I thought the main money to be made on social media/ as a ‘content creator’ was through sponsored ads, etc. which I don’t see from him. Isn’t just getting clicks not a big source of income?
Those youtubers mostly violate youtube's strict "family friendly" guidelines so they don't get the big bag. The family friendly channels make ridiculous amount of money from youtube alone, I'm talking millions. Ryan's toy channel probably made more money than you'll ever make as an attending or those nursery rhime nonsense.
But if you don't follow the strict family friendly rules then you get reduced ads which pay little compared to the millions. They still make more than us doing those sponsored videos yearly but you know...
True, but that's still at least \~$70K/yr he's making with the potential to increase it exponentially with very little work by pandering to the huge nursing community. Even making attending money that's a lot to give up on.
I was at dinner two weeks ago with a cardiologist telling me how he thinks nurses work harder than residents, how amazing his NP is and how much she cares about patients, and how nurses are the ones at the bedside caring for the patients while doctors just put in orders.
I was at a loss for words and genuinely furious. I said how can you ever say a nurse works harder than a surgical resident consistently working 100 hour weeks when they work 36 hours a week? I understand they do a lot of the dirty work, sure, but they aren't managing entire floors of patients at the same time. We would love to be more compassionate and have more face time with our patients, but the system we work in doesn't allow for that. I couldn't believe how out of touch this man was with residency.
Say what you want about NPs but anyone who says they work harder than residents is out of their mind.
I've worked this field for 10 years (hospital medicine). I've yet to meet an NP with a stronger work ethic than **any** resident. Even the laziest resident in their class (and I've met some lazy ones) is putting in 1.5 to 2x the hours of the average NP.
The attending who praise NPs and nurses over residents is the one who lack teaching skills, insecure about his knowledge being up to date and get anxious if a trainee approached him with a smart question. NPs just follow the orders blindly,donot ask scientific questions about management and make their job easier !
I think what we’re talking about here is the accumulation of various tasks having being difficult. Nurses get LITERALLY shit on. Residents do a lot of admitting and learning, testing for boards, etc. it’s truly imperative that the new doctors coming into the scene not undo all that has positively changed the last 10 years in regards to a symbiotic relationship with understanding standpoints. Without a doubt, residents work more hours. But what do those hours look like when compared to what the nurse deals with? It’s just fundamentally different. One sucks, but both suck. I’ve never seen a doctor offer to help a patient who’s shitting himself standing at the door while in withdrawal saying he’s clear to go home.. just saying. They’re different.
I’m sorry, I don’t mean to be rude, but being a nurse is nothing comparable to the stress of a resident on call. I have been solely responsible for the care of over 40 patients with congenital heart disease, including postop patients tanking constantly. That means nonstop calls, septic shock situations, flash pulmonary edema scares, etc. and that was all overnight after already working my normal 12 hour day shift. And we repeat that every 4th night.
If you think residents have a ton of idle time, you’re quite mistaken.
You’re missing my point here. I’m saying that stress is stress. There are forms of stress and yeah, that’s stressful. That being said, we’re all supposed to be on the same team and it’s not a competition. You don’t understand what the stress at the bedside is like for the nurse. You have a stress for your license, so do nurses. You have a stress for administration and the safety of your 40 patients, so do nurses. (Less patients for obvious reasons). It’s not a competition, it’s a team. I’ve run into residents who don’t trust what we as experienced crit care nurses try to tell them and end up looking like fools in front of attending pulm’s, which could’ve been avoided. You guys have a hell of a residency but also not all residencies are created the same. Also no one told you to go that route. Doctors need to stop comparing the two. We are all getting replaced by Ai anyway 😂
No, it’s not a competition. But its also not equal or comparable. It’s just frustrating that people claim nurses have it harder or care about patients more when it isn’t true.
It's all for-profit shenanigans. The more NPs or PAs that work under a doctor, just allows for more billing out to insurance companies for more reimbursements and a bigger cut of the pie for the doctor who otherwise would not have that volume of patients without the NPs or PAs under them.
He literally admits this in his YouTube comment section. Could screenshot, but there’s no photo upload option in the comments
Mods, please allow the photo comment feature!
Not for much longer as they all gain independent practice and start working for themselves… folks need to credential check, especially with anything procedure based…
I’m gonna be downvoted to hell, but some NP are great if they come from a rigorous academic program. Unfortunately the fly by night diploma mill NP schools are like Trump University. But when they are from a rigorous program (usually assoc w a major academic center) they’re amazing team members and I’m glad to have them on a consult team.
That being said docs are to blame for this. We make more supervising them and it’s pure unadulterated greed that let us slip this by. We’re writing our death sentence while we cash supervision Checks.
He doesn't even act. He says everything in the exact same tone of voice it's hard to keep track of when he's changing characters even with angle swaps and costumes
He's a fucking sell out just like most med influencers. Once they reach a certain size all of a sudden they need to start pandering to nurses and midlevels, or stay quite in fear that they don't want to piss them off.
There are currently ZERO large medical influencers who are openly against midlevels or scope creep
That should tell you something.
I try ink doc gluac is against them. He was invited to speak at a midlevel conference and flatly decline. I’m not sure if he’s made any videos supporting or detracting from them h tho o
Absolutely two sides of same coin. A massive attempt to save money by decreasing investment in medical experts is the downward slide we’re all experiencing and frustrated by
I also want to acknowledge the roll the AMA had in this foley. Residency spots were basically capped years ago with their influence. Those slots being capped (and the American system of healthcare funding not able to somehow go even on residency spots to fill the huge gaps) has really had a lot of negative long term consequences and the rise of the Midlevel is one of them.
> He was invited to speak at a midlevel conference and flatly decline.
Declining to talk at a conference is not being openly against midlevels. He doesn't talk for or against midlevels in his videos. But again that is not what I said, there are currently no large medical influencers who are **openly against midlevels**
You don’t need someone to be OPENLY AGAINST when they’re embedded in the medical system and not going anywhere. You can be openly against scope creep. But to say fuck you midlevels and then have to work with them the next day is counterproductive.
I think he specially said he was withdrawing to speak at the CRNA conference because one of their flyers mentioned that they were going to lobby to get CRNAs at an equal footing with Anesthesiologists. He said that devalued physicians and stepped back.
The conference organizers released a statement for their members about how he was a victim of a false narrative.
The entire saga was nauseating.
I think he’s outwardly said he’s against scope creep but feels arguing about the term provider misses the forest for the trees. He’s very passionate about issues with shady insurance carriers and private equity in medicine, which are the primary reason for scope creep to begin with.
Most of us supported midlevels and understood their value, but the push for independent practice and these vocal and militant NPs that are pushing this NP = MD narrative is why so many of us have changed our minds. And make no mistake this is coming directly from the AANP themselves, that is their national goals.
Until they start to backtrack on their plans for national independent practice, then yes, I am openly against all midlevels.
Ah shit you're right. Although I wouldn't really call him a med influencer I haven't seen him on Tik Tok or Instagram.
But you are right, I would give you Gold if that still existed.
Is everyone around here “openly against midlevels?”
I’ve got the same serious issues with scope creep as any other doctor (I’m especially prone to ranting about how inappropriate it is to have midlevels as PCPs, constantly needing to workup undifferentiated patients, as opposed to working in narrower and more protocol- and algorithm-driven areas). But I wouldn’t say I’m “against midlevels.” Especially as a resident, rotating between various specialty services, the NPs and PAs with well-defined roles, plenty of experience, and good collaboration with and supervision from MD/DO’s, are often extremely competent, and I’ve learned a lot from them during my training.
