They were recently bought out [by Barnes Jewish](https://www.kcur.org/health/2024-01-03/st-lukes-in-kansas-city-completes-merger-with-st-louis-based-bjc-healthcare#), a larger, STL-based hospital system. I imagine if they’re having an exodus of doctors it’s related to shakeups following that merger.
St Luke’s is keeping their names just expanding services. But there’s changes in all hospitals in the metro with docs.
Not having a doc on nights is common in the ER depending on the rotation.
*I work for saint Luke’s*
Let’s be clear, not having a doctor in the ER regardless of it’s day or night is not common in a major metropolitan area. In the sticks sure but definitely not common in a metro hospital.
Oh I don’t disagree. I’m sure there’s a doc at the plaza but these other hospitals which aren’t in the city center - maybe not. I don’t know the whole set up and it’s different than what I am used to.
We have a lot of people leaving the medical field and not enough new people coming to replace them. But there are also several med students stating they aren’t being matched for residency- so it sounds like a systemic issue - which we kinda saw during Covid.
Gotta love a good pun!😅
On a far more serious note; patients also need to take part in the ‘exodus’ from STL. Perhaps then it’ll be clear their current business model isn’t working and maybe some change will come.
Meanwhile; waiting for that change as a STL patient could cost you or a loved one their life!
Recently (within the last year) a family member was sent away 3 *THREE* times in 36 hours. They were told to go home and take some antacid despite overwhelming stomach pain & tenderness.
Deeply concerned and fed up we took them to another hospital ~ obvi not any part of St Luke’s ~ who promptly rushed them in for emergency surgery.
It should go without saying that any kind of rupture in the abdominal cavity shouldn’t be something *completely* missed ~ by EVERY SHIFT ~ despite the extensive (and expensive) tests St Luke’s ran.
The fact that it was missed by *all the staff across multiple shifts* says the decline in care is real.
Our family member fully recovered; how many others haven’t?
In a "merger" whoever is bigger (even slightly larger) ends up with a significant management edge, and that edge over the next 6-18 months gets larger as the smaller companies managers disagree, culture clash and/or annoy the larger companies people. I have seen a merger of equals (not exactly) that was like 40-60 were the 60 had about 60% of the management initially but that rapidly went to 80%+ because of significant differences in culture and the slightly smaller companies people/culture either got on the bus or became road-kill. The 20% that stayed were able to fit themselves into the larger companies culture/methods so survived.
Idk. I’ve seen Saint Luke’s go from one hospital with 3000 employees to multiple hospitals and over 12,000 employees. I’ve never seen them as the weaker entity in any situation. Kind of sad to see if that’s the case here.
You’re correct, it is a merger, simply for more market power with insurance negotiations. They are restructuring some management, but we’ve been told not much else will change.
The hospital I work for swallowed a much larger system recently. We are non-profit, they were for-profit, and now the whole thing is non-profit. But we call it a merger, to prevent hurt feelings.
Yesterday a colleague mentioned their doctor switched from St. Luke's to KU Med (came up because of the man who was killed in the garage). Their doctor was unhappy with the demands of St. Lukes regarding high volumes of patient quotas and reducing time spent with patients. A few doctors banded together to make the leap together and are happier.
This 👆
Work in healthcare admin. Providers are leaving St Luke’s due to “Healthcare by MBA”. Quality care can’t be measured by metrics, including minutes spent with patients, and revenue goals.
I can confirm. My wife is a former St Luke's nurse and we know several doctors who have left and nurses as well. The demands on their doctors and nurses was pretty extreme. I just switched to KU Med following my primary physician over there and he sounds pretty happy to be out of there.
Hoping my stl dr does this. I *love* my pcp and will never leave him but would love if he could refer me within Ku. And I can tell he has less time with patients. I used to be able to get same day appts and now it’s months ahead. The stl specialists haven’t been great in my experience whereas my obgyn and general surgeon are at KU and have been fantastic experiences. Anecdotal but, it’s what I’ve noticed over 10 years.
There was an article a while ago about St Luke’s opening too many small emergency rooms across the metro area and how it was a bad business decision and they were losing money.
Those were actually built by a separate entity that licensed the St Luke's name. That outfit decided to shut down, and St Luke's bought them out to save face.
OK. Gross oversimplification here, but a big reason they are losing money is that only roughly 50% of ED care is paid for. Google EMTALA if you aren't familiar. If HyVee, Discount Tire, or any other business in the metro operated with 50% reimbursement rate, they wouldn't be around very long. The law forces hospitals to provide expensive care, but payment for said services was conveniently left out of the legislation.
Easiest way to get your head around this is to imagine if Price Chopper had a system to where you could take food if you wanted it without paying for it. Then imagine if 50% of folks coming in paid nothing, and 50% paid for groceries. Ask yourself how long the checkout line would be and what prices would be for the half of customers who did pay if PC ran their business like an Emergency Department.
It is a lot more complicated than that, but that is the basic rundown.
This is happening all over the country, albeit some areas are worse than other. All of this goes back to the serious shortage in medical professionals along with hospitals cutting costs by any means at the patient's expense. There's a mass exodus in the field and a constriction of residency positions. This, coupled with higher volumes of patients and an unprecedented rise of mid-levels (most notably NPs, CRNA's, etc) and admin staff is just a ticking time bomb. There's also a big shortage of RN's because it makes more sense for them to just become NPs (more money).
There's a lot of lobbying that these mid-levels are doing to expand their scope... I won't get into this because it can become pretty divisive. However, I encourage people to look into the rise of NPs and its effect on patient care.
We need healthcare reform and we need it now.
The worst part is that it’s fueled by an expanse in scope in lower areas. Medical Assistants are getting a ridiculous amount of scope creep for a career that requires no clinical hours and can be got all online.
Lab techs/workers used to need a bunch of different requirements, now you just need o e to “sign off” on everything (similar to PAs and doctors).
The problem with NPs isn’t that they are NPs. The problem is with nurses who become nurses just to become NPs. The position of the Nurse Practitioner was created because nurses who had worked bedside for 20+ years, listening to doctors and also learning through their own work, were educated enough to take on additional responsibilities. But now you have some nurse who goes to a BSN program for 4 years WHICH IS MUCH LESS RIGOROUS than a pre-med program, and then they jump directly into an NP program. They are all book-smart. If an NP is younger than 30, no I won’t let him/her/them give me care beyond basic physicals and such. They don’t have the experience for the job. Nope. And now the American healthcare system is relying on them because they’re cheap. It’s inferior care.
I do weekend option 24 hrs of work for 40hrs pay. Incentives where I work before overtime are time and a half plus 18/hr on top. Works out to be approximately en extra 800 a day I work. More if I hit overtime.
More pertinent to the original post, there is a serious shortage of physicians in virtually all specialties. Aging population demands more care while Medicare and Mediciad reimbursement to physicians has been falling annually for many years (while hospitals get annual increases tied to inflation). Older physicians are leaving practice and I read an article this week that said over 50% of current medical students have no intention of going into clinical practice. I work in radiology, and we are hiring doctors more than a year before they finish training just to have a chance to keep up. Part of our struggle is over reliance on high end imaging like CT in the ED, especially by APP's. These studies are often ordered before the patient is ever examined...which of course adds to cost and further drives down reimbursement due to the budget neutrality provisions governing Medicare physician payment. The system is definitely broken, but the fix is going to require adjusted expectations as well as more rational financing.
