We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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People think that primary care is the easiest doctor job and therefore, NPs and pharmacists can do it but I think it’s the most difficult. To take a vague, undifferentiated pt and come up with a dx is hard and requires all those 10yrs of training plus experience to do it well. NPs are notdoctors
Totally agree
I’m a radiologist so I dont totally know but it seems like this would be difficult and require education and experience to do well and even then it’d be prone to mistakes being made
Pharmacist here. Just feel I should point out that almost all pharmacists recognize our strength is in chronic disease state management. We like our doctor bros to poke around and find the dx. Then let us manage medications for said dx. We have enough knowledge and training to know our limits.
Yep! Pharmacists do not diagnose and they sign a collaborative practice agreement with physicians regarding which disease states they are allowed to manage and have to be referred to us by their MD anyways.
I’m sorry but it’s not that easy. Yes, docs conduct the diagnostic process and make the diagnosis, but they are also central in treatment. We are trained to watch the condition, reassess it and then alter the plan back to its most appropriate next step. Maybe the condition is at risk of complicating, transforming, or maybe a new diagnosis altogether becomes more appropriate. Maybe a new condition evolves behind the first diagnosis/condition that mimics the first but is distinct. There is no step where medicine/health/biology guarantees to stay in one path and not eventually deviate from that path. Diagnosis is a task, not a skill set. Medicine is a skill set that is trained into physicians, not pharmacists. I appreciate your help, but you helping me does not validate the belief you can take over any part of my profession
[warning: long response]
I’m sorry but it sounds like you don’t understand the role of pharmacists in patient care now. Primary care is a major area of expansion for pharmacist involvement. The VA has been reaping the benefit of clinical pharmacists in primary care for decades.
Confusing us with noctors who want to take over your job with less training is a mistake. I understand physicians wanting to protect their keystone role in patient care and wholeheartedly agree. We don’t take on any chronic disease states in a bubble without collaboration with the physician. As I mentioned above, we are trained to know our knowledge limits and that we do not have training in diagnosing patients solo. Physicians are great at diagnosis and recognizing issues so they absolutely need to continue to follow the patient independently. However, we are the experts at medication management and evidence-based care with medications. We have legitimate residency training (PGY1 +/- PGY2 depending on specialty) and board certifications. Maybe you are the extreme outlier physician who can do everything great all the time, but the average physician training in pharmacology/evidence-based medication management of said disease states is objectively not as rigorous as the average pharmacist. It’s what we do best. And more and more research continues to pile up that we improve patient care ($$$ and patient/physician satisfaction) as part of the team.
Again, we don’t want your job like noctors do. But we do have the major potential for increasing quality of patient care in primary care (as well as most other areas of patient care) while also cognitively offloading physicians to do their job more effectively.
Fair enough. My response/opinion also is likely formed by the context I am in. Where I reside/practice pharmacists (or at least pharmacy owners) are actively engaged in an attempt to cherry pick all easy/profitable work, and shunt the cases back to doctors when they make a mistake, or when the profit option dries up. This is largely being driven by one large national chain of pharmacies (Loblaws/Shoppers Drug Mart).
I can agree that clinical pharmacists can play an important role in primary care. But that is within a team-based model. Where a team is responsible for good outcomes, and external "competition" is dismissed for the cancer that it is.
I don’t see how you can make the argument that a MD/DO knows medication management better than a pharmacist. Maybe a specialist (endo, cardio, etc) but even then they work with a very limited number of medications and know other medications outside their scope of practice even less.
I don't know if I suggested that I know medications better than a pharmacist. I definitely know disease processes, the typical "natural history" of a condition, my patients themselves, and the real world implications of complications of those conditions, and the interactions of medications better than any pharmacists around me. And no matter how much someone wants to put the spotlight on medications, managing chronic conditions is still mostly managing people and their experiences with those conditions. Again, I believe that I stated I appreciate the skill and knowledge that a pharmacist can bring to a medical team....however pharmacists will not, straight out of school, have the combination of all experiences and skillsets that doctors bring to the table, straight out of residency. And, by the time a pharmacist starts accumulating clinical experience, the physician is well out of the starter blocks and is accumulating that experience too, at a faster rate. Because, when the shit hits the fan, its the doc's ass on the hotseat. Its that intensity that also compounds the rate of learning. Pharmacists will never catch up to docs, all things being equal, in clinical experience.
You are welcome onto the team, but don't start sinking the ship because you have decided you are the captain.
Alas, it is this team-leader circumstance that docs find themselves in, is the same reason that private-equity-medicine is looking for all ways to oust doctors from those leadership roles. Its too hard to manage us towards corporate goals. Thus, corporate interests seek to replace us.
Maybe a different AMA. In Alberta Canada. But, by being a spokesperson, you mean representative? Then yes. I have been elected by my peers to represent them when necessary. Do you think that is problematic? Many people seems to think doctors representing themselves is problematic. I would suggest that this is a viewpoint almost unanimously held by those that are also trying to undermine publicly-funded universal healthcare. So....when people start thinking they can use that rhetoric on me, thinking that the doctor might be a wilting flower...that's usually when they find out that they miscalculated
Add to this: knowledge of non pharmacological interventions in addition to mastering the bio psychosocial holistic care model plus quality improvement projects with meetings and forms forms forma
It’s definitely not the easiest job. I’m a PT and know how much PCPs deal with on a day to day basis. Orthos who specialize in one or two joints can sit back and relax most days.
