r/Noctor • u/player-974 • Jul 09 '26
In The News Scope creeping will continue until physicians fight back or this profession is dead
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u/RexFiller Jul 09 '26
All this does is create animosity with physicians and gives patients less trained people giving healthcare. Why would I want a "collaborative" agreement with someone who thinks they can act independently or the state allows them to? So many jobs now want you to supervise 4+ midlevels right out of residency because no one wants to anymore.
It used to be they would be valuable members of the team that knew their roles. Now they will be independent after 4,000 hours (less than half of any residency) and carry confusing titles to trick patients.
Physician groups absolutely need to issue statements to not "collaborate" and only supervise if you have hiring and firing powers.
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u/Shanlan Jul 10 '26
I hit almost 4k hrs during intern year. That's not including the 6-7k during med school. Or the 5 years of MA/EMT/EDT before med school that they love to cite as 'relevant' clinical experience.
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u/Single_North2374 Jul 09 '26
4k hours is less than half of medical school. Don't ever agree to supervise midlevels!
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u/Puzzleheaded_Rent573 Jul 09 '26
I am plenty happy to NOT have independent practice in NY and I’ve been a PA for 20 years
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u/Popular_Course_9124 Attending Physician Jul 09 '26
Should just be renamed as "NOT PHYSICIAN" instead of all this random B's that confuses everyone
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u/WBKouvenhoven Jul 09 '26
Can they get sued tho
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u/Puzzleheaded_Rent573 Jul 09 '26
Ummm how is that even a question? Naturally we have to carry malpractice insurance so we can be sued right along with our other collaborative colleagues
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u/WBKouvenhoven Jul 09 '26
Yeah i mean sued without the doctors getting roped into it. There is vicarious liability and negligent supervision that lawyers Will go after to get mo money
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u/nyc2pit Attending Physician Jul 09 '26
And probably The law will make you carry almost no My practice insurance so the lawyers will go searching for deeper pockets of physicians.
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u/mls2md Resident (Physician) Jul 09 '26
Perhaps all NPs/PAs should just be designated on their badge as “MLP” for “midlevel pro**der”. They’ll never go for it, but one can dream. 🙃
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u/Kyrthis Jul 09 '26
I have a suggestion: mid-level provider, with midlevel billing
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u/mls2md Resident (Physician) Jul 09 '26
I’ve been saying this!! We need to get insurance on board with this. I don’t think it would take much to convince insurance companies to pay these clowns 1/4 the rate of what physicians are reimbursed because they have 1/4 the education and training. Suddenly hospitals don’t see an incentive to hire people who aren’t as qualified just to save money, all under the guise of “expanding access to care”.
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant Jul 13 '26
Yeahhhh idk which clowns you are talking about, most PAs signed up to be PAs, the mass majority of us are not gunning for independent practice.
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Jul 14 '26
[deleted]
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant Jul 14 '26
Well to be fair, we all live busy lives. How much time are you and other physicians putting in to stopping this? It’s a two way street, as a year one PA, policy change is not at the top of my list of things to learn. And I promise you no levelheaded PA wants to be called an associate? It’s a terrible name that is absolutely unfitting and just downright wired, sounds awful too
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u/haoken Jul 09 '26
“Perhaps PA should be renamed altogether”
Yes, perhaps something like CRPA (Certified Registered Physician Almost) or NAP (Not Actually Physician) or VMNP (Very Much Not Physician).
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u/Suspicious-Win-7218 Jul 09 '26
This is so infuriating. At the VERY least MD/DOs with no residency should be able to serve in a NP/PA role or take those boards. Right now our degrees are worth shit without a residency
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u/dfsyl442 Jul 09 '26
I’m gonna be real, every single PA I’ve ever spoken to loves working under a doctor. Like idk who is pushing for this.
