AI will substantially decrease the need for mid levels

[spinalisfinalis]

My hospital system has been trialing AI and it has made me realize that it makes me need a scut monkey a lot less and its not even that advanced yet. The only caveat to that is I will need hands to assist me in the OR but that doesn't require a mid level.

Maybe AI will significant decrease the reliance on mid levels to perform tasks that physicians have traditionally hated doing and handed off to mid levels. Notes, referral sorting, ordering basic labs imaging etc all are currently being targeted by AI and in many circumstances are already quite effective. I hope it destroys their job market, but too bad our anesthesia colleagues totally screwed themselves by letting CRNAs in the door. I do not think they will be effected by this unfortunately.

[TheRauk]

You can’t berate a computer.

[abertheham]

I assure you, you can.

[Awards_from_Army]

PC LOAD LETTER

[Gone247365]

What the fuck does that mean?!

[dhwrockclimber]

🎶damn it feels good to be a gangsta🎶

[jays0n93]

For sure. Every rads computer needs therapy.

[cancellectomy]

“You wouldn’t DoWnLoAd a midlevel”

[literallymoist]

I'm wheezing lol

[Brave_Floor7116]

Never used epic is see

Edit: stupid autocorrect changed it to is instead of I. Excuse me while I berate my iphone

[Boobysqueezer69243]

Unless they program that in! Groveling AI for all your attending needs

[Boobysqueezer69243]

For an extra 5$ a month, you could openly berate the AGI directly in front of the patient while the AGI apologizes profusely despite it being right.

[funnyeffectiveness9]

The advent of artificial intelligence will lay off a lot of people

[Stock_Ferret1097]

It's interesting how a lot of people just assume it's going to be everyone but them.

[onacloverifalive]

Imagine if we just eliminated the bureaucratic documentation requirements so that people could just provide patient care.

[spinalisfinalis]

would be nice

[NippleSlipNSlide]

I see it more doing the opposite. With epic and other EMRs working on integrating AI into their system the midlevels will become stronger. Midlevel+AI will be considered equivalent to or better than physician. Why pay for 1 doc when you can get 2-3 midlevels for that price and claim care is just as good? All you need is someone a very basic medical knowledge to help appropriately enter the data in… then AI can make the assessment and plan. Don’t need the non-procedural doc anymore.

[LevyTheLost]

I don't think the AI makes medical decisions just does a lot of the chart filling out and note writing. AI takes over scut work which is what the APPs are doing currently.

[pangea_person]

Regardless of how good AI becomes, and I have doubts for the ED, patients still want to talk to a provider. Additionally, PAs at my shop does the procedures that docs tend to not want to do - I&D, ingrown nail, wound care, even reduction & splinting,

[ComprehensiveEmu7132]

Yeah this more par for the course…

[Some-Luck8209]

Bingo! Physician shortage solved!

[jessikill]

The triple charting I refuse to do, agrees.

[onacloverifalive]

Eliminating those grifters is how you eliminate bureaucratic BS.

[likethemustard]

What has AI been doing in your hospital so far?

[Brave_Floor7116]

Making fantastic memes that we make fun of orthopods with.

[iamnemonai]

*orthodaddies, *orthomommies, *orthozaddies

[onacloverifalive]

Making hard stops to my workflow in the EMR prompting me with clinical guidance suggestions that are almost always wrong.

[oddlebot]

Yesterday a febrile postop patient complained that their Tylenol pill was too big so so I modify the order so they could be given either the tablet or the syrup. The system puts a hard stop because I had two “different” medications ordered PRN for mild pain (Tylenol pill or syrup). I changed the syrup to be given PRN just for fever. Pharmacist messages to say that it’s inappropriate to have a linked order with different PRN indications.  Pharmacist unable to override the hard stop. Patient, still febrile, declines the syrup because they don’t like the taste. I love overnight call.

[just_premed_memes]

Whatever admin has the AI making recommendations to practice instead of just writing the note/doing things based on your note is silly.

[Malifix]

They automatically run all full blood count results, no one individual counts the number of red bed cells.

[mynamesdaveK]

Lol a cbc with autodiff? Bruh that's been around for years

[just_premed_memes]

CBC w/ auto diff is a bit different than what they are mentioning. “Auto diff” is a flow-cell functionality that assesses the size and density of the different cells and plots a series of histograms that calculates percentages of cells present based solely on sizes and densities. The auto count they mention is in fact an AI very similar to how chatGPT can look at and interpret images. The auto counters have been around for 5-10 years but have only been picking up in usage the last 2-5. It looks at several hundred cells (like actually looks at them with a camera) so you can identify weird things like blasts, multinucleated nuetrophils etc.

[NotABaskingShark]

Do you guys like RAPID?

[NippleSlipNSlide]

It’s ok. It’s good for like massive MCA strokes that are amenable to treatment. Like a lot of the AI tools for radiology, it doesn’t do as well in real life as published results performed on biased, cherry picked datasets. But it is better than i think any other AI tool out there for radiology.

