discussion regarding education of NP (DNP) and PA compared to MD/DO

bajasauce07 · Feb 21, 2010

This whole salary argument has got to be the most idiotic spouting of nonsense I've ever heard. Yeah we might be able to skim some salary of a neurosurgeons paycheck since I've seen some that make $999,999 dollars (he didn't want the other dollar because of the tax bracket!) but by and large doctors are UNDERPAID. 12 years of lost income and 1/4-1/2 a million dollars in debt out of school when you graduate in your 30's and you want to cut specialist salaries down to a PCP level? are you mad? you haven't started working yet have you? or paying back your loans? lol, there wouldn't be any doctors, and even this neurosurgeon fellow, you know WHY he makes that much? because there aren't that many of them, it takes a while to be a neurosurgeon. If any of your family gets a brain tumor and there are no more because you cut their salaries making it impossible to sustain and pay their loans off, well I hope you're ready for it.

As far as CAD and DM outcomes? A highschool student with a textbook can do that. Not that I don't believe you, but that is not why he's the Doctor and you are the midlevel.

oh, and lest I forget, patient satisfaction, though important means less than nothing when talking about who's the better provider. If the patients knew what they needed they wouldn't be coming to us. Please never try that one again, and spread the word to anyone else using that argument.

mbreaz1 · Feb 21, 2010

I am not even sure where to start in this post.
You're mixing up 2 disparate problems as the same:
1) Lack of primary care physicians
2) Increasing heathcare costs
I think we should break the lawyer's monopolistic hold on the justice system. We should reduce the demand for their services. It is ridiculous that they should make so much money and force their clients to pay for it when the paralegals could do their job just as well despite the complete lack of experience or education. Using a fallicous argument like that other students don't make as much money makes my argument valid.

Your first mistake is that you think these problems are disparate and you have a complete lack of understanding of the economics surrounding our healthcare problem. These issues are inherently interwoven, but the one part I left out is the third party payor system. That system is what affords doctors the license they have to steal when taken into account with their monopolistic hold on the provision of services. Third party reimbursement affords thet patient the luxury of not questioning the more is better philosophy that physicians have. If patients questioned their need for services, we would have no need for additional primary care physicians. We would have far more supply than would ever be needed. The basic problem is that when reimbursement rates get cut, physicians just say "we will prescribe more medications and order more tests, and see more patients until we make up the difference. The public's problem is, they let them get away with it. The whole issue of lack of midlevel providers goes away when we understand that they have artificially driven up the demand for their services. If we get rid of the unnecessary services that they provide, we get rid of the excess demand and hence there is no problem with lack of providers.

Your comparison regarding the monopolistic hold of attorneys over the legal system is most certainly and apples to oranges scenario. In most legal matters an individual has an option to handle it on their own. If they choose not to handle the matter on their own, they can choose to hire an attorney to represent them. If they choose to hire an attorney, they have a multitude of options when it comes to the price that they wish to pay the attorney. Some attorneys will work for $100 per hour, and some will work for $2,000 per hour. Attorneys also work for contingency fees, in which case the client doesn't have to pay a dime up front to have the attorney take their case. Do you have any idea why that is? It is because it is a competitive environment where the consumer has leverage. That is why attorneys use paraprofessionals, so that they can keep costs down and deliver quality services to their clients at a competitve price. This capitalist model doesn't hold true in the healthcare system. Consumers are not at liberty to shop around based on price and get the deal that they want. Physicians also don't conduct themselves in a manner consistent with a competitive market because they are continually subjected to competitive forces like other professions are. When they are diligent business people and achieve savings, they are able to put them in their pocket and not pass them along to consumers. People in the healthcare profession just don't understand what it means to have to be subjected to a competitive marketplace. if we don't restructure the system such that they are reigned in and costs are lowered, we are all in for a rude awakening when we can no longer afford to pay for it all. The entire economy may see a far worse collapse as this swiftly surges towards a breaking point. Physicians will be left holding the bag when Medicare is broke and the average American citizen can no longer afford to pay their health insurance premiums. It isn't that far off at the current rates of increase.

Also, lets not confuse paraprofessionals with mid level providers. Paraprofessionals are trained to perform specific tasks for the professionals that they work for. They are not professionals themselves. They have associates degrees. Mid level providers are "PROVIDERS" and professionals, not paraprofessionals.

