I do have words, but I'm really tired right now. Mostly I agree with what everybody has already said.
I do have words, but I'm really tired right now. Mostly I agree with what everybody has already said.
The comment thread is all over the place as far as what the commenters clearly know (or lack) for information and experience. Shortest comment is that NPs and PAs and CRNAs and etc. all get extensive training, have licensing requirements, and are fully competent as professionals.
There absolutely is a need for care providers in more underserved areas. One of the reasons is that it is actually very expensive to maintain a medical business, and while that is a dirty word on all sides it is also reality. Medical care is no longer a charity provided by nuns that doesn't need to worry about being a viable business that maintains facilities, employs people, etc. The government and private insurance companies decide how much it costs to run your business; they are not good at listening to people on the ground about realities of costs.
Doctors in underserved areas used to be able to do things like let people pay over time, or barter goods and services. This has been illegal for a while because there were issues of conflict of interest and people who could very well pay getting undue considerations, or family getting free care, or whatever. So it has to be money, it has to be in 30, 60, or 90 days, they have to pay a co-pay, etc.
You do not need as many specialists as generalists. All generalists do not need to be trained to the extreme. While I also went through training with a heavy emphasis on culture and persons and so forth, that is not how everyone is trained, and frankly, you are not graded, tested, or licensed on most of that. There is no one right multiple choice answer for what to do with real people. There's right answers to legal questions, there's right answers to questions of fact (like what the top 10 complications of a given disease are, or this week's favorite numbers to define high blood pressure). There is no one right answer to what to do for a patient who is unable to control their illness due to social needs, and doctors are not supposed to be social workers. Again, I was lucky. I trained with social workers so I had some idea how to refer and access that system. Now ask me if that system is broken in most of this country.
Um, foreign training. Right. pretty much covered that. It is possible but very difficult to compare the US system blanket with "every other Western" blah blah blah. It is indeed the case that many countries do not have the advanced, multiply graduate level training that everyone given the title MD (and now almost the same for osteopaths) in this country have. I don't know now, but I remember being told that many people in England who were physicians could not call themselves doctor precisely because they were what we would call mid-level and did not have a doctoral level of education. That was an advanced level of training and status.
From living and working in Canada, I can say a couple of things. Having a national health care system, which until recently was really just a provincial healthcare system that did not transfer from one province to another, allowed them to do things like having a big motorhome/semi-truck mobile clinic that was staffed by doctors and nurses, etc. that would travel around to isolated and rural areas of Ontario to provide medical care. One of the big points they made about being able to do this was that they didn't have to deal with umpteen different insurers and different medicaid/ medicare rule and all of that. Resident of Ontario with Care Card, you're good, done.
In British Columbia, there is a terrible shortage of primary care anything, especially physicians. Most people do not have a primary care physician. They go to their local care clinic and are seen by whoever is there. They may never see the same person twice.
PAs, I don't know about others although I'm sure much of this is true there as well, are starting to shift toward the higher paid specialties, like neurosurgery. They, too, are not automatically going into primary care. What this should tell people is what it should say about why it's hard to get MDs into it, as well. You work lousy hours, bear responsibility for dozens of people's actual lives, train under insane and abusive conditions (sorry, demanding is a euphemism for things that are actually illegal as working conditions for almost anything else), and get into a lot of debt for a long training period. That's a lot to deal with. Would you do that if all you got for it was not enough money to raise a family, own any kind of home, save for a secure retirement? What if you couldn't afford to eat out? Or take a vacation with your kids?
I will say that I agree that there are still some specialties that are way overpaid. I say that relative to what most physicians, especially primary care physicians, are paid. There is a long-standing bias that shiny toys inspire higher payments than years of experience, expertise, or rapport with patients and their families. That needs to be leveled out.
There was a big fuss in NC when I was there because UNC needed to replace a cardiothoracic surgeon who left. It's supposed to be limited by state funding issues. Nonetheless, the person they hired got way over half a million in salary, nevermind whatever else they got, because that was the going minimum rate nationally for cardiothoracic surgeons.
I do not disagree with a differential for longer training, more high risk work, whatever. I don't think anybody is worth half a million or more. This to me smacks of the same type of thing as overinflated business exec salaries. Just because you've all decided that's what you should get paid, doesn't make you right and it certainly doesn't entitle you to squat.
However, when you lump this in as a national salary figure, you skew the perception of what physicians really get paid. It's been published on a fair bit that Texas pays way more than a lot of other places, and no one can find justifiable reasons for it. More specifically, there's a particular part of Texas known for this whose name escapes me. Again, not ok, but the answer isn't to cut everybody nationally, it's to bring the overpaying back into line.
Plus, there is more and more burden of not just ongoing education, but constant testing for the rest of your life. You will never not have to take tests, and if you fail after you are out there working, you will suddenly lose your livelihood.
