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  • Family medicine MD/DO will be obsolete?

    What is stopping all the bighealthcare companies from replacing primary care doctors wholesale with mid levels ?
    This is not another mid level bashing thread , let’s keep it focused on a single issue
    How does it make sense financially for a organization to hire one MD rather than 2 midlevels ?

  • #2
    From a purely financial standpoint, it doesn’t. We’re a dying breed.

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    • #3
      If and only if value based care and population health starts to matter — then docs will show value compared to mid levels. A specialist friend goes crazy because an NP sees a patient with chronic cough and refers to allergy pulmonary and ENT at same visit (true case). C-suite sees $$$. I’m afraid for primary care— and by extension for our health care system — we will end up with yet worse health outcomes at higher overall expense

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      • #4
        So, taking FP vs IM out of the conversation, I think there will always be a role for a good PCP. I know enough to value a quality PCP. Does the average person? Probably not. But do those who are highly educated and/or affluent? Absolutely.

        I suspect that a large swath of primary care will go the direction you suggest, but there will be a growing role for concierge/cash practice by quality PCPs. I think they’re worth their weight in gold.

        Comment


        • #5
          Unfortunately a lot of our value is knowing when to reassure rather than over test. Or symptomatic care vs antibiotics. When to treat outpatient vs send to ER.

          These things are not valued by the average person or the health system. But they are highly valuable for society and cost of healthcare.

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          • #6
            What are organizations like Kaiser doing? Are they using midlevels for primary care or MD/DOs?

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            • #7
              5 year ago at my wife's kaiser the PCP's were paid more than the non procedural/surgical specialists.(Neuro, endo, ID, renal. allergy). When the specialists complained, the were told the could do PCP. None did of course, but they kept complaining and now they are paid the same as the PCPs. Of course that didn't motivate her from going from inpatient back to outpatient.

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              • #8
                Patients will get tired of their noctor sending them to the ER unnecessarily all the time and then getting stuck with the bill.

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                • #9
                  Originally posted by Lordosis View Post
                  Unfortunately a lot of our value is knowing when to reassure rather than over test. Or symptomatic care vs antibiotics. When to treat outpatient vs send to ER.

                  These things are not valued by the average person or the health system. But they are highly valuable for society and cost of healthcare.
                  Nailed it.

                  Admin talks about wanting quality, but as long as we're still getting paid fee-for-service, they know how their bread is buttered.

                  Comment


                  • #10
                    Im fm, work with 2 mid Levels(don’t supervise either). One of them has 20yrs experience and I’d see him as my pcp. The other has 5yrs and over orders test/referrals….so much so that mgmt had to ask the float ma to help w her bucket. My bucket stays around 50, but my ma doesn’t get help bc “I don’t order a lot”….go figure.

                    as far as the original post..I see Mds in primary care being obsolete in 10-20yrs…it’s already going that way. Just look at the new primary care clinic owned by a large corporation in town…they hired 3 midlevels first, still looking for a doc to supervise them, tells u alot. Atleast for now patients still need me to sign thur diabetic shoe orders, food stamps documents, electric bill assistance forms, and there still a few surgeons who require an MD sign the Oreos clearance. Atleast for now

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                    • #11
                      Are there and statistics about the demographic use of PCP’s?
                      Male/Female and age groups? My only frame of reference is family experience. Significant difference on gender and age groups.

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                      • #12
                        Originally posted by Savedfpdoc View Post
                        Im fm, work with 2 mid Levels(don’t supervise either). One of them has 20yrs experience and I’d see him as my pcp. The other has 5yrs and over orders test/referrals….so much so that mgmt had to ask the float ma to help w her bucket. My bucket stays around 50, but my ma doesn’t get help bc “I don’t order a lot”….go figure.

                        as far as the original post..I see Mds in primary care being obsolete in 10-20yrs…it’s already going that way. Just look at the new primary care clinic owned by a large corporation in town…they hired 3 midlevels first, still looking for a doc to supervise them, tells u alot. Atleast for now patients still need me to sign thur diabetic shoe orders, food stamps documents, electric bill assistance forms, and there still a few surgeons who require an MD sign the Oreos clearance. Atleast for now
                        do you regret going into primary care or no? would you go into it today?

                        Comment


                        • #13
                          I hope physican PCP do not disappear. As a specialist, I can tell who the good primary care providers are. This includes some NPs , but I can tell you where the majority of the silly consults come from.

                          the extra years of school, the years of residency, provides training and education that really makes a difference. ( most of the time)

                          Comment


                          • #14
                            Originally posted by VentAlarm View Post
                            So, taking FP vs IM out of the conversation, I think there will always be a role for a good PCP. I know enough to value a quality PCP. Does the average person? Probably not. But do those who are highly educated and/or affluent? Absolutely.

                            I suspect that a large swath of primary care will go the direction you suggest, but there will be a growing role for concierge/cash practice by quality PCPs. I think they’re worth their weight in gold.
                            Agreed. I wouldn't see a PCP that isn't a physician. So really hope they don't become obsolete!

                            Comment


                            • #15
                              Originally posted by Turf Doc View Post

                              do you regret going into primary care or no? would you go into it today?
                              I tend to believe everything happens for a reason so don’t regret. If I could go back 10yrs earlier I’m not sure I’d choose medicine at all….maybe some sort of agriculture/homesteading…

                              Comment

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