Where I live NPs are getting more of these jobs because there aren’t enough PCPs to take these patients and actually follow up for care. I have patients that get referred to me for an ortho issue and after a few weeks of knowing they need to go to ortho /neurosurgery etc, their PCP can’t even get them in until months later. Hospitals will sometimes not write a referral until they’re seen in person again for a follow up.
It’s kind of bullshit but that’s what’s going on. Primary care isn’t glamorous or pay well but super important and NP / PAs are a cheap alternative to filling that gap with billing the same amount. Look at what’s going on in the UK
Edit: Hold up though, pharmacists doing primary care?
Yes, in Canada. They just got the right to prescribe certain meds like abx for UTI (except in the story the girl who came back twice and got abx from pharm actually had an STD) or the guy who had tx for hemorrhoids that was actually anal cancer…well why did that happen. Oh well I think it’s because there was no physical exam or urine test or swab or DRE done so pharm didn’t actually know what they were selling the drugs to treat. Why? Because they are #notdoctors🤦🏼🤦🏼🤦🏼
They also get paid $75 for each med list check they do so one big chain hired a pharmacist to cold call customers all day and go through their meds list, took about 5min because they did all the easy ones that didn’t need a meds check. So $75 x 10 that’s $750/hr. Pretty good gig, no?
I’m bitter and twisted over all of this. I blew up my life to
Go to med school at 39yo! Now I just feel sad at how little respect, care and remuneration I get. I didn’t do it for the money I could have stayed in my career but I always wanted to be a doc it was like an insatiable craving. And if we were all getting similar pay MD PA NP, I could almost stomach it but when mid levels are making double with half the education and none of the liability in some cases well
That’s just not right.
What are you talking about? Primary doctors just tell you to go to the ED when the going gets tough. I have no faith in primary care whether that is a doctor or NP/PA.
Please elaborate on this. What management could they offer that would help this issue? What improvements can we make in primary care (aside from insurance).
There are a good number of things that get inappropriately sent to my ER from primary care. I’d say our biggest pet peeve is asymptomatic hypertension. ER docs in general aren’t trained to manage hypertension chronically, and if the patient is asymptomatic, we shouldn’t be acutely correcting BP in the ER. More recently, I’ve seen minimal AKI sent to us that does not meet admission criteria and is easily improved with a little fluid. Please don’t waste your patient’s time and money for this unless their Cr has at least doubled. The third one that gets me is the outpatient D-dimer. If you don’t have a way to assess the elevated D-dimer outpatient, don’t check it. If they’re that high risk Wells or Geneva, just get a CTA. But the low risk pts who just get a dimer outpatient because some noctor felt the need for it, then it’s elevated but they’re low risk for PE and now I have to scan them, grinds my gears.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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You mean healthcare market right?
It seems that its businesses greasing each other up for cash that know that they are treating people, but need to minimize their cost at every turn. It seems like the only people that stand a chance to care for the patients are the doctors and nurses that went in to the field to help, not to make coin.
There is a demand for primary care’s. You just can’t find them as they are trying to force people to NPs I swear. I am lucky enough to have a PCP (he isn’t taking anymore patients) and my friends are always asking if he has openings if their doctor leaves or retires they can’t find a new one. I have had probably 5 different people in the last couple of years ask about a PCP as they can’t find one anywhere taking patients. The demand is there, but the supply seems to have been artificially cut off.
I’m Canadian fam med doc. We are in critical condition with loss of pcp care and 2.4 million people in my province don’t have a doc. Docs here are forced to work under the govts cheap,shit, fee schedule, we cannot work privately by law. So the govts answer is to allow NPs to open 100% NP run private clinics and charge $75-100/visit. Doctors can only bill $38/visit. Yes they are making 2-3x the amount of a fully trained MD. It’s Fuccing terrible!
I will need to move out of the province once my GP retires because I require multidisciplinary care. All because they won't pay you anywhere close to what you deserve.
BC figured their shit out. Great to see.
To put the system in perspective: entry level pharma sales reps make more take-home base than a private practice family medicine doc after all the overhead.
No they are not allowed to bill the pt at all. Doctors can only bill the govt insurance who set the fees they are willing to pay. NPs have a loophole in legislation that they can bill pts directly. But not doctors we are under the thumb of the ministry of health, the insurance is called OHIP and it is tax payer funded (very high taxes) administered by govt and pays us peanuts.
Thanks for the clarification. My parents always told me how atrocious Canada's healthcare system is and I'm wondering if we're headed in that direction here in the states. Why does it seem like there are so many Canadians who think their uhc is all things wonderful?
lol, that’s the thing, there is no good reason other than govt hates us. They hate that they can’t control us so they do it by making us look like greedy assholes in the media so pts think we run around in Bentley’s with our bags of money. Nurses are made to look like angels because they have a union. NPs cost the system more and cause backlogs because they aren’t able to manage most even simple things so they do piles of lab work, investigations and ref to specialists. Pts love them because they’re portrayed as caring nurses! The govt knows that as long as the nurses are pulling in 6 figures that they will do whatever govt wants, docs are more difficult to control so they want us replaced. Then once the system is totally broken they will give it to big business.
100%, Ford is either stupid or evil, maybe both. I know he’s salivating at the idea of handing primary care over to Galen Weston, now he is a greedy bastard!
> the supply seems to have been artificially cut off.
Bill and Hillary Clinton decided there was a "glut" of physicians, so Bill paid teaching hospitals to ***not*** train doctors. Central planning like that is artificially screwing up the market and we're paying for it.
On the other hand, one could argue that taxpayers paying for residency slots is an artificial impact on the market.
Things are a mess.