"Using a fallicous argument like that other students don't make as much money makes my argument valid." I think you need to examine this statement closely and tell me what in the world it means??

mbreaz1 · Feb 21, 2010

This whole salary argument has got to be the most idiotic spouting of nonsense I've ever heard. Yeah we might be able to skim some salary of a neurosurgeons paycheck since I've seen some that make $999,999 dollars (he didn't want the other dollar because of the tax bracket!) but by and large doctors are UNDERPAID. 12 years of lost income and 1/4-1/2 a million dollars in debt out of school when you graduate in your 30's and you want to cut specialist salaries down to a PCP level? are you mad? you haven't started working yet have you? or paying back your loans? lol, there wouldn't be any doctors, and even this neurosurgeon fellow, you know WHY he makes that much? because there aren't that many of them, it takes a while to be a neurosurgeon. If any of your family gets a brain tumor and there are no more because you cut their salaries making it impossible to sustain and pay their loans off, well I hope you're ready for it.
As far as CAD and DM outcomes? A highschool student with a textbook can do that. Not that I don't believe you, but that is not why he's the Doctor and you are the midlevel.
oh, and lest I forget, patient satisfaction, though important means less than nothing when talking about who's the better provider. If the patients knew what they needed they wouldn't be coming to us. Please never try that one again, and spread the word to anyone else using that argument.

Here we go again with the crying about physicians being underpaid. Other professionals are compensated based on the value that they provide in a competitive marketplace. If physicians want to compete for the dollars with other professionals without being able to hide from their prices under a third party reimbursement system, then I say let them make all the millions they can. But, if they want to continue to stamp out competetion whenever possible and keep the true cost of their services a secret in a third party payor system, there is absolutely no control over them, and their prices need to be regulated. The truth is that in a competitive environment physicians wouldn't make nearly as much as they do now. OVERPAID or UNDERPAID are relative terms. The truth is that length of education is not necessarily what determines the salary that someone should be paid. Value provided to the consumer and the laws of supply and demand are what determines that. The truth is that if we didn't have third party reimbursement, we would probably have a lot of out of work neurosurgeons because they wouldn't have very many paying patients.

Here is the simple truth, you can't have it both ways. Physicians don't want to be subjected to the scrutiny of consumers and they don't want to be regulated either. The reason is that they want their money to be untouchable. What we need to solve the problem is to either collectively make a decision that we no longer want third party reimbursement or that we want all pricing in the healthcare system to be regulated. Or we could have some mix of that based on the type of service provided, but we can't continue to let it grow unchecked.

Regarding your comments about patient satisfaction, this is a given in any other profession. You either satisfy your client, or you get fired. Again, this is a market force that every other profession has to deal with. You have to be competent AND satisfactory. Physicians have some misconception that they can be competent and that is all that they need to be. Typically being satisfactory has to do with being able to explain your ADVICE to your client and convincing them that it is the best thing for them. The reason that you see people being more satisfied by their experience with midlevel providers is this: they see themselves as being advisors and they understand the need to explain their advice and to convince their patient of why it is the best advice. Physicians typically see themselves as giving orders that are not to be questioned. Ask yourself this - as a consumer, which approach would you be more satisfied with? As to the question of competence, consumers are never satisfied with incompetence, and most are very astute at judging competence in a healthcare provider.

wowza · Feb 22, 2010

Here we go again with the crying about physicians being underpaid. Other professionals are compensated based on the value that they provide in a competitive marketplace. If physicians want to compete for the dollars with other professionals without being able to hide from their prices under a third party reimbursement system, then I say let them make all the millions they can.
Physicians don't want to be subjected to the scrutiny of consumers and they don't want to be regulated either. The reason is that they want their money to be untouchable. What we need to solve the problem is to either collectively make a decision that we no longer want third party reimbursement or that we want all pricing in the healthcare system to be regulated. Or we could have some mix of that based on the type of service provided, but we can't continue to let it grow unchecked.

