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NP/Physician assistant EM "Residents" in USA to make more than medical residents


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1 hour ago, 1D7 said:

We will be shielded somewhat since our system focuses more on cost savings rather than profit. In the American system someone ordering unnecessary tests and consults is encouraged because it generates more billings for the hospital. Administrators realize this which is why midlevel expansion has been much slower here.

My worry is that public opinion and politicians will be the ones who make the end decision, not the administrators who can see/understand the numbers. The general public doesn't care if a doctor works 80 hours/week after 8 years of training at 80-100 hours/week—all they see is that the doctor has a bigger dollar/year figure. The fact that a midlevel is less efficient is actually perceived positively by patients since they get more time with their medical provider.

And because nurses actually collaborate/unite instead of ripping each other up like doctors do, they can maintain a good PR machine while doctors are picked apart villified by the media.

ha I would have to agree to large part with that. 

putting it another way - as a doctor in Canada you are basically in a union, and unions only really work if they are united and willing to push back in some fashion (in other words not afraid to actually piss people off from time to time). Doesn't mean say we would go on strike but does mean you take steps when attacked, or avoid the attack from coming in the first place. 

I always find it odd that doctors seem to be super independent in outlook, and yet at the core are in the most collective form of employment typically there is. 

Nurses, teacher, police, firefighters......none of those groups seem to have that form of cognitive separation from reality. They are all united and act so quite often. 

We may have been trying to avoid making waves but that certainly hasn't helped regardless on the PR front. Doctors well really suck at the PR side, and that is sad because we really do work our asses off, take the same risks other health care professionals take and make a lot of sacrifices along the way (and so do our families). We could position ourselves much better as the true patient advocate, and even pushing against the government when it hurts patient care to save money. There is nothing any of those nurse PR campaigns are doing that we couldn't do as well. 

 

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1 hour ago, rmorelan said:

ha I would have to agree to large part with that. 

putting it another way - as a doctor in Canada you are basically in a union, and unions only really work if they are united and willing to push back in some fashion (in other words not afraid to actually piss people off from time to time). Doesn't mean say we would go on strike but does mean you take steps when attacked, or avoid the attack from coming in the first place. 

I always find it odd that doctors seem to be super independent in outlook, and yet at the core are in the most collective form of employment typically there is. 

Nurses, teacher, police, firefighters......none of those groups seem to have that form of cognitive separation from reality. They are all united and act so quite often. 

We may have been trying to avoid making waves but that certainly hasn't helped regardless on the PR front. Doctors well really suck at the PR side, and that is sad because we really do work our asses off, take the same risks other health care professionals take and make a lot of sacrifices along the way (and so do our families). We could position ourselves much better as the true patient advocate, and even pushing against the government when it hurts patient care to save money. There is nothing any of those nurse PR campaigns are doing that we couldn't do as well. 

 

What drives me nuts from an admin point of view is the nursing union promotes themselves as guardians of healthcare and very interested in saving the public system, but the minute we try to improve the system in any way that isn't simply adding more nursing jobs, they act as a roadblock. In my experience, the union is a massive barrier to improving the system. Probably the biggest internal barrier we have. 

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2 hours ago, NLengr said:

What drives me nuts from an admin point of view is the nursing union promotes themselves as guardians of healthcare and very interested in saving the public system, but the minute we try to improve the system in any way that isn't simply adding more nursing jobs, they act as a roadblock. In my experience, the union is a massive barrier to improving the system. Probably the biggest internal barrier we have. 

For instance? I'm not doubting you, I just want to learn some more. 

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5 hours ago, NLengr said:

What drives me nuts from an admin point of view is the nursing union promotes themselves as guardians of healthcare and very interested in saving the public system, but the minute we try to improve the system in any way that isn't simply adding more nursing jobs, they act as a roadblock. In my experience, the union is a massive barrier to improving the system. Probably the biggest internal barrier we have. 

I respect the nursing union for advocating for their profession as a whole. I think their leadership has the right idea of keeping their profession relevant. Ideally the system would help keep them in check but I don't think they anywhere near aggressive enough which results in these barriers.

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On 3/1/2020 at 6:54 PM, Zuk said:

For instance? I'm not doubting you, I just want to learn some more. 

Quick and simple example:

Severe shortage of OR nurses in our facility due to recent injuries, unplanned leaves and short notice retirements. We are at the point where surgeries may be getting cancelled for lack of staff. We have several nurses with some OR experience and have completed the specific OR nursing course who are interested in coming to the OR to fill the vacancies. Easy fit, you can drop them in to the position and they are ready to perform their job at full capacity within a short period.

Union somehow got it put in the contract that OR nursing positions are "teachable" which means that the position goes automatically to the most senior nurse who applies, even if they have no OR experience and have no formal OR course. Those nurses can take up to a year before they are ready to work as an independent fully functional OR nurse. During that year they are still in the OR, just filling the position and unable to fulfill all it's duties. 

