A lot of you have been asking for a video talking about the issue of unmatched residents. I actually discussed this topic in depth in my Surprising Facts About the 2022 Match over on the Kevin Jubbal, M.D. channel: kzfaq.info/get/bejne/ntZ2jauWvZfaf58.html

I made the decision to pursue PA because I do not want a doctor’s scope of practice. If someone is going to PA or NP school hoping to do a doctor’s job, they are just trying to avoid medical school and the other extra responsibilities (I.e. legal) that doctors hold and those are NOT the people I want treating patients independently.

A Med School Insiders video that explains what happens when a student doesn't match into a residency spot would go a long way in understanding the problem at hand, and what to possibly expect in the future. Thank you!

It’s ridiculous to me that some pre-nursing students will talk to me about how they want to do nursing and do a short course to become an NP because then they’ll be able to do what “doctors do, without having to waste so much time.” It scares me that some people who think the extra practice and guidance a physician get, in order to treat a living human, is a WASTE of time, just because they want to brag about practicing independently. As a newly matriculated med student, I was very fortunate to meet some wonderful PAs/NPs in my premed years that were so smart, but has never had to outwardly brag. They had the trust of their team, and knew exactly where their limits were and strived to learn from it. I only met one NP who was as described above, and although she was the most outspoken, she was the least trusted, even by her fellow NPs.

One of the major takeaways from this research is how far behind NP education and clinical practice is when compared to PA's. Yet, they are granted much more autonomy due to their more immersive internal advocacy.

Thank you, Dr. Jubbal. I wish the AMA advocated for physicians and physician training as strongly as you do.

as a new NP grad, if i wanted the scope of a physician, i would’ve gone to med school. i feel like my school kept pushing “full practice authority!” and i was the only one questioning it. i do not have enough schooling to do the things a physician does!

It's always frustrating when a FPA advocate mentions those comparative studies but neglects to understand that they are not comparing truly independent practicing midlevels with physicians. These are arguments the AANP and AANA continue to have in bad faith.

Good video. I agree with the end assessment. PA for 19 years. I don't like being viewed as a cheap doctor replacement by politicians, and healthcare administrators. I have less training, but I also have a significantly lower paycheck. It is really frustrating when some expect the same volume, and acuity load from PAs and NPs when we are less educated, and PAID LESS. I have worked with a broad spectrum of physicians from the ones who hate us, and treat us like scribes or med students to the ones that supposedly love us, and would be perfectly happy to sit back and let us do all their work for them. I value my physician colleagues both for their skill, and their leadership, and I never wanted to replace them.

Im a PA working in trauma surgery at a level 1 trauma center, and 1/2 of my job is acting as the safety net under the new PGY-1s who rotate through our service every month. I teach them how to admit, discharge!, consult, remove a chest tube, what nurses can do vs what providers need to do, etc. All the little things that can between the cracks- updating a patient’s problem list so we’re billing appropriately, turning off unnecessary IV fluids, labs, and imaging (some patients have had a “stable CXR” for >10 days). And as they advance through residency, they teach me A LOT too. The other 1/2 of my job is running the geriatric trauma service, and those are my patients but I can always (and often do) call the rounding attending that day whenever I have questions on a patient’s care. I love my job because to me I really feel like I am optimizing physician-led care while also getting to provide care of my own when it is needed, which is what APPs are here for!

I love how you emphasized that we shouldn’t think about it in terms of us vs them We all want what is best for our patients and the heath of our country

Hope this gives light to everyone fighting against power when our own common goal is equitable and affordable care for our patients. It's important to back-up arguments with research in all sectors. Thanks Dr. Jubbal! RN here pursuing MD/DO soon.