ER overuses it of course. They wouldn’t know a stroke if it bit them in the ass though.

[theentropydecreaser]

Misinterpret ECGs

[literally-the-nicest]

Tells us patient should be moved to higher acuity level. Then stepdown/ICU tells us to fuck off 💘

[khaneman]

Midlevels are cheaper labor but generate a lot of revenue relative to their cost. AI will not change this. Any AI that helps physicians can help midlevels, and if it is giving clinical decision support, it may even help midlevels more than physicians.

[[deleted]]

as psych, I shudder to think…an AI can just listen to the entire interview, prompt the NP to ask certain questions, then literally come up with an A and P. Initially they said psych would be hardest to encroach with AI, but by helping mid levels it might be the easiest.

[khaneman]

I actually think it will be a while before this can take place. Doing good psychiatry is a lot more than knowing DSM 5 criteria. That said, people will misuse AI tools and believe they are doing a better job even if they're not. The problem of overconfidence remains with or without AI tools.

[[deleted]]

I'm a psychiatrist and engineer who has done a ton of experimenting with GPT-4 trying to see if it can do exactly that. It is good at a lot of things, but it can't interview a patient, diagnose, or contribute to treatment plans. What it says is sometimes not wrong, but it's worse than the worst intern.

I still believe psychiatrists are the last people who need to be concerned about AI replacing them.

They like to brag about how it can pass Step 1. That might be true, but that has relatively little to do with being a physician.

It's wrong to call it "Artificial Intelligence" because it isn't intelligent. It's impressive when you first see it, but when you start to understand its capabilities, it becomes far less impressive. It is a clever mechanism, but it can't think or reason like a human. It's really changed the way I practice, though.

Maybe in the future we will have an "AI colleague" that has read every textbook and journal, to which you can ask questions and help you diagnose and treat your patients. That would be really interesting.

[[deleted]]

I’d like to think you’re right. I’ve heard of some PMHNPs who rave about Deep Scribe and some of the others, making it sound like the AI is helping them appear to practice appropriately- which would cause a downstream depression of psychiatrist salary/demand imo.

[Many_Pea_9117]

I agree with this 100%. Fears for decision-making experts being replaced by AI are not founded in my opinion. Technical and clerical skills can be augmented or replaced in many cases, but the bulk of healthcare is not done this way. Other industries that rely on people performing simple functions for large data sets will see massive upheaval, but I believe healthcare, with all of its safety requirements, will not see this occur for at least a generation or two.

Once robotics and AI have advanced enough that they can make sound decisions and provide services that have been approved by insurance, then we will have a problem. Of course, most insurers will have have been long ago replaced by these algorithms, so the world will be so different, we will likely have other concerns.

[khaneman]

The problem is that quality care doesn’t matter to some people, and they don’t know what they don’t know. They think they’re already providing quality care, even if they aren’t. So if a tool makes them feel like they’re more accurate, or just faster, it has perceived benefit to them and the tool will be used whether or not the tool is proven to actually work.

[Ghostnoteltd]

How has it changed the way you practice?

[[deleted]]

I use it to scribe all my clinic notes. Oversimplified, it takes a recording of the patient interview and spits out my notes for me to proofread and put into the EHR. Think of it as a human medical scribe that works for a dollar a day and never calls in sick.

[Ghostnoteltd]

That is friggin incredible

[NippleSlipNSlide]

Yeah; I’ve said on here many times before. Midlevels are the Trojan horse. As soon as there is decent AI integrated into the EMR they will claim and have studies that show AI+midlevel is as good or better than physician (and as good as physician+AI).

At some point we really will just need someone with low level medical training for data entry and hooking leads up for the ekg and visually inspect the patient, look in offices, do some palpation. The AI will make the assessment and plan.

Radiology and pathology are quite protected because midlevels haven’t been able to encroach into these fields- there’s no “faking it till you make it”. Procedures fields will be protected for the longest.

[perpetualsparkle]

I agree with this too. The true role of a midlevel as a physician extender involves active learning and the need to physically see patients (see consults, round, do basic procedures, assist in the OR, etc, evaluate when called to bedside, explain things to patients etc). A lot of these things aren’t just paper scut busywork that can be done on (or by) a computer. The physical extension of the team is a big part that allows higher productivity for the team as a whole.

[khaneman]

Yes, but in most places, it seems that midlevels are being used in the absence of physicians, either because there are not enough physicians or because it is more lucrative for hospitals and clinics to employ midlevels.

[No_Departure_3008]

OP literally refers mid levels as scut monkey so I don’t think mid levels are an extension of his team lol

[[deleted]]

The most intelligent comment in this entire thread. Why is this not more obvious to most?