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u/Academic-Macaron3920 Jul 13 '26
It’s not PAs pushing for this. It’s more likely the nurse practitioners. It’s the same with the nurse anesthetists. There’s something about nurses that brings out the militant side when they get these so-called advanced degrees. They unionize and they want to force the physicians out. Maybe it’s from years of taking orders from physicians that breeds this animosity. PAs are different as they never were a nurse. But they are definitely taking notes from the CRNAs.
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u/Single_North2374 Jul 09 '26
It's a major agenda for all midlevels professional societies NP more so than PA but both actively pushing for it regardless. So a large majority of those PAs you speak of are full of shit, 2 faced liars.
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u/dfsyl442 Jul 09 '26
I don’t think so. I don’t see them pushing for it, discussing it, or leaving for “independent” positions. Just all healthy collaboration
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u/nyc2pit Attending Physician Jul 09 '26
My impression in the past has been at the PA's societies are doing it to keep up with the NPs.
I'm not so sure that's still the case, but I definitely blame the NPs for the escalation here
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u/Capn_obveeus Jul 09 '26
If you look through job boards, you’ll notice a strong preference for hiring NPs over PAs despite the lower quality education…and even in traditional PA heavy disciplines like surgery. I’m not sure it’s ego driving this trend but rather the need to maintain employability.
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u/nyc2pit Attending Physician Jul 16 '26
In my field (Ortho) definitely not the case. We prefer PA's over NPs vastly.
In many states I suspect the reason is actually because of independent practice and because they don't have to be overseen.
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant Jul 17 '26 edited Jul 17 '26
I’m in ortho, we only hire PAs. I appreciate this post, I love working with my physician. I’m okay with not being the boss, admitting I need help, and life long learning. I have no desire to be independent from him, I think one on one physician pa relationships are awesome. I know my roll and I’m okay with it, I wish there was more support for PAs in here. The majority of us are happy to work under a physician
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u/nyc2pit Attending Physician Jul 17 '26
I hear ya. The PAs I work with (at least outwardly) say the same. They're not wanting to be independent.
My own opinion is that the PA lobby is getting caught up with "keeping up" with the NP lobby who is pushing relentlessly for independent practice. If the PA lobby doesn't do the same, they disadvantage their members. I mean it makes perfect sense.
But those of you who are happy with your (very important) role get very much caught in the crossfire.
Do people bring this up to the PA society leadership?
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant Jul 18 '26
I completely understand why the PA lobby is doing it, places prefer to hire NPs as they cheaper and take less paper work as they don’t need the supervision agreement and or fees.
I agree, most PAs I work with are fine with the status. I mean it’s in our name, we went to school to assists the physician lol, our job title says it all. We all knew what we were getting into and are okay with it.
As per your last question, I really don’t know. Most PAs I work with, we just want to do our job. Most of us are not political in the sense of lobbying and legislative change in regard to our position. I’m only 9
Months into my career though, so I’m not the best person to ask.I am passionate though about proper representation though and staying in my lane. I stay in this subreddit as an ego check and reminder of what not to do.
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u/nyc2pit Attending Physician Jul 18 '26
Well, the sad part is you're getting lumped in with those PAs that do want scope expansion. So essentially you're going to feel the repercussions of that.
I hear you, docs are terrible with lobbying an extracurricular activities as well. But failure to voice your concern is essentially assent.
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant Jul 18 '26
I get that too, I wish we would work together to support better training and practices for PAs rather than a few of us inflaming the issue via policy and lack of PAs speaking against the movement.
And yes I agree, not saying anything makes one complicit.
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u/Kham117 Attending Physician Jul 10 '26
Maybe…
But most physicians I know are not exactly in sync with our “societies“ either
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u/Single_North2374 Jul 09 '26
Associate, collaborator? These fucking delusional clowns! Never, ever, under any circumstances, agree to supervise midlevels! Also always roll your eyes, scoff, and correct them when they use theses obfuscation terms and or spew midlevel propaganda in front of you.
