My father was an awful human being
There has been a lot of spilled ink on this blog about substandard training replacing us – either in terms of midlevel providers, automated flow sheets, automated healthcare, etc.
My father was an awful human being, but one thing he said that was wise was “be careful what you ask for, and doubly so for what you pray for.” Midlevels are asking and praying for independent level of care – and the public will use them for pap smears and bladder infections. Real stuff, the real docs, are going to be fine and we will be here, waiting. Now, it hurts that we don’t get the easy money visits – we rely a lot on those. But we will be fine, independent care will kill a lot of people before it corrects back to where it should be.
We all seem to think that these charlatans that parade as healthcare providers are a new thing. They are not – what they are we were too, and not that stinking long ago. Midlevels get abysmal training, we can all agree on that. That some get better and some worse training we can also agree on. I hearken back to a time at the end of the 1800s when 4 women stood up and said enough is enough. Four. They started the revolution. These women looked at the state of medical training in America (and the world) and they did not go on Twitter, did not blog, did not petition Congress to change. They changed their world (they were the famous starters of the Johns Hopkins School of Medicine.) They set firm that a bachelor’s degree was needed before going on to medical school, medical school was a real regulated thing with professors that were vetted, and women should be allowed to attend. At this time there were hundreds of “medical schools” with varying numbers of students, a few to a few dozen to a few hundred – but all terrible in quality. They were glorified diploma mills with a charade of an apprenticeship sufficing for rigor. If this sounds familiar, it is meant to.
The story goes on with those women though. The board of the medical school refused their criteria and told them to go away. They did; they sat quietly for five years. Then the board went back to them after exhausting all the other options available and decided to try it their way. The rest, as they say, is history. What happened? They did not petition Congress for real rules and real medical schools – everyone else did! The quality was so far superior that quickly patients decided they knew who was going to help them, and it was not the quack school graduates. Congress did eventually step in and close hundreds of schools. They mandated the change that those patient, and very correct, women initiated.
So, if the midlevel training is awful (it is) and change is desired (it is) then do something dramatic. Wait. Patients will get their crap care, midlevels may even get their independent practice of medicine ability. Patients will see the difference, and they will get terrible outcomes, and they will sue people with minimal insurance and no doctor to sue, and they will come back to the physicians. I don’t care a whit if a thousand independent nurse practitioners and physician assistants (associates?) set up shop across the freaking street from me. If I cannot do better, provide better, and be better than they can with their crap education, then that is on nobody but me.
If patients want crap care they can get it. If they want high end care, which I respectfully provide, they will have to pay. You get what you pay for.
I find a good question to ask a midlevel NP or PA – did your professors – have legs?
The vast majority of recent graduates have no idea. They were trained via Zoom or even worse, YouTube. It’s appalling that anyone would spend that kind of money on such awful training – and then have to line up their own rotations which consisted of watching someone else do care.
I employ two NPs recently out of training. I consider their training way up amongst the worst there is (The University of Texas at Arlington.) Neither had any idea if their professors had legs, both saw people at their graduation for the first time that they assume were professors, but were in reality hucksters stealing nice women’s money. Can I work with these people? Absolutely – I train, they learn, I make money – that is how this works. Is it ideal? No. Are they ready for independent practice? OMG no. They would have stacked up 20 bodies each by now.
So what about petitioning and yelling and putting a stop to the independent practice movement? I am too old, too fat, too tired to care. I will wait, and so far, my waiting room seems plenty crowded.
Dr.LeCroy,
Outstanding,!! I came out of PA school in August 1976.Trained to assist my Physician supervisor,in Family Practice, ER, the OR. What I got was an Admin that wanted me to be a cheap Doctor and work 100 hours a week. I have been a PA for almost 47 years.I do not want independent practice,yes I have done remote site care,with my supervising physician 30 to 90 miles away. But always available by phone, and who visited every 2 weeks to see patients.Sometimes I intubated and shipped patients out to him/her.Amputations,burns hypertension, heart attacks, .I left a couple places because of poor supervision, no physician support or not very good physician. But I want to be # 2 his or her assistant,follow their lead,do routine stuff and leave the complicated stuff to my Physician.Better access to care more timely faster appointments.Learning all the neat new knowledge/understanding of human disease, genetics, cancer care, ain care ,addiction.All came thru my clinics or ER. GLORIOUS,
FUN stuff.Making people better one person at a time.. What greater gift can one get as a lifes work?.. Thank You Dr.LeCroy
Do you want a job? I’m in the mid cities between Dallas and Fort Worth. I am actually not (only) jesting but I am also so grateful to you. I never wanted this to sound like I was bashing on the midlevel. I absolutely love the mid-level position. I have had them in my life for 20 years and essential all of my OB delivery training in medical school was through midlevels (midwives.) In an appropriate team based care they are absolutely invaluable and I sound really corny saying it, but thank you for your service.
Excellent piece, Kenneth, lots of very good, hard won points.
Sadly, I have to disagree with your prognosis: I do not think this is going to correct. When the four ladies set out on their quest, there was no corporate health care, no fascistic relationship between BlueHumanaPermanente, Etc., and most importantly, no general population belief in a right to health care.
I’ve spent years on this site criticizing physicians for abdicating their leadership in health care, and I’m not about to stop. But happy-happy cheerleader rival sites like that “leading physician voice” are mere collaborators. Patients, ignorant, vengeful, greedy, and yes, sick and hurting, PATIENTS, customers-by-another-name will accept cheaper, lesser, even mandated care in lieu of what you and I trained to be. If you doubt that, look back over the wreckage of the past three years and all the conditioning that led to it. The patient-doctor relationship was the foundation, and both sides deserve condemnation.
I applaud the candor of your opening. I too asked, and prayed, and am too far along to switch to an honest profession, if any still exist. But you and I can at least, have earned, the right to call things by their real names. Salute.