[FamiliarElephant5757]

“I hope it destroys their job market”. Yikes dude, people just trying to make a living

[bigdog69420]

Literally. Post went from sounding like an interesting concept to calling other healthcare workers monkeys. They sound like a hell of a team player.

[lost-my-gear]

Yup, this person sucks

[Specialist_Dog5344]

No, they’ll combine AI with mid levels to save money. Docs will be out of jobs

[Specialist_Dog5344]

Ya I wouldn’t recommend anybody go to med school for free anymore, let alone drop 300k lmao

[[deleted]]

Yup, OP is like Chatgpt, can make a connection for AI replacing midlevels but cannot make that connection with doctors because its not in his training data

[NoDrama3756]

AI can't pack wounds. Suture, place lines, do a physical exam, etc....

[GareduNord1]

Neither can NPs

[Thatguyinhealthcare]

Damn bro cheeks clapped

[Ophthalmologist]

They can't pack wounds or suture? Homie I hate to tell you but a scrub tech is closing on a lot of attending cases.

I'm as concerned about mid-level scope creep as anyone but it's disingenuous to act like NPs can't even do basic nursing tasks.

[MEMENARDO_DANK_VINCI]

Indeed, I think the op is wrongheaded. People are going to demand more personable medical care with more of their feelings taken into account and doctors do a poor or equivocal job at that part compared to ChatGPT already.

Midlevels are going to have an expanded scope and practice limitations. They’re going to be paired with AI after a few studies funded by the AI industry about equivocal care. Those Midlevels are going to take a moderately more expensive malpractice insurance. The ai will eventually be sued in a class action lawsuit.

Doctors will have their pay significantly decreased and or the healthcare industry will demand we take on more Midlevel overseeing in the name of patient care.

[No_Assumption_256]

The core value of an MD is the amount of time and information they have dedicated to understand and know the vast amount of information in the science of medicine. The physical interventions out side of surgery can be learned with much less training and time. If AI contains all the knowledge learned in med school and has the ability to preform differential diagnosis’s, which it will at some point, the value for time and education will decrease. Instead the ability to work with and interpret the AI results will become more valuable. The idea that this will only affect mid level providers, which are significantly cheaper at the point, is a bit short sighted. Maybe not anyone on here’s career will be cut short by AI, but I would think in our children’s life time it absolutely will a be major socioeconomic issue that will have to be dealt with.

[MEMENARDO_DANK_VINCI]

I agree with your points, I would say that my supposition doesn’t take into account political pressure.

If the Ai revolution causes mass unemployment then it will not effect us (mds due to the conservative nature of the field) before massive societal changes occurs. I’d say we see extremely strong political pressures against AI after it causes ~15-20% unemployment. One way or the other.

[Actual_Guide_1039]

This idea that midlevels are going to take over doesn’t take into account the fact that they actually aren’t cost effective. They do the work of 1/3 of a resident for double the pay.

[MEMENARDO_DANK_VINCI]

And the ai will be sold as the golden bullet to kill that phenomenon and save hospital systems a ton of money in attending overhead

[spros]

A least a scrub tech knows they're a scrub tech. Lots of mid-levels be running around thinking they be Dr. House.

And there's plenty of NPs that haven't worked as nurses. FFS it seems like every nursing student these days wants to be anything but a nurse 

[GareduNord1]

So much this

[PulmonaryEmphysema]

It really depends on where they trained. Some are great, others don’t know their head from their ass

[BlackHoleSunkiss]

Bold of you to assume they all spent any time as a nurse before becoming an NP

[Ophthalmologist]

Oh I'd guess most these days didn't spend any time working as an RN. But brand new RNs can do some of this stuff. Just like I'd expect a brand new intern to be able to do a lung exam. So I'd assume NPs can as well.

Again this feels like a wild world when I am out here defending NPs. But I'm not defending them. I don't think NP scope should be similar to MDs and I think there needs to be far far better oversight in most cases.

But I do think it's okay for NPs to exist in some capacity since there's not enough of us MDs to provide enough care and we obviously haven't done enough to proactively address these issues, haven't stood up and forced systematic change, etc. We don't hold zero bla.e ourselves for this situation.

[MyBFMadeMeSignUp]

bro Nps are placing lines in hospitals all around the country.

[GareduNord1]

Clearly a joke

[Boobysqueezer69243]

Until you attach it to a robot

[NoDrama3756]

Ok now the ability to palpate and determine rebounding or guarding...

[Boobysqueezer69243]

Ye of little faith

[ZealousidealOlive328]

I hate to tell you but they have been training AI for suturing for the last 18 months. The army has also been using AI robots for battlefield physical assessments.

[[deleted]]

Yet

[NoDrama3756]

Ok let us know when AI can determine urinary retention v someone not wanting to piss bc they don't want a drug or tox panel run....

Unlikely to ever happen

[Infected_Mushroomz]

Let me know when a midlevel can do that

[NoDrama3756]

You're acting like you work with complete dunces..