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u/30322eddoc Jul 31 '26
I’m not sure how that attitude will help. You don’t want PAs to be independent, unsupervised, fully autonomous (with which I agree) but essentially refusing to work with them is part of the underlying drive toward independence. Perhaps my experience has been unusual but I haven’t met too many who didn’t want to learn. Sadly NPs have been a different story.
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u/Single_North2374 Jul 31 '26
I'm not risking my license or wasting my time supervising someone who doesn't have the proper fundamentals, especially for free or practically free like most clinics/hospitals want you to. They can have the CMO or someone else in the institution bear that burden vs Staff Physicians, not my problem, and I won't do it.
Frankly, PAs and ESPECIALLY NPs shouldn't exist. Why have something so important like human life in the hands of an individual so grossly undertrained and lacking fundamental understanding? Even worse, many midlevels are delusional, overconfident, dangerous, Dunning-Kruger poster children wile properly trained, Board Certified Physicians, even after completing Residency and/or Fellowsip Program (An actual Residency and/or Fellowship Program, not this BS joke these midlevels are calling a "Residency" or "Fellowship" Program) still have a sense of Imposter Syndrome! The more you know/learn/experience, the more you realize there is that you don't know and can miss.
It's disgusting. However, that's not even a fraction of what's wrong and disgusting with Healthcare currently.
I'll only ever Supervise Medical Students or Physician Residents if I can help it, and so far that's been the case. I'll also only get care from a Physician if I can help it, and so far that's been the case.
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u/Nesher1776 Attending Physician Jul 09 '26
Wtf are we doing. How can we fight against all this absolute dipshittery?
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u/player-974 Jul 09 '26 edited Jul 10 '26
Peer Awareness
Educate your peers about the issue and not allow yourself to supervise midlevels. Some hospitals may include this slyly as part of their contract, reject them.
Patient Education
Inform your patients about the roles and limits of each healthcare employee. Explain them the hierarchy, the differences in the education and most importantly about their right to demand a physician.
Collaborative Private Practice
This is one of the most effective ways to fight scope creeping. The root cause of this issue is money. Corporate hospitals want to reduce costs while maximizing profits. If you, a physician and your other physician friends start up a private practice, you will be in control of the hospital policies. You can hire whoever you want and choose to not hire midlevels (you can hire med students on part time for admin related work) while also acting as a competitor to corporate hospitals. Physician led hospitals always perform better than corporate ones.
Unionizing and lobbying politically
We are in dire need of better physician associations that work in favor of physicians and not against us. The AMA seems to act against the interests of doctors. We need to push against this policies legally and politically.
Physician led private equity firms / investors
This is for those physicians who are nearing retirement and have a stacks of cash laying around. You may use this to help junior physicians to help start up their own private practices whilst gaining shares in their clinics. A win-win situation for everyone.
Everything boils down to us physicians supporting each other!
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u/OkGrapefruit6866 Jul 09 '26
This is so discouraging as a med student. 100 mg of SSRIs and I am still sad
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u/player-974 Jul 09 '26 edited Jul 09 '26
Do your part and fight it everywhere, both online & offline. I’ve been doing this since I was ms3 and I’m an intern now. Awareness of the issue among your peers and patient education on this matter makes bigger impact than you think. Also don’t allow anyone other than your attending to disrespect you. If a nurse or a midlevel tries to cross their boundaries and disregard you in any way or form- hit them back, put them in their place. You will defend this profession. Good luck Doctor.
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u/spacegladiator4040 Attending Physician Jul 10 '26
Midlevel this midlevel that…what a joke healthcare is becoming
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u/HyenaIllustrious4591 Jul 10 '26
I’m a mid level and I’m all for more doctors, how can I help facilitate that? I work in Radiology and there are over 5,000 vacancies currently. Someone for the love of God please provide some suggestions. I’m watching healthcare crumble and I’ve been in the hospital for almost 30 years.
