The Future of Medicine

As I begin my journey into this field, I have been looking into what the future holds for it. Obviously, health care is changing, but is it for the better for our doctors? I have done some research, but what are you guys hearing/thinking?


My questions are:

  1. Is the education path going to change any time soon?

  2. What specialties are going to be in high demand besides family?

  3. In regards to family, is it going to have more incentives to curb the shortage?

  4. Is the government going to have a negative impact on the field with regulations?

  5. Does anyone really know if Obamacare is going to change the workplace?

  6. Will the government make medicine the most awesome, sought after craft with zero problems, zero corruption, and everyone goes home happy?

Well I have few years until I begin that Journey. However, one surgicl specilaity I am possibly considering has about a 20 year shortage from the info that I have been reading. Im sure other specialities have a shortage as well. I guess its really all about which avenue you choose to pursue and where you would like to practice,also hospital setting vs private pratice vs group practice,etc. Definitely a lot to think about before pursuing this journey but I’m determined.

I only have a response to #5, I think there will be an increase in the demand for ALL types of Doctors except Family Med, where I expect the role of DNP’s will play a significant role.


As to all the other questions, I don’t really care I’m just gonna go for it, and let the chips fall where they may!

And I completely see the opposite with Family Medicine. In the last couple years other specialties have decreased and FM has increased financially. A FM doc making less than $200k has a negotiation issue or unwillingness to move to greener pastures.


There are no answers to your questions but tons of speculation from those in the field, going into the field, regulating the field…


There are zero incentives from medical schools to deal with primary care shortages, there’s no money in it. However for physicians willing to work there is plenty of money in primary care in family medicine and general internal medicine. Will that get better? Worse? Who knows? When Medicaid/Care first came out there was quite an uproar…until the salary of many doubled. Will this happen with the Affordable Care Act? I doubt it. The government is the biggest thief and will take more money without question, therefore the money has to come from somewhere. The easiest and most likely are from the salaries of physicians. I’m just guessing and really, really, really, really, hope I’m wrong.

The only incentive I have seen and change in med school is Texas Tech. They offer a 3 year family med program. I think it is quiet small though, they only take like 15 students.

  • croooz Said:
And I completely see the opposite with Family Medicine. In the last couple years other specialties have decreased and FM has increased financially. A FM doc making less than $200k has a negotiation issue or unwillingness to move to greener pastures.



Or a desire to live in a blue state.

And I'm curious about where you (and others) think DNP's are going to fit in. FP's are the obvious place due to cost and shortages.
  • pathdr2b Said:
  • croooz Said:
And I completely see the opposite with Family Medicine. In the last couple years other specialties have decreased and FM has increased financially. A FM doc making less than $200k has a negotiation issue or unwillingness to move to greener pastures.



Or a desire to live in a blue state.

And I'm curious about where you (and others) think DNP's are going to fit in. FP's are the obvious place due to cost and shortages.



http://medicinesocialjust ice.blogspot.com/2009/01/...

I'll see if I can find the article that interviewed NP-to-physicians. It was very well written and talked about how NP's are out of their depth but don't know it. It's the same situation of not knowing what you don't know. Most assumed how easy they would have it during med school both didactically and clinically and they were shocked at the reality. They had no clue how little they really knew and were all appalled at how they'd placed their patients at risk when they were NP's.

I once believed in how NP's could fulfill the role of the lowly FM docs but not no mo. As soon as the stats begin to come in and more and more misdiagnose patients it will become obvious that primary care is not, nor should it ever be hoped to be a NP dominated field. Primary care deserves more than an extra year or two of clinical schooling...and definitely more than online coursework.

Where they fit in? Since they lobbied for independence because what they practice is not medicine but "advanced" nursing I opine they best fit out of the way of medical professionals. Sure they can open up a practice and see patients but they are limited in depth and scope and the hubris of the nursing lobby to promote them as an equivalent to physicians is downright dangerous.
  • croooz Said:
I once believed in how NP's could fulfill the role of the lowly FM docs but not no mo. As soon as the stats begin to come in and more and more misdiagnose patients it will become obvious that primary care is not, nor should it ever be hoped to be a NP dominated field. Primary care deserves more than an extra year or two of clinical schooling...and definitely more than online coursework.



I agree with you 1000%, DNP's will NEVER be on the same level training wise as Physicians. But Physicians won't be making the calls as the cost of healthcare continues to rise, insurance companies will.

I'd be willing to pay more to see at MD over an DNP if my insurance company won't pay for it, but will the general public be willing to do the same?


Hmm! Some good points, some not so good. I’d have to disagree with “as soon as the stats begin to come in and more and more misdiagnose patients…” because the stats ARE in. If one is taking an evidence based look at NP practice as a whole one sees “Studies comparing the quality of care provided by physicians and nurse practitioners have found that clinical outcomes are similar. For example, a systematic review of 26 studies published since 2000 found that health status, treatment practices, and prescribing behavior were consistent between nurse practitioners and physicians.


