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Which personally, I'm fine with, but I'm a 35 year old healthy person with connections to many medical specialties and a PA for a wife.

I'm not sure the 68 year old diabetic with COPD and an abnormal liver panel wants his treatment from a NP or PA.

I agree completely. I don't see much of an issue with going that route, but as you've said, I can see the concern with a very diverse patient load.

Wouldn't this eventually push PAs and NPs out of traditional family medicine much the way they are currently chasing MDs and DOs into more specialized practices without some added incentive to move into primary care specialties?

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Medicaid is also a HUGE problem for PCP's. MCD reimbursement does not cover the cost of providing care, forcing docs that see mostly MCD patients to herd them through clinic as fast as possible in order to simply break even. Obamacare has only made this problem much worse by adding so many uninsured to MCD rolls. Particularly when most PCP's won't even take it at this point if they don't have to.

This is also my concern. The added MCD patient rolls would hurt the bottom line for primary care professionals such as your wife, thus providing less incentive to enter primary care specialties out of allopathic/osteopathic medical schools, PA schools, or nursing schools.

This would hit the rural area like my home town especially hard. It's not uncommon for my parents to have to wait a week or more to see their doctor for a 10-15 minute appointment.

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MSMhater

Thanks for the insight.

This post was edited on 11/17/14 at 10:38 am

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Posted by MSMHater

Houston

Member since Oct 2008

22782 posts

Posted on 11/17/14 at 10:35 am to dewster

quote:
Wouldn't this eventually push PAs and NPs out of traditional family medicine much the way they are currently chasing MDs and DOs into more specialized practices?

Nah. They can specialize in the same way a phsyician can. My wife is a fellowship trained hepatology PA. She would have no business seeing you in a primary care setting, but she can get you a new liver. Honestly, I believe prgrams are actively encouraging mid levels into primary care fields b/c they know the situation at hand, and it's really eazy to find opportunities in primary care for mid levels right now.

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So basically nothing

Correct

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My wife is starting med school next year (and seems to be interested in pediatrics),

Pediatricians are pediatricians b/c they love treating kids. There is very little money to be had (relative to hours worked) simply as a Pedi. She would need to further specialize (i.e. Pedi-onc, Pedi-ortho, etc...) to make good money.

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and I'm trying to develop an opinion on the challenges PCPs face in today's medical field and I'm trying to understand what impact Obamacare would have on the PCP shortage (particularly in rural areas).

As people are charged more and more for insurance, they are eventually going to get tired of that and just pay the doc directly to keep him on retainer. Without change, that is the direction we are headed. Boutique/Concierge practices for the "wealthy", and long lines for access to mid levels or foreign graduates for people with insurance.

Foreign medical graduates already make up a staggering percentage of rural physicians. I'll see if I can find the data.

ETA: 19.3% of rural physicians are foreign medical graduates. LINK

This post was edited on 11/17/14 at 10:39 am

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