DEAL WITH IT!
I witnessed a conversation between two Internal Medicine doctors about Nurse Practitioners and Physician Assistants. They worked with two different groups. One refused to employ PA’s and NP’s. The other was in a group that heavily employed them.
“I cannot and will not take the liability of supervising PA’s and NP’s,” said one. “The care is not good enough.”
The other one responded: “One of your partners will soon retire and you will be left with that doctor’s patients. How do you expect to provide care? Are you planning to dramatically instantly increase your patient load? Will you just hire a new doctor? Where do you think you’ll find such a doctor? Seriously! You know you won’t find one! No! They don’t exist and they certainly don’t exist at a salary offer you can afford. They certainly won’t be able to carry the workload you carry to make a tolerable salary! Bottom line: You will work with them and your group will hire them because you will have no choice. It’s not great and we both hate it, but it’s all we’ve got.”
Silence.
The facts were indisputable. This is where we are at.
Primary care is essential. Yet, the workload for PCP’s is insane. No doctor wants to do it. Increasingly, patients treat us as mere triage providers. That means, you cannot find and you certainly cannot hire a replacement. So, what are you going to do? What if you’re not ready or able to retire?
It’s what we’ve got.
The old days of Marcus Welby, M.D. died long ago.
(Editor’s Note: The answer is DPC).
Ummmmm, When I retired from a rural “classical” practice be it office, hospital practice and taking call, there where many newly graduated residents that applied for my job opening and other docs. There are some out there who want to take the self abuse. Actually many are thriving in that noxious environment. I don’t know how but they are thriving.
I went to a “mass” town Covid-19 immunization and the young fellow doc who sort of replaced me when I retired 2 years ago, I only met one time previously, approached me and thanked me for leaving him a lot of patients in decent shape for him to pick up. I mentioned to him he has to win them over and he’ll be In Like Flint. I could tell he had a great personality after he spoke two sentences and he should do well as long as he doesn’t burnout and stays. Office, hospital work and call is a bear to deal with these days and most primary care docs do “office only” care. Don’t blame ’em. I didn’t mind doing a broad practice as I spent 5 and a half years in residency and did three years in a surgical track and then switched to FP and in 2.5 years I was done and was very confident. EHR killed me. Not because I didn’t like computers. Oh contraire. I love computers except I saw that EHR was using computers to make a primary care physicians’ job so much harder dinking with a keyboard instead of dictating. There were guys in the past that could get through 60 patients a day and did a decent job caring for them. I know as I saw some of their patients when their doc was out of town and they worshiped them. I felt honored that many of the patients transferred to me when their doc finally retired. I must’ve made an impression in a single visit! Retirement is a happy/sad eventuality for all docs. Happy to be done and sad to be leaving the “good” patients who were a pleasure to take care of and their families. The druggies I had pity on but I did not cater to. I moonlighted in a methadone clinic when I was a resident and the nurses there taught me a lot about drug abuse so I was incredulous when I started out and could deal with it. Kurt
Dear Sirs;
I understand your observations and objections.I am A PA-C FOR 45 PLUS years.
I was trained to Assist You,the Physician,seeing your less complicated patients doing routine follow up in YOUR practice.That was my role. But everywhere I practiced more was expected.
Sometimes I was the Only provider in town.ER,HOSPITAL ROUNDS,some first assisting,
intubations, IV lines. Trying to keep my drunk Surgeon from operating, watching a general/family practice doc with 25 years experience kill people.. Yeah Fun Stuff..Watching a family practice Doc abuse 15 female service members.He got tossed out after a year or 2 in Leavenworth..I had a small hand in that.Watching a PA in the army do that to wives and Kids of service members.He got a bunch of years in Leavenworth.
Watching NP’s use inappropriate meds and almost kill a couple people.I encouraged the local community of Doctors to talk to her,help guide her,find better medical resources.She is doing fine after 6 years of collaboration.Has not killed anyone yet.
Many new PA’s and NP’s need supervision and training cause they have no idea yet , how much they do not know.. Like MDs /DOs they cover their uncertainity with arrogance and bluster.. Most funny. Humility comes hard after doing foolish things. But lives depend on it..
Our profession of Medicine has hit a new low with vaccines that harm instead of protect.
Doing Gender affirming counseling, puberty blockers, removal of healthy adolescent breasts
penis, vagina/uterus,testes,ovaries. Hormones to replace what was never there,constructing a vagina, or penis that does not ever function … Yes how God like of us..Hubris,arrogance.
and criminal behavior.. First do no harm..
You Physicians are supposed to be leading.Instead just the Dollars.. and hide so you are not a target.. NO GUTS,NO GLORY and you are killing our profession.Hope you take pride in your EVIL.
The primary care groups I see in my area, when a physician retires, the remaining doctors most certainly do NOT take on the patients of the retiring doctor. Every time a doctor retires in my area, my phone starts ringing with the former patients of that retiring doctor. Generally I notice the ones knocking on my door tend to be narcotic problems.
One in particular was so bad, I had to call the practice manager, and told her I would not accept any patients from their retiring doc, as it was clear the remaining doctors were cleaning house.
Shall we say, it was a good thing the doctor in question retired. My humble opinion.
In any event, when a primary care physician retires from a group practice in my area, if that doctor has a load of “X” patients, the practice keeps some number between 0 and “X”, clearly based on insurance factors and headache factors.
So, no, I can’t agree with “You will work with them [NP’s and PA’s] and your group will hire them because you will have no choice. It’s not great and we both hate it, but it’s all we’ve got.”.
You most definitely have a choice. That’s the opportunity for the practice to clear out the poor-paying insurance, Medicare and Medicaid, and patients who are simply a headache to the practice.
That absolutely what I see in my area.
What happens to the patients discharged? I feel for them, in that I have trouble finding physicians for my own parents, and they are not particularly problem patients medically or socially, and I encouraged them to get the best Medicare coverage they can, to appeal to the widest number of physicians. Don’t save money by buying a Medicare plan that limits them to one big box or another.
Anyway, I have long ago learned from the wisdom of Ruk.
https://www.youtube.com/watch?v=uMaKPOtFAnA
You still can live in the world of Marcus Welby MD via DCP. The editor is correct. YOU control how you practice. It has to be horrible under the boot heel of corporate medicine.