Family medicine MD/DO will be obsolete?

[CordMcNally]

I hear that there is a penguin run urgent care that does just that!

I’ve also seen studies that show penguins are comparable to physicians in knowledge and outcomes.

[GlassPusher]

I’ve also seen studies that show penguins are comparable to physicians in knowledge and outcomes.

And pigeons.

https://www.scientificamerican.com/article/using-pigeons-to-diagnose-cancer/

[CordMcNally]

And pigeons.

https://www.scientificamerican.com/a...agnose-cancer/

“I’m sorry, ma’am, the physician that is supposed to be looking at your biopsy is currently crapping on cars in the parking lot then is going to go fight ducks for bread in the park.”

[Hank]

“I’m sorry, ma’am, the physician that is supposed to be looking at your biopsy is currently crapping on cars in the parking lot then is going to go fight ducks for bread in the park.”

Narrator: “He wasn’t talking about a pigeon…”

[FunkDoc83]

CordMcNally has the best one liners.

[Max Power]

What is killing primary care even more than the financials or the lack of specialty knowledege is the fact that people now want a "nice" doctor who "listens good" and has 4.9 star ratings...

Gone are the days of high functioning folks with a wealth of information who can manage things properly and efficiently. "Customer service" is the new correct diagnosis. Long appointments so they feel validated. Tests ordered by the doctor if the patient wants it or certain Rx if they read about it or a friend takes it.

People want fast food and walk-in care with a smile. They want to see "Jill" who pals around and asks them about their pet and talks vitamins and green vegetables... instead of boring old Dr. Brownstein who could actually interpret electrolytes, know the guidelines for HTN and DM and CA screens, and would order a test or two that might detect pre-malignancy or early CAD.

Specialists have skills too far beyond the reach of any midlevel or jokester, but that won't last forever either. People will get whatever they'll settle for. And that's exactly what they deserve. If I threw darts for a mechanic or an attorney or a CPA that could see me asap and picked bubbly over educated, I'd deserve whatever wretched result I'd probably get also.

Like it or not, the new culture is searching on their phone for doctors who work around their time and do things to their liking, and they should also be attractive and available same day for a minimum 30min visit (80% listening)... and must also read and memorize the entire patient medical record from all other hospitals and past treating docs. It is the age of hand holding. Fun times...

[familydocPA]

What is killing primary care even more than the financials or the lack of specialty knowledege is the fact that people now want a "nice" doctor who "listens good" and has 4.9 star ratings...

Gone are the days of high functioning folks with a wealth of information who can manage things properly and efficiently. "Customer service" is the new correct diagnosis. Long appointments so they feel validated. Tests ordered by the doctor if the patient wants it or certain Rx if they read about it or a friend takes it.

People want fast food and walk-in care with a smile. They want to see "Jill" who pals around and asks them about their pet and talks vitamins and green vegetables... instead of boring old Dr. Brownstein who could actually interpret electrolytes, know the guidelines for HTN and DM and CA screens, and would order a test or two that might detect pre-malignancy or early CAD.

I was thinking about this recently. It seemed to subtly creep into the expectations over the years, but I'm wondering why the cultural expectation has been to make chit chat and all the other "customer service" type stuff? No one would ever expect that from their lawyer or other professional, especially if they were paid by the hour. We are paid for our expertise, not to be a friend.

[PrimaryCareMD84]

I was thinking about this recently. It seemed to subtly creep into the expectations over the years, but I'm wondering why the cultural expectation has been to make chit chat and all the other "customer service" type stuff? No one would ever expect that from their lawyer or other professional, especially if they were paid by the hour. We are paid for our expertise, not to be a friend.

Of course we care about that with our attorneys, accountants and other professionals. To be clear, you can be friendly, personable AND correctly interpret guidelines and labs. Patients have choices and they will choose those they like better than those they don't. It does help create a therapeutic alliance and, importantly, it encourages patients to open up and talk to you about their issues.

[Max Power]

Of course we care about that with our attorneys, accountants and other professionals. To be clear, you can be friendly, personable AND correctly interpret guidelines and labs. Patients have choices and they will choose those they like better than those they don't. It does help create a therapeutic alliance and, importantly, it encourages patients to open up and talk to you about their issues.

Yes, and we all should aim for both. However, the clock doesn't stop ticking. People used to realize that and pay for a professional medical or surgical result.

Now, they want a friend and a listener... with an acceptable skill level being a bonus. They look to tell their friends afterward "that doctor was really nice" instead of "that doc is sharp, they really saved my life." Part of the issue is probably that people from the millennial and Gen-X are now coming in with such hocus pocus complaints or borderline vanity issues that boomers and ww2 gen would have ignored that midlevels can handle most of them, and part of it is cultural expectations that everyone has insurance and 'deserves' hand holding. At any rate, it has been a boon to midlevels and has largely switched around from results-oriented to personal service in terms of priority.

As was said, if medicine could bill by the hour, it would probably be a different story. The days when doctors would run the hospitals are over, and now we yield to their admins... or they are increasingly even the ones signing our checks and doing our evals.

[StarTrekDoc]

Yes, and we all should aim for both. However, the clock doesn't stop ticking. People used to realize that and pay for a professional medical or surgical result.