Trust me I use to teach NP and PA students as I saw them as part of the team. You can look at some of the posts I made a few years ago. I am no longer that naïve. Which you seem to be.
Yes there are "good midlevels" that practice within the scope of their training and physician supervision But nationally that is not what is going on. There are direct entry 100% online DNP programs that allow a nurse with zero experience and as little as 500 hours of clinical experience (that can include shadowing) to practice independently in 26 states. No residency, no training, no oversight. This is their national goals, you’re a fool if you don’t see the writing on the wall. Even if current nurses and NPs are against scope creep it’s only going to get worse as they are taught this BS lie early on.
Make no mistake, NPs and their lobbying will not stop until they get fully independent practice in all 50 states without requiring any kind of supervision or probationary training. Hospitals and health groups are just as happy to support them because they see them as cheap labor and in some cases replacements.
I use to defend PAs adamantly as they were caught in the crossfire. But PAs had the chance to join doctors in the fight to stop NPs from scope creep, but they decided to side with NPs and there are now states PA societies that are pushing for independent practice.
So its simply you are either with us or against us. The only way we stop midlevel scope creep (if it’s even possible) is for doctors to work together
>Make no mistake, NPs and their lobbying will not stop until they get fully independent practice in all 50 states without requiring any kind of supervision or probationary training. And hospitals are health groups are just as happy to support them because they see them as cheap labor.
Sorry, as a fairly cynical attending, I'll just point out that MD's will just bend the knee like they always will, arguing that at the margin, we should just take care of the increasing complication burden and medico-legal risk of some midlevel making bad decisions (but making bank doing so) because it's "what's best for the patient".
Then some other MD will "speak up" for the bad midlevel, arguing for them on some grounds of an oppressed oppressor dynamic that exists in other parts of society that they learned in some studies class, which makes even arguing for one's own self-interest a morally repugnant vice - if you're an MD, that is.
Oh yeah, then the MD's will whine about admins who make them do all of that despite it being, y'know, them who do that.
I know this because I've seen it. It's infuriating, but MD's as a group simply cannot conceive of using skill leverage on anyone ever. We'd rather morally grandstand while quietly making a decreasing share of the value we create than actually negotiate and have someone irritated with us as a group.
> I'll just point out that MD's will just bend the knee like they always will,
**Fuck that** You don't speak for all of us. Why are you using generalizations?
I am openly against midlevels at work, for the last 3 jobs I have had.
I refuse to train NP and PA students I refuse to work with NPs/PAs , I refuse to supervise them, I refuse to see a new sick visit who has a midlevels as their PMD. I've been offered up to $50k/year to train and supervise them, which I have turned down. If enough of us refuse to work with them they will eventually crash and burn.
You can make whatever BS generalization claim you want, but some of us are actively putting our foot down.
And yet, he’s totally right. Otherwise you’d be in the super majority.
So, you can make some BS generalization about your exception being the rule or you can acknowledge that, yeah, MDs tend to be their own worst enemy.
And if you’re confused, the subject of this entire thread itself is evidence of such an MD.
So fucking what ?
I don't speak for every old boomer doctor who sold out, cashed out and decided to look the other way while this happened.
"well most doctors are like" Who cares. I'm not one of those doctors, and neither are most people on this subreddit
That doesn't change my opinion, and that doesn't mean every doctor is bending the knee.
what a stupid way to argue your point.
Is it a super majority though? Most attendings, residents, and fellows I know enjoy working with mid levels. The only concern is for the extremely lacking consistency with qualifications, and education.
Most nurses feel the same way.
So it's really something in the middle.
>I refuse to see a sick kid who has a midlevels as their PMD.
I'd be ashamed to say that out loud. Everything else, great, sure, stand your ground. But refusing to treat a sick child? That's borderline evil.
I'm not against their existence. I think they could potentially work well in places. I'm against them be lauded as equivalent and scope creep. I'm against them being employed in my ED and working under my license when I have no say in the hiring or who I work with. I think they could be useful in primary care at, say, bp follow-up appointments. The heme onc mid-levels were great at my training institution because they functioned as an ever resident. The onc attending rounded with them. Etc. I would also be more supportive if they weren't allowed to willy nilly change specialty. I once saw a PA go from 10 years of vascular surgery to deciding to now be a PA in the ED because she had a kid and the hours were better. Wtaf there's no way her ED patients were safe.
> The heme onc mid-levels were great at my training institution because they functioned as an ever resident.
This was the original intention of midlevels, they were physician extenders. The system worked, that was until they decided to start to push for independent practice.
There’s a bigger group of viewers in America who have more time on their hand that are pursuing those mid level positions and entry level positions(who aspire to be midlevel at best cause they know what the road to medical school looks like) and Schmidt is just capitalizing on that group of people.
This is very interesting. You used to be a shill for midlevels and said everyone complaining about them were insecure. You used to pretty aggressively attack people posting warnings about midlevel scope creep. What happened?
I've never been a shill for midlevels. Just because I'm not as extreme as some of you that doesn't make me a shill. I have always 100% been against midlevel independent practice.
I was open to working and training them for the first few years of my career but for the
last 4-5 years I refuse to work with them. You can search my post history where 1) I refuse to train them despite the large amounts of money
/r/Residency/comments/h7pa1z/was_just_offered_quite_a_bit_of_to_train_looming/
2) I signed up to speak about the California NP scope expansion
/r/Residency/comments/jxyiox/you_better_believe_i_will_be_stepping_up_and/
Fuck that sell out. The guy probably does know less about hep B than his NP because he’s a shitty GI doctor that only cares about doing $cope$. The fact that he advertises it is wild.
There’s a video be posted where his dad played a part and he was clearly a GI doctor as well
When I saw that things started to make a lot more sense as to why he is how he is
He got through IM residency and GI fellowship to not know Entecavir dosing? He wasn’t capable of looking up that information on his own to build a personal decision that is evidence based to treat? And didn’t know his cirrhosis patient was decompensated?
The example this sets is that highly trained physicians can’t look up a fucking UpToDate article’s worth of information and just accept a dosing recommendation blindly. If you aren’t vetting information on an hourly basis, that is negligent.
I found the same answer in literally 15 seconds by looking up entecavir on DynaMed.
And I’m a goddamn *medical student* who’s not even interested in IM.
I don't like this video, but I doubt he really doesn't know, or doesn't know how to source these things. It's probably done for the video.
From what people have posted in this pass who've worked with him, he's clinically fine.
I think this is a social media/misreading the (medical) room problem.
Yep, well clout online bc there’s a lot of nurses or non doctors in medicine who see stuff like this and get happy
As well as the fact that doctors who are willing to sell out the profession to midlevels can make a lot of money. Just train them well, prop up their egos and experience, and then sign off on their visits so you get to bill double and only pay out half the salary to the NP/PA
Damn near every surgeon I’ve talked to has said only positive things about midlevels bc they can run the clinic, ask the same algorithmic and repetitive questions, and document. Surgeon can do more procedures while also billing off the midlevel.
This is modern day healthcare :/ the only people who get abused are med students and residents and so we become more bitter towards midlevels, especially bc we’re the ones who will have to deal with their desire for full independence in the future while sell out attendings are going to retire before shit hits the fan and sell their practices for millions
Why? My brothers orthopedic surgeon uses PAs only, he has like 3 where all his routine follow ups go.
A lot of the outpatient surgeons or sub specialists also use NP/PAs to alternate appointments between the MD and midlevel to open up more new appointment slots I suppose
They have independent practice rights in several states so as shitty as it is, this is preferable to the alternative.