It's not a surprise to find out that a patient receiving treatment from someone with a third of the training would cost patients more money in the aggregate. It's so tempting to just look at any given interaction and its cost, "MD cost $100, APP cost $65. Aha! See!?" In the world, however, it's more complicated, you can pay $100 one time, or $65 three times (you may even eventually pay that $100 anyway) for the same outcome. And that cold math doesn't consider the indirect costs to the patient such as time off work going to more appointments, time spent living with uncertainty when there's no diagnosis, the frustration with thinking your APP solved your issue only for it to resurge, etc.

Really frustrating trying to make an appt and asking for a doctor but being told NPs are basically the same thing just book with the NP provider instead

Would love to see a video on MD/MBA programs! With your background this would be especially interesting. There are so many problems in medicine that some business acumen could help navigate, but it's hard to know if these programs are worth it because few people have shared about them. Thanks!!

I’m a nurse who is preparing to become a NP, and I’m against independent practice and supporting the idea if working under a physician’s supervision

There needs to be more investment in the amount of residency slots across the board, as well as greater incentives for primary care paths. I would even say that there should be more efforts to supporting expansion of medical school if the applicant load continues to increase like this. I don't think growing these endeavors will be easy but it needs to be acknowledged and supported by anyone able to help!

Y'all my med school just assigned this video as a part of one of our classes. I'm dead haha. Great stuff @medschoolinsiders.

amazing video!!!! when discussing cost, you mentioned it's definitely cheaper for the hospitals to employ mid-levels. however, these mid-levels often make it more expensive for the patient (or government if they are on Medicare) for those reasons you stated. so basically the hospitals are saving money while the patients spend more money...ahhhh the world we live in :(

Thanks for putting this out there, we need to raise awareness so patients understand who they are actually being treated by.

There aren't a lot of physicians out there who say, "Damn! I don't know what this is or what to do about it. Let me consult the PA/NP." That's just not happening. Not because physicians hate APPs or anything like that. It's just that APPs are not likely to have the answers for the kinds of things that will vex a physician. NOTE: that is not to say that an APP _cannot_ have the answer. Considering the time crunch healthcare workers are under, it is not worth hounding an APP for a consult. This alone ought to be enough to help draw some conclusions about where the guidelines should begin and end.

this is honestly why I want to be a PA. I want to practice medicine and provide care to my community, but I'm not comfortable with the level of responsibility that comes with MD or DO. I'm more than happy to have someone I can ask questions especially in more complex or zebra cases.

Depends on if you're practicing at the bottom or top of your license. The NPs who lack diagnostic skill or experience always compensate by ordering more tests. You see this same behaviour in Physicians who practice at the bottom of their license and residents in training. The difference is residents gain more experience and medical education and become more precise. That infrequently happens for mid levels unless they work alongside good doctors in a solid institution. Healthcare providers are like bodyguards. You get what you pay for. Experience cannot be taught.

This is reassuring. I really want to go into FM but other students keep telling me that I'll just be doing what NPs and PAs can do. It's nice to see the data to back up otherwise.

This was the BEST presentation on this topic I have ever seen! Thanks, Dr.Jubbal! 🙂👋🏽👨🏽‍⚕️ - PA since 2000

Online diploma mill DNP programs require as little at 500 hours of "clinical experience" this can be online or shadowing, many of these schools do NOT require any previous nursing experience. Blows my mind that these people are allowed to practice independently

I love how detailed this is. So helpful! 🙏🏽

ICU PA here. I love working alongside attending physicians and residents as part of the comprehensive team. I enjoy having oversight and the ability to ask questions when I am unsure how to manage certain diagnoses/issues. I have also seen the reverse of this be of value when residents are able to ask PAs with many years of experience questions they may have pertaining patient care. In the inpatient setting I believe this team approach ensures patients are provided the highest quality care possible.

Imagine completing med school and not being able to become a doctor because you never match 😭 would be horrible

Thank you so much for explaining the difference between these medical careers as I am a non-traditional pre med that wants to become a doctor. I’m still in my twenties but was feeling like it’s too late. I want to be a physician! I want to practice independently and now I understand the reason for the rigor of education.