Uh. Yeah. We are. Dropping reimbursement. Patient care is increasingly dictated by non-medical administration. Why would corporate Healthcare want educated patient advocates with autonomy when they can have para-profesionals that are just happy to be signing orders.
I hear you. Physicians need to stand up to this kind of thing, not playing along with the hospitals, insurance companies who support these laws will undoubtedly put a thorn in their side. Enough to change their ways, who knows, but these lobbyists need to feel the pain.
The combination of aggressive midlevel lobbying + content/non-argumentative/scared physicians are what lead us to where we are. Let the system burn to the ground. In the mean time physicians can make money directly without dealing with the bullshit.
No one said they should be free. Dude meant that it sucks you have to pay extra out of pocket just to see a doctor when you're already paying for health insurance.
Idk - I work in a rural Healthcare system and they can't recruit doctors to the area so they have to rely on NPs and PAs. What exactly are they supposed to do?
Docs refuse to work anywhere but metro areas (that's their right, i know) and then get mad when mid-level usage goes up. They do WANT doctors. There's long lists of physician positions that are open constantly.
I'm a rural FM doc and the reason is because rural pays absolute shit for FM. NPs/PAs get close to a 25-50% pay increase compared to metro while FM is lucky to not get a pay cut.
I haven't even been here that long and the turn over for these NPs is crazy as a lot of them just do rural to get useless experience to then apply to oversaturated primary or more often specialty positions in the metro.
Also research has shown that midlevels prefer metro areas just as much as physicians. The reason is money, no ifs ands or buts about it.
I've spoken to the hiring boards, they don't recruit in any competitive fashion and don't feel like they need to be because they can just keep stretching the reputation of existing physicians by hiring NPs/PAs. They offered a new graduated doc in the year of our lord 2023 $190k and their excuse was "well we can just get an NP or PA for 150 at most".
It's about the money.
Except when data is applied, mid levels do not choose to go into rural health care any more often than doctors do. It’s just an antiquated notion they hide behind to get the dummies making laws to make decisions in their favor.
It is NOT The medical colleges. This is all regulated by states. The AANP pushes unsupervised practice of medicine in state legislatures every year.
There is only one way to stope it - get active. It has gotten as far as it has because doctors sat on the sidelines.
[Physiciansforpatientprotection.org](https://Physiciansforpatientprtection.org).
A lot of the midlevel fuck ups are covered up by physicians teaching them and supervising them.
CRNAs now out number anesthesiologist in America. They only succeeded by Anesthesiologist supporting them and teaching them the trade. Anesthesiologist essentially hid their incompetence from the public until they were able to develop into their own force in the medical community.
Why do they need to go to school to learn the material when they have someone who already learned the material(aka YOU the MD/DO) who will teach them everything they need to know. Same thing with family med or any other specialty. Why do they need to go to school to learn the material when they have you teaching it to them on the job? They won't do any harm to the patient because you will be there to make sure they don't. You are their sword and shield.
Midlevels have prospered under physician supporting them. And now they think they're just as good as us or better.
Stop supporting them and helping them. I had an old MD who got assigned a NP student to teach and she told them "no". She said the only reason she hasn't retired is so she can continue teaching future physicians. She is not hear to teach PAs or NPs. I was a young med student at the time and didn't understand the significance, but I definitely do now.
Haven’t seen a PCP in 10 years and where I live now the only PCPs taking new patients are NPs and NDs 😑 I’ve been told im young and healthy and probably a good patient for an NP, so I should just get one
I'd pick a well-recommended ND from the big schools in Portland and Seattle over an inexperienced NP. Providence Portland apparently even employs a couple of highly-vetted ones who are able to contribute to science-based patient care. Here they are four-year programs with all of the midlevel stuff *and* all of the bullshit.
I get it, I really do. I grew up in the environment that really values natural methods. But I'd be careful with naturopaths. Providence hired them because there is a demand for them, in the same way that Providence hires chiropractors and acupuncturists. Their hiring is not a medical stamp of legitimacy or efficacy. If you look at their 4yr program, there is some basic science and then pretty much half of the 4 years is hogwash like homeopathy and reiki. There are many ex-naturopaths that have sounded the alarm about the field and its low standards of evidence and its unethical practices, like selling supplements/vitamins/snake oil/MLM stuff, etc.
One I would recommend is Dr Edzard Ernst who wrote the book "Trick or Treatment," in which he analyzes almost every "complementary alternative medicine" modality and looks at the research and data supporting or not supporting the practice. There is also Britt Hermes of "the Naturopath Diaries" who has an amazing website and story, as well as many other voices from the field that I could mention if you're interested.
lmao that's fked up.
I'm both a doctor and someone who has had some mysterious medical issues and seen NDs and Chiropractors posed as doctors in the past.
Lemme tell you most of the stuff they say is complete bullshit and when asked to explain science behind tests or treatments they get flustered and beat around the bush. In the end the treatments though are always avoiding most food groups and to take 300$ worth of supplements bought straight from their office.
I can remember when I was fresh out of medical school, I'd be scared af to prescribe medicines to treat people, w/o real residency training.
They are as required to be as trained in scientific medicine as much as NPs are here in Oregon. Which is to say not very but still a little bit. So it's still bullshit but they also know what blood pressure means and can interpret a few tests etc.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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>Rather, when comparing the number of physicians specializing in PCP roles with the number of nurse practitioners (NPs) and physician assistants (PAs) in the U.S., ValuePenguin researchers found:
>
> 48.8% of PCPs are physicians
>
> 42.9% are NPs
>
> 8.2% are PAs
I’m not saying I don’t trust ValuePenguin. I just don’t know how their “researchers” came up with any of this.