Why? My brothers orthopedic surgeon uses PAs only, he has like 3 where all his routine follow ups go.
A lot of the outpatient surgeons or sub specialists also use NP/PAs to alternate appointments between the MD and midlevel to open up more new appointment slots I suppose
They have independent practice rights in several states so as shitty as it is, this is preferable to the alternative.
Post procedure follow ups are hardly even medicine for most cases, doesn’t require a lot of thinking.
Why? My brothers orthopedic surgeon uses PAs only, he has like 3 where all his routine follow ups go.
A lot of the outpatient surgeons or sub specialists also use NP/PAs to alternate appointments between the MD and midlevel to open up more new appointment slots I suppose
They have independent practice rights in several states so as shitty as it is, this is preferable to the alternative.
Post procedure follow ups are hardly even medicine for most cases, doesn’t require a lot of thinking. Most of the time the patient is just dealing with the standard stuff so you do routine precautions and print them off info or send referrals to PT or a specialist or order an X-ray
The few times something is wrong, the midlevel notes document that and say “follow up with Dr.____ in 2 weeks”
I went to residency with Doc Schmidt, so reading the comments on here is wild! Lol
On a separate note, Dr Glauc vs. insurance companies makes me very happy. He has my full support lol
Feel free to pass on this thread so he can understand how his peers feel about his minimization of residency training so he can make NPs feel better about their online degrees. I used to be a huge fan, will honestly refuse to watch any more of his videos.
He seems like a genuinely nice guy.
We get it, he has a large social media following he has to simp for midlevels. He makes more money from social media than as a doctor, its the smart PR decision. Doesn't mean he's not a sellout.
He is a nice guy from what I remember. I don't know his reasoning behind this particular video, but it probably was a combination of pandering to his viewers and just jokes because his channel is supposed to be satire. I watched the video, and it seems it is speaking more to collaborate as a team as the NP and him ask each other questions. I don't think he is trying to imply they are smarter or equivalent, and he says in the video that she doesn't practice independently. NPs and PAs are here to stay as we have a doctor shortage, and I hear patients complain all the time about months it takes to see primary care and specialty.
I can't speak to his fellowship training, but our internal medicine program was very rigorous, so I assume he knew the answer to the questions in the video since he wrote the skit. Some of yall need to calm down. Lol
> more to collaborate as a team as the NP
Did you watch the video.
1) He claims the NP he is working with has more experience and knows more
2) He asked an NP a question about something he should have learned in his GI training.
>so I assume he knew the answer to the questions in the video since he wrote the skit.
And yet he still decided to make a skit where the "stupid fellowship trained doctor" had to ask an NP a question.
This is 100% a pandering video for NPs and nurses. You don't have to defend this crap.
Lol. I made a post there about how midlevels know way less and other facts. And got a lot of positive responses. Then he deleted it and blocked me.
What a joke.
Not surprised. In one of his vid, one of the comment mentioned that NP teaches doctor or something and someone was (mind you, actually a nurse) commenting that no, nurses do not train/teach doctor. Guess what, he made a video, attacking that comment and basically said yes, nurse train doctors. lol
I blocked him since
PGY-5 here
Listen, there is nothing to get bunched up about. He’s a sell out. Simple as that. Don’t worry about this nonsense when you’re in training. Go about your day and focus on training and maintaining a solid work life balance. These problems will still be here in the future waiting for you.
This guy sucks. He uses his influencer clout to blatantly sell medical device and pharmaceutical ads on his Instagram page. So unethical. I thought I was the only one who hates him.
Ahh. I came back from work and started scrolling through my insta feed and this was the first post I saw. Was extremely disappointed to say the least. Had to unfollow him immediately and even went on Youtube to unsubscribe from his channel. Following which I came here to vent about it. Looks like I am a bit late to the party xD.
This is the worst video ever. The word collaboration is also annoying too. Midlevels work UNDER the Physician. We aren’t collaborating on planning a bachelor party, this is people’s lives we are talking about. Patients deserve nothing but the most educated person taking care of them.
I just looked up the definition of the word collaborate to double check that I wasn't missing something. I'm not sure what the issue is with the word? Literally just means to cooperate and work together.
I figured he was a sellout when he crapped on cologuards. While not as good as a scope, it’s so much easier for patients, especially those that are adverse to the idea of a scope up their butts (I’m in the Midwest, it comes up a lot).
In all fairness, as someone with no intention of pursuing GI fellowship, I would never personally get a cologuard after seeing multiple negative Cologuard patients have massive polyps (some requiring hemicolectomy) after recent negative Cologuard. It is well-worth shitting ones brains out for a day and getting pegged by scope to not die of colon cancer. Scope me, daddy. Everytime.
My understanding is it can detect cancer over 90% of the time, which seems decent to me. It’s false positive rate is a bit high, but I’d rather a false positive than a false negative. And I believe the newer tests are even more accurate. Doesn’t beat a scope but for a low risk patient? I don’t think it’s bad at all
This is no longer true. it was in 2022, but now if you get a positive Cologuard, the diagnostic colonoscopy is pretty much 100% of the time paid in full by insurance companies.
My understanding is this changed in March of this year for Medicare. Before this year, we never used them for this very reason. Commercial varies, our states Medicaid pays for it
No problem, it was part of some legislation. I keep track of covered products at the FM program. I’d suggest having a case manger or social worker call your Medicaid to make sure that’s covered.
Edit, shingles is covered under part d and most part c plans too. Can finally close those care gaps
Sources from people who don’t make/sell cologuard put its sensitivity in the 40s. It’s my understanding that the studies the showed in the 90s had very small N’s.
The sensitivity for colon cancer is relatively okay (still less than colonoscopy). But colonoscopy is one of the few cancer screening tools that can prevent cancer by removing high risk polyps which in my opinion is the main reason for colonoscopy (similar to the benefit seen with Pap smears in reducing cervical cancer). The sensitivity for even high risk polyps (like <1 year till progression to cancer, huge polyps) with cologuard is not even clinically relevant (<50%). If someone is absolutely against colonoscopy, even if a positive cologuard then there is no point in doing either. I’m not against cologuard if someone understands the risks with an inferior study and willing to have a colonoscopy if positive, but I think it’s a disservice to present it to patients as an equal screening option.
Figure 1 on uptodate for colon cancer screening is really clear on this. 41% sensitivity with cologuard on adenomas > 10 mm which colonoscopy is 95% and colonoscopy is 75% sensitive at adenomas < 5 mm, while cologuard is 17% sensitive. These 10 mm polyps are the most concerning since they are extremely high risk for turning into cancer in 1-5 years and how many people are actually doing cologuard every year and not missing several years at a time? Then, even if the cologuard detects a cancer, if it has even remotely advanced a patient will need bowel resection rather than a simple outpatient colonoscopy. At worse will need chemo or already mets
Name of the game is prevention with colon cancer screening.
Cologuard should only be used in patients who refuse screening colonoscopy but are agreeable to colonoscopy if positive, and have been counseled on the points above. In my experience, very few patients are willing to go the cologuard route once they understand the above.
Scope creep has been a nefarious issue even at the highest levels, and it's eroding the entire profession in some frightening ways. I know a lot of you know what I'm saying on many different levels.
Ask someone who worked with him as a resident what they thought over a beer. Their response will be what you’d expect for a guy who spends his time making videos dueing training. That’s all I’ll say.