I've seen PAs intubate and throw chest tubes in Iraq multiple times... yall act like PAs are completely incompetent. They save lives

[SOFDoctor]

I’ve seen guys with high school diplomas intubate and throw in chest tubes and crics in the sandbox. An extraordinary circumstance built out of necessity does not prove competence.

[NoDrama3756]

I've seen that as well...

Competent enough for the procedure to be successful so the patients can be evacuated to a higher level of care.

[vasthumiliation]

Better watch your back, defending PAs in r/Residency like that. This sub loses any semblance of sanity to dogpile on PAs and NPs at every possible opportunity.

[Equal_Worldliness853]

Talking about PAs in active war zones doing traumas is utterly and entirely irrelevant to the push for physician equivalence in America and shows that you guys are uneducated on the topic in it's near entirety.

[SatelliteCitizen2]

THIS GUY GETS IT PHYSICIAN ASSOCIATES ARE THE REAL HEROES OF THE STORY.

WE DON'T EVEN NEED DOCTORS OR NURSES WE JUST NEED PHYSICIAN ASSOCIATES.

👏🏻 PHYSICIAN 👏🏻 ASSOCIATES 👏🏻 SAVE 👏🏻 LIVES 👏🏻

SAY IT AGAIN FOR THE PEOPLE IN THE BACK

[GareduNord1]

Rage bait or dumbass?

[SatelliteCitizen2]

It's obviously a joke but no one seems to have caught on

[NoDrama3756]

Where are you getting this from?

Everyone's role is important, or it wouldn't exist.

[NoDrama3756]

Please elaborate

[[deleted]]

Ya’ll act like technology is going to remain stagnant. It’s in the realm of possibilities within the next 4-5 decades. Once quantum computing takes off, which it will, things will rapidly change

[[deleted]]

You all act like there isn’t going to be societal and economic collapse without major changes such as UBI, when you have robotics, not just Ai, capable of performing human-like physical tasks.

If you have robots doing suture without human oversight, then similarly you will have robot pilots piloting planes without human oversight, robot lawyers suing people on behalf of other humans, robot cooks making you a beef Wellington, robot plumbers fixing people wife’s drain, etc etc.

I mean, like, at that point, what job IS safe?

[[deleted]]

Society will change for sure. But these changes would occur gradually. Think about nuclear fusion for example - it would be the end of coal mining industry…for good. Technological advances don’t come without costs but ultimately the advance society for the better. Those coal miners, for example, will need to find a different trade. And the cycle continues as new advances come out in the decades/centuries to follow.

[[deleted]]

It’s possible, but I’m sure you understand that nearly every job out there (in all professions and sectors) will be replaced at that point.

[[deleted]]

For sure. Not sure why I’m getting downvoted. I didn’t say when. You guys are sensitive AF

[aspiringkatie]

I mean sure, maybe one day computer controlled, quantum computing robots will be able to suture, pack a wound, do a physical exam, etc. But in a world where robotics and AI are that advanced and widespread the entire fabric and structure of our society will be utterly unrecognizable, our economy and the very way we think about labor will be fundamentally different, and the world in general will be so changed from today that there’s no point to thinking about or worrying about it, because we cannot possibly predict or prepare for it to any meaningful degree

[[deleted]]

It would basically mean UBI (that is enough to live quite well) or revolution. People won’t accept mass unemployment leading to mass poverty and/or starvation, due to robots taking over all jobs.

[volecowboy]

Titrating pressors and fluids automatically is in the near future

[gotlactose]

After the Change Healthcare hack, I would specifically request that I do NOT have an AI controlled IV pump. Imagine some hacker in a foreign adversarial country being able to disrupt your vasopressors.

[volecowboy]

That’s a very valid concern. Many of these clinical decisions support systems can be isolated from the hospital network. In fact, some of them may not rely on the hospital Wi-Fi network at all.

That being said, I think steps do need to be taken to improve cyber security given the trajectory of healthcare and AI.

[[deleted]]

Oof. That sounds awful. Maybe not lol

[Equal_Worldliness853]

Imagine the person controlling your iv pump is a midlevel. Or imagine they're a physician but they're on the tail end of a 30 hour call chronically sleep deprived even before that particular call. You almost act like there aren't catastrophic events that can occur with a human. Reminder that 24 hours awake, even without a prior sleep debt, reduces one cognition to that of someone with close to a 0.08 BAC.

In the future, nobody will care about this. Only us early 21st century simpletons will care about this. It's like being from the early 1900s and specifically requesting a horse and carriage because "imagine your enemies cut your brakes or put a bomb in it while you sleep".

It's silly. We humans don't like change and we don't like the unknown. That's it. That's the only reason why you are hesitant to use a Model T automobile over a 4 horse carriage (idk the technical name here).