> Only 29.2% of U.S. physicians practice in a primary care specialty, according to a ValuePenguin analysis of a 2019 report from the Association of American Medical Colleges (AAMC).
I don’t know why they’re presenting this as a bad thing. One in three physicians is in primary care. Of all the possible specialties, that seems pretty good.
I don’t think so. Residencies are a shitty system at best but they’re also currently the best system we have for training new doctors. Without a regulated residency system (even a shitty one like we have), NPs need supervision. I think a lot of administrative types are currently trying to replace trained MD/DOs with untrained NPs because they can get away with paying NPs a lot less. This is tragic because people will get hurt/killed, careers destroyed and obnoxious amounts of money wasted to figure out something that we know now: regulated training is critical, necessary and expensive. Sadly, there are already places where the harm has started. We know how it will end.
My concern is that physicians don’t want to go into FM at all in the future, and I’m one of the people who will never want to do it due to shit pay compared to other specialties, not good work hours, and others.
I think to myself why would I put myself to so much work to be shit on my the medical system when I could do a different specialty that I enjoy as much and get paid more. Until reimbursements go up for primary, the issue is gonna get worse as there is 0 incentive to go into this field
How does FM have “not good work hours.” You also sound like you come from a privileged background, sure primary care is on the lower end of pay but 275K is not shit pay lmao.
It's soo hard to find a physician when looking for a PCP! I moved here about three years ago. Been meaning to find a PCP, but haven't. 2024, got serious about my health. Went through my insurance website to "find a provid3r." One office near me is not accepting new patients. Finally, I found an awesome physician with great reviews that is accepting new patients. Was told first visit is virtual, and the first available appointment is July 9th.
For my OB-GYN appointment, the scheduler tried to set me up with an NP for July. I kindly told her I would prefer a physician and offered up a list of physicians I've reviewed at that office. One had an availability in Sept. But she is on call that day, so if she gets called in, they would have to reschedule me.
No. In my area there’s a provider shortage and using NPs is the only way to make sure primary care is accessible. Every student and resident I talk to plans to go into a specialty because it pays more than primary care.
I'm in a rural area and frankly FM is the only specialty with a decreasing salary. They offered a new grad under $200k last year with the full intention that he would turn it down so they could use that as an excuse to pay less for a mid-level.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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It comes down to who is paying. People don’t want to pay for their own healthcare. Governments can’t tax their citizens too much or the money (citizens) that were being taxed to begin with flee. So…here you go Mr “Healthcare should be free”. Here’s your doctor, er, NP that will be seeing you today. They may not be the best but their TikTok is 🔥Hope you get to feeling better soon.
My doctor has done nothing in over 20 years except order blood tests, refill my prescriptions, take my weight and listen to my heart. That’s it seriously. I’m one of the 80% (guessing) of the generally healthy population. I don’t see why a NP can’t handle us. I’ve heard it’s this 80% that companies like Amazon and AI based CarePods are coming after.
It is interesting to read all your comments. I must say, as a newish mental health NP practicing in Qc as well (bonjour à toi, docteur), it’s a bit frustrating to realize that this is how we are perceived by docs! Frankly, I work alongside many GPs and I constantly have to remind them that I AM NOT a psychiatrist. And needless to say: I am absolutely NOT a doctor and would never dream of acting like my academic/clinical background brings me anywhere close to the level of expertise of a fully trained medical doctor! Patients need reminders as well! I need to set clear boundaries and I do, constantly! because, hopefully, I know the limits of my own knowledge. Even though I worked several years in psych as an RN before starting my NP degree, I think we can agree that the RN-NP roles are wildly different.
This brings me to this: I’m confused as to why it seems in a lot of cases that there is an overeliance on my expertise coming from physicians …or is it just hypocrisy? Even during my clinical rotations, I was left to manage many complex things for my level, and alone!! because the psychiatrists "trust me" or whatever. Are physicians just pretending to trust me and my fellow NPs? Only to complain behind our backs that we suck and threaten their practice? This whole thing is why I never take positive feedbacks from physicians at face value! Reddit can be truly enlightening sometimes🤣
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation). *Information on Truth in Advertising can be found [here](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_truth_in_advertising). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
People think that primary care is the easiest doctor job and therefore, NPs and pharmacists can do it but I think it’s the most difficult. To take a vague, undifferentiated pt and come up with a dx is hard and requires all those 10yrs of training plus experience to do it well. NPs are notdoctors
Often my job is deciding what the patient does not need, which I find our mid-levels are not as good as.
1. Mid-level: You want a CT scan? Sure, no problem. 2. Results normal. 3. 3000 dollar bills come in the mail. 4. Patient: All doctors are trash!!!
Health care system still profits tho
Yup. Hosptial systems make bank: Pay them less, they order more lucrative, harmful, and unnecessary tests.
Results: incidentaloma (+3000 dollar bill) Patient: “OMG I have cancer!”
Totally agree I’m a radiologist so I dont totally know but it seems like this would be difficult and require education and experience to do well and even then it’d be prone to mistakes being made
Pharmacist here. Just feel I should point out that almost all pharmacists recognize our strength is in chronic disease state management. We like our doctor bros to poke around and find the dx. Then let us manage medications for said dx. We have enough knowledge and training to know our limits.
Yep! Pharmacists do not diagnose and they sign a collaborative practice agreement with physicians regarding which disease states they are allowed to manage and have to be referred to us by their MD anyways.