You must be very unfamiliar with the very recent past in health care. I'm gonna guess you are a nursing student or one of the nursing educators that drinks to cool-aid

You are right physicians are not paid based on the market. When they were (ie before gov't intervention into reimbursement) their salaries were much higher than they currently are. This is further supported by the fact that those physicians that take cash, make more money and have more time for patients because people are willing to pay it.

Again, you act as though physician salaries are going up. They are actually going down, especially when compared to real income. And this is not because of NP competition but because the gov't is cutting reimbursement- against the demand of the market. This is why physicians can open up boutique practices and make more money if they want while also seeing fewer patients.

wowza · Feb 22, 2010

"Using a fallicous argument like that other students don't make as much money makes my argument valid." I think you need to examine this statement closely and tell me what in the world it means??

I was mocking your argument. It makes it better that I had to explain it to you.

mbreaz1 · Feb 22, 2010

You must be very unfamiliar with the very recent past in health care. I'm gonna guess you are a nursing student or one of the nursing educators that drinks to cool-aid
You are right physicians are not paid based on the market. When they were (ie before gov't intervention into reimbursement) their salaries were much higher than they currently are. This is further supported by the fact that those physicians that take cash, make more money and have more time for patients because people are willing to pay it.
Again, you act as though physician salaries are going up. They are actually going down, especially when compared to real income. And this is not because of NP competition but because the gov't is cutting reimbursement- against the demand of the market. This is why physicians can open up boutique practices and make more money if they want while also seeing fewer patients.

I will start by telling you that I am very familiar with the very recent past in healthcare, and by telling you that you are way off on your guessing. You know what you get when you assume.

When physicians were paid based on the market, they took chickens and eggs. That has been so long ago that it isn't even worth discussing. Nobody is really old enough to be able to remember that as it was before the war. The "fact" that physicians who take cash make more money in their boutique practices doesn't prove anything about the market as a whole as those physicians cater to a very small group of high net worth individuals. There aren't enough of those to support any more than a tiny fraction of the physicians in practice today.

Physicians are making more money and their salaries are going up. What do you mean "when compared to REAL INCOME"?? If you would take a look at the trends, most economists say that everyone's wages are stagnant because of healthcare costs. I wonder if that is having an affect on physician wages too maybe? What exactly does "against the demand of the market" mean? Are these some sort of terms that are concocted by the healthcare industry? I would assume that you are a medical student who has never taken an economics course and that is why you like to argue using terms that have no meaning, but I don't want to assume things like you do. You probably need to find some evidence to bolster your arguments, but that will be hard to do.

I find it comical that you never mention the article in my earlier post. Did you even bother to read it? Physicians ARE the problem! They are dysfunctional and they are the primary beneficiaries of their own dysfunction.

mbreaz1 · Feb 22, 2010

I was mocking your argument. It makes it better that I had to explain it to you.

It sounds more like you have no clue what you are talking about. That statement makes absolutely no sense whatsoever. You had to explain it to me? Where is your explanation?

prairienp · Feb 22, 2010

As far as CAD and DM outcomes? A highschool student with a textbook can do that. Not that I don't believe you, but that is not why he's the Doctor and you are the midlevel.
oh, and lest I forget, patient satisfaction, though important means less than nothing when talking about who's the better provider. If the patients knew what they needed they wouldn't be coming to us. Please never try that one again, and spread the word to anyone else using that argument.

Please understand I am not a midlevel, I am a healthcare provider. If a HS student can do these things why can't the MD who works in the same clinic? I am not sure if you practice, I can tell you the majority of my patients have a good idea of what they need, we discuss their healthcare. If patient satisfaction is a invalid argument why is it used? not only in healthcare, but education, business, and life in general. My nursing education provided a strong foundation in communication and health promotion (for many naysayers "fluff").

wowza · Feb 22, 2010

Many students in other professions graduate with a far greater proportion of debt related to their starting salaries. We don't really need more primary care physicians. If they won't do the job for a reasonable price, let someone else fill their role. Maybe we could even find someone who doesn't cry about not having enough prestige or not making enough money.

It sounds more like you have no clue what you are talking about. That statement makes absolutely no sense whatsoever. You had to explain it to me? Where is your explanation?

Seriously?! You still don't get it. I figured you could at least understand what it meant, just not why I posted it. Wow. Let me break it down for you like a 2 year old.