What’s more, patients seeing nurse practitioners were also found to have higher levels of satisfaction with their care. Studies found that nurse practitioners do better than physicians on measures related to patient follow up; time spent in consultations; and provision of screening, assessment, and counseling services.” This is from Health Affairs and the Robert Woods Johnson Foundation : http://www.healthaffairs.org/healthpolicybriefs/br …


There is NOT evidence that NP’s provide substandard primary care. Part of that is because (as I know, as a NP/CNM) NP’s work with physicians. In primary care particularly, in most states the NP cannot set up a separate office, and has a collaborating physician and a specific set of protocols which specify, among other things, what categories of meds they can prescribe, and some specifics about patient managment.


It is also true that there is a LOT I did not know. I did NOT expect to breeze thru med school or clinicals, because I had already realized that my knowledge base was not deep enough --one of the many reasons I did not go for an additional certification as an FNP was because I was frustrated with what I didn’t know, and knew I didn’t know. So I wasn’t surprised to find out how much more there was to know. Interestingly, having been thru 3 years of med school, what I learned so far as far as OB/GYN was appallingly limited regarding obstetrics compared with what I learned in nurse-midwifery school, but I HAVE learned quite a bit more GYN than I knew before. And I have been sobered by thinking of some gyn cases I may have handled inadequately. But none of them were very sick, because NP’s/CNM’s refer more complex cases to the MD’s/DO’s. Being ready to refer is important.


In my first 8 week family med rotation, the family practice doctor I worked with talked about his cutoff for referrals. He said that he is not always sure about a diagnosis but makes the best differential he can, tries the treatment he feels is appropriate. If they come back, he might order additional testing for what he thought was a less likely diagnosis, or try another treatment approach. But if they come back a third time and the problem isn’t getting better, he will definately send them on to a specialist. I’d say that most NP’s probably do the same, or the patients may self-refer. So, hopefully those “zebras” get caught in followup. Meanwhile the otitis medias and allergies that can make up so much of a family practice office’s day can be seen by an NP, or a PA, and if something is an unusual problem, they can consult their collaborating physician.


NP’s and PA’s can NOT, however, meet the primary care shortage because there are not enough docs to prartner with, especially in HPSA areas.


That’s my 2 cents. I think NP care is safe for common medical problems and CNM care (or family practice doctor care) is safe for low-risk pregnancies. I think ANY provider can miss something. I think doctors have a MUCH greater depth of knowledge, which is, I think, realized by nurses and NP’s and PA’s who have been in practice for a long time, but they might be cockier before they had a lot of experience. I think in some cases, NP’s can know more than doctors in specific areas - their areas of expertise (normal labor for CNM’s), just as physical therapists can know more than doctors about THEIR areas of expertise.


The patient is best served by a health care team, and that is well supported by research.


AND, we need more primary care physician providers, which is why I’m here in medical school.


Kate

  • Kate429 Said:
That's my 2 cents. I think NP care is safe for common medical problems and CNM care (or family practice doctor care) is safe for low-risk pregnancies. I think ANY provider can miss something.



First off my mother is a retired NP, so I have a tremendous amount of respect for what they do and their role on the healthcare team.

My issue is that it's hard enough for Docs to know when they should "pass the ball", I'm concerned that a DNP (not an NP because I think there's a difference in "attitude"), will not know when they should "pass the ball".

In my mind, anyone insistent on being called a Doc in a setting where they KNOW it would be confusing to patients, can't necessarily be trusted to know when they've reached the limits of their training.
  • pathdr2b Said:
  • Kate429 Said:
That's my 2 cents. I think NP care is safe for common medical problems and CNM care (or family practice doctor care) is safe for low-risk pregnancies. I think ANY provider can miss something.



First off my mother is a retired NP, so I have a tremendous amount of respect for what they do and their role on the healthcare team.

My issue is that it's hard enough for Docs to know when they should "pass the ball", I'm concerned that a DNP (not an NP because I think there's a difference in "attitude"), will not know when they should "pass the ball".

In my mind, anyone insistent on being called a Doc in a setting where they KNOW it would be confusing to patients, can't necessarily be trusted to know when they've reached the limits of their training.





path and I are coming from the same place. My issue is not with NP's but those who've gone on to earn their doctorates. I had a conversation with a couple of those and their hubris was incredible. A healthcare team approach is great however I don't get the impression from the nursing lobby and DNP's that they are after teamwork but forcibly carving out a niche of "separate but equal."

Kate I hope nothing I posted offended you that was not my intent.

Oh, no prob It didn’t offend me so much as encourage me to respond with “the rest of the story”. Yes, looking back I do see that the original post was specifically asking about DNP’s, and that might be a very valid point. I lack any experience with DNP’s or the programs, but looked briefly at the ND program at Case Western, which is billed as a clinical doctorate. I think the DNP is a mistake in direction for nursing although that is not the “politically correct” position re the ANA. Time will tell.


Kate