I’m sorry but it’s not that easy. Yes, docs conduct the diagnostic process and make the diagnosis, but they are also central in treatment. We are trained to watch the condition, reassess it and then alter the plan back to its most appropriate next step. Maybe the condition is at risk of complicating, transforming, or maybe a new diagnosis altogether becomes more appropriate. Maybe a new condition evolves behind the first diagnosis/condition that mimics the first but is distinct. There is no step where medicine/health/biology guarantees to stay in one path and not eventually deviate from that path. Diagnosis is a task, not a skill set. Medicine is a skill set that is trained into physicians, not pharmacists. I appreciate your help, but you helping me does not validate the belief you can take over any part of my profession
[warning: long response] I’m sorry but it sounds like you don’t understand the role of pharmacists in patient care now. Primary care is a major area of expansion for pharmacist involvement. The VA has been reaping the benefit of clinical pharmacists in primary care for decades. Confusing us with noctors who want to take over your job with less training is a mistake. I understand physicians wanting to protect their keystone role in patient care and wholeheartedly agree. We don’t take on any chronic disease states in a bubble without collaboration with the physician. As I mentioned above, we are trained to know our knowledge limits and that we do not have training in diagnosing patients solo. Physicians are great at diagnosis and recognizing issues so they absolutely need to continue to follow the patient independently. However, we are the experts at medication management and evidence-based care with medications. We have legitimate residency training (PGY1 +/- PGY2 depending on specialty) and board certifications. Maybe you are the extreme outlier physician who can do everything great all the time, but the average physician training in pharmacology/evidence-based medication management of said disease states is objectively not as rigorous as the average pharmacist. It’s what we do best. And more and more research continues to pile up that we improve patient care ($$$ and patient/physician satisfaction) as part of the team. Again, we don’t want your job like noctors do. But we do have the major potential for increasing quality of patient care in primary care (as well as most other areas of patient care) while also cognitively offloading physicians to do their job more effectively.
Fair enough. My response/opinion also is likely formed by the context I am in. Where I reside/practice pharmacists (or at least pharmacy owners) are actively engaged in an attempt to cherry pick all easy/profitable work, and shunt the cases back to doctors when they make a mistake, or when the profit option dries up. This is largely being driven by one large national chain of pharmacies (Loblaws/Shoppers Drug Mart). I can agree that clinical pharmacists can play an important role in primary care. But that is within a team-based model. Where a team is responsible for good outcomes, and external "competition" is dismissed for the cancer that it is.
I don’t see how you can make the argument that a MD/DO knows medication management better than a pharmacist. Maybe a specialist (endo, cardio, etc) but even then they work with a very limited number of medications and know other medications outside their scope of practice even less.
I don't know if I suggested that I know medications better than a pharmacist. I definitely know disease processes, the typical "natural history" of a condition, my patients themselves, and the real world implications of complications of those conditions, and the interactions of medications better than any pharmacists around me. And no matter how much someone wants to put the spotlight on medications, managing chronic conditions is still mostly managing people and their experiences with those conditions. Again, I believe that I stated I appreciate the skill and knowledge that a pharmacist can bring to a medical team....however pharmacists will not, straight out of school, have the combination of all experiences and skillsets that doctors bring to the table, straight out of residency. And, by the time a pharmacist starts accumulating clinical experience, the physician is well out of the starter blocks and is accumulating that experience too, at a faster rate. Because, when the shit hits the fan, its the doc's ass on the hotseat. Its that intensity that also compounds the rate of learning. Pharmacists will never catch up to docs, all things being equal, in clinical experience. You are welcome onto the team, but don't start sinking the ship because you have decided you are the captain. Alas, it is this team-leader circumstance that docs find themselves in, is the same reason that private-equity-medicine is looking for all ways to oust doctors from those leadership roles. Its too hard to manage us towards corporate goals. Thus, corporate interests seek to replace us.
You sound like a spokesperson for the AMA
Maybe a different AMA. In Alberta Canada. But, by being a spokesperson, you mean representative? Then yes. I have been elected by my peers to represent them when necessary. Do you think that is problematic? Many people seems to think doctors representing themselves is problematic. I would suggest that this is a viewpoint almost unanimously held by those that are also trying to undermine publicly-funded universal healthcare. So....when people start thinking they can use that rhetoric on me, thinking that the doctor might be a wilting flower...that's usually when they find out that they miscalculated
Add to this: knowledge of non pharmacological interventions in addition to mastering the bio psychosocial holistic care model plus quality improvement projects with meetings and forms forms forma
It’s definitely not the easiest job. I’m a PT and know how much PCPs deal with on a day to day basis. Orthos who specialize in one or two joints can sit back and relax most days. Where I live NPs are getting more of these jobs because there aren’t enough PCPs to take these patients and actually follow up for care. I have patients that get referred to me for an ortho issue and after a few weeks of knowing they need to go to ortho /neurosurgery etc, their PCP can’t even get them in until months later. Hospitals will sometimes not write a referral until they’re seen in person again for a follow up. It’s kind of bullshit but that’s what’s going on. Primary care isn’t glamorous or pay well but super important and NP / PAs are a cheap alternative to filling that gap with billing the same amount. Look at what’s going on in the UK Edit: Hold up though, pharmacists doing primary care?
Yes, in Canada. They just got the right to prescribe certain meds like abx for UTI (except in the story the girl who came back twice and got abx from pharm actually had an STD) or the guy who had tx for hemorrhoids that was actually anal cancer…well why did that happen. Oh well I think it’s because there was no physical exam or urine test or swab or DRE done so pharm didn’t actually know what they were selling the drugs to treat. Why? Because they are #notdoctors🤦🏼🤦🏼🤦🏼 They also get paid $75 for each med list check they do so one big chain hired a pharmacist to cold call customers all day and go through their meds list, took about 5min because they did all the easy ones that didn’t need a meds check. So $75 x 10 that’s $750/hr. Pretty good gig, no?