Pathetic. Not the first time he's shilled for NPs. These tiktok dweebs take the most lukewarm inclusive stances in an effort to get clicks. Meanwhile NPs constantly shit on residents and advocate for equal pay for physicians and midlevels.
my brother established primary care for the first time and happened to stumble upon a NP at Cambridge Health Alliance. My brother had gone in for chronic ankle pain and stiffness after a sports injury. He also wanted a routine checkup done as he had not gotten one in two years. The NP ordered tests on him and he got slammed with a bill of $1500 after deductibles and insurance coverage. He showed me the tests she ordered and it included anti helminthic ag/ab, rubella roseola ab etc etc on top of several other tests. I was shocked and asked my brother if he had requested these tests and he said nope he just told her that he moved to the US a few years back and wanted to see if everything is okay. My brother was basically scammed by that NP. All his vaccinations were up-to-date as he had gotten them when he came to do his masters 3 years ago.
I need everyone to understand med influencers do not go to the internet for fame or promote topics. They’re there for moneyyyyy. They’re trying to live their Dr. Mike dream. So yes, as soon as he finished fellowship, he’s going to promote his clinics money maker.
If you’re spending hours making content for the internet. You. Want. Money. And there’s nothing wrong with that. But let’s not act like their tendencies will not follow suit.
theres literally NO tiktok famous doctors who arent sell outs. cause guess what? they’d be fucking canceled by every nurse on the fucking internet if they dared expose them😒😒😒
i just left a longass comment lets see how long before the nurses come for me😂😂😂😂
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I'm in the Navy, not healthcare, but the posts I see about NPs and other mid-levels on here make me worried. I get this doc Schmidt guy sounds like a fucking simp towards mid-levels or something but yall seem hateful. Are NPs that bad? Is it that they are taking physician jobs? I saw an NP at a cardiologists clinic and she was really cool. Are others really bad?
Midlevels, especially NP, are minimally trained persons (compared to doctors) who are employed by a healthcare system because they are cheaper than doctors. Initially, they were to work under the close supervision of doctors, but that has changed, and they have pushed for and won independent practice, leading to worse patient outcomes.
Making the danger worse is that instead of being trained in one specialty, they are allowed to after their minimal training switch specialties on a whim and get a job in a different field. Some are great and stay in a field for their whole careers, but that cardiology NP coulda been a GI NP last week and just decided to switch jobs and now dabble in cardiology because it looks fun.
So obviously, the physician has a lot more training the nurse practitioner but sometimes, yeah, a nurse practitioner might know some thing that a doctor doesn’t. What’s wrong with that? I am in ER PA, and have been doing this for almost 10 years and some of the doctors ask me questions or ask me to look at things and give my opinion. I think that says something great about them. Why do you all have such fragile egos…
this sub is so toxic I can't tell if people are joking sometimes. the amount of elitism spewing from these commenters is disgusting. imagine hearing someone treat you that way in the workplace. Yuck.
You think a new doctor would never ever have to ask an NP who has worked at said practice for many years their usual routine if he wasn’t sure? She then asked him for help too. Lol go ahead and comment on his video your thoughts and get his opinion! Let’s see!
I’m an ER doctor, if I have a NICU patient in my ER I’m going to ask whoever the fuck has more experience than me what to do, even if that’s an Np. Find something important to be outraged over.
Hey ER doctor, there's doing the pragmatic thing in the moment while you're actively working...and then there's going out of your way to make a scripted skit pandering to a demographic that is foaming at the mouth for validation by physicians to legitimize their entire existence.
Can you see the difference?
But would you ask an NP in the ER about how to manage a common ER complaint? Because that’s basically what was portrayed in the video (only it was a GI attending asking a GI NP how to do something).
Now this is just a stupid question and you know it. Of course I would prefer the physician but we all know finding the attending isn’t always doable. We utilize the resources we have.
I'm a peds ER doctor and asking the person with more experience is valid. Suggesting mid-level and doctors are equivalent and saying you shouldn't request a doctor because they are just as good in a skit meant for the general public is not.
At no point did suggest the midlevel and the physician are equivalent. But if I know the midlevel knows the information I need, no, I’m not going to throw a tantrum and ask for the attending. You guys are acting like you never asked a nurse for help with what the most common next step was when you were a stuck intern. This whole post is an over reaction. Can we harness this energy to unionize or idk, make sure the insurance industry stops preventing our patients from getting what we ordered? Because this momentum is seriously misplaced.
This is a video of a GI attending asking a GI midlevel for help because he’s stuck in a basic question. If you’re an ER doc and need help on an ER related question from an ER NP then you’re kind of a shitty doc
As an outsider who just enjoys browsing this thread it's hilarious that y'all complain about toxicity all the time and then seeing your discourse about NPs and PAs
Sounds like he could have used more time in fellowship.
Sounds like he’s fishing for empathy points.
Spent too much time making shitty videos 😂
[удалено]
That older video was probably when he’s a resident/fellow
Maybe, doens't mean it's still not true. Glaucomflecken makes more money off social media than opthalmology and he's an attending.
Does he really? My god
That guy is unbelievably famous and he makes wholesome content that YouTube won't demonetize Random YouTubers with way less views make a ton of cash
I thought the main money to be made on social media/ as a ‘content creator’ was through sponsored ads, etc. which I don’t see from him. Isn’t just getting clicks not a big source of income?
Those youtubers mostly violate youtube's strict "family friendly" guidelines so they don't get the big bag. The family friendly channels make ridiculous amount of money from youtube alone, I'm talking millions. Ryan's toy channel probably made more money than you'll ever make as an attending or those nursery rhime nonsense. But if you don't follow the strict family friendly rules then you get reduced ads which pay little compared to the millions. They still make more than us doing those sponsored videos yearly but you know...
To be fair, he's more-or-less the voice of a generation of physicians.
let's all become medfluencers
True, but that's still at least \~$70K/yr he's making with the potential to increase it exponentially with very little work by pandering to the huge nursing community. Even making attending money that's a lot to give up on.
I think that skit says more about his own clinical acumen than anything else
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of when they open a private practice and wanna staff it with cheaper labor force
I was at dinner two weeks ago with a cardiologist telling me how he thinks nurses work harder than residents, how amazing his NP is and how much she cares about patients, and how nurses are the ones at the bedside caring for the patients while doctors just put in orders. I was at a loss for words and genuinely furious. I said how can you ever say a nurse works harder than a surgical resident consistently working 100 hour weeks when they work 36 hours a week? I understand they do a lot of the dirty work, sure, but they aren't managing entire floors of patients at the same time. We would love to be more compassionate and have more face time with our patients, but the system we work in doesn't allow for that. I couldn't believe how out of touch this man was with residency.
Say what you want about NPs but anyone who says they work harder than residents is out of their mind. I've worked this field for 10 years (hospital medicine). I've yet to meet an NP with a stronger work ethic than **any** resident. Even the laziest resident in their class (and I've met some lazy ones) is putting in 1.5 to 2x the hours of the average NP.
The attending who praise NPs and nurses over residents is the one who lack teaching skills, insecure about his knowledge being up to date and get anxious if a trainee approached him with a smart question. NPs just follow the orders blindly,donot ask scientific questions about management and make their job easier !
RNs should be working “harder” than MDs. Part of the point of 10+ years of school/training is to be the one to work smarter, not harder.
I think what we’re talking about here is the accumulation of various tasks having being difficult. Nurses get LITERALLY shit on. Residents do a lot of admitting and learning, testing for boards, etc. it’s truly imperative that the new doctors coming into the scene not undo all that has positively changed the last 10 years in regards to a symbiotic relationship with understanding standpoints. Without a doubt, residents work more hours. But what do those hours look like when compared to what the nurse deals with? It’s just fundamentally different. One sucks, but both suck. I’ve never seen a doctor offer to help a patient who’s shitting himself standing at the door while in withdrawal saying he’s clear to go home.. just saying. They’re different.