Bedside manners matter. Being an arse while having technical skills still is marginally passable with the highly specialized folk. The amount of time I spend in 'service recovery' for our system is significant thanks to those with folk without such bedside manners --- people care about BOTH; but still it's about the bottom line - getting stuff done right.

midlevels are great where patient as expectation of getting xxx med/order as does the system think so too -- eg; antibiotic, xray, -- lumps and bumps stuff that can be diagnosed from the door -- sure. Take all those all you want and solid reason no docs at these retail point-of-care+pharmacy shops a la CVS minute clinics.

PrimaryCareMD84 gets it right regarding achieving therapeutic alliance and that's the power of the MD/DO in primary care. We can possess BOTH, hence no worry about the demise of the physician PCP.

[nastle]

What is killing primary care even more than the financials or the lack of specialty knowledege is the fact that people now want a "nice" doctor who "listens good" and has 4.9 star ratings...

Gone are the days of high functioning folks with a wealth of information who can manage things properly and efficiently. "Customer service" is the new correct diagnosis. Long appointments so they feel validated. Tests ordered by the doctor if the patient wants it or certain Rx if they read about it or a friend takes it.

People want fast food and walk-in care with a smile. They want to see "Jill" who pals around and asks them about their pet and talks vitamins and green vegetables... instead of boring old Dr. Brownstein who could actually interpret electrolytes, know the guidelines for HTN and DM and CA screens, and would order a test or two that might detect pre-malignancy or early CAD.

Specialists have skills too far beyond the reach of any midlevel or jokester, but that won't last forever either. People will get whatever they'll settle for. And that's exactly what they deserve. If I threw darts for a mechanic or an attorney or a CPA that could see me asap and picked bubbly over educated, I'd deserve whatever wretched result I'd probably get also.

Like it or not, the new culture is searching on their phone for doctors who work around their time and do things to their liking, and they should also be attractive and available same day for a minimum 30min visit (80% listening)... and must also read and memorize the entire patient medical record from all other hospitals and past treating docs. It is the age of hand holding. Fun times...

Very true
it sickening

[nastle]

Kamban
you are describing a private practice model , other than that there is no hope for employed family /primary care medicine doctors?

[Kamban]

Kamban
you are describing a private practice model , other than that there is no hope for employed family /primary care medicine doctors?

I know a couple of employed PCP's in the local health systems They have absolutely no control. If they get a APP or two they get them. If they have to supervise they have to. Sometimes they have a good MA and sometimes poor. The admins rule and at one time a surgical subspecialist was in charge of all the medical groups and decided how a PCP group should run.

The people who are happy are ones who don't care, clock in, clock out and take a paycheck. The ones who are unhappy are those who grumble but cannot get out, start on own or join a PP. A few got out at one point and started a PCP group and employed APPs and are happy.

[F0017S0]

What is killing primary care even more than the financials or the lack of specialty knowledege is the fact that people now want a "nice" doctor who "listens good" and has 4.9 star ratings...

Gone are the days of high functioning folks with a wealth of information who can manage things properly and efficiently. "Customer service" is the new correct diagnosis. Long appointments so they feel validated. Tests ordered by the doctor if the patient wants it or certain Rx if they read about it or a friend takes it.

People want fast food and walk-in care with a smile. They want to see "Jill" who pals around and asks them about their pet and talks vitamins and green vegetables... instead of boring old Dr. Brownstein who could actually interpret electrolytes, know the guidelines for HTN and DM and CA screens, and would order a test or two that might detect pre-malignancy or early CAD.

Specialists have skills too far beyond the reach of any midlevel or jokester, but that won't last forever either. People will get whatever they'll settle for. And that's exactly what they deserve. If I threw darts for a mechanic or an attorney or a CPA that could see me asap and picked bubbly over educated, I'd deserve whatever wretched result I'd probably get also.

Like it or not, the new culture is searching on their phone for doctors who work around their time and do things to their liking, and they should also be attractive and available same day for a minimum 30min visit (80% listening)... and must also read and memorize the entire patient medical record from all other hospitals and past treating docs. It is the age of hand holding. Fun times...

This YouTube video belongs in the confines of the containment vessel of the melted-down Unit 2 at the Three Mile Island nuclear generating station.

[afan]

I am not in primary care.

We have a shortage of PCPs at our place and this has long been the case. There are many physician extenders, NPs, PAs, etc. They do things that one does not need a physician's knowledge to do. They are great for simple procedures. Some of the more experienced ones do a good job of initial intake and consults. I don't think any function independently on the inpatient side but they definitely do on outpatients. As a consultant this makes it tough for me at times since I cannot count on talking with someone who has doctor-level knowledge of medicine. But I have not seen patient care problems.

Think of the waste to take someone with 4 years of med school and a full residency and have them do things that someone with far less education and training could do. I cannot remember ever having a doc take my blood pressure or draw labs. Waste of their time. Docs should be doing those things that one needs to be a doc to do. Simple stuff should go to less skilled people. They are easier to come by they make less money and let us care for more people at the same cost.

If you are threatened by this, the solution is not some rent-seeking attempt to prevent qualified people from practicing within their abilities. The solution is to focus on things they cannot do.