Where Have We Seen This Before?
The above is captured from an online discussion.
If you convince enough people that training and education don’t matter then they start believing it. Ladies and gentlemen, I give you the Dunning-Kruger Effect in all its glory.
But remember, the PAs are not trying to get FPA. That is what they are saying. Getting a “doctorate” is only to keep up with the NPs. Changing their name to Physician Associate is not to confuse patients. We can believe them, right?
Do not get lost in the message. Texas and other states are outlawing abortions. I saw a report that the Governor Connecticut plans to allow MDs, PA, NPs and others to perform them. Don’t get distracted by the abortion topic, but rather that NPs and PAs will perform unsupervised procedures.
And like in Pennsylvania with Kermit Gosnell, I bet the Department of Health and the Boards will ignore any reported mortalities.
Mid-levels don’t seem to realize that they are being used as the cat’s paw for the ghastly Weberian mess known as American Medical Management, 1800’s style. Like Communism, bureaucracy was born of abstract ideas of human management and behavior. Nice ideas that failed utterly, though.
In manufacturing theory, one determines an acceptable failure rate, and strives to keep the failure rate below this target. The work of the American IOM, To Err Is Human, suggested that failure rates could be kept below the nebulous “six sigma” if some obligatory management methods could be enforced on medical practice. Twenty-five years, and we have this. It is institutionalized. Like the old members of the old tribes, the elders are going away and the language is lost, and there is no memory of any different way of doing things.
One of the old principles in medicine was that there was no back door. Now, we see the need to bundle up the patient and dump them off to the next guy. Then, there was no way out – you were the end of the line. If something was too much for your skill-set, you consulted an expert. Modern conveyor-belt medicine follows principles of process-and-dump, and don’t let ’em die on your shift.
And yes, PA’s and EMT’s and really anyone can handle 50% of the problems in, say, dermatology, that come their way. It’s the other 50% that make the difference, but hey – consult dermatology! Missing a melanoma here and there is okay, as long as you remain above the acceptable failure rate.
I enjoy watching hockey, and I played a little in college intramurals. I’ll see a young goaltender making six million a year, stopping shots that I could stop – or even worse, missing an easy grab and letting up a goal. If I played in the Stanley Cup as a goaltender, I could easily stop over half the shots that came my way. Lots of them are soft floaters or long-distance shots just to get the puck in the zone. So many even miss the net! What’s the six million dollars all about?
It’s not for stopping the easy ones, but stopping the one good shot that could lose you the game. The blistering slapshot when you are screened.
If I played goal in the Stanley Cup, the other guys would get no more than 8 or 10 goals, max. If that’s the acceptable failure rate, I’m in. But it’s not. Games start with a shut-out, and the big money’s paid so that they end with a shut-out. But hey, a puck’s a puck, right, and sitting here on my couch, I know I could play in the pro’s, right?
I don’t have enough profanity to do this justice.
This is why I stay off of social media. According to the moron who posted as a PA, my 20 years as a 911 and critical care paramedic in major cities and working on teams at Hopkins and Children’s National medical center qualifies me to claim equality with an MD. I too have read lots of books and attended lots of extra classes including all the ceu classes required by the doctors on our teams. I’ve even watched some YouTube videos on how to insert chest tubes. Maybe I’ll watch one on inserting a PICC line. Maybe I’ll just buy my own ambulance and driver around with a bullhorn advertising home colonoscopy exams. There’s no end to the possibilities. Where’s my pay raise?
The last comment is the most telling. He is little intention of being a reconstructive dermatologist feeling a need in a rural area diagnosing skin cancers. He States he is getting injector classes. That means he plans on being an aesthetic dermatologist. He plans on injecting fillers and Botox. That is why they want full practice authority it’s not for filling a need it’s not for underserved areas it’s all about money. The flood of nurse practitioners and now PA’s into plastic surgery is becoming a major issue. At the same time hospitals don’t want to pay for call and the same hospitals want patient satisfaction of plastic surgeons showing up lacerations. Of course the payment in 2022 is based on what the ER doctor would receive for 10 minutes and no overheadnot someone giving up an evening of his life. Plastic surgeons thus are having to give up emergency room call because they can’t compete against this flood of mid-levels that are able to offer services without the burden of providing emergency room call.