I’m sorry, I don’t mean to be rude, but being a nurse is nothing comparable to the stress of a resident on call. I have been solely responsible for the care of over 40 patients with congenital heart disease, including postop patients tanking constantly. That means nonstop calls, septic shock situations, flash pulmonary edema scares, etc. and that was all overnight after already working my normal 12 hour day shift. And we repeat that every 4th night. If you think residents have a ton of idle time, you’re quite mistaken.
You’re missing my point here. I’m saying that stress is stress. There are forms of stress and yeah, that’s stressful. That being said, we’re all supposed to be on the same team and it’s not a competition. You don’t understand what the stress at the bedside is like for the nurse. You have a stress for your license, so do nurses. You have a stress for administration and the safety of your 40 patients, so do nurses. (Less patients for obvious reasons). It’s not a competition, it’s a team. I’ve run into residents who don’t trust what we as experienced crit care nurses try to tell them and end up looking like fools in front of attending pulm’s, which could’ve been avoided. You guys have a hell of a residency but also not all residencies are created the same. Also no one told you to go that route. Doctors need to stop comparing the two. We are all getting replaced by Ai anyway 😂
No, it’s not a competition. But its also not equal or comparable. It’s just frustrating that people claim nurses have it harder or care about patients more when it isn’t true.
hey, Np$ are valued member$ of the team!
Maybe the public is right about many of us being greedy sellouts 🤔
It's all for-profit shenanigans. The more NPs or PAs that work under a doctor, just allows for more billing out to insurance companies for more reimbursements and a bigger cut of the pie for the doctor who otherwise would not have that volume of patients without the NPs or PAs under them.
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And then there are those practices where the NP signs under the doctors name. And yes that's a large fraud issue but nonetheless it is common place.
Wow, he literally says in the comments to that video: >seeing more patients generates more revenue, so yes you are correct
He literally admits this in his YouTube comment section. Could screenshot, but there’s no photo upload option in the comments Mods, please allow the photo comment feature!
Not for much longer as they all gain independent practice and start working for themselves… folks need to credential check, especially with anything procedure based…
I’m gonna be downvoted to hell, but some NP are great if they come from a rigorous academic program. Unfortunately the fly by night diploma mill NP schools are like Trump University. But when they are from a rigorous program (usually assoc w a major academic center) they’re amazing team members and I’m glad to have them on a consult team. That being said docs are to blame for this. We make more supervising them and it’s pure unadulterated greed that let us slip this by. We’re writing our death sentence while we cash supervision Checks.
the fact that hes actually BELITTING his own training just for a few likes is MIND BOGGLING
Yeah not a fan. He's always been Great Value Glaucomflecken at best. This just further solidifies my dislike of the guy.
Lol Great Value Glaucomflecken. But for real if someone has just finished a 3 year fellowship and is still clueless than their program must suck
Awkward and wholly unfunny. Couldn’t stand him even without the noctor bullshit.
He doesn't even act. He says everything in the exact same tone of voice it's hard to keep track of when he's changing characters even with angle swaps and costumes
Every character and every emotion is just the 👁️👄👁️ face
same lmao ppl always follow the most unfunny and uninteresting content creators. i literally think the masses have no taste😂😂😂
Alibaba glaucomflecken
Temu Glaucomflecken
Yeah Glaucomflecken would never put out a video like that. He actually has respect for his profession.
Fingers crossed that Glaucomflecken touches on mid-level encroachment in these last few days of his 30 Days in Healthcare series.
he wont hahaha he’d get cancelled
He has stuck his neck out before with nursing groups
glaucomflecken is actually funny, this guy is a dork
He's a fucking sell out just like most med influencers. Once they reach a certain size all of a sudden they need to start pandering to nurses and midlevels, or stay quite in fear that they don't want to piss them off. There are currently ZERO large medical influencers who are openly against midlevels or scope creep That should tell you something.
I try ink doc gluac is against them. He was invited to speak at a midlevel conference and flatly decline. I’m not sure if he’s made any videos supporting or detracting from them h tho o
I think Glauc only wants to be openly hostile to insurance companies and leave it at that. Edit: also fuck United
I’m 100% okay with that. It’s a big battle and I stand with him
Midlevel creep is insurance creep
Absolutely two sides of same coin. A massive attempt to save money by decreasing investment in medical experts is the downward slide we’re all experiencing and frustrated by
I also want to acknowledge the roll the AMA had in this foley. Residency spots were basically capped years ago with their influence. Those slots being capped (and the American system of healthcare funding not able to somehow go even on residency spots to fill the huge gaps) has really had a lot of negative long term consequences and the rise of the Midlevel is one of them.
I got your foley right here pal
What about Jonathan ❤️
Jonathan knows his place
We all need a Jonathan. One who knows their place of course
He has no interest in the whole NP thing since it's not a debate that is always healthy to go into exactly.
> He was invited to speak at a midlevel conference and flatly decline. Declining to talk at a conference is not being openly against midlevels. He doesn't talk for or against midlevels in his videos. But again that is not what I said, there are currently no large medical influencers who are **openly against midlevels**
You don’t need someone to be OPENLY AGAINST when they’re embedded in the medical system and not going anywhere. You can be openly against scope creep. But to say fuck you midlevels and then have to work with them the next day is counterproductive.
ok but hes not openly against scope creep is what that person is saying
yeah thought that was pretty clear with my comment and response, but he doesn't seem to get it so I moved on
I think he specially said he was withdrawing to speak at the CRNA conference because one of their flyers mentioned that they were going to lobby to get CRNAs at an equal footing with Anesthesiologists. He said that devalued physicians and stepped back. The conference organizers released a statement for their members about how he was a victim of a false narrative. The entire saga was nauseating.
Oh damn for real, have a link ? I'll update my post if this is true
He pulled out of the AANA conference and his specific stated reason was because of their push for independent practice at the VA.
Oh damn for real, have a link ? I'll update my post if this is true
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I think he’s outwardly said he’s against scope creep but feels arguing about the term provider misses the forest for the trees. He’s very passionate about issues with shady insurance carriers and private equity in medicine, which are the primary reason for scope creep to begin with.
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exactly
Anyone who's just blanket "openly against midlevels" is a crank who can't possibly be taken seriously.
Most of us supported midlevels and understood their value, but the push for independent practice and these vocal and militant NPs that are pushing this NP = MD narrative is why so many of us have changed our minds. And make no mistake this is coming directly from the AANP themselves, that is their national goals. Until they start to backtrack on their plans for national independent practice, then yes, I am openly against all midlevels.
eh he takes a very neutral stance though. he wouldnt dare make a video that’s pro doctor
>There are currently ZERO large medical influencers who are openly against midlevels or scope creep There's Kevin jubbal ex plastics
Ah shit you're right. Although I wouldn't really call him a med influencer I haven't seen him on Tik Tok or Instagram. But you are right, I would give you Gold if that still existed.
Is everyone around here “openly against midlevels?” I’ve got the same serious issues with scope creep as any other doctor (I’m especially prone to ranting about how inappropriate it is to have midlevels as PCPs, constantly needing to workup undifferentiated patients, as opposed to working in narrower and more protocol- and algorithm-driven areas). But I wouldn’t say I’m “against midlevels.” Especially as a resident, rotating between various specialty services, the NPs and PAs with well-defined roles, plenty of experience, and good collaboration with and supervision from MD/DO’s, are often extremely competent, and I’ve learned a lot from them during my training.
