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Can PCPs be the “ mid levels “ of some specialists

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  • Can PCPs be the “ mid levels “ of some specialists

    As it says on the tin
    what do you guys think , I’m a pcp myself not meant to be offensive
    rather than specialists use NP PA for frontline jobs which hopefully any half decent trained pcp can do ?

  • #2
    Do you want to be paid like a mid level? It would be a weird situation having an internist work for an orthopedist or something like that. I’m not even sure how that would work. You wouldn’t be working under their license since you have your own.

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    • #3
      What? thats almost like asking if the EM doc or CCM can be a mid level for the specialist.

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      • #4
        Originally posted by CordMcNally View Post
        Do you want to be paid like a mid level? It would be a weird situation having an internist work for an orthopedist or something like that. I’m not even sure how that would work. You wouldn’t be working under their license since you have your own.
        Eh, not really. Some orthopods have nonop sports med docs who are EM or FP who did a 1y fellowship.

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        • #5
          When I was in training, I remember three primary care physicians, who were in private practices in the community, worked as part-time neonatal hospitalists at that time. They would organize overnight events/numbers/information for rounds, round, place orders, communicate with families, assist with procedures, attend deliveries, etc. On rounds, the plan was directed by the neonatologist, or the neonatology fellow if there was one on service. Agree that liability could be viewed differently for physicians, as compared to NNPs. I don't know whether they got paid the same rate or a different rate than the NNPs (who also worked shifts in the NICU) as a result of their training background and experience or the potential risk for liability.

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          • #6
            I think there are some doctors out there who wouldn’t mind less pay to have the option to do this.

            Advantages:
            Learn about something new
            get immersed in a new environment (similar to learning something new, but a specialty office often functions differently than a generalist office in many ways)
            potentially better schedule, if you are actually treated the same way as a pa/np regarding the boundaries of their schedules
            better patient care

            Disadvantages:
            less pay (if you are FI or coast FI and value professional learning over maximizing income that may be a fair trade)
            maybe the specialist looking down on you/treating you as less than (hopefully not, and the person looking to do this probably doesn’t have a giant ego anyway).

            i know a PCP (FP) who went to work seeing a subset of patients in a rheumatology practice. He is happy—learning new things and better environment than prior FP office.

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            • #7
              Originally posted by VentAlarm View Post

              Eh, not really. Some orthopods have nonop sports med docs who are EM or FP who did a 1y fellowship.
              I feel like those arrangements are a little different than a midlevel working under a specialist. I have a buddy that is a FM trained sports med doc and he is far from acting as a midlevel.

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              • #8
                Originally posted by VentAlarm View Post

                Eh, not really. Some orthopods have nonop sports med docs who are EM or FP who did a 1y fellowship.
                This is actually a mutually beneficial business model. Referrals back and forth from a group of op sports med docs. Not everything requires a hammer.

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                • #9
                  I think it could be great.
                  Last edited by cards67; 04-17-2022, 09:32 AM.

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                  • #10
                    Several FM/IM docs embedded within subspecialties already we're cost efficient AND operate higher level for complex cases. Remember, we're a quaternary academic center so it's a bit different there too.

                    For vertically integrated systems, primary care docs function as many mid-levels to the subspecialists via coordinated service agreements.

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                    • #11
                      Originally posted by CordMcNally View Post
                      Do you want to be paid like a mid level? It would be a weird situation having an internist work for an orthopedist or something like that. I’m not even sure how that would work. You wouldn’t be working under their license since you have your own.
                      There are definitely mid levels that make more than some PCPs.

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                      • #12
                        Originally posted by AR View Post

                        There are definitely mid levels that make more than some PCPs.
                        Obviously that was a general statement. There’s plumbers that make more than neurosurgeons but I think most people would prefer the average salary of the neurosurgeon.

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                        • #13
                          Originally posted by CordMcNally View Post

                          Obviously that was a general statement. There’s plumbers that make more than neurosurgeons but I think most people would prefer the average salary of the neurosurgeon.
                          Yeah, but I don't think the question is intended to be a general question. I interpreted it like, "Would you change from neurosurgery if being a plumber made more money?".

                          Or in this case, "If being a mid-level made you more money (or was more desirable in some other way), could you be one if you possessed PCP credentials?"

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                          • #14
                            Originally posted by AR View Post

                            Yeah, but I don't think the question is intended to be a general question. I interpreted it like, "Would you change from neurosurgery if being a plumber made more money?".

                            Or in this case, "If being a mid-level made you more money (or was more desirable in some other way), could you be one if you possessed PCP credentials?"
                            Right. And for most PCPs it would be a paycut. You’ve also got to keep in mind this forum is not how a typical physician behaves financially. I’d say a majority of physicians can’t really afford to make much less. There is a subset of physicians who could take a pay cut and would like the possibly reduced hours but these physicians are likely financially savvy enough that they could probably do their own thing. I guess what I’m trying to say is that there’s a reason you don’t really see this scenario playing out in the real world. Physicians can’t or won’t do it.

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                            • #15
                              Originally posted by CordMcNally View Post

                              Physicians can’t or won’t do it.
                              Yeah, that's the question. Is it "can't" or "won't"?

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