It would definitely be interesting to see the true data about the physician shortage because even though some don't match, there are also those in transitional years but medical schools count them as matching even though they don't have a guaranteed specialty, and residency slots still go unfilled post soap which blows my mind.

My PCP is an NP and she’s awesome, but these concerns are very valid. It’s terrifying, the thought that even if I get into med school, I might not get into residency. It motivates me even more to learn as much as I can now.

I don’t understand why NP/PA get offended by the term “mid-level.” I am an EMT-Basic, and provide Basic Life Support. I don’t see “Basic” as an insult. It’s just a descriptor of my training in the overall medical hierarchy, like “mid-level.”

I love that you have read all the statistics so we don't. Thank you.

As a future Nurse Practitioner, I look forward to working alongside a physician and becoming an important part of the healthcare system in order to achieve positive patient outcomes.

If you want to be a doctor, you have to go to medical school. There's no way around that 🤷🏾‍♀️

Would very much enjoy a video of the issues you raised regarding matching and lack of places for training medical students at graduation. This is a problem that I had no idea existed.

Great video. Everyone in the hospital has a vital role based on knowledge, skill, and training and it's important to stick to those roles. Would love a video addressing the physician shortage!

I’d love to see a video on the physician shortage and what can be done about it. As an Army Veteran who’d love to attend Medical School, a ~6.5% acceptance rate isn’t exactly appealing and then the residency issues on top of that have pushed me to consider other careers.

This is awesome, also shows the symbiotic relationship between the NP/PA and doctor.

not to mention DNPs who can go by "dr" and more states beginning to legally allow it. nurses have a strong lobby for independence and are vying for more pay along with being called a doctor

There is a physician shortage but mainly because a lot of medical students don’t want to match into a primary care specialty, and the shortage is mainly in rural and remote areas that are places where a lot of ppl just don’t want to live

Ask any psychiatrist about new patients presenting to their clinic who were being managed by an NP. It’s horrific. I’ve reported multiple NPs to their state licensing board for gross mismanagement of medications and unnecessary use of medical procedures like brain imaging. Their diagnostic skills are awful. If a patient has irritability they get a diagnosis of bipolar disorder despite meeting no further mania criteria. It’s gross mismanagement of patient care. I recently had a new patient who didn’t meet criteria for major depressive disorder and was started on paxil… Arguably the worst SSRI for depression in a young patient based on its side effect profile. A competent fourth-year medical student could do a better job on a psych eval of many of these patients than an independent NP. They should never be practicing independently, at least in my field of mental health.

I am just curious how many ppl in AMA/congress that are pushing for the mid-level provider independent practice has (and prefer to see) NP/PA as their PCP over MDs. This would be really interesting research studies to conduct and find out.

Video about bottleneck for MD/DO training, including the different match rates between US MD vs US DO vs American IMG vs Foreign IMG would be awesome! Especially regarding how it's ultimately connected to Medicare funding

My mom is a CNM/NP, and based on what I hear about her coworkers I agree they should not be independently practicing. Especially in labor and delivery it’s common for CNMs to not understand (or ignore) provider/patient boundaries especially in birth centers. Because of not having boundaries they put their patients at risk thinking that they can save the patient when they don’t have the training. My mom worked as an RN for 20 years so she understands the boundaries, but the ones who went straight through from RN to NP seem to lack those boundaries.

I feel like a fresh attending will not be as effective as a NP who has been practicing for 20 years. Also a 20 year FM attending will perform better than a fresh attending. The point I think is that not every patient needs the best possible care--the number of House tier doctors are very small. So the question should be "what is an appropriate level of care, and who is capable of providing that". Research clearly points to NPs and PAs being capable of delivering high-quality primary care on their own. This decision should ultimately be up to the patient to choose which provider they want. Nobody is forcing anyone to have a NP/PA. The patient chooses to go to the appointment. In rural areas they may not have many choices, but it's still a choice. And if a provider is not giving excellent care, they are removed.

Valuable part of the team, they are great to work with, help alleviate the burden. I love working alongside with them.

