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Message
re: I hate our healthcare system and PAs/NPs
Posted on 8/11/17 at 11:27 am to BeaumontBengal
Posted on 8/11/17 at 11:27 am to BeaumontBengal
medical school is graduate school.
3.5 years
Residency is on the job training
3-5 years
Fellowship is an additional year of on the job training for a specific type of problem or set of problems.
I agree fellowship trained physicians have had more training than an entry level mid level.
But let's not sling mud with phrases like diploma mill.
Not all mid- levels undergo online training. Most do 1.5 year of didactic training with 1 year of rotations in multiple fields.
Not unlike the 2 years or didactic training in med school and 1.5 years of rotations in multiple fields.
Residencies are available for mid levels as well as specialty certifications in order to gain experience and demonstrate competence in a feild.
A mid levels undergo on the job training daily from physicians also gaining experience from seeing patients.
Any healthcare provider has the option to seek out additional education and resources and the good ones do this. Also, all healthcare providers should be able to recognize when a problem is beyond their capabilities and good providers do this.
This isn't to compare the training to mid-levels to physicians. It's not the same. But just because a provider is a mid-level doesn't make them incompetent and being a physician doesn't make a provider infallible
3.5 years
Residency is on the job training
3-5 years
Fellowship is an additional year of on the job training for a specific type of problem or set of problems.
I agree fellowship trained physicians have had more training than an entry level mid level.
But let's not sling mud with phrases like diploma mill.
Not all mid- levels undergo online training. Most do 1.5 year of didactic training with 1 year of rotations in multiple fields.
Not unlike the 2 years or didactic training in med school and 1.5 years of rotations in multiple fields.
Residencies are available for mid levels as well as specialty certifications in order to gain experience and demonstrate competence in a feild.
A mid levels undergo on the job training daily from physicians also gaining experience from seeing patients.
Any healthcare provider has the option to seek out additional education and resources and the good ones do this. Also, all healthcare providers should be able to recognize when a problem is beyond their capabilities and good providers do this.
This isn't to compare the training to mid-levels to physicians. It's not the same. But just because a provider is a mid-level doesn't make them incompetent and being a physician doesn't make a provider infallible
1
Posted on 8/11/17 at 11:30 am to Spock's Eyebrow
quote:
What if you do have an acute minor condition such as a sinus infection that coincides with your "annual wellness visit" scheduled months in advance? I have no doubt I'd be charged for that even though I wouldn't have come in for it. Under our system, I'd need to postpone my annual physical until I'm well. It's nuts.
I went in for my annual wellness check a few years ago and one minor remark about some chest tightening from a few months prior led to $1200 in lab tests and a charge for an office visit with my PCP.
Posted on 8/11/17 at 12:08 pm to Ireallyamgerman
quote:
I agree fellowship trained physicians have had more training than an entry level mid level.
All physicians have had more training than an entry level mid level. There are no online diploma mills for physician training.
This post was edited on 8/11/17 at 12:10 pm
Posted on 8/11/17 at 12:46 pm to Golfer
quote:
one minor remark about some chest tightening from a few months prior led to $1200 in lab tests and a charge for an office visit with my PCP.
That's the thing about healthcare though. In general, patients don't understand how significant a complaint is (please take that in context- patients are not dumb or uninformed. They just don't hear people "complaining" (again, the word "complaint" not being derogatory or suggesting that people whine) about things and are not able to pick apart what is significant vs not). If they did, the role of the physician would be much lessened. But because of this, a fair number of people with that complaint (based on the description and risk factors) could have anywhere from tendonitis of the little rib muscles to an aorta that is about to rupture and nearly anything in between, including pneumonia, large clots in the lung or legs. I could probably run through 15 different things in my head.
Now, being idealistic, I hope your story was concerning enough that tests were needed to justify the workup. There are some physicians who are not confident enough in their history taking and physical exam skills to say that your pain was not of concern with no additional workup. But there is at least a moderate to good chance that any average Joe would have done the same thing for you.
Posted on 8/11/17 at 9:32 pm to BeaumontBengal
Not every mid level has a degree from an online college. I understand that this is a narrative that plays well to the cause of discounting mid level providers but it simply isn't true.
Posted on 8/11/17 at 10:08 pm to Spock's Eyebrow
quote:
So what do you think crosses the line from annual wellness visit to cha-ching cha-ching? Specific examples, please. How many issues? Assume it's all done in one visit in the allotted time. I'm asking because every time I go for my "annual wellness visit," I'm told at the desk it's free, but then if I comment on anything, no matter how minor, my doctor codes it differently, I get charged for it, and I have to spend 30 minutes on the phone getting it fixed. I've gotten it fixed every time, but I'm sick of this shite. I'm looking for a new doctor because of it.
We usually just do that to assholes we don't like and wish they'd go somewhere else.
Posted on 8/11/17 at 10:17 pm to SmackoverHawg
quote:
We usually just do that to assholes we don't like and wish they'd go somewhere else.