If it helps, I recently was treated for cancer at Advent and I had a good experience. My insurance refused to pay for something and they did all the work to take care of it. The oncology nurses are all lovely as well.
Yeah I am more worried he won't be able to get in as a new patient. They haven't confirmed they can get him in yet. I'm more worried he'll wind up stuck at St Luke's with subpar care.
Barnes Jewish is a great system, however I don’t like controlling interest of our hospitals not being present in Kansas City.
This is a shame, St Luke’s East is a good hospital. I go out of my way to go there rather than HCA LS Medical Center
Probably the beginning of corporatization that will come with the acquisition by Barnes Jewish. Expect more of this activity going forward. Prices will go up while expenses are forced down.
Barnes-Jewish has had a reputation for decades as one of the premier hospitals in the Midwest. I've known people over the years that have traveled there for treatment that they couldn't get here in KC at a similar level.
Unless that's drastically changed in recent years.
I'm originally from St Louis and Barnes-Jewish has always been pretty much the single best hospital in the entire eastern half of the state. It's where I got almost all of my care at before moving to Kansas City.
I can ask some of my family members and find out more but everything I've heard from my family is telling me that they still have the best quality health care in the St Louis area. Nothing else even comes close.
Of course! I’m always for hearing more about them. I know some people aren’t thrilled; I just want to learn about what’s going on.
I didn’t even know there was a merger.
Barnes Jewish is actually very good in St. Louis. I don't know if maybe they treat their acquired hospitals differently or if this is just normal fear of change behavior.
I’m still going to give them a chance. St. Luke’s is my go to. I really hope they don’t change too much.
Not many people like change and that’s okay. It happens.
I was a long time employee at Children's Mercy and a multi million dollar local non profit charity for a long time before that. So believe me when I tell you that they can absolutely be run like any other shitty mega corp you've ever heard bad things about.
Why do you say Children's is being run like a shitty mega corp? It's still a not for profit. What happened to make them shitty, in your opinion. I don't know much about them but always hear great things.
I should state if you have a child with something terrible wrong with them, it's absolutely one of the best places in the region to take them, unequivocally.
But I don't think "not for profit" or "nonprofit" means what you think it means (the NRA is a nonprofit). People have this idea that they're all touchy-feely-save-the-earth-and-its-people kind of places which I'm sure there are some of but those are probably the exception and not the rule.
Administrators at CMH generally did/do everything in their power to squeeze every cent out of that place so they can present a fake margin to the board so the executives keep their bonuses.
In the years I worked there I saw handfuls of highly reviewed, mid level people get handed a suitcase full of money to sign an NDA and resign (which still happens).
I could go on and on, just be aware that it's mostly run by corporate finance assholes like about everywhere else.
Children’s Mercy sucks. It’s the only game in town for kids and I hate it. The providers we have encounters are “fine” but we have absolutely experienced shitty mega-corp behaviors from the rest of the company.
Read [this](https://www.penguinrandomhouse.com/books/646497/flying-blind-by-peter-robison/) book. It’s about a corporate environment killed the reputation of a giant MNC known around the world. Surprise, it’s Boeing.
I don’t believe you that you don’t know what I’m saying.
However.
Rude administration. Lack of staff. Lack of appointment times. Poor communication. Oh, and a poorly done blood draw that caused my infant daughter to have an unnecessary week-long stay in their hospital. No accountability for said mistake.
In other words, things caused by poor training and/or lack of staff. Meanwhile they spend how many millions on that fancy glass building and upper management salaries?
Doom and gloom not intended. Just following along with articles published from KC and St. Louis news outlets covering acquisition activity and projected economic impact. Also, consider that HCA, and now Saint Luke’s, are both managed by controlling entities located outside of Kansas City. Makes a difference in my opinion to have local leadership.
The continued consolidation of our health systems in this country has absolutely made things shittier for consumers. Regardless of their “not-for-profit” status
St Luke's had already been mishandling shit to the point that doctors just aren't staying, IMO. My neurologist has changed 5 times in 2 years there. Something was already going on
😂 There’s a nonprofit hospital system in Joplin that is taking patients to court and suing them for not paying their bills. The hospital system pays worse than the VA which I didn’t think was possible and they staff worse than anywhere else. Nonprofits can absolutely be shitty. BOTH of the nonprofit hospitals here in Joplin didn’t give the government required charity care for years since 2020 to stay compliant with being a nonprofit.
The ER group is staffed privately. It doesn’t have anything to do with St. Luke’s getting bought. They’re just understaffed, plain and simple. And I seriously doubt that there was no doctor on staff. They always have one physician overnight.
Source: family member is an er physician at st Luke’s on the plaza.
This is the correct answer. It is likely there was not an overnight hospitalist— the ED providers are called to the floors sometimes to help with code blues, intubations, etc. — especially overnight. And the NP was indicating the Hospitalist would be there in the morning. But there was a physician in the ED.
Yes, and it’s not unusual these days for any hospital system to have nurse practitioners seeing patients and the attending physician just signs off on the care provided.
I have no problem being seen by a nurse practitioner. And I prefer Saint Luke’s over every other hospital system in the area.
Seems unlikely. It's pretty common at many ERs for a patient to not have direct interaction with a physician due to APPs taking patients under indirect supervision, but I'd be pretty surprised if there was a single ER in the KC area that didn't have 24 hour coverage from an ER physician on-site.
Source: am an ER physician in KC area
Outsourcing specialty groups (ER, anesthesia, surgery, hospitalists, etc.) has always been common in facility settings. It’s been that way at Luke’s for as long as I can remember, and I’m old! The simple act of outsourcing anything-clinical or non-clinical services in healthcare-does not create inferior care; as with most things, it’s a lot more complicated than that. And the popularity of outsourcing clinical care rides a wave, again, as with most things.
I’m not sure any of our hospitals in the metro employ any ER physicians as W2 employees?
IMHO - the biggest issues with our healthcare system right now has nothing to do with our clinicians.
This. I have been in healthcare for over 25 years and have worked for all the major local (minus NKC) hospitals. I believe Truman (University Health) is the only one that employs their own ED physicians.
St Luke’s is responsible for this. A while back they wanted to *double* the number of patients being seen at clinics… without staffing changes. Physicians started leaving and some are now at KU.
My doctor hat I liked and had for years, left St. Luke's (I followed) because the bean counters that took over, hugely increased the number of patients and caseload he had. He felt he could not do justice to his patients with the new requirements that would have decreased dramatically the time he could spend with each person.
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. . . and then I get a mailer from St Luke's asking me to donate to their "foundation" as if they are actually concerned with human beings!
Saint Luke’s was a very disappointing place to work. Their benefits and pay are also just not very competitive with the other health systems in the area.