An absolute BANGER of a video. Thank you for such a detailed video

The other problem, in addition to residency issues, is the issue of cost of medical school vs PA/NP programs. I’m a Bachelor Degreed Flight Paramedic, B. S. In Emergency Medical Care Paramedic Sciences, that was a pre-med/PA degree. However, after 13 years of practicing as a prehospital provider, I’m looking to expand either into a PA role or MD, but having 2 kids, a wife, and house payment, I can’t in good conscience put our family into the debt of a 2nd house, just to attend school, not even considering the loss of what might as well be 7 years of income between how little residents get pay and getting paid nothing to attend medical school. If we want more physicians we have to make medical school accessible, and the post medical training programs have to take all the medical students that graduate, otherwise good, even great, candidates go to PA/NP school or into business, law, etc. Personally I’ve been waiting/hoping for the NAEMSE’s 2010 position paper on EMS education to get picked up more mainstream, particularly by PA programs who seem uniquely suited to create this prehospital practitioner level in combination with PA training to provide a more independent practice PA, but alas, I’m starting to think it won’t happen in my life time.

Would love to see a quick video covering the same topic for anesthesiologists and APPs in the field

Unmatch MDs and DOs should jump into mid-level rolls immediately and indefinitely until they match, whether they are AMGs or IMGs, their training out the gate is far superior to any PA or Nurse imo.

A physician shortage video would be excellent

*copy* (Thanks Doc), A Med School Insiders video that explains what happens when a student doesn't match into a residency spot would go a long way in understanding the problem at hand, and what to possibly expect in the future. Thank you!

Definitely need a video on how to overcome the shortage of physicians.

This is ridiculous, and I'm shocked AMA is allowing and promoting this! NPs will NEVER be MDs, and vice versa. They are two different types of work. It's crazy harmful not only for MDs, but first and foremost for patients. Absolutely baffled this is happening.

Great video. Very informative. Thank you for using actual data to back up the facts instead of the echo chambers we all live in.

The limited number of residency spots is scary for many pre-meds out there. There are already so many obstacles not being able to get into residency for a certain specialty is not cool. If there is anything that pre-meds can do to help I am sure we would be down to help.

Would love to see a video describing what you mentioned near the end of the video…Physician shortage, the Match, Medicare funding for residencies etc…

Doesn't it make sense to allow the scope of practice of NPs/PAs to include the majority of common ailments/disease and the scope of MD and DO to be more specialized? Why not let NPs/PAs practice like a physician, but with physician oversight in the case where something falls outside of a NP/PAs scope?

I’m currently a nursing student and having a hard time deciding what to do. I cannot afford med school, and frankly see more appeal to working as an NP. I don’t want a doctor’s scope of practice, I don’t want to be in surgery, and don’t feel comfortable with the responsibility of making the decision on someone’s care. I would much rather go to a consuting physician if I’m unsure than be the physician that “has” to know everything. Especially for the specialty I want to go into I see a lot more appeal to being an NP vs physician. However I also don’t want to be distrusted/disrespected by patients or other healthcare professionals because of being an NP. Like, I fully understand that as an NP I’ll be less educated on complexities or rarities or details and would GLADLY speak to a physician when it gets into that. I just don’t want people to look down on me or lump me in with scope creeps. I don’t know. I anyone has avoid, please lol

I 100% agree with your verdict that APPs should not be independently practicing. As an ER scribe and freshly-matriculated nursing student who has very possible future plans of becoming an APRN in the distant years, I've seen the kind of complex cases that even some of the APPs I've worked with have even felt stumped on themselves, and the doctor on site was happy to help and they've been equally grateful for the help and have had subsequent good patient outcomes. This is a beautiful system that I honestly feel doesn't need any fixing whatsoever. I definitely can see the provider shortage at hand, but I too just simply want to see more residency spots open, so that the same system can continue but at greater outreach. Plus, if I become an APRN, I wouldn't want to go in it entirely alone. Something like that is my one of my worst nightmares. I love directly working with doctors and receiving the great teaching and lessons I've learned just in my time as a scribe, and I trust their judgment and experience completely and wholly. If I become an NP or CRNA, I would want nothing more than that same collaborating relationship to continue on. When I have a doctor directly above me and nearby for consult as needed, it makes me feel as happy and secure as it gets.