Can't answer the question in a justifiable way, huh?
Posted on 8/11/17 at 10:23 pm to Spock's Eyebrow
quote:
Can't answer the question in a justifiable way, huh?
I did. Most of the time I just do the wellness if the complaints are minor. But ANY new issue could trigger an additional charge under some insurance plans. Your insurance and it's their rules. Bitch to them. We have to chart and document our work to prevent litigation as well. Pretty sure you were one of the ones all in favor of doctors getting their asses sued off. Guess what? There's a cost to that. If I'm gonna do the work and have potential liability for it, I'm justified in billing for my services at a rate agreed to with YOUR insurer that YOU choose. We just play within the rules they set.
Posted on 8/11/17 at 10:25 pm to schwartzy
I don't mind aeeing an NP or PA for routine/no big deal issues. But, I don't think you should have the same copay to see them as you do to see a physician.
Posted on 8/11/17 at 10:26 pm to SmackoverHawg
quote:
I did.
bullshite.
quote:
Pretty sure you were one of the ones all in favor of doctors getting their asses sued off.
Why in the world would you say that? It calls into question your entire reasoning process.
quote:
I'm justified in billing for my services at a rate agreed to with YOUR insurer that YOU choose. We just play within the rules they set.
You're a partner in their system. Patients are victims in it. That's the difference.
Posted on 8/11/17 at 10:30 pm to drunkenpunkin
quote:
I don't mind aeeing an NP or PA for routine/no big deal issues. But, I don't think you should have the same copay to see them as you do to see a physician.
Your insurer doesn't care. They pay NP's 15-20% less while you still pay the same. Who do you thinks pushing this? Doctors? shite no. Insurances, pharmacy chain retail clinics, big hospital owned clinics. They've duped people into taking a bait and switch. And pushed the "they're just as good as doctors if not better!!!!!"
Nobody and I mean NOBODY gave a shite when doctors where standing against this. Now people can reap it. Posted on 8/11/17 at 10:32 pm to Spock's Eyebrow
quote:
Why in the world would you say that? It calls into question your entire reasoning process.
A thread from the PT. May have you mixed up with someone else.
quote:Partner? I think not. They screw us all the time. You have 100% control if you buy there product or not. Don't like their rules, don't buy their insurance.
You're a partner in their system. Patients are victims in it. That's the difference.
Posted on 8/11/17 at 10:32 pm to SmackoverHawg
Dude, I work for a physician and NP, both excellent. Bring the snark down a little. I know how it works. I just think it's dumb.
Posted on 8/11/17 at 10:33 pm to drunkenpunkin
quote:
Dude, I work for a physician and NP, both excellent. Bring the snark down a little. I know how it works. I just think it's dumb.
Posted on 8/11/17 at 10:34 pm to SmackoverHawg
quote:
You have 100% control if you buy there product or not. Don't like their rules, don't buy their insurance.
The alternative is worse. Not much of a choice.
Posted on 8/11/17 at 10:38 pm to Spock's Eyebrow
quote:
The alternative is worse. Not much of a choice.
Agreed. But we can offer cheaper cash prices and more transparent pricing if insurance isn't involved. Hard to give a price when we don't even know. It varies from insurance to insurance. I admit that it sucks. We hate being made out to be the assholes all the time.
Posted on 8/11/17 at 10:39 pm to schwartzy
Went through the same 2 minute bs with a lump in my back. Cept it was an actual doctor who was like "yeah that big arse thing in your back, don't worry about it until it grows"
Cool, i pay out the arse for health insurance and this is what i get. Take a fricking test at least since I took off work and drove out here to see you.
Cool, i pay out the arse for health insurance and this is what i get. Take a fricking test at least since I took off work and drove out here to see you.
Posted on 8/11/17 at 10:41 pm to shotcaller1
quote:
Went through the same 2 minute bs with a lump in my back. Cept it was an actual doctor who was like "yeah that big arse thing in your back, don't worry about it until it grows" Cool, i pay out the arse for health insurance and this is what i get. Take a fricking test at least since I took off work and drove out here to see you.
Sounds like he was saving you money and time. I'm sure if you asked him to run some tests, he'd be fine with letting you blow hundreds if not thousands of your hard earned dollars to give you the same answer you started with.
ETA-but know that it'll be expensive and stuff like that is why you insurance costs so much. People DEMAND expensive test when we can give them a simple, quick answer. I see it every day. I'll gladly spend their money on test I don't feel they need after they insist on them.
This post was edited on 8/11/17 at 10:45 pm
Posted on 8/11/17 at 10:45 pm to shotcaller1
You would've paid out the arse some more for any testing. You got your docs opinion that it wasn't worrisome looking. And he told you what would make it worrisome in the future. Why would you want to pay for an unecessary test?
Posted on 8/11/17 at 10:46 pm to TigerFanInSouthland
Pimple popper MD
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