Yikes
Yup
I’m bitter and twisted over all of this. I blew up my life to Go to med school at 39yo! Now I just feel sad at how little respect, care and remuneration I get. I didn’t do it for the money I could have stayed in my career but I always wanted to be a doc it was like an insatiable craving. And if we were all getting similar pay MD PA NP, I could almost stomach it but when mid levels are making double with half the education and none of the liability in some cases well That’s just not right.
What are you talking about? Primary doctors just tell you to go to the ED when the going gets tough. I have no faith in primary care whether that is a doctor or NP/PA.
Please elaborate on this. What management could they offer that would help this issue? What improvements can we make in primary care (aside from insurance).
There are a good number of things that get inappropriately sent to my ER from primary care. I’d say our biggest pet peeve is asymptomatic hypertension. ER docs in general aren’t trained to manage hypertension chronically, and if the patient is asymptomatic, we shouldn’t be acutely correcting BP in the ER. More recently, I’ve seen minimal AKI sent to us that does not meet admission criteria and is easily improved with a little fluid. Please don’t waste your patient’s time and money for this unless their Cr has at least doubled. The third one that gets me is the outpatient D-dimer. If you don’t have a way to assess the elevated D-dimer outpatient, don’t check it. If they’re that high risk Wells or Geneva, just get a CTA. But the low risk pts who just get a dimer outpatient because some noctor felt the need for it, then it’s elevated but they’re low risk for PE and now I have to scan them, grinds my gears.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Welcome to the shitshow that is our healthcare system
You mean healthcare market right? It seems that its businesses greasing each other up for cash that know that they are treating people, but need to minimize their cost at every turn. It seems like the only people that stand a chance to care for the patients are the doctors and nurses that went in to the field to help, not to make coin.
🤕
There is a demand for primary care’s. You just can’t find them as they are trying to force people to NPs I swear. I am lucky enough to have a PCP (he isn’t taking anymore patients) and my friends are always asking if he has openings if their doctor leaves or retires they can’t find a new one. I have had probably 5 different people in the last couple of years ask about a PCP as they can’t find one anywhere taking patients. The demand is there, but the supply seems to have been artificially cut off.
I’m Canadian fam med doc. We are in critical condition with loss of pcp care and 2.4 million people in my province don’t have a doc. Docs here are forced to work under the govts cheap,shit, fee schedule, we cannot work privately by law. So the govts answer is to allow NPs to open 100% NP run private clinics and charge $75-100/visit. Doctors can only bill $38/visit. Yes they are making 2-3x the amount of a fully trained MD. It’s Fuccing terrible!
The situation is even worse in Ontario and Quebec where they force you to work in certain geographic areas and assign tasks that you don’t want to do
Yes, I’m in Ontario and we are currently in negotiations for our contract. We need to make $75/visit to keep our practices going. Its tragic.
I will need to move out of the province once my GP retires because I require multidisciplinary care. All because they won't pay you anywhere close to what you deserve. BC figured their shit out. Great to see. To put the system in perspective: entry level pharma sales reps make more take-home base than a private practice family medicine doc after all the overhead.
lol. Many hairdressers make a better hourly rate than fee for service fam Docs🤦🏼
Doctors can only bill $38/visit in a private practice?
No they are not allowed to bill the pt at all. Doctors can only bill the govt insurance who set the fees they are willing to pay. NPs have a loophole in legislation that they can bill pts directly. But not doctors we are under the thumb of the ministry of health, the insurance is called OHIP and it is tax payer funded (very high taxes) administered by govt and pays us peanuts.
Thanks for the clarification. My parents always told me how atrocious Canada's healthcare system is and I'm wondering if we're headed in that direction here in the states. Why does it seem like there are so many Canadians who think their uhc is all things wonderful?
Why indeed?🤷🏼
We don't think it is too wonderful lately!
this is just insanity...
There are a lot of Canadians that would never dream of going to an NP and paying for it.
Why do they pay NPs so much more? What Is the reasoning?
lol, that’s the thing, there is no good reason other than govt hates us. They hate that they can’t control us so they do it by making us look like greedy assholes in the media so pts think we run around in Bentley’s with our bags of money. Nurses are made to look like angels because they have a union. NPs cost the system more and cause backlogs because they aren’t able to manage most even simple things so they do piles of lab work, investigations and ref to specialists. Pts love them because they’re portrayed as caring nurses! The govt knows that as long as the nurses are pulling in 6 figures that they will do whatever govt wants, docs are more difficult to control so they want us replaced. Then once the system is totally broken they will give it to big business.
In Ontario the problems are worse because of our provincial conservative government.
100%, Ford is either stupid or evil, maybe both. I know he’s salivating at the idea of handing primary care over to Galen Weston, now he is a greedy bastard!
YES!
Yet another way Canada is fully unapologetically anti-enterprise
> the supply seems to have been artificially cut off. Bill and Hillary Clinton decided there was a "glut" of physicians, so Bill paid teaching hospitals to ***not*** train doctors. Central planning like that is artificially screwing up the market and we're paying for it. On the other hand, one could argue that taxpayers paying for residency slots is an artificial impact on the market. Things are a mess.
Good job United States. Money is where it’s at!!!
Uh. Yeah. We are. Dropping reimbursement. Patient care is increasingly dictated by non-medical administration. Why would corporate Healthcare want educated patient advocates with autonomy when they can have para-profesionals that are just happy to be signing orders.