Been waiting YEARS for this episode

You should really stratify out PAs and NPs instead of lumping them together as APPs/Mid-Levels. Our training as PAs is *exponentially* better than an NP's. Most don't even know how to do something as basic as suturing when coming out of school. Our training is nowhere near that of a residency-trained physician, though.

I would really like a video on physician shortage.

Let’s be real y’all we all know that insurance companies will not ensure NP and cRNA‘s independent process Unless they could pay leagues more than a physician. This is strictly a way to get hospitals to hire a cheaper labor to replace physicians

As a future PA I cant appreciate this video enough. It is a problem and its nice that you distinguished this creep isnt from every mid level.

Very detailed video that sticks to the data. Love it! I would enjoy a video describing the residency cap-I made a short video about the 1997 Balanced Budget Act that was largely responsible for the bottleneck problem and would like another perspective.

Thanks for your work spreading awareness about this situation!

That is why i like surgical branches because many think medicinal branches are talking, precribing, and ordering...

Improving access to high tier care is HUGE and the whole grasping onto scopes is really really really hurting the growing population of humans, especially in remote areas. However, I think anyone whos taking any university science course can agree. When it comes to research and formulating unproven treatment plans you really want someone well versed in science and cellular function. Which usually comes from the scientific approach that is gained otw to medical school. I actually wonder what the thought process is on Paramedics, they work independently on critical calls ALL THE TIME. Where there is No supervision and you really have to self study beyond what they teach you to be effective. Now for the acceptance rate arguement, thats usually reflective of how many facilities are available to train them. So for instance, as a Canadian I can skip the rigor of getting into a Canadian medical school and go to the UK which has hundreds of years into building university infrastructure to teach medical students. So the UK has more slots available and pumps out more Docs. Personally, I think every career choice should simply have a recognizable pathway towards entering medical school, that has nothing to do with your undergrad - How long have you been practicing, what are the results of your patients, and can you pass the med school entrance exam? It should be, oh your a PA/ NP well now if you want into medical school you have to to this and this and this, regardless of your experience because we said so, I dont think that really considers the reality that these people will be highly successful in medical school and thus increase the health care provided to the overall society. The problem to me is, the difficulty of recieving medical school training. Haha buddy says exactly that in the end nice.

nice summary of this issue, would love to see a video going into the physician shortage/limited residency spots

for the final study, dd they ensure they were comaparing similar patients? I'm wondering about the social and economic determinants of health and if that was assessed.

Great video. Train folks to become independent practitioners. Many NPs and ARNPs may not have the mental maturity or experience to practice independently without putting the patient at risk. I prefer to see a Physician.

The Hattiesburg Clinic study happened at my med school. It was very informative and put a dud in the NP’s and PA’s can practice independently talk

A video about the causes and effects of the physician shortage would be awesome!!

Excellent. Hope you do continue this line of research/presentation. Very valuable stuff. Thank you.

I'm not going to lie. Seeing that acceptance rate is rather disheartening. I'm a practicing speech therapist, and I'm studying for the MCAT. I do NOT have the same undergraduate training as, I imagine, most other applicants. I do have more than 6000 hours of clinical experience, but I doubt that'd be good enough to place me significantly above than higher scoring applicants. I would definitely like to hear thoughts on how the med school/residency acceptance rate could be addressed. Thanks for the great video!

I cannot say anything about a Physician Assistance but after going to a urology department in a hospital in Akron Ohio. I can tell you I was so disappointed in the ability and knowledge of the Nurse Practitioner, I now wear a medical ID bracelet that states “I refuse all treatment from any Nurse Practitioner.” Nothing was explained and I was not told of all the equipment needed and how to use it. This caused two trips to the emergency department to take care of problems. These problems could have been handled at home had proper information and equipment been explained.