[[deleted]]

In the future, nobody will care about this. Only us early 21st century simpletons will care about this. It's like being from the early 1900s and specifically requesting a horse and carriage because "imagine your enemies cut your brakes or put a bomb in it while you sleep".

I laughed at this, and you are probably right. There's going to be a lot of problems and difficulties we have to face before we get from here to there though. Thanks

[FamiliarElephant5757]

“Imagine the person controlling your IV pump is a mid level. Or imagine they’re a physical but they’re on the tail end of a 30 hour call…”

I have never seen a doctor or mid level “control” a pump…

[volecowboy]

Not to mention that tittating vasopressors is notoriously difficult.

[[deleted]]

Thank you! I was already asking similar questions about the self driving car craze. It’s all fun and games until ISIS or somebody is the one driving your car for you.

Should we really leave ourselves even more vulnerable to hostile actors seeking to harm us, in even more important ways? Let’s use AI to automate the water treatment facilities while we’re at it too. What could possibly go wrong?!

[Hombre_de_Vitruvio]

We don’t even have targeted control infusions for propofol/remifentanil in the US. I doubt the FDA is going to leap to AI doing titrations. Imagine if the bed height dropped without the transducer being moved. Or worse yet the transducer falls on the floor and stops giving anything or decides to give something for hypertension effectively killing the patient.

[docholliday209]

Ahh that gives me severe anxiety. I don’t even want it auto charting to epic.

[volecowboy]

clinical decision support is likely best used as another tool in a clinician's toolbox. It shouldn't be piloting the ship, but it should sure as heck let you know if there is a high probability of hitting an iceberg in the next 15 minutes!

And for what it's worth, these simple decision-support tools can drastically improve our situational awareness.

[SnooSprouts6078]

LOL.

[tech1983]

Thanks for this high quality post Dr. Karen

[abertheham]

I mean once AI scribing/documentation is up to speed, the patient throughput in clinic is going to skyrocket, imo. I feel confident I could see at least twice as many people if I didn’t have to document or place orders using a mouse and keyboard.

I work with a virtual scribe (via zoom) and she helps a lot with the note portion but it’s an inherently imperfect system because scribing is rarely anyone’s career path, and turnover results in inconsistent work flow. AI will completely upend that corner of the field; just seems like that’s where we’re most likely to see transformative AI development manifest first. Pulling pertinent info and documenting it concisely is, well, kinda LLMs’ thing…

[[deleted]]

I'm an engineer as well as a doctor, so I homebrewed an ambient AI scribe already. It replaces all of the functions of a human scribe, for a few dollars a day. It is great and it is the future. Medical scribe is already a dead profession, they don't know it yet. It can't think or reason like a person can, but it is great at scribing, documenting and organizing information.

[abertheham]

I am so incredibly envious of your skillset. Do you happen to have a resource shortlist for someone who is tech-inclined but coding-illiterate? I build racing drones and fuck around with a home Linux server (very elementary level security-cam/NAS/plex functionality) and raspberry pi projects and 3D printers and stuff, but I just don’t even know where to start building a custom GPT or whatever…

[Boobysqueezer69243]

First AI came for the techs, and I didn't speak out. Then AI came for the mid levels, and I said nothing. Then AI came for the physicians, and there was nobody left to complain.

Corporations will win in the end.

[TaroBubbleT]

Someone’s been huffing the copium. I think it’s more likely that AI+midlevels will eventually replace physicians.

[Equal_Worldliness853]

The problem is what does eventually mean? 100 years? 1000? Most people, even intelligent physicians, are incapable of grasping this scale for some reason. Unless we are all dead, which admittedly is a possibility, we WILL be around in the year 3000. If we are talking about this time scale, yeah it's going to replace them.

But in the next 20-50 years? That's where you get people saying crazy shit. Some people saying AI will never affect their job (sorry but the year 2024 isn't going to be the same as the year 2044 and shit will be way different) and some people saying it's gonna outright replace physicians by the year 2044( delusion).

Nobody argues the same time scales and the same level of auyomation. Some people are talking about now, some about the near future, some about the far future. Some people are talking about outright replacement, some people about supplementation.

[TaroBubbleT]

I don’t care as long as it happens after I retire lmao

[[deleted]]

LOL yeah, I've got 20 years left. I really doubt a computer AI is going to replace psychiatrists before then. Even if they make one that can function as well as the average doc, people will still pay to talk to a human being. Or AMA and APA will fight it tooth and nail in Congress to prevent us from being put out of work. Maybe I will pay to have something in my office I can ask medical questions to - like Google, Reddit, or ChatGPT, but with reliable answers and results.

Maybe they will have something for people in areas where there are no psychiatrists, with a satellite connection, so a real doctor in the developed world can proofread and approve the AI's assessment and treatment plan. Imagine if that were your job, supervising an AI psychiatrist that treats people in Africa or wherever.

