Announcement

Collapse
No announcement yet.

To use mid-levels, or not?!

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #31
    Patients are confused … the pa in my clinic (don’t supervise him) has been there 15 yrs. Patients call him doctor all the time….same w the np in clinic. They think everyone is the same…

    Comment


    • #32
      Btw I got denied a raise, np got one…so yea. Shows you what corporate thinks. I produced 710 wrvus last mth, she likely produced a lot less

      Comment


      • #33
        APCs work 3 of our 11 shifts a day. That results in our hourly rate being about 1/4 higher than it otherwise would be. If that money wasn't going into my pocket, I'd be much less happy about the situation.
        Helping those who wear the white coat get a fair shake on Wall Street since 2011

        Comment


        • #34
          Originally posted by Huggy View Post

          hmm interesting take. So who is doing the triaging to determine whether a patient’s medical problem is worthy of being evaluated by a physician versus hopefully one of those decently trained midlevels? Example, I just admitted a patient last night with a hemoglobin of 3 and melanotic stool who visited an NP (or APP as you like to call them) one week prior for generalized weakness, fatigue and feeling like her legs are “giving out.” No labs obtained, patient prescribed ibuprofen twice daily for her leg discomfort. Her only medical history is gastric ulcers and iron deficiency anemia requiring frequent transfusions by the way.

          Additionally, I don’t see “APPs can be compensated well” and “physician owners can get reasonable compensation” as compelling reasons to justify the use of midlevels but to each their own. Does that not just prove my original statement that financial interests are the primary driver for the utilization of inferiority trained medical providers? And i think it is safe to assume based on your position that you have a financial interest in the employment of midlevels in your practice, please correct me if I’m wrong.
          If midlevels were not working up undifferentiated patients, and patients didn't seem to be randomly assigned to a midlevel vs. physician, I wouldn't be nearly as concerned about the whole thing. But as it is, I'm just perplexed that there is such incredible variability in the systems they work in and their scope of practice. There's just no logic behind it

          Comment


          • #35
            Originally posted by The White Coat Investor View Post
            APCs work 3 of our 11 shifts a day. That results in our hourly rate being about 1/4 higher than it otherwise would be. If that money wasn't going into my pocket, I'd be much less happy about the situation.
            Does your EM group decide how they function? or the hospital? For instance, assuming they're working, when does a patient see a physician vs. midlevel if they're undifferentiated? Just depending on whose available or there are systems where x. complaint goes to physician and y goes to midlevel?

            It would be interesting to see a poll on how this works

            Comment


            • #36
              Originally posted by Turf Doc View Post

              Does your EM group decide how they function? or the hospital? For instance, assuming they're working, when does a patient see a physician vs. midlevel if they're undifferentiated? Just depending on whose available or there are systems where x. complaint goes to physician and y goes to midlevel?

              It would be interesting to see a poll on how this works
              They're our employees under our control and sit right next to us as they do their work. I think ours are far better supervised than most. And yes, they see the lower acuity complaints. They don't see codes, or traumas, or strokes, but acuity in EDs is rising and that has me concerned. Now some of the lower acuity patients may still end up being a level 5 chart or even admitted occasionally whereas 15 years ago that was much less common.
              Helping those who wear the white coat get a fair shake on Wall Street since 2011

              Comment


              • #37
                Originally posted by Turf Doc View Post

                Does your EM group decide how they function? or the hospital? For instance, assuming they're working, when does a patient see a physician vs. midlevel if they're undifferentiated? Just depending on whose available or there are systems where x. complaint goes to physician and y goes to midlevel?

                It would be interesting to see a poll on how this works
                Whoever employs them decides how they function. For us, they see lower acuity stuff and a lot of psych stuff. We all sit together so if they have questions or if we have questions then they can be addressed/answered. We control hiring/firing so I like to think that we’ve got pretty competent midlevels.

                Comment

                Working...
                X