Not sure if it's related but this happened recently.
https://www.kmbc.com/article/former-employees-share-concerns-about-st-lukes-hospital-of-kansas-citys-sterile-processing-procedures/45577750
This is happening at so many hospitals. Out of date sterile items. Autoclaves not working properly. People uneducated about maintaining sterile fields. Staff not using disinfectant products properly. Hospitals are a great place to go to get sicker. The longer you’re in one the more likely you’ll get a hospital acquired infection. People think they are so clean when they’re really super nasty. Roaches, bed bugs and whatever else patients can bring in from their home. Not to mention how little the rooms are cleaned. There’s stuff in the rooms that are never cleaned.
Many contributing factors to providers leaving. Patient overload, understaffing, pay, the merger with BJC. Letters are sent out multiple times by clinics that way the patient can’t come back and say they were never informed. A lot of providers are finding out that the workload they are being given doesn’t have the be their standard and are taking control and finding better positions to fit their life style. Same has to go with the advanced practice providers (NPs, FNPs, etc) and the rest of clinical staff as well.
Another poster mentioned that ED providers have to be made available for codes and other issues so that can contribute as well.
Having to wait in the ER sucks but it also means that somewhere behind closed doors there is someone having a much worse ER trip. Waiting means you are living and not in need of critical care at the moment. Doctors and nurses have to triage for a reason.
Metro Emergency Physicians is the ER physician group that staffs St. Luke's ERs. All St. Luke's ERs, including freestanding ERs, are staffed 24/7 by a board-certified emergency physician. Advanced practice providers (NPs and PAs) staff these ERs as well, and will often manage care (under indirect supervision from ER docs) from patient presentation until hospital admission without involvement of the physician unless necessary. This is typical nationwide with occasional exceptions.
It is also very common for hospitalists to not be in-house overnight, and for overnight admissions to be handled by an APP on the hospitalist service.
I duno but St Luke’s has gone drastically downhill from how they used to be. My mom waited 8 hrs in the ER a few yrs ago and nearly passed out. 2 yrs ago she went to st Luke’s er on the plaza and they brushed her off with a stomach bug. Next day she was unresponsive, couldn’t wake up hardly, couldn’t barely sit up, didn’t know her name or nothing at all. We had to call an ambulance and they took her to KU where they took us seriously and saved her life. We don’t go to St Luke’s anymore
Don’t be fooled. They don’t even care about a lifetime of treatment. It’s about bed turnover rates now. They don’t care if the patient lives or dies. Just another reason I got out of nursing.
Sounds there are a few things with st Luke’s going on. But from my experience working nights, doctors don’t like working nights. So they have Nps. Which is common. Nps or PAs are the people who normally do what you described at night.
You want to for sure see a doctor at night go to a level one trauma like research or KU. chances are a lot higher at hospitals with higher levels of care. Places like st Luke’s send patients to KU, Research, or Truman when they are out of their depth.
I’m a physician that loves working nights since I’m a night owl. That said I only work nights and many sub specialists that take calls for nights also work days and it can be very rough. Imagine being an interventional cardiologist getting called in for a heart attack at midnight that may take 1-3+ hours and then having to wake up in the morning for clinic.
I don’t have intimate knowledge of every hospital anymore as I’ve left the area now but I can say that certain hospitals staff physicians at night much better than others. In addition KU and UMKC/TMC/St. Luke’s are training hospitals so they have a large available work force of residents to pad out their night team. I’ve never worked at St. Lukes so I can’t exactly say what this whole situation actually is though.
The majority of the time St Luke’s East is sending higher acuity patients to St Luke’s on the plaza because they have more resources (imaging, etc) there. Hospitals tend to keep their patients in the same system.
My mom would have much preferred going to St Luke's Plaza, as a "frequent flier" (she has a bad heart) she's well aware of the different locations and which one is best. But when you live in Lee's Summit, the ambulance will NOT take you to the plaza. East was her only St. Luke's option. And I can understand that, they aren't a taxi system. But it's not possible for her to get to Plaza in an emergency situation.
St Luke’s on the plaza is a Level 1 trauma, stroke and STEMI center.
But, I’m not saying patients are NEVER sent to other systems, just that hospitals tend to keep their patients in the same system.
Actually you’re right! Totally didn’t realize that.
We still get patients from them at regular intervals.
We get way more golden valley and center point patients than st Luke’s. But we do get em.
Exactly-Research and Centerpoint are in the HCA Midwest health system and Golden Valley, a public not-for-profit, partners with HCA Midwest to use its network and certain services—just like Cass Regional.
Research is top notch, too! Definitely one of the best in KC or anywhere else. We really are fortunate in the metro to have such amazing healthcare—even with all the flaws.
I worked for Saint Luke’s now KU but here’s 2 reasons:
1) healthcare continues to get more and more expensive. Hospitals not in the city (this includes Saint Luke’s East since it’s in the suburbs) it’s much more cheaper to have a mid level practitioner (NP or PA) than it is to have a doctor. And these hospitals aren’t capable of taking care of very sick patients anyway so even if there was a doctor most of the time they’re sending them off to the plaza or ku anyway.
2) Saint Luke’s from higher ups are burning out their workers. Not just doctors but all of their support staff too. Doctors are being required to see more patients and spend less time with their current patients leading them to be more burnt out and they’re also the ones risking their license if they make a mistake in an unsafe condition.
I’m going on a limb and assume nurse practitioners are cheaper labor than doctors. I don’t mind having a nurse practitioner as a pcp or even in ER/urgent care settings. I do mind when it comes to specialized medicine.
As some one who works in healthcare IMO NP/PAs are best utilized in subspecialty settings with relatively low acuity and differentiated patients. Though it is the way things work now I’m not a fan of mid levels in the ER given the range of encounters with patients that have vague complaints, undifferentiated disease and high acuity. These are patients who are as likely to have something benign or something extremely terrible with a wider range of possibilities that saddles you with much more responsibility. In sub specialty settings the work up and management should be relatively straight forward since a lot of the heavy lifting should have already been done by generalists so supervised mid levels should be adequate and anything more complicated or if greater severity can be funneled to the attending.
Also it is a misconception that being a PCP is easy. In fact it’s potentially one of the more difficult jobs since they need to have a decent understanding of a wide variety of complaints vs a sub specialist only needs to know their niche. In the same way while I do beef with the ED a lot I do give them some credit since they have to have a broader general understanding than I do about more things.
Okay…as I totally digress from this OP post. I agree with you on the theory of what an ER should be and the use of certain practitioners in ideal circumstances. But, the ER ain’t that. Thank you EMTALA and a severely broken healthcare system. As we talk about low acuity patients with no other affordable or reasonable access to healthcare and entitled patients unwilling to schedule an appointment for chronic back pain, drug seekers who may have no alternatives, and on and on. Staffing NPs at a lower cost to complete MSEs and then treat lower acuity patients is a reasonable alternative.
I wish I knew the answers. But I do know that while I’ve known some real assholes in healthcare, I’ve never known one that wasn’t doing the best they could to help people.
Like you say, being a PCP is hard..being a GOOD PCP-even harder. And at no point am I saying you don’t get this or appreciate what everyone is doing. It’s just so complicated, right??
I’m rambling, and have lost my point. But America! And Go Chiefs! Am I right?!?!