I can’t wait to see the details of the Physician shortage video in the future!

NP is a masters, plus training, plus Clinicals, plus state exam. Not bachelors…

Nice video! As a future medical oncologist, I’d love to see a detailed video on that. Are we getting that anytime soon?

What a great video, im glad you made a video on this!

The best midlevels I’ve worked with have been those that went to an in-person program and those that chose specialties that matched their previous clinical background. Online trained NPs have an enormous learning curve and should NOT be independently practicing.

Just work with each other! It's a teamwork, not a competition. Every profession has a role. I don't know the statistics, but there are always people from every profession, including physicians, who makes mistakes. For example, physicians also misdiagnose and/or give wrong dosages, so that's when the pharmacists come in and correct them. Not every person is expected to know/do everything and hence different professions were made. The job is to work together and always prioritize the patient's health and safety.

A big thing is that I don't think the cost savings of using an NP or PA vs a physician will be passed down to the patient from the system.

Np, PA cannot be equal to an MD. Increase the residency spot, There are many Us citizens IMG passed USMLE but not getting residency and even cant work as PAs or NP. so they are working at Walmart LOL

The only thing I’m hearing here is MD school needs to be better to their students and NP&PA schools need more structure

As a PA, I’m not a fan of being lumped in with NPs especially with education, clinical hours, studies, etc. I know we do similar things in a day but to me I don’t understand why NPs have independent practice and we cannot (although I’ll say I do not want independent practice, and I did not become a PA because I wanted to be a doctor). I love working together as a team. Honestly a big reason PAs are pushing for something called optimal team practice is because the NPs do have independent practice in some states and the issue is, they are getting more jobs because they don’t need to be linked to a physician. Do I think that’s right? No. As far as PA school, our didactic years are usually 15 months and we barely have any breaks (1-2 weeks in between semesters and no summer breaks). We must have healthcare experience because we are hitting the ground running. One of my semesters was 32 credit hours in a semester. After PA school we have done more credit hours in our masters program than most doctorate programs have. We have at least 1 year full time clinical experience. And what you mentioned about clinicals with NPs, that’s another difference with PAs. According to our national standards, our programs are mandated to have clinical sites for us. We do not find our own. Depending on the school it’s usually 4-6 weeks a rotation and these include core mandatory rotations (including general surgery which NPs do not do) and 1-2 electives usually. We also cannot work in most programs and those who do may be doing a shift or two in a month compared to where it seems NP schools, a lot of nurses work (even full time) while in school. Another difference is online programs. As you mentioned there are a lot of online programs for NP. There are a couple hybrid PA programs (although most of us PAs are pushing against those and do not think they should be a thing). In those they must go into school a certain amount of times in didactic but the lectures are online mostly (most PA programs you must be present at every single lecture, this is even different from what I have heard with med school). During clinical year of course it’s all in person. There was another thing you said about the differences and I’ll post it if I think about it. Oh.. acceptance rate. Yes. It seems like it’s easy to get into NP school why it’s increasingly difficult to get into PA programs. It took me 5 years with a 3.6 GPA, and 10k direct patient care hours to be accepted. One program I was accepted to, had a 1% acceptance rate. On average I think PA programs have a 2-10% acceptance rate and I may have heard that overall like how many people apply to any PA school and how many get in, is about 30% (most students apply to multiple programs). And the majority of pre PAs do not get into PA school their first year. I started in primary care I was expecting them to do some training before I was seeing patients. Well.. they had me shadow a NP for 2 days and the next day I started seeing 14 patients on my own. By the end they were wanting us seeing 22 patients a day. I left after 22 months. I moved states and I’m looking for a job that has good training models. I don’t want to cause harm to anyone of course. I want to help these patients the best I can. I’m also looking for a more collaborative job than in family medicine. Oh and from what I have seen these days more and more nurses are getting their BSN and then going straight into DNP without any nursing clinical experience. And then they want to be called doctor. I don’t think if you’re not a physician, you should not be called doctor in clinical practice as it’s confusing. Same goes for doctorates for PAs but I haven’t really heard of those PAs calling themselves doctor other than in the educational (not clinical) setting which is one of the reasons they got their doctorate in the first place (for education). Two more I thought of. You had mentioned studied show we prescribe more abx and order more tests then physicians. Inthink that’s possibly true for older PAs but in my program (graduated in 2020) they were very adamant about not prescribing abx when not needed because of abx resistance and also not ordering a bunch of labs and imaging that aren’t needed. So I think us need PAs will change that.