During your little rant a few days ago you said, "Many students in other professions graduate with far greater proportion of debt related to their starting salary" as evidence that doctors should be paid less because other students do not make as much money. Your argument does not hold water for a few reasons. First, to become a doctor you have to spend longer in training than other fields. Second, it is much more competitive to become a physician than other jobs that do not pay nearly as much. So I responded by saying, "using a fallicious argument like, that other studetns don't make much money, makes my argument valid." I was mocking you and your point that it matters what other students. It did not support your point. I mocked you.

Now, the fact that I had to explain it to you twice is hilarious and makes it better.

wowza · Feb 22, 2010

Your first mistake is that you think these problems are disparate and you have a complete lack of understanding of the economics surrounding our healthcare problem.

Physicians are making more money and their salaries are going up. What do you mean "when compared to REAL INCOME"??

Clearly you are the one without the understanding of the economics of healthcare if you think that physician salaries are increasing. Someone who is unfamiliar with real income should not be acting like they know anything about economics. Real income is an intro economics concept. It is income adjusted for inflation and gives you a better idea whether salaries are actually increasing or not.

This is from the Center for Studying Health System Change: http://www.hschange.com/CONTENT/851/#ib1

"Between 1995 and 2003, average physician net income from the practice of medicine declined about 7 percent after adjusting for inflation, according to a national study from the Center for Studying Health System Change (HSC). The decline in physicians’ real income stands in sharp contrast to the wage trends for other professionals who saw about a 7 percent increase after adjusting for inflation during the same period. Among different types of physicians, primary care physicians fared the worst with a 10.2 percent decline in real income between 1995 and 2003, while surgeons’ real income declined by 8.2 percent... this is a statistically significant change p

That is a 14% change compared to other professions in less than 10 years. Imagine over 10 years, your salary went from $80K to $69K. That is a massive change. Note that it doesnt take into account anything that has happened in the last 7 years.

This also doesn't take into account the increase in weekly hours physicians have had to do to try and keep pace with cuts in reimbursement. Add to the fact that medicare has taken out consult codes this year for specialist which, for some doctors, will decrease income 20% in a single year. Add to that the potential 21.5% scheduled cut in medicare that may occur this year. You have absolutely no idea what you are talking about.

What exactly does "against the demand of the market" mean? Are these some sort of terms that are concocted by the healthcare industry? I would assume that you are a medical student who has never taken an economics course and that is why you like to argue using terms that have no meaning, but I don't want to assume things like you do. You probably need to find some evidence to bolster your arguments, but that will be hard to do.

The irony of the bolded statement, esp when you have no idea what real income is or what demand of the market is. Clearly it is you that has never taken an econ course. I was pre-finance at a top undergraduate institntuion but I decided I didn't want to go into finance during my third year of college and opted for medicine (good thing too with the economy).

What I mean is the true demand for physician services would make reimbursement higher. The gov't has artificially set reimbursement lower, against the demand of the market. This is seen by the fact that physician reimbrusement was higher just a few years ago before reimbursement rates were cut. The market will bear a higher reimbursement because the demand is so high.

I find it comical that you never mention the article in my earlier post. Did you even bother to read it? Physicians ARE the problem! They are dysfunctional and they are the primary beneficiaries of their own dysfunction.
Now with regard to the article, it is an editorial, from a single person! You act as though it is fact. Some of his points are valid. Some are not. None are supported by data.
Maybe next you can post a link to an article from the Huffington post! Hahaha

mbreaz1 · Feb 22, 2010

Seriously?! You still don't get it. I figured you could at least understand what it meant, just not why I posted it. Wow. Let me break it down for you like a 2 year old.
During your little rant a few days ago you said, "Many students in other professions graduate with far greater proportion of debt related to their starting salary" as evidence that doctors should be paid less because other students do not make as much money. Your argument does not hold water for a few reasons. First, to become a doctor you have to spend longer in training than other fields. Second, it is much more competitive to become a physician than other jobs that do not pay nearly as much. So I responded by saying, "using a fallicious argument like, that other studetns don't make much money, makes my argument valid." I was mocking you and your point that it matters what other students. It did not support your point. I mocked you.
Now, the fact that I had to explain it to you twice is hilarious and makes it better.