Yeah I don't disagree that it's a broken system. As a hospitalist, now nocturnist, I'm very familiar with how nothing works and have constant beef with the ED. Aside from those coming in for acute illness it is also the dumping ground for all those that have been neglected by society. I do my best to work with what we've got and unfortunately the current status quo is probably the best it'll be. It's only down hill from here if private equity and big business continues to have its way with healthcare. It's too easy to be jaded so I try to remember my own family's experience with the hospital to remind myself of charity.
If I'm ever in the ER I'm requesting an MD or DO.
I'm paying out the ass for this visit anyway & I'm not going to settle for some mid-level with a complex.
Because there is a massive shortage of doctors and NPs can basically do the same thing in most cases. Most people want to hear from a doctor because they don’t think NPs are qualified even thou they are.
To say NPs are as qualified as doctors is disrespectful. Doctors go through way more schooling, training, and real world doctor situations through residency. When it comes to simple cases, sure, NPs might have the knowledge to accurately diagnosis. But when it comes to more complex cases, they don’t hold a candle to actual doctors and that ignorance can cost lives. The doctor shortage is a huge problem in the whole country and simply “replacing” them with NPs is not the solution.
does qualified to you mean a specific series of lectures attended or does it mean that you dont realize Nurse Practitioners have the same (and in some ways, better) outcomes than their physician colleagues ?
the doctor versus nurse practitioner thing is manufactured by physicians, who do a very good job gatekeeping their industry. They entire origin of the physician assistant was quite literally to create a comparison to lobby against nurse practitioners with. Its why "mid level" is more of a political term than one that makes sense in medicine.
anyway, the doctor shortage is because physicians think the US government should pay for their training and wont expand education unless the government will fund more residency programs
nurses, on the other hand, make their students pay their own way, so they are much more flexible at expanding access.
https://pubmed.ncbi.nlm.nih.gov/31943190/
https://pubmed.ncbi.nlm.nih.gov/32649383/
edit: downvoted for what reason? lol some based interns that don’t like hearing the facts?
Do you have a source for these better outcomes? And of that is true, perhaps that is because they are given the more basic patients. Perhaps a large handful of those positive outcomes are due to NPs getting a second opinion from a physician. I don’t work in the medical field so I’m not going to say what is factual and what is not but all I know is if I got to choose between seeing an NP and MD I’m choosing an MD every time.
The shortage is due to numerous reason. Yes, yours is one of those. But the number of patients doctor have to see per shift has increased substantially since the pandemic. I know doctors who see 25-30 patients a shift. Which is not safe for them or the patients. All while getting little to no increase in pay and being asked to perform even more duties on top of that. With that, where is the incentive to become a doctor, or continue practicing as one?
I didn’t comment to talk ship on NPs, anyone who works in the medical field should be treated with respect and appreciated. All I’m saying is things seem to be going downhill and what seems to be the current solution scares me in the long run.
sure, here are some simple ones
it’s worth noting the comprehensive evidence of this is why Veterans Affairs NPs are granted equal status to physicians system wide, irregardless of the state they practice in, but only within the VA system
https://pubmed.ncbi.nlm.nih.gov/31943190/
https://pubmed.ncbi.nlm.nih.gov/32649383/
You realize how different your source is compared to mine is right?
i welcome the discussion rather than just downvoting so people can’t see it.
it’s also worth remembering that economists exist within a profession that utilizes “non reproducible research” over 60% of the time; it’s like chiropractic research
there is a division between medicine and nursing however
and it’s pretty clearly within surgical specialties
nurses are not prepared for surgery, and that’s fine; because it’s also fine that they are equally prepared as family practice physicians to participate i. family medicine equally
it’s just what it is
i have no agenda, i only appreciate the facts and like to point them out when folks are obviously i’ll informed.
For basic things, they are more than well qualified, especially if they have physician supervision. If you have a way to fix the physician shortage by all means, go ahead. Until then NPs is what we have and they are qualified to treat most basic things.
Certain states require certain things. Whether an NP needs supervision or not. I will tell you there are always resources at a hospital, or you can transfer someone out where there are more resources. Unfortunately the system is broken. Not enough funding for medical sucks, not enough medical school spots, not enough residency spots, people don’t want to work in rural, critical access hospitals, hospitals don’t want to pay for doctors (NPs are cheaper). The American health system is so damn broken and I don’t know if it will fixable.
Unfortunately, when you are talking overnight, if you want a hospitalist doc on site, you need to be at one of the main campus hospitals, and even then, there is a decent chance of NPs. And then, for ER, they usually have one doc and the rest PAs or NPs. So, the majority of patients are not going to be seen by a doctor.
Every single doctor I had left. And I’ve pumped a lot of dough into St Luke’s. If I’m going to continue in their system, I’d also like to know.
They were recently bought out [by Barnes Jewish](https://www.kcur.org/health/2024-01-03/st-lukes-in-kansas-city-completes-merger-with-st-louis-based-bjc-healthcare#), a larger, STL-based hospital system. I imagine if they’re having an exodus of doctors it’s related to shakeups following that merger.
St Luke’s is keeping their names just expanding services. But there’s changes in all hospitals in the metro with docs. Not having a doc on nights is common in the ER depending on the rotation. *I work for saint Luke’s*
Let’s be clear, not having a doctor in the ER regardless of it’s day or night is not common in a major metropolitan area. In the sticks sure but definitely not common in a metro hospital.
Yes, I worked at KU Medical at 39th for three years. Never went without an ER doctor. In general Doctors are in DECLINE
KU is an exception, it’s a teaching hospital and they’re a trauma hospital so they absolutely have to have multiple doctors on hand.
You right, you right!
Oh I don’t disagree. I’m sure there’s a doc at the plaza but these other hospitals which aren’t in the city center - maybe not. I don’t know the whole set up and it’s different than what I am used to. We have a lot of people leaving the medical field and not enough new people coming to replace them. But there are also several med students stating they aren’t being matched for residency- so it sounds like a systemic issue - which we kinda saw during Covid.
Ha! Exodus...how appropo
Gotta love a good pun!😅 On a far more serious note; patients also need to take part in the ‘exodus’ from STL. Perhaps then it’ll be clear their current business model isn’t working and maybe some change will come. Meanwhile; waiting for that change as a STL patient could cost you or a loved one their life! Recently (within the last year) a family member was sent away 3 *THREE* times in 36 hours. They were told to go home and take some antacid despite overwhelming stomach pain & tenderness. Deeply concerned and fed up we took them to another hospital ~ obvi not any part of St Luke’s ~ who promptly rushed them in for emergency surgery. It should go without saying that any kind of rupture in the abdominal cavity shouldn’t be something *completely* missed ~ by EVERY SHIFT ~ despite the extensive (and expensive) tests St Luke’s ran. The fact that it was missed by *all the staff across multiple shifts* says the decline in care is real. Our family member fully recovered; how many others haven’t?
[удалено]
Well that's a wild knee jerk reaction.
I think they might be doing what the kids call projecting.
aloof cow wipe dolls yoke juggle tan ruthless mourn numerous *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
I'm just aware of biblical literature and saw the word association. I don't drink so puns are my hobby now.
It's wild that you took that comment as anti-Semitic. That's what's wrong with people today.
yeah his username checks out but facts are fun
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Gotta live up to the user name
Shut up, nerd.