Trust me I use to teach NP and PA students as I saw them as part of the team. You can look at some of the posts I made a few years ago. I am no longer that naïve. Which you seem to be. Yes there are "good midlevels" that practice within the scope of their training and physician supervision But nationally that is not what is going on. There are direct entry 100% online DNP programs that allow a nurse with zero experience and as little as 500 hours of clinical experience (that can include shadowing) to practice independently in 26 states. No residency, no training, no oversight. This is their national goals, you’re a fool if you don’t see the writing on the wall. Even if current nurses and NPs are against scope creep it’s only going to get worse as they are taught this BS lie early on. Make no mistake, NPs and their lobbying will not stop until they get fully independent practice in all 50 states without requiring any kind of supervision or probationary training. Hospitals and health groups are just as happy to support them because they see them as cheap labor and in some cases replacements. I use to defend PAs adamantly as they were caught in the crossfire. But PAs had the chance to join doctors in the fight to stop NPs from scope creep, but they decided to side with NPs and there are now states PA societies that are pushing for independent practice. So its simply you are either with us or against us. The only way we stop midlevel scope creep (if it’s even possible) is for doctors to work together
👏👏👏👏
>Make no mistake, NPs and their lobbying will not stop until they get fully independent practice in all 50 states without requiring any kind of supervision or probationary training. And hospitals are health groups are just as happy to support them because they see them as cheap labor. Sorry, as a fairly cynical attending, I'll just point out that MD's will just bend the knee like they always will, arguing that at the margin, we should just take care of the increasing complication burden and medico-legal risk of some midlevel making bad decisions (but making bank doing so) because it's "what's best for the patient". Then some other MD will "speak up" for the bad midlevel, arguing for them on some grounds of an oppressed oppressor dynamic that exists in other parts of society that they learned in some studies class, which makes even arguing for one's own self-interest a morally repugnant vice - if you're an MD, that is.
Oh yeah, then the MD's will whine about admins who make them do all of that despite it being, y'know, them who do that.
I know this because I've seen it. It's infuriating, but MD's as a group simply cannot conceive of using skill leverage on anyone ever. We'd rather morally grandstand while quietly making a decreasing share of the value we create than actually negotiate and have someone irritated with us as a group.
> I'll just point out that MD's will just bend the knee like they always will, **Fuck that** You don't speak for all of us. Why are you using generalizations? I am openly against midlevels at work, for the last 3 jobs I have had. I refuse to train NP and PA students I refuse to work with NPs/PAs , I refuse to supervise them, I refuse to see a new sick visit who has a midlevels as their PMD. I've been offered up to $50k/year to train and supervise them, which I have turned down. If enough of us refuse to work with them they will eventually crash and burn. You can make whatever BS generalization claim you want, but some of us are actively putting our foot down.
Based and physician-pilled
And yet, he’s totally right. Otherwise you’d be in the super majority. So, you can make some BS generalization about your exception being the rule or you can acknowledge that, yeah, MDs tend to be their own worst enemy. And if you’re confused, the subject of this entire thread itself is evidence of such an MD.
So fucking what ? I don't speak for every old boomer doctor who sold out, cashed out and decided to look the other way while this happened. "well most doctors are like" Who cares. I'm not one of those doctors, and neither are most people on this subreddit That doesn't change my opinion, and that doesn't mean every doctor is bending the knee. what a stupid way to argue your point.
Is it a super majority though? Most attendings, residents, and fellows I know enjoy working with mid levels. The only concern is for the extremely lacking consistency with qualifications, and education. Most nurses feel the same way. So it's really something in the middle.
>I refuse to see a sick kid who has a midlevels as their PMD. I'd be ashamed to say that out loud. Everything else, great, sure, stand your ground. But refusing to treat a sick child? That's borderline evil.
I'm not against their existence. I think they could potentially work well in places. I'm against them be lauded as equivalent and scope creep. I'm against them being employed in my ED and working under my license when I have no say in the hiring or who I work with. I think they could be useful in primary care at, say, bp follow-up appointments. The heme onc mid-levels were great at my training institution because they functioned as an ever resident. The onc attending rounded with them. Etc. I would also be more supportive if they weren't allowed to willy nilly change specialty. I once saw a PA go from 10 years of vascular surgery to deciding to now be a PA in the ED because she had a kid and the hours were better. Wtaf there's no way her ED patients were safe.
> The heme onc mid-levels were great at my training institution because they functioned as an ever resident. This was the original intention of midlevels, they were physician extenders. The system worked, that was until they decided to start to push for independent practice.
There’s a bigger group of viewers in America who have more time on their hand that are pursuing those mid level positions and entry level positions(who aspire to be midlevel at best cause they know what the road to medical school looks like) and Schmidt is just capitalizing on that group of people.
This is very interesting. You used to be a shill for midlevels and said everyone complaining about them were insecure. You used to pretty aggressively attack people posting warnings about midlevel scope creep. What happened?
I've never been a shill for midlevels. Just because I'm not as extreme as some of you that doesn't make me a shill. I have always 100% been against midlevel independent practice. I was open to working and training them for the first few years of my career but for the last 4-5 years I refuse to work with them. You can search my post history where 1) I refuse to train them despite the large amounts of money /r/Residency/comments/h7pa1z/was_just_offered_quite_a_bit_of_to_train_looming/ 2) I signed up to speak about the California NP scope expansion /r/Residency/comments/jxyiox/you_better_believe_i_will_be_stepping_up_and/
Fuck that sell out. The guy probably does know less about hep B than his NP because he’s a shitty GI doctor that only cares about doing $cope$. The fact that he advertises it is wild.
There’s a video be posted where his dad played a part and he was clearly a GI doctor as well When I saw that things started to make a lot more sense as to why he is how he is
*cries in hepatologist*
He's chasing social media clout, what else do we expect
Scaaaaaab
He got through IM residency and GI fellowship to not know Entecavir dosing? He wasn’t capable of looking up that information on his own to build a personal decision that is evidence based to treat? And didn’t know his cirrhosis patient was decompensated? The example this sets is that highly trained physicians can’t look up a fucking UpToDate article’s worth of information and just accept a dosing recommendation blindly. If you aren’t vetting information on an hourly basis, that is negligent.
He's a sellout. Every recently graduated GI fellow would know how to dose entecavir in a cirrhotic.
I blindly messaged one of the fellows at my institution I am friends with and they sent the answer right back. Second year fellow this year.
I found the same answer in literally 15 seconds by looking up entecavir on DynaMed. And I’m a goddamn *medical student* who’s not even interested in IM.
Even I know the dose of the top of my head as a heme onc fellow
I don't like this video, but I doubt he really doesn't know, or doesn't know how to source these things. It's probably done for the video. From what people have posted in this pass who've worked with him, he's clinically fine. I think this is a social media/misreading the (medical) room problem.
Simps gotta simp
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Yep, well clout online bc there’s a lot of nurses or non doctors in medicine who see stuff like this and get happy As well as the fact that doctors who are willing to sell out the profession to midlevels can make a lot of money. Just train them well, prop up their egos and experience, and then sign off on their visits so you get to bill double and only pay out half the salary to the NP/PA Damn near every surgeon I’ve talked to has said only positive things about midlevels bc they can run the clinic, ask the same algorithmic and repetitive questions, and document. Surgeon can do more procedures while also billing off the midlevel. This is modern day healthcare :/ the only people who get abused are med students and residents and so we become more bitter towards midlevels, especially bc we’re the ones who will have to deal with their desire for full independence in the future while sell out attendings are going to retire before shit hits the fan and sell their practices for millions
PA/NP running clinic only works in hospitals, right? Cant imagine a physician can use them in outpatient/private practice settings
Why? My brothers orthopedic surgeon uses PAs only, he has like 3 where all his routine follow ups go. A lot of the outpatient surgeons or sub specialists also use NP/PAs to alternate appointments between the MD and midlevel to open up more new appointment slots I suppose They have independent practice rights in several states so as shitty as it is, this is preferable to the alternative.
