicians can perform (e.g., surgery mostly). This is not true in most general medical care and even in specialized care.
bradleyjg 7y ago
Because Americans all think they deserve attention from someone that fits their personal image of what a doctor should be—-in terms of race, gender, age and personality. Someone who is in the top .001% of intelligence and with twenty years of training. All to spend hours listening to them complain about their cold or achey knees. And they don’t want to have to wait. Also, they don’t think they should have to pay anything for it. Instead of acknowledging the impossibility of their desires they jump from villain to villain and magical silver bullet to magical silver bullet. The politicians of course don’t tell them they are being childish, but instead indulge their fantasies. Why do you think the ability to shop around for a physician something so crucial to preserve in any reform? What does that have to do with outcomes?
- HeyLaughingBoy 7y ago
  That's not all bad though. I don't want to wait to see a doctor and I don't want to pay for it either. What's surprising about that? Hell, I don't want to pay for anything but I acknowledge that people need to eat so I'm quite happy to have that payment be from my tax dollars.

chimi 7y ago

We should go through the process of training more physicians, because every day in the USA many people are harmed, up to death, due to there not being enough physicians. We need more midlevels too, I agree, though midlevels are not allowed to do everything doctors can do and are required to have many things approved by a doctor as well. So to increase midlevels would naturally require an increase in physicians. I come to this from the perspective of someone being harmed by the way it is right now and I don't like being harmed.

vo2maxer 7y ago
I don’t mean to underestimate what you’re going through and those in similar situations, but consider the significant harm being done by unnecessary procedures and medications which add no value to a patient’s life. A lot of it is being done by a glut of avaricious physicians in metropolitan areas, particularly those with large elderly populations. Witness end-of-life care with its outrageous in-hospital costs, which again adds little to the quality of someone’s life. This is one of the great scandals in U.S. healthcare. Edit: For whatever reason, I was downvoted on this comment. I’m truly curious to know why. Is it too alarmist? Is it betrayal of my colleagues from someone in the trenches of our inefficient healthcare? Am I just restating the well known? Is it believable? Here is an article which should stimulate continuing discussion[1]. As far as I know, this hasn’t changed. I’m not sure how increasing the amount of medical school graduates and residency spots will deal with the issue described. [1] https://www.propublica.org/article/unnecessary-medical-care-is-more-common-than-you-think https://www.propublica.org/article/unnecessary-medical-care-...
- snagglegaggle 7y ago
  That is an issue, but I don't think preventing the training of physicians will help. If anything it shows our training is inadequate.
- saghm 7y ago
  > I don’t mean to underestimate what you’re going through and those in similar situations, but consider the significant harm being done by unnecessary procedures and medications which add no value to a patient’s life. A lot of it is being done by a glut of avaricious physicians in metropolitan areas, particularly those with large elderly populations. Witness end-of-life care with its outrageous in-hospital costs, which again adds little to the quality of someone’s life. This is one of the great scandals in U.S. healthcare. I wasn't one of the downvoters (and in fact didn't read this comment until after your edit), but I think part of the issue people might have had with it is that it does across as a bit dismissive of GP's complaints. Yes, you've also correctly identified a problem that's tangentially related to the one under discussion, but you haven't given any insight to why that solving that problem will have any effect in what people were already discussing. It's sort of like jumping into a discussion about people starving due to inadequate food supplies and saying "Yeah, but what about people dying from eating food that should have been recalled due to contamination?" Both issues are about food, but there's no apparent context for the sudden shift in topic.
  - vo2maxer 7y ago
    You’re right. I appreciate your comment. I allowed my own frustration with the obvious problems around me to cloud my comments. Here, hoping to clarify my original argument: Adding healthcare services by producing more physicians, costly in training and by their later contribution through a perverse incentive system, does not appear to be the simple answer. In addition, is there a physician shortage [1] or not [2]? I recommended more midlevel providers, who are capable of handling a vast majority of medical problems. To suggest that only professionals with years of training and paid an exorbitant rate can do this, is not to understand what physicians do or midlevel providers’ capability. It is another way of buying into the self-serving mantra promulgated by medical boards and organizations: Only a doctor knows and, furthermore, needs to be board certified. Depending on the state, multiple nurse practitioners and physician assistants can be supervised remotely by one physician. Add telemedicine and other online tools to this partnership and you’ve got a pretty robust team able to care for a much larger population than one physician could. A zillion other tweaks to the system, and all of a sudden efficiency starts to make an impact. But some artificial barriers must be broken in the process (e.g., coordinated information dissemination between health professionals). [1] https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage https://www.aamc.org/news-insights/press-releases/new-findin... [2] https://www.ncbi.nlm.nih.gov/pubmed/26177529 https://www.ncbi.nlm.nih.gov/pubmed/26177529 Edit: For now and the near future, there are procedures that only physicians can perform (e.g., surgery mostly). This is not true in most general medical care and even in specialized care.

bradleyjg 7y ago

Because Americans all think they deserve attention from someone that fits their personal image of what a doctor should be—-in terms of race, gender, age and personality. Someone who is in the top .001% of intelligence and with twenty years of training. All to spend hours listening to them complain about their cold or achey knees. And they don’t want to have to wait. Also, they don’t think they should have to pay anything for it. Instead of acknowledging the impossibility of their desires they jump from villain to villain and magical silver bullet to magical silver bullet. The politicians of course don’t tell them they are being childish, but instead indulge their fantasies. Why do you think the ability to shop around for a physician something so crucial to preserve in any reform? What does that have to do with outcomes?

HeyLaughingBoy 7y ago
That's not all bad though. I don't want to wait to see a doctor and I don't want to pay for it either. What's surprising about that? Hell, I don't want to pay for anything but I acknowledge that people need to eat so I'm quite happy to have that payment be from my tax dollars.