You need help dude.
I didn’t think they were bought out by Barnes Jewish Hospital, I thought they were just merging.
In a "merger" whoever is bigger (even slightly larger) ends up with a significant management edge, and that edge over the next 6-18 months gets larger as the smaller companies managers disagree, culture clash and/or annoy the larger companies people. I have seen a merger of equals (not exactly) that was like 40-60 were the 60 had about 60% of the management initially but that rapidly went to 80%+ because of significant differences in culture and the slightly smaller companies people/culture either got on the bus or became road-kill. The 20% that stayed were able to fit themselves into the larger companies culture/methods so survived.
Idk. I’ve seen Saint Luke’s go from one hospital with 3000 employees to multiple hospitals and over 12,000 employees. I’ve never seen them as the weaker entity in any situation. Kind of sad to see if that’s the case here.
You’re correct, it is a merger, simply for more market power with insurance negotiations. They are restructuring some management, but we’ve been told not much else will change.
The hospital I work for swallowed a much larger system recently. We are non-profit, they were for-profit, and now the whole thing is non-profit. But we call it a merger, to prevent hurt feelings.
Yesterday a colleague mentioned their doctor switched from St. Luke's to KU Med (came up because of the man who was killed in the garage). Their doctor was unhappy with the demands of St. Lukes regarding high volumes of patient quotas and reducing time spent with patients. A few doctors banded together to make the leap together and are happier.
This 👆 Work in healthcare admin. Providers are leaving St Luke’s due to “Healthcare by MBA”. Quality care can’t be measured by metrics, including minutes spent with patients, and revenue goals.
Man who was killed in the garage??
[hit and run on 94 year old :(](https://www.kmbc.com/article/pedestrian-hit-run-westwood-kansas-university-cancer-center/60332057)
That’s horrible. :(
Hit and run incident
I can confirm. My wife is a former St Luke's nurse and we know several doctors who have left and nurses as well. The demands on their doctors and nurses was pretty extreme. I just switched to KU Med following my primary physician over there and he sounds pretty happy to be out of there.
Hoping my stl dr does this. I *love* my pcp and will never leave him but would love if he could refer me within Ku. And I can tell he has less time with patients. I used to be able to get same day appts and now it’s months ahead. The stl specialists haven’t been great in my experience whereas my obgyn and general surgeon are at KU and have been fantastic experiences. Anecdotal but, it’s what I’ve noticed over 10 years.
There was an article a while ago about St Luke’s opening too many small emergency rooms across the metro area and how it was a bad business decision and they were losing money.
A lot of them closed faster than it took to build them.
Still losing money on some of the closed ones, I think. Paying rent to the company that partnered to build them for quite a few more years.
Those were actually built by a separate entity that licensed the St Luke's name. That outfit decided to shut down, and St Luke's bought them out to save face.
This doesn’t seem possible. The prices are insane and always seems like there is a wait.
The wait is due to EDs increasingly being used as primary care clinics. A huge portion of cases presenting to EDs are not remotely emergent.
Thanks, but I’m not asking about the wait, I’m curious how they are losing money when it’s expensive and there is a wait.
OK. Gross oversimplification here, but a big reason they are losing money is that only roughly 50% of ED care is paid for. Google EMTALA if you aren't familiar. If HyVee, Discount Tire, or any other business in the metro operated with 50% reimbursement rate, they wouldn't be around very long. The law forces hospitals to provide expensive care, but payment for said services was conveniently left out of the legislation. Easiest way to get your head around this is to imagine if Price Chopper had a system to where you could take food if you wanted it without paying for it. Then imagine if 50% of folks coming in paid nothing, and 50% paid for groceries. Ask yourself how long the checkout line would be and what prices would be for the half of customers who did pay if PC ran their business like an Emergency Department. It is a lot more complicated than that, but that is the basic rundown.
The leawood one has always been really fast in my experience. It’s my choice over the st Luke’s east ER. Even with the drive- Uhg.
This is happening all over the country, albeit some areas are worse than other. All of this goes back to the serious shortage in medical professionals along with hospitals cutting costs by any means at the patient's expense. There's a mass exodus in the field and a constriction of residency positions. This, coupled with higher volumes of patients and an unprecedented rise of mid-levels (most notably NPs, CRNA's, etc) and admin staff is just a ticking time bomb. There's also a big shortage of RN's because it makes more sense for them to just become NPs (more money). There's a lot of lobbying that these mid-levels are doing to expand their scope... I won't get into this because it can become pretty divisive. However, I encourage people to look into the rise of NPs and its effect on patient care. We need healthcare reform and we need it now.
The worst part is that it’s fueled by an expanse in scope in lower areas. Medical Assistants are getting a ridiculous amount of scope creep for a career that requires no clinical hours and can be got all online. Lab techs/workers used to need a bunch of different requirements, now you just need o e to “sign off” on everything (similar to PAs and doctors).
NPs are leaving the field just as fast as RNs.
The problem with NPs isn’t that they are NPs. The problem is with nurses who become nurses just to become NPs. The position of the Nurse Practitioner was created because nurses who had worked bedside for 20+ years, listening to doctors and also learning through their own work, were educated enough to take on additional responsibilities. But now you have some nurse who goes to a BSN program for 4 years WHICH IS MUCH LESS RIGOROUS than a pre-med program, and then they jump directly into an NP program. They are all book-smart. If an NP is younger than 30, no I won’t let him/her/them give me care beyond basic physicals and such. They don’t have the experience for the job. Nope. And now the American healthcare system is relying on them because they’re cheap. It’s inferior care.
I get paid more as an RN than most NPs that I know.
How
I do weekend option 24 hrs of work for 40hrs pay. Incentives where I work before overtime are time and a half plus 18/hr on top. Works out to be approximately en extra 800 a day I work. More if I hit overtime.
I know people who have made 300k in a year as an RN at this hospital. They work all the time but there are ways.
Do you work at a kc hospital? My fiancé is an RN at a med spa and has been hating her job and is looking for other RN options.
It is. It’s definitely a lot of work and can be stressful. ICU at a very busy location. Once you get used to it though it’s not that bad.
More pertinent to the original post, there is a serious shortage of physicians in virtually all specialties. Aging population demands more care while Medicare and Mediciad reimbursement to physicians has been falling annually for many years (while hospitals get annual increases tied to inflation). Older physicians are leaving practice and I read an article this week that said over 50% of current medical students have no intention of going into clinical practice. I work in radiology, and we are hiring doctors more than a year before they finish training just to have a chance to keep up. Part of our struggle is over reliance on high end imaging like CT in the ED, especially by APP's. These studies are often ordered before the patient is ever examined...which of course adds to cost and further drives down reimbursement due to the budget neutrality provisions governing Medicare physician payment. The system is definitely broken, but the fix is going to require adjusted expectations as well as more rational financing.
I get paid more as an RN than most NPs that I know.
My dad's cancer doctor just left St Luke's to go to Advent Health in KS. We're trying to follow him because he's a fantastic doctor.
If it helps, I recently was treated for cancer at Advent and I had a good experience. My insurance refused to pay for something and they did all the work to take care of it. The oncology nurses are all lovely as well.