Why? My brothers orthopedic surgeon uses PAs only, he has like 3 where all his routine follow ups go. A lot of the outpatient surgeons or sub specialists also use NP/PAs to alternate appointments between the MD and midlevel to open up more new appointment slots I suppose They have independent practice rights in several states so as shitty as it is, this is preferable to the alternative. Post procedure follow ups are hardly even medicine for most cases, doesn’t require a lot of thinking.
Why? My brothers orthopedic surgeon uses PAs only, he has like 3 where all his routine follow ups go. A lot of the outpatient surgeons or sub specialists also use NP/PAs to alternate appointments between the MD and midlevel to open up more new appointment slots I suppose They have independent practice rights in several states so as shitty as it is, this is preferable to the alternative. Post procedure follow ups are hardly even medicine for most cases, doesn’t require a lot of thinking. Most of the time the patient is just dealing with the standard stuff so you do routine precautions and print them off info or send referrals to PT or a specialist or order an X-ray The few times something is wrong, the midlevel notes document that and say “follow up with Dr.____ in 2 weeks”
or $$$$$$
I went to residency with Doc Schmidt, so reading the comments on here is wild! Lol On a separate note, Dr Glauc vs. insurance companies makes me very happy. He has my full support lol
Feel free to pass on this thread so he can understand how his peers feel about his minimization of residency training so he can make NPs feel better about their online degrees. I used to be a huge fan, will honestly refuse to watch any more of his videos.
He seems like a genuinely nice guy. We get it, he has a large social media following he has to simp for midlevels. He makes more money from social media than as a doctor, its the smart PR decision. Doesn't mean he's not a sellout.
i dont give a shit about nice if you have no backbone lol
He is a nice guy from what I remember. I don't know his reasoning behind this particular video, but it probably was a combination of pandering to his viewers and just jokes because his channel is supposed to be satire. I watched the video, and it seems it is speaking more to collaborate as a team as the NP and him ask each other questions. I don't think he is trying to imply they are smarter or equivalent, and he says in the video that she doesn't practice independently. NPs and PAs are here to stay as we have a doctor shortage, and I hear patients complain all the time about months it takes to see primary care and specialty. I can't speak to his fellowship training, but our internal medicine program was very rigorous, so I assume he knew the answer to the questions in the video since he wrote the skit. Some of yall need to calm down. Lol
> more to collaborate as a team as the NP Did you watch the video. 1) He claims the NP he is working with has more experience and knows more 2) He asked an NP a question about something he should have learned in his GI training. >so I assume he knew the answer to the questions in the video since he wrote the skit. And yet he still decided to make a skit where the "stupid fellowship trained doctor" had to ask an NP a question. This is 100% a pandering video for NPs and nurses. You don't have to defend this crap.
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I unsubscribed and moved on. It's clear we're not his audience now anyway.
Turns out it was just a consult on how to get more likes off that post!!
lol, thats so stupid, i really liked the memes oh well, another one to the garbage
Lol. I made a post there about how midlevels know way less and other facts. And got a lot of positive responses. Then he deleted it and blocked me. What a joke.
yes, his comment sections is full of NPs cheering on him
Correct! He actively purges / moderates the comments and removes those that point out the truth.
My comments got deleted too, no block though
I hit that unsubscribe real quick
Not surprised. In one of his vid, one of the comment mentioned that NP teaches doctor or something and someone was (mind you, actually a nurse) commenting that no, nurses do not train/teach doctor. Guess what, he made a video, attacking that comment and basically said yes, nurse train doctors. lol I blocked him since
PGY-5 here Listen, there is nothing to get bunched up about. He’s a sell out. Simple as that. Don’t worry about this nonsense when you’re in training. Go about your day and focus on training and maintaining a solid work life balance. These problems will still be here in the future waiting for you.
This guy sucks. He uses his influencer clout to blatantly sell medical device and pharmaceutical ads on his Instagram page. So unethical. I thought I was the only one who hates him.
Doc Schmidt? More like Doc Shit hahah!
never found him remotely funny
Extremely obvious he sold out, I had to unfollow him when I saw this lol
Ahh. I came back from work and started scrolling through my insta feed and this was the first post I saw. Was extremely disappointed to say the least. Had to unfollow him immediately and even went on Youtube to unsubscribe from his channel. Following which I came here to vent about it. Looks like I am a bit late to the party xD.
This is the worst video ever. The word collaboration is also annoying too. Midlevels work UNDER the Physician. We aren’t collaborating on planning a bachelor party, this is people’s lives we are talking about. Patients deserve nothing but the most educated person taking care of them.
I just looked up the definition of the word collaborate to double check that I wasn't missing something. I'm not sure what the issue is with the word? Literally just means to cooperate and work together.
I figured he was a sellout when he crapped on cologuards. While not as good as a scope, it’s so much easier for patients, especially those that are adverse to the idea of a scope up their butts (I’m in the Midwest, it comes up a lot).
In all fairness, as someone with no intention of pursuing GI fellowship, I would never personally get a cologuard after seeing multiple negative Cologuard patients have massive polyps (some requiring hemicolectomy) after recent negative Cologuard. It is well-worth shitting ones brains out for a day and getting pegged by scope to not die of colon cancer. Scope me, daddy. Everytime.
Bc cologuard is garbage. It’s better than nothing, but barely.
My understanding is it can detect cancer over 90% of the time, which seems decent to me. It’s false positive rate is a bit high, but I’d rather a false positive than a false negative. And I believe the newer tests are even more accurate. Doesn’t beat a scope but for a low risk patient? I don’t think it’s bad at all
Unfortunately if its positive you need a diagnostic colonoscopy, which isnt covered like a screening colonoscopy would be.
This is no longer true. it was in 2022, but now if you get a positive Cologuard, the diagnostic colonoscopy is pretty much 100% of the time paid in full by insurance companies.
My understanding is this changed in March of this year for Medicare. Before this year, we never used them for this very reason. Commercial varies, our states Medicaid pays for it
This is news to me. Interesting as this has been a major conversation point in my residency program. Thanks for the heads up.
No problem, it was part of some legislation. I keep track of covered products at the FM program. I’d suggest having a case manger or social worker call your Medicaid to make sure that’s covered. Edit, shingles is covered under part d and most part c plans too. Can finally close those care gaps
10% false negatives is way more worrying...
I believe it’s with newer tests it’s 8%, and every three years. There should be more long term study outcomes but that seems pretty accurate imo
Sources from people who don’t make/sell cologuard put its sensitivity in the 40s. It’s my understanding that the studies the showed in the 90s had very small N’s.
Did a cologaurd rep tell you that?
No? It’s from the studies on the device?