The comment thread is all over the place as far as what the commenters clearly know (or lack) for information and experience. Shortest comment is that NPs and PAs and CRNAs and etc. all get extensive training, have licensing requirements, and are fully competent as professionals.
There absolutely is a need for care providers in more underserved areas. One of the reasons is that it is actually very expensive to maintain a medical business, and while that is a dirty word on all sides it is also reality. Medical care is no longer a charity provided by nuns that doesn't need to worry about being a viable business that maintains facilities, employs people, etc. The government and private insurance companies decide how much it costs to run your business; they are not good at listening to people on the ground about realities of costs.
Doctors in underserved areas used to be able to do things like let people pay over time, or barter goods and services. This has been illegal for a while because there were issues of conflict of interest and people who could very well pay getting undue considerations, or family getting free care, or whatever. So it has to be money, it has to be in 30, 60, or 90 days, they have to pay a co-pay, etc.
You do not need as many specialists as generalists. All generalists do not need to be trained to the extreme. While I also went through training with a heavy emphasis on culture and persons and so forth, that is not how everyone is trained, and frankly, you are not graded, tested, or licensed on most of that. There is no one right multiple choice answer for what to do with real people. There's right answers to legal questions, there's right answers to questions of fact (like what the top 10 complications of a given disease are, or this week's favorite numbers to define high blood pressure). There is no one right answer to what to do for a patient who is unable to control their illness due to social needs, and doctors are not supposed to be social workers. Again, I was lucky. I trained with social workers so I had some idea how to refer and access that system. Now ask me if that system is broken in most of this country.
Um, foreign training. Right. pretty much covered that. It is possible but very difficult to compare the US system blanket with "every other Western" blah blah blah. It is indeed the case that many countries do not have the advanced, multiply graduate level training that everyone given the title MD (and now almost the same for osteopaths) in this country have. I don't know now, but I remember being told that many people in England who were physicians could not call themselves doctor precisely because they were what we would call mid-level and did not have a doctoral level of education. That was an advanced level of training and status.
From living and working in Canada, I can say a couple of things. Having a national health care system, which until recently was really just a provincial healthcare system that did not transfer from one province to another, allowed them to do things like having a big motorhome/semi-truck mobile clinic that was staffed by doctors and nurses, etc. that would travel around to isolated and rural areas of Ontario to provide medical care. One of the big points they made about being able to do this was that they didn't have to deal with umpteen different insurers and different medicaid/ medicare rule and all of that. Resident of Ontario with Care Card, you're good, done.
In British Columbia, there is a terrible shortage of primary care anything, especially physicians. Most people do not have a primary care physician. They go to their local care clinic and are seen by whoever is there. They may never see the same person twice.
PAs, I don't know about others although I'm sure much of this is true there as well, are starting to shift toward the higher paid specialties, like neurosurgery. They, too, are not automatically going into primary care. What this should tell people is what it should say about why it's hard to get MDs into it, as well. You work lousy hours, bear responsibility for dozens of people's actual lives, train under insane and abusive conditions (sorry, demanding is a euphemism for things that are actually illegal as working conditions for almost anything else), and get into a lot of debt for a long training period. That's a lot to deal with. Would you do that if all you got for it was not enough money to raise a family, own any kind of home, save for a secure retirement? What if you couldn't afford to eat out? Or take a vacation with your kids?
I will say that I agree that there are still some specialties that are way overpaid. I say that relative to what most physicians, especially primary care physicians, are paid. There is a long-standing bias that shiny toys inspire higher payments than years of experience, expertise, or rapport with patients and their families. That needs to be leveled out.
There was a big fuss in NC when I was there because UNC needed to replace a cardiothoracic surgeon who left. It's supposed to be limited by state funding issues. Nonetheless, the person they hired got way over half a million in salary, nevermind whatever else they got, because that was the going minimum rate nationally for cardiothoracic surgeons.
I do not disagree with a differential for longer training, more high risk work, whatever. I don't think anybody is worth half a million or more. This to me smacks of the same type of thing as overinflated business exec salaries. Just because you've all decided that's what you should get paid, doesn't make you right and it certainly doesn't entitle you to squat.
However, when you lump this in as a national salary figure, you skew the perception of what physicians really get paid. It's been published on a fair bit that Texas pays way more than a lot of other places, and no one can find justifiable reasons for it. More specifically, there's a particular part of Texas known for this whose name escapes me. Again, not ok, but the answer isn't to cut everybody nationally, it's to bring the overpaying back into line.
Plus, there is more and more burden of not just ongoing education, but constant testing for the rest of your life. You will never not have to take tests, and if you fail after you are out there working, you will suddenly lose your livelihood.
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