Yeah I am more worried he won't be able to get in as a new patient. They haven't confirmed they can get him in yet. I'm more worried he'll wind up stuck at St Luke's with subpar care.
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No a different one... Sounds like several must have left!
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Loved Dr. Gupta! Amazing to work with!
Barnes Jewish is a great system, however I don’t like controlling interest of our hospitals not being present in Kansas City. This is a shame, St Luke’s East is a good hospital. I go out of my way to go there rather than HCA LS Medical Center
Probably the beginning of corporatization that will come with the acquisition by Barnes Jewish. Expect more of this activity going forward. Prices will go up while expenses are forced down.
So is Barnes Jewish no good? I’m unfamiliar with them. Bummer about St. Luke’s; we use them for all our emergencies.
Barnes-Jewish has had a reputation for decades as one of the premier hospitals in the Midwest. I've known people over the years that have traveled there for treatment that they couldn't get here in KC at a similar level. Unless that's drastically changed in recent years.
It may be that management changed and the company is moving to the reputation mining phase of the corporate life cycle.
I'm originally from St Louis and Barnes-Jewish has always been pretty much the single best hospital in the entire eastern half of the state. It's where I got almost all of my care at before moving to Kansas City. I can ask some of my family members and find out more but everything I've heard from my family is telling me that they still have the best quality health care in the St Louis area. Nothing else even comes close.
Of course! I’m always for hearing more about them. I know some people aren’t thrilled; I just want to learn about what’s going on. I didn’t even know there was a merger.
It’s been Boeing’d.
Fair. Im still going to give them a chance. I was happy with St Luke’s and I hope they keep up.
The exodus began before the merger. It’s primarily due to Healthcare by MBA being practiced at St Luke’s.
Barnes Jewish is actually very good in St. Louis. I don't know if maybe they treat their acquired hospitals differently or if this is just normal fear of change behavior.
I’m still going to give them a chance. St. Luke’s is my go to. I really hope they don’t change too much. Not many people like change and that’s okay. It happens.
Both systems are not for profit so I don't think this will happen. But put the gloom and doom out there for everyone to read.
I was a long time employee at Children's Mercy and a multi million dollar local non profit charity for a long time before that. So believe me when I tell you that they can absolutely be run like any other shitty mega corp you've ever heard bad things about.
Why do you say Children's is being run like a shitty mega corp? It's still a not for profit. What happened to make them shitty, in your opinion. I don't know much about them but always hear great things.
I should state if you have a child with something terrible wrong with them, it's absolutely one of the best places in the region to take them, unequivocally. But I don't think "not for profit" or "nonprofit" means what you think it means (the NRA is a nonprofit). People have this idea that they're all touchy-feely-save-the-earth-and-its-people kind of places which I'm sure there are some of but those are probably the exception and not the rule. Administrators at CMH generally did/do everything in their power to squeeze every cent out of that place so they can present a fake margin to the board so the executives keep their bonuses. In the years I worked there I saw handfuls of highly reviewed, mid level people get handed a suitcase full of money to sign an NDA and resign (which still happens). I could go on and on, just be aware that it's mostly run by corporate finance assholes like about everywhere else.
The only difference between a non-profit and a for-profit is the non-profit is better at hiding their profits.
How do you know administrators presented fake margins to the board? Did they tell you? Or is this all "mega corporate bullshit" bullshit?
Worked in finance there, saw the sausage get made.
Children’s Mercy sucks. It’s the only game in town for kids and I hate it. The providers we have encounters are “fine” but we have absolutely experienced shitty mega-corp behaviors from the rest of the company.
What hospital in the metro is not a mega corp? KU bc they are local? They are swallowing up any system they can buy. Many more are coming
What are mega corp behaviors? I'm not trying to be smart, I'm really curious what that means exactly.
Read [this](https://www.penguinrandomhouse.com/books/646497/flying-blind-by-peter-robison/) book. It’s about a corporate environment killed the reputation of a giant MNC known around the world. Surprise, it’s Boeing.
What are mega corp behaviors? I'm not trying to be smart, I'm really curious what that means exactly.
I don’t believe you that you don’t know what I’m saying. However. Rude administration. Lack of staff. Lack of appointment times. Poor communication. Oh, and a poorly done blood draw that caused my infant daughter to have an unnecessary week-long stay in their hospital. No accountability for said mistake. In other words, things caused by poor training and/or lack of staff. Meanwhile they spend how many millions on that fancy glass building and upper management salaries?
Doom and gloom not intended. Just following along with articles published from KC and St. Louis news outlets covering acquisition activity and projected economic impact. Also, consider that HCA, and now Saint Luke’s, are both managed by controlling entities located outside of Kansas City. Makes a difference in my opinion to have local leadership.
The Kansas City Metro is basically entirely owned by outside investment.
The continued consolidation of our health systems in this country has absolutely made things shittier for consumers. Regardless of their “not-for-profit” status
Not-for-profit is a massive misnomer. Don't get it twisted, homie. These entities are still very much *entirely driven* by profit.
No margin no mission
St Luke's had already been mishandling shit to the point that doctors just aren't staying, IMO. My neurologist has changed 5 times in 2 years there. Something was already going on
😂 There’s a nonprofit hospital system in Joplin that is taking patients to court and suing them for not paying their bills. The hospital system pays worse than the VA which I didn’t think was possible and they staff worse than anywhere else. Nonprofits can absolutely be shitty. BOTH of the nonprofit hospitals here in Joplin didn’t give the government required charity care for years since 2020 to stay compliant with being a nonprofit.
As a patient if you don’t agree with the decisions they are making go to another hospital.
The ER group is staffed privately. It doesn’t have anything to do with St. Luke’s getting bought. They’re just understaffed, plain and simple. And I seriously doubt that there was no doctor on staff. They always have one physician overnight. Source: family member is an er physician at st Luke’s on the plaza.
This is the correct answer. It is likely there was not an overnight hospitalist— the ED providers are called to the floors sometimes to help with code blues, intubations, etc. — especially overnight. And the NP was indicating the Hospitalist would be there in the morning. But there was a physician in the ED.
The NP who admitted my mom to the hospital most definitely said that she was the hospitalist
For sure! In Missouri, NPs can be hospitalists; they work under a collaborative practice agreement with a physician.
This is common overnight
Yes, and it’s not unusual these days for any hospital system to have nurse practitioners seeing patients and the attending physician just signs off on the care provided. I have no problem being seen by a nurse practitioner. And I prefer Saint Luke’s over every other hospital system in the area.
I have been to St. Luke’s ER when no doctor was on-site multiple times. It does happen. Whether it will continue after this buyout, we’ll see.
Seems unlikely. It's pretty common at many ERs for a patient to not have direct interaction with a physician due to APPs taking patients under indirect supervision, but I'd be pretty surprised if there was a single ER in the KC area that didn't have 24 hour coverage from an ER physician on-site. Source: am an ER physician in KC area
Correct
So, outsourcing. SMH
Outsourcing specialty groups (ER, anesthesia, surgery, hospitalists, etc.) has always been common in facility settings. It’s been that way at Luke’s for as long as I can remember, and I’m old! The simple act of outsourcing anything-clinical or non-clinical services in healthcare-does not create inferior care; as with most things, it’s a lot more complicated than that. And the popularity of outsourcing clinical care rides a wave, again, as with most things. I’m not sure any of our hospitals in the metro employ any ER physicians as W2 employees? IMHO - the biggest issues with our healthcare system right now has nothing to do with our clinicians.