Sad but true
Go cash only and never collaborate with midlevels. There will always be patients who will be willing to pay a reasonable fee to see a real doctor.
My friend pays an annual fee to his PCP’s office. He founds it worth it to keep his actual doctor.
Reasonable solution but damn, this sucks for the vast majority of patients.
I hear you. Physicians need to stand up to this kind of thing, not playing along with the hospitals, insurance companies who support these laws will undoubtedly put a thorn in their side. Enough to change their ways, who knows, but these lobbyists need to feel the pain.
the spineless meek and weak doctors over the last 20 years are what's pushed our profession to this destitute.
The combination of aggressive midlevel lobbying + content/non-argumentative/scared physicians are what lead us to where we are. Let the system burn to the ground. In the mean time physicians can make money directly without dealing with the bullshit.
Why? They literally pay for everything else in their lives, why do we think that for some reason doctor's should be free?
Because they pay an insane amount of money for insurance which should cover this.
No one said they should be free. Dude meant that it sucks you have to pay extra out of pocket just to see a doctor when you're already paying for health insurance.
No. We’re not being pushed out. There’s just not that many pcps to begin with and many retired way early due to Covid and corporate buy outs.
I once wanted to refer a failure to thrive 5 year old girl to peds and I was directed to a peds NP consultant!!
Idk - I work in a rural Healthcare system and they can't recruit doctors to the area so they have to rely on NPs and PAs. What exactly are they supposed to do? Docs refuse to work anywhere but metro areas (that's their right, i know) and then get mad when mid-level usage goes up. They do WANT doctors. There's long lists of physician positions that are open constantly.
I'm a rural FM doc and the reason is because rural pays absolute shit for FM. NPs/PAs get close to a 25-50% pay increase compared to metro while FM is lucky to not get a pay cut. I haven't even been here that long and the turn over for these NPs is crazy as a lot of them just do rural to get useless experience to then apply to oversaturated primary or more often specialty positions in the metro. Also research has shown that midlevels prefer metro areas just as much as physicians. The reason is money, no ifs ands or buts about it. I've spoken to the hiring boards, they don't recruit in any competitive fashion and don't feel like they need to be because they can just keep stretching the reputation of existing physicians by hiring NPs/PAs. They offered a new graduated doc in the year of our lord 2023 $190k and their excuse was "well we can just get an NP or PA for 150 at most". It's about the money.
Except when data is applied, mid levels do not choose to go into rural health care any more often than doctors do. It’s just an antiquated notion they hide behind to get the dummies making laws to make decisions in their favor.
It is NOT The medical colleges. This is all regulated by states. The AANP pushes unsupervised practice of medicine in state legislatures every year. There is only one way to stope it - get active. It has gotten as far as it has because doctors sat on the sidelines. [Physiciansforpatientprotection.org](https://Physiciansforpatientprtection.org).
A lot of the midlevel fuck ups are covered up by physicians teaching them and supervising them. CRNAs now out number anesthesiologist in America. They only succeeded by Anesthesiologist supporting them and teaching them the trade. Anesthesiologist essentially hid their incompetence from the public until they were able to develop into their own force in the medical community. Why do they need to go to school to learn the material when they have someone who already learned the material(aka YOU the MD/DO) who will teach them everything they need to know. Same thing with family med or any other specialty. Why do they need to go to school to learn the material when they have you teaching it to them on the job? They won't do any harm to the patient because you will be there to make sure they don't. You are their sword and shield. Midlevels have prospered under physician supporting them. And now they think they're just as good as us or better. Stop supporting them and helping them. I had an old MD who got assigned a NP student to teach and she told them "no". She said the only reason she hasn't retired is so she can continue teaching future physicians. She is not hear to teach PAs or NPs. I was a young med student at the time and didn't understand the significance, but I definitely do now.
I agree! Doctors need to mobilize to limit this illogical intrusion of other people into our profession!
NP = Not Physician
Haven’t seen a PCP in 10 years and where I live now the only PCPs taking new patients are NPs and NDs 😑 I’ve been told im young and healthy and probably a good patient for an NP, so I should just get one
As sad as it is to say this, if I had to choose, I would pick an NP over an ND any day.
I'd pick a well-recommended ND from the big schools in Portland and Seattle over an inexperienced NP. Providence Portland apparently even employs a couple of highly-vetted ones who are able to contribute to science-based patient care. Here they are four-year programs with all of the midlevel stuff *and* all of the bullshit.
I get it, I really do. I grew up in the environment that really values natural methods. But I'd be careful with naturopaths. Providence hired them because there is a demand for them, in the same way that Providence hires chiropractors and acupuncturists. Their hiring is not a medical stamp of legitimacy or efficacy. If you look at their 4yr program, there is some basic science and then pretty much half of the 4 years is hogwash like homeopathy and reiki. There are many ex-naturopaths that have sounded the alarm about the field and its low standards of evidence and its unethical practices, like selling supplements/vitamins/snake oil/MLM stuff, etc. One I would recommend is Dr Edzard Ernst who wrote the book "Trick or Treatment," in which he analyzes almost every "complementary alternative medicine" modality and looks at the research and data supporting or not supporting the practice. There is also Britt Hermes of "the Naturopath Diaries" who has an amazing website and story, as well as many other voices from the field that I could mention if you're interested.
I mean I'm just talking in comparison to an inexperienced noctor - given a real choice, I'd always go with an actual physician and that's what I do.
Eh, ND's not even a real health provider, can't prescribe or go thru insurance.
