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The problem I see with that is, a typical medical student is going to have to do study and clinical rotations across all disciplines - even ones they don't end

by ejb999 3y ago

The problem I see with that is, a typical medical student is going to have to do study and clinical rotations across all disciplines - even ones they don't end up practicing - i.e. pysch, derm, emergency medicine, surgery, ortho etc - i.e., they will get training in all those areas. Compare that to an NP that went from their 18 month NP class, to work in primary medicine/family practice office - and lets say they work there for 10 years, so great, now they are an experienced NP in family medicine (and someone I for one would be perfectly happy to see as a patient for most routine things) - but what they don't have is the experience in all those other areas that matter - even if they are not practicing it. There is just no shortcut without putting in the time - thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD. There is nothing wrong with being an experienced NP seeing patients (and that is mostly who I end up seeing) - but there is simply no reason to somehow 'promote' those people to doctors - they don't have the same skills or the same experience, and doing so doesn't solve any problem.

IG_Semmelweiss 3y ago
>>> There is just no shortcut without putting in the time What do you think is 10+ years of experience as NP in a busy office setting, exactly ? >>> thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD. You mean, the hours that you were cognitively impaired and mostly a blur due to sleep deprivation ? Or the hours of time you will not get any feedback whatsoever because the patient went home and you will never ever see him/her again? (as opposed to a NP, who's always 1 one call away and has a direct feedback loop to the consequences to her/his actions?)
- ejb999 3y ago
  It will be 10+ years of seeing a variation of the exact same type of scenarios that they have seen before - which is very different then getting education and training across all disciplines - which is my entire point. Primary care NPs are good at what they do, but what they do is very limited - most of them will admit it. Anything they haven't seen before comes along, first thing they want to do is call an ambulance and send them to the hospital or a specialist - or they will pull in an actual MD to ask them what they should do. So if an NP has 10 years of experience working in a primary care facility - what problem does it solve to somehow 'promote' them to an MD based on that experience? Will they magically now be able to see more patients per hour? How does that solve any systemic health care system issues? It doesn't - it simply allows them to get paid like a real MD, when they aren't - so if anything, drives up costs.
  - IG_Semmelweiss 3y ago
    I think you are grossly underestimating the power of incentives. A magic promotion means they now have incentives to open their own practice. Or work at another practice at a promoted level. Or they can simply develop further into a specialty. It simply opens doors where the need is more need and gives them rewards for doing hard work. Getting motivated people moving up in the pipeline opens more avenue for care of patients, relieving the stress on the existing system. The fact that you think it drives up costs actually goes against the rules of reality. If you have more supply of something, it simply lowers the cost of that supplied. The problems we have in healthcare in USA is not one of quality. People from all over the world go to USA, seekign help. The problems in healthcare are related to access and cost. Both of which, this is a magic bullet for. Why would you keep someone hostage at an underpaid role where they have no way of advancing unless they bend the knee and pay tribute to the powers that be, even though they are perfectly qualified to the role and have more experience than virtually all applicants? If you are concerned because you had to pay your way thru med school, think of it this way: 1) MD paid in dollars and sweat equity to afford that BMW at age 32. 2) NPs will pay in opportunity cost to afford to promote into an MD at age 32. No BMW yet either.

by ejb999 3y ago

IG_Semmelweiss 3y ago

>>> There is just no shortcut without putting in the time What do you think is 10+ years of experience as NP in a busy office setting, exactly ? >>> thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD. You mean, the hours that you were cognitively impaired and mostly a blur due to sleep deprivation ? Or the hours of time you will not get any feedback whatsoever because the patient went home and you will never ever see him/her again? (as opposed to a NP, who's always 1 one call away and has a direct feedback loop to the consequences to her/his actions?)

ejb999 3y ago
It will be 10+ years of seeing a variation of the exact same type of scenarios that they have seen before - which is very different then getting education and training across all disciplines - which is my entire point. Primary care NPs are good at what they do, but what they do is very limited - most of them will admit it. Anything they haven't seen before comes along, first thing they want to do is call an ambulance and send them to the hospital or a specialist - or they will pull in an actual MD to ask them what they should do. So if an NP has 10 years of experience working in a primary care facility - what problem does it solve to somehow 'promote' them to an MD based on that experience? Will they magically now be able to see more patients per hour? How does that solve any systemic health care system issues? It doesn't - it simply allows them to get paid like a real MD, when they aren't - so if anything, drives up costs.
- IG_Semmelweiss 3y ago
  I think you are grossly underestimating the power of incentives. A magic promotion means they now have incentives to open their own practice. Or work at another practice at a promoted level. Or they can simply develop further into a specialty. It simply opens doors where the need is more need and gives them rewards for doing hard work. Getting motivated people moving up in the pipeline opens more avenue for care of patients, relieving the stress on the existing system. The fact that you think it drives up costs actually goes against the rules of reality. If you have more supply of something, it simply lowers the cost of that supplied. The problems we have in healthcare in USA is not one of quality. People from all over the world go to USA, seekign help. The problems in healthcare are related to access and cost. Both of which, this is a magic bullet for. Why would you keep someone hostage at an underpaid role where they have no way of advancing unless they bend the knee and pay tribute to the powers that be, even though they are perfectly qualified to the role and have more experience than virtually all applicants? If you are concerned because you had to pay your way thru med school, think of it this way: 1) MD paid in dollars and sweat equity to afford that BMW at age 32. 2) NPs will pay in opportunity cost to afford to promote into an MD at age 32. No BMW yet either.