A video on physician shortages would be great.

You got to do a video on physical therapy

We wouldn’t have a physician shortage if medical school wasn’t so damn expensive. People just aren’t willing to go into those crazy amounts of debt anymore.

Medical liability and accountability is all that matters.

Yes please! I’d love a video discussing the issue of medical school graduates getting into residency programs.

I agree! An MD is much better educated. I was forced to see an APN who was not supervised by an MD. I was sent for 3 unnecessary expensive tests. It delayed the diagnosis, put my health at risk, and put my body thru more stress and radiation in a short period of time than the best practice standards recommended. The APN I had seen never truly understood the results of my tests and did not know what the steps to take next. As a patient I needed to know my Physician knew what to do to take care of my situation. I am changing to an MD as soon as possible.

Thank you, I’ve been waiting for this video.

I just think you're ignoring how often APPs are left out of changes to Medicare policy and private health insurance coverage all together when talking about increased cost to patients. Even if an APP is working at an in-network facility, the individual practioner is often not covered or covered at a lower percentage than the physician. Also, working in more rural settings is very difficult when the patient demographic might not understand the difference between a virus and bacteria and may demand an antibiotic every time they are sick despite being informed by their APP that it won't help them- I personally see it as no reason to just write a prescription anyway, but some APPs in rural areas may face threats for not prescribing, or it might mean that pt. may never return for medical treatment, become completely non-compliant with all meds, and develop further distrust for practioners... a cycle that rural APPs aim to stop to improve rural Healthcare outcomes. Also, ordering more tests does not necessarily mean they are bad practioners, insurance institutions including Medicare and Medicaid want you to defend your ordered scans and tests tooth and nail because they don't want to pay for them. The hospital of course eats the cost while the pt. can't pay the outrageous balance so they're angry too, but I'd argue this phenomenon has more to do not with APPs ordering too many tests, but with greedy insurance companies and hospitals prioritizing profits and raising CEO salaries over their pt.s and hospital workers... and they shame practioners for ordering too many things...roping them into this mentality that they should always be trying to prove their worth by making the hospital more money. I'm sorry, but that should not be their goal. That also ties in with your overarching point you made about Medicare not finding residences.... it's all tied into it... because there is so little emphasis on providing quality care for patients and so much more on making money. Even if the funding was there... it would have to be specifically set aside for it, and it would take a very long time for residency programs to pop up at hospitals that don't want to pay physicians or any of their employees what they deserve. The problem is our Healthcare system in general and our government not maximizing taxes dollers towards it because they don't care. That is why APPs exist in the first place.... instead of investing in more doctors which takes more time and money, they opted for a quick fix... all of those PAs at the very least (NPs take a very different route) would be physicians without the residency shortage. So I found that comment insulting- if there's an indication for an MRI... sorry we've now probably got an xray, and ct, and now an mri and I'd argue that's the fault of the hospital and insurence requiring people to first get lower quality scans first to prove they need higher imaging. Notice how the studies are never about that.

do a video about CRNAs!

Absolutely fire and informative video, thanks for all you do!

RN here and future critical care NP. i very much look forward to working along side a physician and do not wish for independent practice. find it ridiculous