Re: unhappy doc/letter to editor Originally Posted by traumaRUs 
I totally understand the frustration as far as the reimbursement issue goes. However, in most circumstances, mid-level providers actually add to the practice and thus to the MD's income. I work in a large nephrology practice and see patients on chronic homodialysis. Medicare says that in order to receive full reimbursement for the physician services, these pts must be seen a total of four times per month and one of these visits must be the MD. However, the mid-levels see the pts the other three times and receive 85% of the reimbursement that the MDs receive. However, it frees up the MDs to see pts in the hospital who are acutely ill and to accept more office patients and consults.
The mid-level providers do generate a profit and income for the practice. So...I guess I see this MDs concern is more geared to this particular state's issues and in particular, this governor.
However, from such a highly educated person, I would expect more eloquent and more unbiased comments. I also don't see any reason to resort to name-calling - this just actually demeans the physician writing it.
You are absolutely right. Any physician should be able to figure out how to improve and inhance his or her practice with NPs and PAs. If the NP or PA is a drain on the practice, then either the doc hasn't figured out how to best incorporate that person into the practice, or just plain won't "let go" of any of the patients. (I've seen a few like that- every patient is "my" patient to the doc and he or she can't effectively transition into "our" patient.)
There is also the issue of rural areas. I've been in rural areas since I've been a NP and it's very difficult to attract physicians- or maybe it's physician's spouses- to those areas. A lot of them want to be close to big cities, like Dallas, Houston, Atlanta, etc and don't want to live out in the "boonies" where things like opera, ballet, symphony, and high-end shopping aren't readily available. In the rural areas, we often end up with foreign-born docs who have fewer alternatives. This isn't to knock foreign-born docs- I've worked with very good ones- but dealing with them can be more difficult for patients in rural areas who have less exposure to other cultures and languages. The docs are often unhappy, too, and leave as soon as they can, so there's more provider turnover.
I mentioned physican's spouses because I once had a recruiter tell me that it wasn't the docs who wanted the big cities, it was the wives.
Statistically most NP's and PA's probably aren't in rural areas, but in some rural areas we are crucial to health care.
Personally, I enjoy rural/small town living and don't think you could pay me enough to live in a city of over 250,000 people, but that's just me.
And one more thing. Physicians often say, or imply, that NPs and PAs have less education and therefore provide inferior care. That totally denigrates the considerable experience some of us have, some of it in teaching hospitals helping medical students/interns/residents learn their jobs. I have yet to see anyone offer any statistical evidence that NPs or PAs provide inferior care. I don't expect to see it, either, because I don't think it's true!
