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Northeastern Blot @northeasternblot.bsky.social · 4d

I agree! There are some wonderful NPs and PAs. But I think this is not really downstream of their training. I wish those best of both had the training and widened scope of practice of a physician. Obviously this is more of a long term workforce planning thing.

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Northeastern Blot @northeasternblot.bsky.social · 4d

The difference is that an FM resident is both in training and working. A PA or NP stops training.

And determining what checks you need and interpreting your labs is emphatically something that benefits from a family physician’s training.

Northeastern Blot @northeasternblot.bsky.social · 4d

One thing to note is that the hospital spaces needed to train NPs and PAs do compete for those of MDs and especially DOs. Since DO schools don’t have their own hospitals they get in bidding wars with NP and PA schools for training slots.

Northeastern Blot @northeasternblot.bsky.social · 4d

Now, most apparently routine things are routine, and of course if there aren’t enough physicians we need NPs and PAs to handle them. But in the long term we should aim to have enough physicians.

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Northeastern Blot @northeasternblot.bsky.social · 4d

I fundamentally disagree. One of the most fundamental things you learn in medical training is how often something that appears routine just isn’t. Having better understanding of physiology and far more clinical experience are both essential and we should aim to have more encounters run by doctors.

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Northeastern Blot @northeasternblot.bsky.social · 4d

And to be as clear as can be, many of these professionals do absolutely essential work under our current system. But when doing long term workforce planning we should think about whether we should take someone who spends 2-3 years in a PA program and just make them stay a bit longer for the MD.

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Northeastern Blot @northeasternblot.bsky.social · 4d

Also, this is a bit more speculative, but I can’t help but wonder if the crisis in bedside nurse staffing is worsened by the NP path being something that can be done mostly online with a significant pay raise at the end.

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Northeastern Blot @northeasternblot.bsky.social · 4d

I don’t think that’s really true. I think most things that are done by PAs and NPs would be better done by physicians. And it only takes one to two more years to make a resident physician as to make a PA or NP.

I think they serve a critical role in our current system, but are not ideal long term.

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Northeastern Blot @northeasternblot.bsky.social · 4d

Recall that a FM resident is able to do *more* for the healthcare system than a PA or NP after only one or two years more of schooling. The same near-term staffing issues are addressed by expanding FM slot as by training more PAs, while long term we get more physicians.

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Northeastern Blot @northeasternblot.bsky.social · 4d

I don't think a 2 year residency program could feasibly cover everything a family physician actually needs to know.

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Northeastern Blot @northeasternblot.bsky.social · 4d

I think we should aim long-term for a system where everyone can access a physician for their care. The training differences are very significant.

That being said, I think it's also clear in the shorter term that more PAs would be an immense help. NP training should be far more standardized.

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Northeastern Blot @northeasternblot.bsky.social · 4d

I think it is probably feasible to shorten med school to 3 years for people specifically going into FM, but it's still important to recall that the rate-limiting step in medical training is residency slots, not medical school.

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Northeastern Blot @northeasternblot.bsky.social · 4d

That's not a terribly efficient distribution of subsidies, which might be better used specifically funding residencies that aren't otherwise profitable for a hospital to run, which was their original purpose.

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Northeastern Blot @northeasternblot.bsky.social · 4d

There is a lot to be said about our residency slot "limit" system, but it's important to recall that it's a limit on *subsidized* slots, not slots as a whole. There are many unsubsidized IM & surgery residencies at for-profit hospitals, but there are also many subsidized IM & surgery residencies.

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Northeastern Blot @northeasternblot.bsky.social · 4d

One big challenge is that the residencies that are most profitable to run (thus can run without subsidies) are also limited in spots by beds. IM or surgery residents make lots of money for the hospital, but need inpatients to train on. FM residents are less profitable but can be trained outpatient.

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Northeastern Blot @northeasternblot.bsky.social · 4d

I do think all of this discussion would be helped by remembering that we can easily fill every residency slot in the US with international medical graduates. The number of med schools has very little to do with doctor shortages.

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Reposted by Northeastern Blot

the abbot of unreason (an archaeologist) @merovingians.bsky.social · 5d

this RULES man

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Northeastern Blot @northeasternblot.bsky.social · 6d

I’m not saying that turning towards socialism is a negative thing. It’s certainly better than austerity.

Northeastern Blot @northeasternblot.bsky.social · 6d

I wonder if the Dems in this scenario would back austerity or if they would turn towards socialism.

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Northeastern Blot @northeasternblot.bsky.social · 10d

When would a House rule be found in a law?

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Northeastern Blot @northeasternblot.bsky.social · Sep 23

I genuinely do not know how so many people go about life when they're this unable to apply critical thinking.

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Reposted by Northeastern Blot

Evan Urquhart @evanurquhart.bsky.social · Sep 2

I think the disconnect between the far left and centrists right now is that the far right's least popular dreams swiftly became the dominant political reality so "you're outside the mainstream and no one agrees with you" isn't the deterrent it might have been.

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Northeastern Blot @northeasternblot.bsky.social · Aug 2

This is our Latke-Hamantash debate.

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Northeastern Blot @northeasternblot.bsky.social · Jul 31

It's a real shame it's during the summer. You know Jesuit schools would have a field day with it.

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Northeastern Blot @northeasternblot.bsky.social · Jul 30

The big question is if Dems can polarize their voters against it the way the GOP has theirs.

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