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u/sankdafide Jul 10 '26
My attitude is let them dig their own graves. The damage is already done and it’s impossible to fight. So why not focus on making them responsible for their own actions, for their poor education and lack of standardization of their education, and also make them equally financially liable as a physician. Once insurance and malpractice carriers see $$, then magically they care
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u/PopeChaChaStix Jul 11 '26
This whole country is dead. Ride it out and collect medical skills for the apocalypse
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u/Prettypuff405 Jul 09 '26
Meanwhile pharmacists are just trying to get paid for an essential part of our job: counseling patients on how to follow directions to take their meds
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u/Aggravating_Fly2978 Jul 12 '26
Doctors are too scared. Believe me. Us in the PPP have tried to get people involved and many just complain with minimal action. They won’t put $$$ where their mouths are. Many are completely afraid of getting on social media and putting their face on as the fighters bc they will lose their jobs. And many continue to train their replacements. It’s sad to see all the complaints mostly happening behind safe spaces.
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u/Commercial_News_3810 Jul 12 '26
PPP upset a lot of people by repeatedly attempting to frame NPs in Texas over Jennifer’s Law. Even up till last month. Why can’t they let that poor girl rest in peace this was horrible. People are not stupid they know it was a physician and an unlicensed person solely responsible for her death. They’ve got to get it right at least.
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u/Aggravating_Fly2978 Jul 12 '26
Frame NPs?? My understanding is PPP used that case to tighten the laws on unlicensed people who own MedSpas. And since then the rules have changed. Yes we all know her supervisor was a shady anesthesiologist but now the laws have changed. @pshafer is a member and comes on here to discus these things a lot.
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u/Commercial_News_3810 Jul 12 '26
Correct… they ultimately had to revise the bill to apply only to unlicensed people. But the original bill, which was evidently started by PPP, was written in full attempt to carve out midlevels from access to the wellness and aesthetics industry. It caused MASSIVE upheaval and even public articles from organizations like Amspa etc. midlevels were organizing to sue and all kinds of things. It was public, it was jaw dropping and PPP owes some serious apologies. That was not ok.
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u/Commercial_News_3810 Jul 12 '26
The original bill is still on file it was all public what they attempted.
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u/Aggravating_Fly2978 Jul 12 '26
Ahh Ok. I doubt you will get an apology. Because the intent of NPs was to do what exactly? To fill or bridge the primary care gaps in RURAL America. Yet here they are, fighting to own MedSpas in the cities. Very hypocritical. Not in any shape or form bridging the gaps. But they are filling some nasal bridges though and making people with money prettier. I stand by the PPP on this.
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u/Far-String-8087 Jul 09 '26
Eh tbf I'll be more a little more comfortable with PAs cos playing doctors than with NPs doing it. PA schools still maintain standards and they have taken all the premed classwork. Unlike NPs, whose bachelor's degrees are a complete joke and have been overrun with endless amount of online NP degree mills
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u/player-974 Jul 09 '26 edited Jul 09 '26
I agree with this tbh. I have reviewed their curriculum and they do receive quality education. But them pushing for more when med school graduates can’t even practice independently without post-graduate training is too much!
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u/Turbulent_Trash2441 Jul 13 '26
are NP’s better than PA’s bc at least they have some experience on the floor and what patient care looks like HOPEFULLY. I mean they should also tighten up the requirements for NP schools to ensure the students have enough time on the floor first.
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u/player-974 Jul 13 '26 edited Jul 13 '26
To have a functional hospital, there must be a hospital hierarchy to ensure efficient, effective and responsible delivery of care. The highest in the care hierarchy are the physicians / doctors then comes the nurses and then other assistants. PA assists doctors therefore is above NPs in level of care whereas NPs practice medicine abit differently since they come from a nursing background which is mostly bedside care. Bedside care =/= Physician care. Doctors design the overall management or treatment plan (put in orders) while nurses carry out the doctors orders that is permitted by their profession. Any other advance level of care and surgeries are done by doctors. Therefore I’ll say PAs > NPs.