I never used that statement to justify paying physicians less. I used it to say that they should stop crying about their student loan debt and stop trying to use that to justify getting paid more. We don't hear students in other professions crying like little babies about their horrible student loan debts. We only hear that coming from medical students. It fully supports my point. You just need to think about it for a few minutes, I'm sure it will register, after all, medical students are smarter than anyone on earth aren't they? Doctors don't spend longer in training than anyone else, they just spend longer in formal training. It really isn't necessary to do that, it is just a choice by the profession to handle it that way. Since it is the choice of the profession, don't clamor with the public about it. Talk to the profession about it if you have a complaint. Tell them to shorten the amount of formal training. Don't cry to everybody else that this should make you eligible for higher compensation. Furthermore what do you mean it is more competitive to become a physician than other jobs that do not pay nearly as much? Give me some kind of an example of what you are talking about.

mbreaz1 · Feb 22, 2010

Clearly you are the one without the understanding of the economics of healthcare if you think that physician salaries are increasing. Someone who is unfamiliar with real income should not be acting like they know anything about economics. Real income is an intro economics concept. It is income adjusted for inflation and gives you a better idea whether salaries are actually increasing or not.
This is from the Center for Studying Health System Change: http://www.hschange.com/CONTENT/851/#ib1
"Between 1995 and 2003, average physician net income from the practice of medicine declined about 7 percent after adjusting for inflation, according to a national study from the Center for Studying Health System Change (HSC). The decline in physicians' real income stands in sharp contrast to the wage trends for other professionals who saw about a 7 percent increase after adjusting for inflation during the same period. Among different types of physicians, primary care physicians fared the worst with a 10.2 percent decline in real income between 1995 and 2003, while surgeons' real income declined by 8.2 percent... this is a statistically significant change p
That is a 14% change compared to other professions in less than 10 years. Imagine over 10 years, your salary went from $80K to $69K. That is a massive change. Note that it doesnt take into account anything that has happened in the last 7 years.
This also doesn't take into account the increase in weekly hours physicians have had to do to try and keep pace with cuts in reimbursement. Add to the fact that medicare has taken out consult codes this year for specialist which, for some doctors, will decrease income 20% in a single year. Add to that the potential 21.5% scheduled cut in medicare that may occur this year. You have absolutely no idea what you are talking about.
The irony of the bolded statement, esp when you have no idea what real income is or what demand of the market is. Clearly it is you that has never taken an econ course. I was pre-finance at a top undergraduate institntuion but I decided I didn't want to go into finance during my third year of college and opted for medicine (good thing too with the economy).
What I mean is the true demand for physician services would make reimbursement higher. The gov't has artificially set reimbursement lower, against the demand of the market. This is seen by the fact that physician reimbrusement was higher just a few years ago before reimbursement rates were cut. The market will bear a higher reimbursement because the demand is so high.
I find it comical that you never mention the article in my earlier post. Did you even bother to read it? Physicians ARE the problem! They are dysfunctional and they are the primary beneficiaries of their own dysfunction.
Now with regard to the article, it is an editorial, from a single person! You act as though it is fact. Some of his points are valid. Some are not. None are supported by data.
Maybe next you can post a link to an article from the Huffington post! Hahaha
First of all, I think your study here is a little dated. If you check more recent figures, physician salaries are growing again. Don't bring out a study that is seven years old and try to call it current. Also, physician salaries had to go throuh an adjustment during the period cited in the article because they had been growing at such an alarming rate in the years prior to that period. It was a necessary adjustment to keep them in line with inflation.
Again you go using some general term that you don't understand the meaning of. What is true demand? What you are trying to imply is that the demand for physician services functions in a capitalist free market system. It doesn't. What you don't understand is that the "TRUE DEMAND" for physician services would be cut in half if people had to pay out of their pocket for the service. You are obviously not telling the truth about being a finance major, or you studied at flunkee community college because they surely didn't train you very well. Your logic is flawed in your argument about physician reimbursement rates being higher a few years ago. Maybe they didn't teach that at Flunkee University either? The true demand for physician services could only be measured if you got rid of third party reimbursement.
The real point of the opinion article is not just the opinion, but whose opinion it is. Could you please state for the record the profession of the author?