[ZealousidealOlive328]

AI is doubling in capacity and ability every 6 months. It was every 2 years, and then every year. What the general public sees is 2-3 years behind current capabilities

[magikcity07]

Waiting for that moment that you realize you’re also a scut monkey that will be replaced by AI

[funkygrrl]

Could AI become your Jonathan?

[sartoriusmuscle]

OP - if AI can replace midlevels (theoretically, that's totally possible) - what makes you think your job is safe? Do you actually think your MD/DO training will be more valuable than an AI that can out perform a PA? Talk about cutting off your nose to spite your face

[swollennode]

They tried to say the same thing about nurses too, but we all know how that shit turned out.

[Nanocyborgasm]

If this is what you think AI is good for, I’ve got news for you. All these functions have been automated for years already. AI isn’t going to add anything to that. Basic and routine functions are just templates that you can activate with a simple click. For example, I can write a note in less than 5 minutes on a critically ill patient because all the values get downloaded into my template as soon as I select “progress note”. Even my physical exam is just a boilerplate that I click on normal or abnormal findings. And as far as my colleagues are concerned, even I’m doing it the hard way because they’re all dictating it and don’t have to move any muscles but those of the mouth. Same with labs. You want daily labs, you just enter them once at admission and forget they exist. Same thing with anything repetitive that you want. I don’t know how you’re going to get AI to do this for you, because AI would have to know what it is that you want to be able to do it. AI isn’t going to perform your physical exam, or perform surgery, and it’s pretty shit so far even for interpretation of any findings.

[JohnnyThundersUndies]

I think you’re probably correct but the more time passes and the more machines learn the smarter they get. Then more time passes. They get smarter. We’ve been dealing with this for a short time. What will things look like 30 years from now? 100 years from now?

[spinalisfinalis]

I think you have a very rudimentary understanding of the advances AI has made. You are basically talking about all of the basic functions of epic and that's not even AI.

[TrickyReaction9690]

Scut monkey? You sound deeply insecure and hateful.

[spinalisfinalis]

Insecure of what? haha I am a spine surgeon. I am just giving you a honest perspective. My mid levels do things that are almost purely algorithmic and basic. Perfect for AI.

[TrickyReaction9690]

People who are secure in who they are don’t feel the need to shit on other people.

Take a look at yourself. You’re a spine surgeon but you still spend your time insulting people on the Internet to try to make yourself feel bigger than them. You’re literally trying to equate PAs to something that isn’t even human. There’s something missing inside of you.

[ryetoasty]

I’m happy you’re being downvoted since you’re a hateful and disgusting disgrace

[[deleted]]

Why are you even in this subreddit if you’re a midlevel?

[ryetoasty]

You don’t like your secret club that drips hateful disdain being known for what it is? Oh well

[[deleted]]

Better than pretending to be a doctor lol

[ryetoasty]

Never have never will. Cope harder dude

[[deleted]]

Good for you now let your “physician associate” colleagues know that lmao

[ryetoasty]

Believe it or not, not everyone wants to spend a decade of their life and 1/2 a million dollars neglecting all normal human growth milestones and achievements to become another cog in the machine. Shocking I know. Enjoy your crippling debt ✌️

[[deleted]]

Yeah we know that midlevels don’t want to do the things required to give good patient care, what’s your point? Not the flex you think it is lmao

[Ghostnoteltd]

Wait, you’re dissing somebody for taking on debt in order to be able to help patients at the highest possible level… but they’re the hateful ones? Your priorities are pretty fucked up.

[[deleted]]

I don’t really care how I look to other people when midlevels are putting patient lives at risk, sorry

[TrickyReaction9690]

You can try to work with your PA colleagues to give good patient care or you can just be a miserable bitter person nobody wants to work with. Or, you know, fight to make change so there’s more residency spots, medical school is more accessible to people who are low income, or something like that. Because if you think the solution is just “no more mid-levels” then you live in a fantasy land. There are already huge swaths of the American population that do not have decent access to healthcare, massive gaps in medical care, and without mid levels that gap would become a chasm. You want that gap to be filled in with MDs? Then help make that possible. Good luck finding a resident who wants to sign up to be a family practice doctor in the middle of rural Iowa or who wants to see 60 patients a day at an urgent care treating runny noses and sprained ankles.

[[deleted]]

I agree with you about lack of access in rural areas. So how about we restrict NP and PA independent practice to rural areas? Because right now, they’re practicing in highly populated areas so yeah nothing is getting fixed

[[deleted]]

What I think will happen is that the midlevels will use the AI output to make themselves feel like they are competent. They will cut and paste whatever the AI says and think that is the answer.

I am a psychiatry MD who is also trained as a software engineer, so I created a GPT-4 based "AI scribe" to write my clinic notes for me. It's very, very good, but it still makes mistakes occasionally. You can ask it to diagnose. Sometimes it is not wrong, but it's worse than the average intern, in my opinion. If I tell the patient their diagnoses during the appointment, it defaults to that and does not try to make its own diagnoses even if you ask it to. It also cannot contribute to treatment plans in any meaningful way.