It was pointed out that the current rules will make it extremely difficult to run the OR at full capacity for the coming year and surgeries will likely be cancelled, resulting in more patient suffering and delay of care. Union gives zero shits. Not to mention the fact that each "teachable" nurse will cost the system an extra 80k or so because we are paying someone to do a job that they can't fully do. Plus having a nurse who has to be actively trained for a year while working in the OR means the entire OR efficiency goes down.

Drives me insane because it's such a waste of resources and impacts our patients in a negative way. Also, the logic the union uses is stupid because technically, anything is a trainable position. Should we be naming the most senior nurse in the building the new general surgeon? That is "teachable", we weren't born instinctual surgeons. What about making them an astronaut, lawyer or F1 driver? All those people are "taught" to do what they do.

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I recommend people to consider dentistry, after lengthy discussion with friend who graduated few years ago and already bought his own practice with excellent income. What he does is equally interesting with mix of medical and surgical management. There is no residency match to worry about. The only downside is school tuition is higher during the 4 years, but you make that up since you don't have to do residency.

People don't realize how many barriers there are in medicine beyond just getting into med school. CaRMS is a mess, with specialties like psychiatry becoming competitive, that would've been nonsense few years ago. Good luck if you want to do derm or plastics. Then you gotta find job or fellowship after residency, another mess. Trying to secure a good fellowship is even harder because there is no open system like CaRMS, it's all about who you know, and if there is an internal applicant (who might be much weaker than an external applicant), they'll still take the internal applicant. Jobs are spotty, with specialties that need hospital infrastructure suffering the most. People who can't find job are doing 1, 2 or even 3 fellowships in some specialties. Renumeration is stagnant is many provinces, while marginal rate of income tax goes up and advantage of incorporation shrinks. Changing specialty is next to impossible, because CaRMS second round has fewer and fewer spots left. Many academic physicians are there not because they like academics, but because there isn't enough community opportunities. Some academic physicians lose their general skills, and they're stuck in academics for rest of their career.  Many community physicians well past 65 aren't retiring, because they know they are sitting on a goldmine, and any new graduating resident will never get the deal and leeway they get. 

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On 3/5/2020 at 3:55 PM, shikimate said:

I recommend people to consider dentistry, after lengthy discussion with friend who graduated few years ago and already bought his own practice with excellent income. What he does is equally interesting with mix of medical and surgical management. There is no residency match to worry about. The only downside is school tuition is higher during the 4 years, but you make that up since you don't have to do residency.

People don't realize how many barriers there are in medicine beyond just getting into med school. CaRMS is a mess, with specialties like psychiatry becoming competitive, that would've been nonsense few years ago. Good luck if you want to do derm or plastics. Then you gotta find job or fellowship after residency, another mess. Trying to secure a good fellowship is even harder because there is no open system like CaRMS, it's all about who you know, and if there is an internal applicant (who might be much weaker than an external applicant), they'll still take the internal applicant. Jobs are spotty, with specialties that need hospital infrastructure suffering the most. People who can't find job are doing 1, 2 or even 3 fellowships in some specialties. Renumeration is stagnant is many provinces, while marginal rate of income tax goes up and advantage of incorporation shrinks. Changing specialty is next to impossible, because CaRMS second round has fewer and fewer spots left. Many academic physicians are there not because they like academics, but because there isn't enough community opportunities. Some academic physicians lose their general skills, and they're stuck in academics for rest of their career.  Many community physicians well past 65 aren't retiring, because they know they are sitting on a goldmine, and any new graduating resident will never get the deal and leeway they get. 

,

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3 hours ago, PA2021 said:

 

Also, being a PA may seem good on the surface and compensate decently in Canada but the impact and autonomy that a doctor has (combined with better job stability) outweighs everything. 

The stability comes as a very high price of limited mobility. It is far, far easier to move jobs as a mid level than it is as a physician, especially if you are in a specialty with limited job opportunities. I frequently wonder if it is worth it.

The autonomy is mostly for FFS physicians (I worked a salaried corporate non medicine job before I went to med school). Salaried physicians have much less autonomy than FFS.

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On 3/6/2020 at 2:41 AM, NLengr said:

The stability comes as a very high price of limited mobility. It is far, far easier to move jobs as a mid level than it is as a physician, especially if you are in a specialty with limited job opportunities. I frequently wonder if it is worth it.

The autonomy is mostly for FFS physicians (I worked a salaried corporate non medicine job before I went to med school). Salaried physicians have much less autonomy than FFS.

.

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2 hours ago, PA2021 said:

As a midlevel PA, I'd have to sell myself to employers showing the need for a PA in order to get a job. Doesn't even mean I'll have a job in 2-3 years if funding goes away. Literally seen three PAs beg for a job since their funding got taken away and no hospital wants to create funding for them. There is barely any job stability compared to physicians and although mobility is limited, at least physicians can potentially practice all across Canada. PAs can only practice in 4, provinces so being a midlevel ain't all that good.

NPs definitely have a much better situation than PAs right now. 

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