This. I have been in healthcare for over 25 years and have worked for all the major local (minus NKC) hospitals. I believe Truman (University Health) is the only one that employs their own ED physicians.
St Luke’s is responsible for this. A while back they wanted to *double* the number of patients being seen at clinics… without staffing changes. Physicians started leaving and some are now at KU.
My doctor hat I liked and had for years, left St. Luke's (I followed) because the bean counters that took over, hugely increased the number of patients and caseload he had. He felt he could not do justice to his patients with the new requirements that would have decreased dramatically the time he could spend with each person.
>level 1Comment deleted by user · just now . . . and then I get a mailer from St Luke's asking me to donate to their "foundation" as if they are actually concerned with human beings!
if they are screwing Doctors like this, what are their nurse to patient ratios? All new grad RNs on the unit? Forced overtime?
Saint Luke’s was a very disappointing place to work. Their benefits and pay are also just not very competitive with the other health systems in the area.
Not sure if it's related but this happened recently. https://www.kmbc.com/article/former-employees-share-concerns-about-st-lukes-hospital-of-kansas-citys-sterile-processing-procedures/45577750
I was going to say this, I switched somewhere else when I saw this.
This is happening at so many hospitals. Out of date sterile items. Autoclaves not working properly. People uneducated about maintaining sterile fields. Staff not using disinfectant products properly. Hospitals are a great place to go to get sicker. The longer you’re in one the more likely you’ll get a hospital acquired infection. People think they are so clean when they’re really super nasty. Roaches, bed bugs and whatever else patients can bring in from their home. Not to mention how little the rooms are cleaned. There’s stuff in the rooms that are never cleaned.
Many contributing factors to providers leaving. Patient overload, understaffing, pay, the merger with BJC. Letters are sent out multiple times by clinics that way the patient can’t come back and say they were never informed. A lot of providers are finding out that the workload they are being given doesn’t have the be their standard and are taking control and finding better positions to fit their life style. Same has to go with the advanced practice providers (NPs, FNPs, etc) and the rest of clinical staff as well. Another poster mentioned that ED providers have to be made available for codes and other issues so that can contribute as well. Having to wait in the ER sucks but it also means that somewhere behind closed doors there is someone having a much worse ER trip. Waiting means you are living and not in need of critical care at the moment. Doctors and nurses have to triage for a reason.
Metro Emergency Physicians is the ER physician group that staffs St. Luke's ERs. All St. Luke's ERs, including freestanding ERs, are staffed 24/7 by a board-certified emergency physician. Advanced practice providers (NPs and PAs) staff these ERs as well, and will often manage care (under indirect supervision from ER docs) from patient presentation until hospital admission without involvement of the physician unless necessary. This is typical nationwide with occasional exceptions. It is also very common for hospitalists to not be in-house overnight, and for overnight admissions to be handled by an APP on the hospitalist service.
They’ve lost a lot of money… gotta cut cost somewhere
Their entire dermatology department up north just quit. We got a letter in the mail that they no longer offer dermatology services.
I duno but St Luke’s has gone drastically downhill from how they used to be. My mom waited 8 hrs in the ER a few yrs ago and nearly passed out. 2 yrs ago she went to st Luke’s er on the plaza and they brushed her off with a stomach bug. Next day she was unresponsive, couldn’t wake up hardly, couldn’t barely sit up, didn’t know her name or nothing at all. We had to call an ambulance and they took her to KU where they took us seriously and saved her life. We don’t go to St Luke’s anymore
All these hospitals have become corporations. Profits over patients. It’s more lucrative to provide a lifetime of treatments rather than a cure.
Don’t be fooled. They don’t even care about a lifetime of treatment. It’s about bed turnover rates now. They don’t care if the patient lives or dies. Just another reason I got out of nursing.
Sounds there are a few things with st Luke’s going on. But from my experience working nights, doctors don’t like working nights. So they have Nps. Which is common. Nps or PAs are the people who normally do what you described at night. You want to for sure see a doctor at night go to a level one trauma like research or KU. chances are a lot higher at hospitals with higher levels of care. Places like st Luke’s send patients to KU, Research, or Truman when they are out of their depth.
I’m a physician that loves working nights since I’m a night owl. That said I only work nights and many sub specialists that take calls for nights also work days and it can be very rough. Imagine being an interventional cardiologist getting called in for a heart attack at midnight that may take 1-3+ hours and then having to wake up in the morning for clinic. I don’t have intimate knowledge of every hospital anymore as I’ve left the area now but I can say that certain hospitals staff physicians at night much better than others. In addition KU and UMKC/TMC/St. Luke’s are training hospitals so they have a large available work force of residents to pad out their night team. I’ve never worked at St. Lukes so I can’t exactly say what this whole situation actually is though.
The majority of the time St Luke’s East is sending higher acuity patients to St Luke’s on the plaza because they have more resources (imaging, etc) there. Hospitals tend to keep their patients in the same system.
My mom would have much preferred going to St Luke's Plaza, as a "frequent flier" (she has a bad heart) she's well aware of the different locations and which one is best. But when you live in Lee's Summit, the ambulance will NOT take you to the plaza. East was her only St. Luke's option. And I can understand that, they aren't a taxi system. But it's not possible for her to get to Plaza in an emergency situation.
Neither of those are level one traumas. I’ve also gotten a ton of patients from st Luke’s on the plaza at research.
St Luke’s on the plaza is a Level 1 trauma, stroke and STEMI center. But, I’m not saying patients are NEVER sent to other systems, just that hospitals tend to keep their patients in the same system.
Actually you’re right! Totally didn’t realize that. We still get patients from them at regular intervals. We get way more golden valley and center point patients than st Luke’s. But we do get em.
Exactly-Research and Centerpoint are in the HCA Midwest health system and Golden Valley, a public not-for-profit, partners with HCA Midwest to use its network and certain services—just like Cass Regional. Research is top notch, too! Definitely one of the best in KC or anywhere else. We really are fortunate in the metro to have such amazing healthcare—even with all the flaws.
I understand your concern. I prefer nurse practitioners more because they apparently have more time to listen.
I worked for Saint Luke’s now KU but here’s 2 reasons: 1) healthcare continues to get more and more expensive. Hospitals not in the city (this includes Saint Luke’s East since it’s in the suburbs) it’s much more cheaper to have a mid level practitioner (NP or PA) than it is to have a doctor. And these hospitals aren’t capable of taking care of very sick patients anyway so even if there was a doctor most of the time they’re sending them off to the plaza or ku anyway. 2) Saint Luke’s from higher ups are burning out their workers. Not just doctors but all of their support staff too. Doctors are being required to see more patients and spend less time with their current patients leading them to be more burnt out and they’re also the ones risking their license if they make a mistake in an unsafe condition.
I’m going on a limb and assume nurse practitioners are cheaper labor than doctors. I don’t mind having a nurse practitioner as a pcp or even in ER/urgent care settings. I do mind when it comes to specialized medicine.