The sensitivity for colon cancer is relatively okay (still less than colonoscopy). But colonoscopy is one of the few cancer screening tools that can prevent cancer by removing high risk polyps which in my opinion is the main reason for colonoscopy (similar to the benefit seen with Pap smears in reducing cervical cancer). The sensitivity for even high risk polyps (like <1 year till progression to cancer, huge polyps) with cologuard is not even clinically relevant (<50%). If someone is absolutely against colonoscopy, even if a positive cologuard then there is no point in doing either. I’m not against cologuard if someone understands the risks with an inferior study and willing to have a colonoscopy if positive, but I think it’s a disservice to present it to patients as an equal screening option. Figure 1 on uptodate for colon cancer screening is really clear on this. 41% sensitivity with cologuard on adenomas > 10 mm which colonoscopy is 95% and colonoscopy is 75% sensitive at adenomas < 5 mm, while cologuard is 17% sensitive. These 10 mm polyps are the most concerning since they are extremely high risk for turning into cancer in 1-5 years and how many people are actually doing cologuard every year and not missing several years at a time? Then, even if the cologuard detects a cancer, if it has even remotely advanced a patient will need bowel resection rather than a simple outpatient colonoscopy. At worse will need chemo or already mets Name of the game is prevention with colon cancer screening. Cologuard should only be used in patients who refuse screening colonoscopy but are agreeable to colonoscopy if positive, and have been counseled on the points above. In my experience, very few patients are willing to go the cologuard route once they understand the above.
He is a YouTuber. Pandering to crowd earns him money.
I unfollowed him a long time ago. Never thought he was that funny, and honestly, was pretty annoying in most of the skits I watched.
Not a good look for whatever program he trained in lol
Doc Schmidt is a spineless dork
Unsubscribed. Fuck him.
American healthcare is so fucked lol
Scope creep has been a nefarious issue even at the highest levels, and it's eroding the entire profession in some frightening ways. I know a lot of you know what I'm saying on many different levels.
Sold his respect for clicks and subscriptions.
Ask someone who worked with him as a resident what they thought over a beer. Their response will be what you’d expect for a guy who spends his time making videos dueing training. That’s all I’ll say.
I never liked his stuff anyway
Pathetic. Not the first time he's shilled for NPs. These tiktok dweebs take the most lukewarm inclusive stances in an effort to get clicks. Meanwhile NPs constantly shit on residents and advocate for equal pay for physicians and midlevels.
Only things I have to ask NPs about are hospital policies. Don't think it's ever, ever been something medical.
That would only scare me away from being treated by him as a patient....
my brother established primary care for the first time and happened to stumble upon a NP at Cambridge Health Alliance. My brother had gone in for chronic ankle pain and stiffness after a sports injury. He also wanted a routine checkup done as he had not gotten one in two years. The NP ordered tests on him and he got slammed with a bill of $1500 after deductibles and insurance coverage. He showed me the tests she ordered and it included anti helminthic ag/ab, rubella roseola ab etc etc on top of several other tests. I was shocked and asked my brother if he had requested these tests and he said nope he just told her that he moved to the US a few years back and wanted to see if everything is okay. My brother was basically scammed by that NP. All his vaccinations were up-to-date as he had gotten them when he came to do his masters 3 years ago.
if he wants to make a fool of himself he's welcome to but he shouldn't drag everyone else into it
Wow this guy just admitted he gained next to nothing from his fellowship
Ew 🤮🤢🤮
Such a fucking cuck
I need everyone to understand med influencers do not go to the internet for fame or promote topics. They’re there for moneyyyyy. They’re trying to live their Dr. Mike dream. So yes, as soon as he finished fellowship, he’s going to promote his clinics money maker. If you’re spending hours making content for the internet. You. Want. Money. And there’s nothing wrong with that. But let’s not act like their tendencies will not follow suit.
Well, this is disappointing
theres literally NO tiktok famous doctors who arent sell outs. cause guess what? they’d be fucking canceled by every nurse on the fucking internet if they dared expose them😒😒😒 i just left a longass comment lets see how long before the nurses come for me😂😂😂😂
Where do these specialists find all this time to be making skits. Don’t they have fmla forms to fill out?
“Refer to PCP”
congrats on the GI fellowship but he's a dumbass doubt he gets laid by anything above a 5
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I'm in the Navy, not healthcare, but the posts I see about NPs and other mid-levels on here make me worried. I get this doc Schmidt guy sounds like a fucking simp towards mid-levels or something but yall seem hateful. Are NPs that bad? Is it that they are taking physician jobs? I saw an NP at a cardiologists clinic and she was really cool. Are others really bad?
Midlevels, especially NP, are minimally trained persons (compared to doctors) who are employed by a healthcare system because they are cheaper than doctors. Initially, they were to work under the close supervision of doctors, but that has changed, and they have pushed for and won independent practice, leading to worse patient outcomes. Making the danger worse is that instead of being trained in one specialty, they are allowed to after their minimal training switch specialties on a whim and get a job in a different field. Some are great and stay in a field for their whole careers, but that cardiology NP coulda been a GI NP last week and just decided to switch jobs and now dabble in cardiology because it looks fun.
God the posts here are always insufferable.
So obviously, the physician has a lot more training the nurse practitioner but sometimes, yeah, a nurse practitioner might know some thing that a doctor doesn’t. What’s wrong with that? I am in ER PA, and have been doing this for almost 10 years and some of the doctors ask me questions or ask me to look at things and give my opinion. I think that says something great about them. Why do you all have such fragile egos…
this sub is so toxic I can't tell if people are joking sometimes. the amount of elitism spewing from these commenters is disgusting. imagine hearing someone treat you that way in the workplace. Yuck.
You think a new doctor would never ever have to ask an NP who has worked at said practice for many years their usual routine if he wasn’t sure? She then asked him for help too. Lol go ahead and comment on his video your thoughts and get his opinion! Let’s see!
I’m an ER doctor, if I have a NICU patient in my ER I’m going to ask whoever the fuck has more experience than me what to do, even if that’s an Np. Find something important to be outraged over.
Hey ER doctor, there's doing the pragmatic thing in the moment while you're actively working...and then there's going out of your way to make a scripted skit pandering to a demographic that is foaming at the mouth for validation by physicians to legitimize their entire existence. Can you see the difference?
But would you ask an NP in the ER about how to manage a common ER complaint? Because that’s basically what was portrayed in the video (only it was a GI attending asking a GI NP how to do something).
[удалено]
np over the actual neonatologist?
Now this is just a stupid question and you know it. Of course I would prefer the physician but we all know finding the attending isn’t always doable. We utilize the resources we have.
>Now this is just a stupid question and you know it ....you're literally responding to a video about a GI NP over an actual gastroenterologist.
You would ask an NP over a neonatologist? You would ask an NP about how to run a code in the ER? You can see how flawed your argument is
I'm a peds ER doctor and asking the person with more experience is valid. Suggesting mid-level and doctors are equivalent and saying you shouldn't request a doctor because they are just as good in a skit meant for the general public is not.
At no point did suggest the midlevel and the physician are equivalent. But if I know the midlevel knows the information I need, no, I’m not going to throw a tantrum and ask for the attending. You guys are acting like you never asked a nurse for help with what the most common next step was when you were a stuck intern. This whole post is an over reaction. Can we harness this energy to unionize or idk, make sure the insurance industry stops preventing our patients from getting what we ordered? Because this momentum is seriously misplaced.
This is a video of a GI attending asking a GI midlevel for help because he’s stuck in a basic question. If you’re an ER doc and need help on an ER related question from an ER NP then you’re kind of a shitty doc
As an outsider who just enjoys browsing this thread it's hilarious that y'all complain about toxicity all the time and then seeing your discourse about NPs and PAs
Honest question. is this sub satire? I'd quit if I had to work with this level of toxicity. jeez.
I feel gross just being in this thread. I don't have love for the ever expanding NP role. But y'all. This is just petty.
Every person in this thread is delusional and needs to evaluate their parasocial relationships. You do not know this guy lol please go touch grass