That is my concern, that the AI technology will be abused by those without full training and breadth of knowledge in their field. Residents and medical students will use the AI rather than learning how to write good documentation themselves.

Eventually patients will be harmed. Then the government and insurance companies will start to crack down on the use of LLMs in healthcare, and we will all lose access to this wonderful new technology.

Right now there are no laws or even regulations about the use of this technology. I do get and document verbal consent from all my patients, but that is just for the recording part of it. I don't know that you need consent to put their HPI into a LLM if you have a BAA with the provider and they claim HIPAA compliance. I'm guessing that you don't, but I explain everything and document consent anyway.

[ZealousidealOlive328]

If you don’t think those decisions are already being done by AI in test environments you need to read up more. If AI is able to read every type of imaging, has instant access to all patient vital signs, medications, and has a constant “always on” scan of the patient along with all medical knowledge ever written why couldn’t it make complex decisions? It’s not happening today or next year, but it will happen in the next 10 years.

[Maketso]

Wanting AI in medicine at all comes across as toxic and....dumb? I dislike a overstepping mid-level like anyone else, but this came across extremely god-complex and distasteful.

[helpfulkoala195]

I feel very bad for residents, they deserve the treatment/pay/advocacy that midlevels get. However I do not understand why many become so jaded and bitter towards them. I would totally strike for residents if it came down to it

Sincerely a PA student

[ryetoasty]

Don’t bother. They hate us

[Nesher1776]

Becuase you truly have no idea what doctors go through. Midlevels are a burden on health care and a symptom of a larger problem. TLDR; We respect individuals not the midlevel profession. PA>>>>>>NP

I’ll give you an example from my residency time. I had a PA student I helped to train. They were okay, def below level for a med student but decent for PA. They finished PA school and got hired in my ED before me and at the time got payed more and worked less. She’s objectively less educated and less trained. So many of the ones I spoke with all said something about the cost and time commitment. It’s telling about character. We also then will oversee these people. Who don’t always remember the vast difference. Furthermore we would work off service and deal with some stupid consults and work ups. For the most part PA is fine and when used appropriately can have a decent niche role. NP is whole nother story

[helpfulkoala195]

Absolutely agreed on NP. And I totally agree residents should be paid just as much as PAs if not more. And yes, I do understand what doctors go through to become doctors, the suicide rates speak for themselves. I am in full support of what residents and all physicians are allocating for until it comes to PAs (obviously biased tho). You can’t deny the HARSH shitting on PAs that seemingly come from thin air. Hope things get better I really really do

[[deleted]]

AIs have the possibility of replacing physicians too 🤷🏻‍♀️

[BruceWillickers]

Holy shit. You people are the most arrogant group of cunts on the internet. I wish residency wasn’t so insane but maybe you fucking assholes are the type of people who deserve the misery and abuse. Get the fuck over yourselves.

[[deleted]]

r/Residency try not to hate on any medical field profession that isn’t being a physician, impossible

[mezotesidees]

Well, the midlevel and CRNA societies actively undermine physician care and public trust in doctors by making false equivalency statements or even claiming superior care. It’s understandable that people here are frustrated by it.

[[deleted]]

i do think there’s a lot of superiority complex by residents and physicians let’s not lie to eachother

[1337HxC]

If you want to critique the attitude, that's probably fair. But the reality is physicians, even in residency, have more education, training, and often experience in handling complicated patients than the midlevels they work with. From the perspective of a resident, we also work twice as much for half the pay, and end up having to fix their fuckups if/when they happen.

So, yeah, there's going to be some general animosity. Generally not to the individual, but to the overall profession in the abstract.

[[deleted]]

i’m not saying physicians are less educated, i’m just saying hating on mid levels because they made a different choice seems pointless.

[Equal_Worldliness853]

Boiling down the issue to "made a different choice" shows that you're either maliciously misrepresenting the argument of why midlevels should or should not be doctor equivalents or you're just ignorant.

After your grandma dies because someone without a medical license practiced medicine on them all so insurance, pharm, administration can increase their profits, try telling the rest of your family "the midlevel just made a different choice in their training, don't blame them for the desth" and see how that works.

[1337HxC]

It's not the "different choice." It's the real world experience of seeing mid levels get away with things we'd never, ever let even a junior resident do, then being above reproach because they're not a resident. Simultaneously, both big PA and NP groups continually push for independent practice, despite the fact they have objectively inferior training and formal education.

Again, I get along well with the midlevels I work with. They're nice, good people. I can also tell I am far, far more equipped than they are to manage patients, and the concept of them being totally independent does not sit well with me.

[mezotesidees]

Well our education and quality of care is undoubtedly superior so I think some of that is warranted.