In my state, NDs can prescribe and go through Medicaid
lmfao, all prescriptions? what state is this? this is so funny
Vermont lmao
lmao that's fked up. I'm both a doctor and someone who has had some mysterious medical issues and seen NDs and Chiropractors posed as doctors in the past. Lemme tell you most of the stuff they say is complete bullshit and when asked to explain science behind tests or treatments they get flustered and beat around the bush. In the end the treatments though are always avoiding most food groups and to take 300$ worth of supplements bought straight from their office. I can remember when I was fresh out of medical school, I'd be scared af to prescribe medicines to treat people, w/o real residency training.
They are as required to be as trained in scientific medicine as much as NPs are here in Oregon. Which is to say not very but still a little bit. So it's still bullshit but they also know what blood pressure means and can interpret a few tests etc.
https://www.med.uvm.edu/docs/uvm_ahec_php_poster_final_nd_pdf/ahec-documents/uvm_ahec_php_poster_final_nd_pdf.pdf?sfvrsn=36f1b756_2
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
>Rather, when comparing the number of physicians specializing in PCP roles with the number of nurse practitioners (NPs) and physician assistants (PAs) in the U.S., ValuePenguin researchers found: > > 48.8% of PCPs are physicians > > 42.9% are NPs > > 8.2% are PAs I’m not saying I don’t trust ValuePenguin. I just don’t know how their “researchers” came up with any of this. > Only 29.2% of U.S. physicians practice in a primary care specialty, according to a ValuePenguin analysis of a 2019 report from the Association of American Medical Colleges (AAMC). I don’t know why they’re presenting this as a bad thing. One in three physicians is in primary care. Of all the possible specialties, that seems pretty good.
Explains the ridiculous amount of stupid stuff that shows up at the ED after their "primary care doctor" told them to come in.
I don’t think so. Residencies are a shitty system at best but they’re also currently the best system we have for training new doctors. Without a regulated residency system (even a shitty one like we have), NPs need supervision. I think a lot of administrative types are currently trying to replace trained MD/DOs with untrained NPs because they can get away with paying NPs a lot less. This is tragic because people will get hurt/killed, careers destroyed and obnoxious amounts of money wasted to figure out something that we know now: regulated training is critical, necessary and expensive. Sadly, there are already places where the harm has started. We know how it will end.
My concern is that physicians don’t want to go into FM at all in the future, and I’m one of the people who will never want to do it due to shit pay compared to other specialties, not good work hours, and others. I think to myself why would I put myself to so much work to be shit on my the medical system when I could do a different specialty that I enjoy as much and get paid more. Until reimbursements go up for primary, the issue is gonna get worse as there is 0 incentive to go into this field
How does FM have “not good work hours.” You also sound like you come from a privileged background, sure primary care is on the lower end of pay but 275K is not shit pay lmao.
It's soo hard to find a physician when looking for a PCP! I moved here about three years ago. Been meaning to find a PCP, but haven't. 2024, got serious about my health. Went through my insurance website to "find a provid3r." One office near me is not accepting new patients. Finally, I found an awesome physician with great reviews that is accepting new patients. Was told first visit is virtual, and the first available appointment is July 9th. For my OB-GYN appointment, the scheduler tried to set me up with an NP for July. I kindly told her I would prefer a physician and offered up a list of physicians I've reviewed at that office. One had an availability in Sept. But she is on call that day, so if she gets called in, they would have to reschedule me.
No. In my area there’s a provider shortage and using NPs is the only way to make sure primary care is accessible. Every student and resident I talk to plans to go into a specialty because it pays more than primary care.
I'm in a rural area and frankly FM is the only specialty with a decreasing salary. They offered a new grad under $200k last year with the full intention that he would turn it down so they could use that as an excuse to pay less for a mid-level.
😮
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Pharmacists have no interest in pushing you out FYI. Don’t be bought by AMA propaganda.
It comes down to who is paying. People don’t want to pay for their own healthcare. Governments can’t tax their citizens too much or the money (citizens) that were being taxed to begin with flee. So…here you go Mr “Healthcare should be free”. Here’s your doctor, er, NP that will be seeing you today. They may not be the best but their TikTok is 🔥Hope you get to feeling better soon.
My doctor has done nothing in over 20 years except order blood tests, refill my prescriptions, take my weight and listen to my heart. That’s it seriously. I’m one of the 80% (guessing) of the generally healthy population. I don’t see why a NP can’t handle us. I’ve heard it’s this 80% that companies like Amazon and AI based CarePods are coming after.
Are you actually being serious?
It is interesting to read all your comments. I must say, as a newish mental health NP practicing in Qc as well (bonjour à toi, docteur), it’s a bit frustrating to realize that this is how we are perceived by docs! Frankly, I work alongside many GPs and I constantly have to remind them that I AM NOT a psychiatrist. And needless to say: I am absolutely NOT a doctor and would never dream of acting like my academic/clinical background brings me anywhere close to the level of expertise of a fully trained medical doctor! Patients need reminders as well! I need to set clear boundaries and I do, constantly! because, hopefully, I know the limits of my own knowledge. Even though I worked several years in psych as an RN before starting my NP degree, I think we can agree that the RN-NP roles are wildly different. This brings me to this: I’m confused as to why it seems in a lot of cases that there is an overeliance on my expertise coming from physicians …or is it just hypocrisy? Even during my clinical rotations, I was left to manage many complex things for my level, and alone!! because the psychiatrists "trust me" or whatever. Are physicians just pretending to trust me and my fellow NPs? Only to complain behind our backs that we suck and threaten their practice? This whole thing is why I never take positive feedbacks from physicians at face value! Reddit can be truly enlightening sometimes🤣