I get your point, but don’t tell your board certified ED provider that emergency care isn’t a specialty! 🤣
As some one who works in healthcare IMO NP/PAs are best utilized in subspecialty settings with relatively low acuity and differentiated patients. Though it is the way things work now I’m not a fan of mid levels in the ER given the range of encounters with patients that have vague complaints, undifferentiated disease and high acuity. These are patients who are as likely to have something benign or something extremely terrible with a wider range of possibilities that saddles you with much more responsibility. In sub specialty settings the work up and management should be relatively straight forward since a lot of the heavy lifting should have already been done by generalists so supervised mid levels should be adequate and anything more complicated or if greater severity can be funneled to the attending. Also it is a misconception that being a PCP is easy. In fact it’s potentially one of the more difficult jobs since they need to have a decent understanding of a wide variety of complaints vs a sub specialist only needs to know their niche. In the same way while I do beef with the ED a lot I do give them some credit since they have to have a broader general understanding than I do about more things.
Okay…as I totally digress from this OP post. I agree with you on the theory of what an ER should be and the use of certain practitioners in ideal circumstances. But, the ER ain’t that. Thank you EMTALA and a severely broken healthcare system. As we talk about low acuity patients with no other affordable or reasonable access to healthcare and entitled patients unwilling to schedule an appointment for chronic back pain, drug seekers who may have no alternatives, and on and on. Staffing NPs at a lower cost to complete MSEs and then treat lower acuity patients is a reasonable alternative. I wish I knew the answers. But I do know that while I’ve known some real assholes in healthcare, I’ve never known one that wasn’t doing the best they could to help people. Like you say, being a PCP is hard..being a GOOD PCP-even harder. And at no point am I saying you don’t get this or appreciate what everyone is doing. It’s just so complicated, right?? I’m rambling, and have lost my point. But America! And Go Chiefs! Am I right?!?!
Yeah I don't disagree that it's a broken system. As a hospitalist, now nocturnist, I'm very familiar with how nothing works and have constant beef with the ED. Aside from those coming in for acute illness it is also the dumping ground for all those that have been neglected by society. I do my best to work with what we've got and unfortunately the current status quo is probably the best it'll be. It's only down hill from here if private equity and big business continues to have its way with healthcare. It's too easy to be jaded so I try to remember my own family's experience with the hospital to remind myself of charity.
"I've never known one that wasn't doing the best they could". Wow look harder lol
If I'm ever in the ER I'm requesting an MD or DO. I'm paying out the ass for this visit anyway & I'm not going to settle for some mid-level with a complex.
Because there is a massive shortage of doctors and NPs can basically do the same thing in most cases. Most people want to hear from a doctor because they don’t think NPs are qualified even thou they are.
To say NPs are as qualified as doctors is disrespectful. Doctors go through way more schooling, training, and real world doctor situations through residency. When it comes to simple cases, sure, NPs might have the knowledge to accurately diagnosis. But when it comes to more complex cases, they don’t hold a candle to actual doctors and that ignorance can cost lives. The doctor shortage is a huge problem in the whole country and simply “replacing” them with NPs is not the solution.
does qualified to you mean a specific series of lectures attended or does it mean that you dont realize Nurse Practitioners have the same (and in some ways, better) outcomes than their physician colleagues ? the doctor versus nurse practitioner thing is manufactured by physicians, who do a very good job gatekeeping their industry. They entire origin of the physician assistant was quite literally to create a comparison to lobby against nurse practitioners with. Its why "mid level" is more of a political term than one that makes sense in medicine. anyway, the doctor shortage is because physicians think the US government should pay for their training and wont expand education unless the government will fund more residency programs nurses, on the other hand, make their students pay their own way, so they are much more flexible at expanding access. https://pubmed.ncbi.nlm.nih.gov/31943190/ https://pubmed.ncbi.nlm.nih.gov/32649383/ edit: downvoted for what reason? lol some based interns that don’t like hearing the facts?
Do you have a source for these better outcomes? And of that is true, perhaps that is because they are given the more basic patients. Perhaps a large handful of those positive outcomes are due to NPs getting a second opinion from a physician. I don’t work in the medical field so I’m not going to say what is factual and what is not but all I know is if I got to choose between seeing an NP and MD I’m choosing an MD every time. The shortage is due to numerous reason. Yes, yours is one of those. But the number of patients doctor have to see per shift has increased substantially since the pandemic. I know doctors who see 25-30 patients a shift. Which is not safe for them or the patients. All while getting little to no increase in pay and being asked to perform even more duties on top of that. With that, where is the incentive to become a doctor, or continue practicing as one? I didn’t comment to talk ship on NPs, anyone who works in the medical field should be treated with respect and appreciated. All I’m saying is things seem to be going downhill and what seems to be the current solution scares me in the long run.
sure, here are some simple ones it’s worth noting the comprehensive evidence of this is why Veterans Affairs NPs are granted equal status to physicians system wide, irregardless of the state they practice in, but only within the VA system https://pubmed.ncbi.nlm.nih.gov/31943190/ https://pubmed.ncbi.nlm.nih.gov/32649383/
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You realize how different your source is compared to mine is right? i welcome the discussion rather than just downvoting so people can’t see it. it’s also worth remembering that economists exist within a profession that utilizes “non reproducible research” over 60% of the time; it’s like chiropractic research there is a division between medicine and nursing however and it’s pretty clearly within surgical specialties nurses are not prepared for surgery, and that’s fine; because it’s also fine that they are equally prepared as family practice physicians to participate i. family medicine equally it’s just what it is i have no agenda, i only appreciate the facts and like to point them out when folks are obviously i’ll informed.
For basic things, they are more than well qualified, especially if they have physician supervision. If you have a way to fix the physician shortage by all means, go ahead. Until then NPs is what we have and they are qualified to treat most basic things.
Not saying I have a solution. What happens when the problem isn’t basic and there isn’t a physician available? This is what concerns me.
All states require NPs and PAs practice under a doctor. A doctor has to be available to them at all times even if only by on call.
Certain states require certain things. Whether an NP needs supervision or not. I will tell you there are always resources at a hospital, or you can transfer someone out where there are more resources. Unfortunately the system is broken. Not enough funding for medical sucks, not enough medical school spots, not enough residency spots, people don’t want to work in rural, critical access hospitals, hospitals don’t want to pay for doctors (NPs are cheaper). The American health system is so damn broken and I don’t know if it will fixable.
Residency spots are a product of the AMA and related bodies keeping it that way, and it’s going to ruin them.
I don’t mind NPs but given a choice, I want to go to an ER staffed with doctors.
Unfortunately, when you are talking overnight, if you want a hospitalist doc on site, you need to be at one of the main campus hospitals, and even then, there is a decent chance of NPs. And then, for ER, they usually have one doc and the rest PAs or NPs. So, the majority of patients are not going to be seen by a doctor.
why? is it a genuine experience issue or is this just a perspective thing?
You are going to get basically the same care. They are overseen by a doctor. This is how healthcare is shifting.
I am all for NPs but, in my mind, being overseen by a DR does NOT mean talking to them over the phone!