Brilliant. Interesting that many organizations, especially in Direct Primary Care, are advancing game-changing models of care that mostly involve physicians seeing fewer patients than ever! It is definitely the right of approach from an individual patient point of view, but is infinitely far from a practical solution given all the constraints you so eloquently organize in this article.
I am a primary care physician with my own practice. My wife is an APRN with me, and we just hired another APRN, who is very smart but fresh out of school. I have worked with several PAs and APRNs in the past. I agree with the article that freshly minted mid-levels are woefully unprepared to care for patients. When my wife was in APRN school at UConn, I looked at her curriculum, and it 1/3 was a complete waste of time. She barely got any clinical time at other practices. We were lucky that we had our own practice so I could train her (which is what I am doing now with our new APRN).
The other question about why MD/DOs don’t train midlevels. The colleges offering these programs are predators. They don’t want to pay MDs/DOs to train their students (I also train medical students and am compensated for my time by the University). They offer CEUs, which we cannot use, so they barter with other midlevels to train their students by offering CEUs. This creates another problem, as these midlevels get their CEUs from training and do not attend actual CEU programs where they can learn.
These programs have created a very strong lobby to convince legislators that they should be able to practice independently. The legislators give in because these lobbies are funded by large hospital systems that benefit tremendously from cheap labor.
By the way, I got a call from the Yale PA program several years ago to train their PAs. When I asked about compensation, I was told that being a doctor, it is my responsibility to the community to train the next generation of clinicians. When I told the administrator that I was happy to train their PAs if they would forgive their tuition, he said it was above his pay grade to make that decision. Needless to say, Yale never called me again.
That was well put, as usual. I agree with everything, with the exception of Non Physician Providers being a practical solution when they undermine the value of doctors. Maybe this is temporary. The truth is Americans have the power to change the current state of healthcare, but change must start with employers. Employers control the flow of finances and patients and need an affordable, high-value solution for healthcare. The solution is self-funding. It's time for everyone to take a stand, and for employers to lead the way to better healthcare.
Brilliant. Interesting that many organizations, especially in Direct Primary Care, are advancing game-changing models of care that mostly involve physicians seeing fewer patients than ever! It is definitely the right of approach from an individual patient point of view, but is infinitely far from a practical solution given all the constraints you so eloquently organize in this article.
I am a primary care physician with my own practice. My wife is an APRN with me, and we just hired another APRN, who is very smart but fresh out of school. I have worked with several PAs and APRNs in the past. I agree with the article that freshly minted mid-levels are woefully unprepared to care for patients. When my wife was in APRN school at UConn, I looked at her curriculum, and it 1/3 was a complete waste of time. She barely got any clinical time at other practices. We were lucky that we had our own practice so I could train her (which is what I am doing now with our new APRN).
The other question about why MD/DOs don’t train midlevels. The colleges offering these programs are predators. They don’t want to pay MDs/DOs to train their students (I also train medical students and am compensated for my time by the University). They offer CEUs, which we cannot use, so they barter with other midlevels to train their students by offering CEUs. This creates another problem, as these midlevels get their CEUs from training and do not attend actual CEU programs where they can learn.
These programs have created a very strong lobby to convince legislators that they should be able to practice independently. The legislators give in because these lobbies are funded by large hospital systems that benefit tremendously from cheap labor.
By the way, I got a call from the Yale PA program several years ago to train their PAs. When I asked about compensation, I was told that being a doctor, it is my responsibility to the community to train the next generation of clinicians. When I told the administrator that I was happy to train their PAs if they would forgive their tuition, he said it was above his pay grade to make that decision. Needless to say, Yale never called me again.
Sudeep Bansal, MD, MS
Owner, Avanta Clinic LLC
Author/Podcaster at www.PCPLens.com
That was well put, as usual. I agree with everything, with the exception of Non Physician Providers being a practical solution when they undermine the value of doctors. Maybe this is temporary. The truth is Americans have the power to change the current state of healthcare, but change must start with employers. Employers control the flow of finances and patients and need an affordable, high-value solution for healthcare. The solution is self-funding. It's time for everyone to take a stand, and for employers to lead the way to better healthcare.