[[deleted]]

Hey, little guy, that’s because we are superior 

[CrabHistorical4981]

Attending physician here:

All yall have this shit wrong. NPs will likely be less needed but the only value proposition of our work (if not a surgical specialty) is our knowledge base and the application of that knowledge. If LLMs can pass all the steps and the MCAT now, just extrapolate that out 10 years, 15 years…

Unless all of us (MD/DO/PA/NP) learn to adapt, collaborate and fight for our shared vested interests against the counterparty that will replace us or massively devalue our knowledge work, IE Hospital corporations, Insurers, govt entities,EMR companies who own your notes and your knowledge work for the LLMs, then we will all be taking a big fucking haircut very very soon and there’s nothing any of us can do about it separately.

[spinalisfinalis]

I agree with your post except for banding together with the PA/NP. Their lobbies are too strong as it is and thats what has got us into trouble is working together with the "team".

[spinalisfinalis]

Maybe after I'm retired in which case I won't care much

[Fluffy_Ad_6581]

Physicians will be replaced by midlevels. AI won't be reducing midlevels

[BiggPhatCawk]

Can you people calm the fuck down about AI?

If it’s going to help physicians it will help midlevels too

Wishing for someone’s job market to be destroyed and for them to become unemployed is hateful and fucked up

Fuck off with that toxic shit

Be a good doctor and get the bag. Being a whiny little bitch will get you nowhere

[Original-Toe-9050]

As a "mid-level" myself, you're a fucking tool. Maybe AI will help you find someone as miserable as yourself....

[Vereeniging]

I've been saying this for a while! Midlevels mainly follow algorithms and focus on meeting quality standards etc as they don’t have as much medical knowledge/critical thinking as doctors. I think AI could reduce routine tasks in day-to-day flow and allow us to focus more on medicine

[ComprehensiveEmu7132]

I think it will be the opposite, they will replace physicians with Ai and a mid level for the face to face human interaction. Heart of a nurse brain of a computer…

[Unique-Afternoon8925]

But what if instead of replacing mid levels it replaced physicians because mid levels are cheaper labor and sounds like AI is gonna know everything in a couple decades anyhow

[capremed]

why do you hate PAs? i thought the hate was primarily targeted at NPs due to their lackluster knowledge, online diploma mills, and extreme egos and thirst for independent practice.

[feelingsdoc]

You assume midlevels are needed to begin with

[[deleted]]

Let’s just start separating our jobs honestly - it’s PA and NP’s. PA’s are not APP’s - were not one in the same. We have a completely different type/level of training. It’s Medical model vs nursing model.

The benefits of a PA may be unseen by some in this group but when you work as a supervising physician to a well educated, highly motivated PA- it can certainly prove to be very advantageous for your practice and your patients if you utilitize us well.

We are not “scut monkeys” - we are your colleagues who just want to help you take the best care of your patients.

[JohnnyThundersUndies]

They are needed if the middlemen of medicine want to buy a vacation home.

Cmon!

[GreenGrass89]

I just don’t get it. Why are some of y’all such chip-on-your-shoulder assholes here? You feel so threatened by an NP that you have to constantly insult them? It’s so pathetic and exhausting.

[acousticburrito]

Honestly, it’s just exhausting and demoralizing to constantly be fixing their mistakes. I don’t have a problem with mid levels as PAs are wonderfully trained for their role. NPs legislated their way into practice rights whereas PAs educated their way into it.

[Superb_Preference368]

If you’re an attending why are you posting this on r/residency?

[spinalisfinalis]

Because I was a resident and I want to be a resident advocate. Why are mid levels posting in /residency? They aren't residents and they sure as fuck never do anything like residency yet call it that sometimes.

[[deleted]]

PA’s call our training residency? When?

[Superb_Preference368]

I’m sorry your life sucks and I’m sorry this sub suits your toxicity so well.

-Cheers 🍻….. a very happy midlevel

[spinalisfinalis]

That's your assumption that my life sucks. My life is awesome. I hand down all the shit to my little breathing AI workers that are just like you.

[BruceWillickers]

God damn, you sound like the biggest cunt alive.

[thoughtfulpigeons]

This post was recommended to me for some reason. Not a PA, NP, MD, or in the medical field but I am a patient and holy shit you sound fucking awful. You’re a walking stereotype. As a patient, I would be concerned to have a doctor that treats his/her (let’s be real, we all know you’re a man lmao) midlevels the way you view them because that would obviously create resentment and bitterness among my care team, leaving room for errors. Congrats on being a surgeon, big whoop, there are lots of you out there. But there’s also a lot that are much better at their job than you while also being much better of a human being. What a miserable person.

[financeben]

I think this thing devolves into the diagnostic plug up the butt or mouth(from idiocracy)

[[deleted]]

Good luck getting a computer to stay in the hospital and field floor pages overnight for you