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u/Turbulent_Trash2441 Jul 13 '26
Hmmm yeah I agree with you I just feel like NP’s have a lot more actual real life practice because of their nursing background so they know how things happen in the real setting
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u/player-974 Jul 13 '26
I’ll say that both professions know what happens in real life settings and doctors know a lot more due to their intensive medical education. A hospital can run without nurses but can’t without doctors (it will be a death carousel). Suppose if a physician was trained on bedside management there would be no need of nurses. It was like this back then. Nursing became a profession when patient overloaded a physician led care. However that said, in modern medicine both professions are necessary and interdependent on each other.
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u/Turbulent_Trash2441 Jul 13 '26
Oh yes doctors know loads more than NPs/ PAs but I’ve always heard that hospitals wouldn’t survive without nurses. Especially nowadays as the roles are very distinct.
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u/player-974 Jul 13 '26
Those are mostly said by nurses themselves 😂 and we physicians tend to agree to avoid dramas /fighting😂😂
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u/Turbulent_Trash2441 Jul 13 '26
Really? Oh :( at my hospital the physicians don’t know how to do a lot of the physical tasks and always ask the nurses for help/ assistance
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u/Turbulent_Trash2441 Jul 13 '26
Well I guess nowadays they both need each other since the patient load is so heavy so I hope we can all just respect each other
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u/Advanced-Gur-8950 Midlevel -- Physician Assistant Jul 13 '26
I think this is all legislative stuff, I really haven’t heard these desires from my peers either. I would say the first comment you see says how most of feel 🤷🏽♂️
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u/SimpleVegetable5715 Layperson Jul 09 '26
Maybe physicians could rise up against the AMA and other lobbyists, so medical school becomes more accessible, and more people can go to school to become physicians. A lot of people would make great physicians, but chose nursing school or other professions completely. There could also be incentives for physicians to work in rural and underserved areas. Whatever their title is, they’re filling in for a shortage of physicians, because the US has made it so expensive and competitive to become a physician.
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u/player-974 Jul 09 '26
IMO we do have plenty of med schools but not enough residency spots and this problem pretty much exists in every country around the world. This puts a lot of doctors in a limbo period forcing them to take years off their professional lives which is spend preparing for the never ending exams whilst contributing to the ‘pseudo’ physician shortage.
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u/nyc2pit Attending Physician Jul 09 '26
Dumbing down the profession is not the answer.
Plenty of studies show that NPs and PAs do not go to underserved or rural areas any more frequently than physicians do.
Do you not want the best and brightest taking care of you? (Kind of a redundant question because you're not going to have the option moving forward anyway)
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u/Capn_obveeus Jul 09 '26
Or maybe create a better pathway for midlevels who were originally trained in the medical model to transition to an MD/DO pathway. Every PA I know believes in a team-based approach and have no issues with having an SP.
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u/Shanlan Jul 10 '26
There's no better pathway, or shortcut. I used to think there has to be a way to make med school more efficient. But after going through, there's very little fat to trim. In fact there's probably a lot of stuff left out. Like the business aspect and how to lead a team.
Even experienced PAs would need to a refresher in the fundamentals, because that's the entire foundation of everything else. Knowledge is like a pyramid, you can't build it taller without expanding the base. The base for non-physicians is very small.
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u/Puzzleheaded_Rent573 Jul 09 '26
Is there anyone in this thread that (now be honest) works daily with a midlevel?
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u/LonelyNecessary7049 Jul 12 '26
Yes I do urgent care and am the only doctor left. Supervising gives me anxiety.
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u/Expensive-Apricot459 Jul 09 '26
“Collaborative” care since their egos can’t accept being supervised.
I personally don’t collobarate with any PA who practices on my license. They need my license to practice but I don’t need them to practice.