[mact3333]

Originally Posted by Dr. G

Don't let salary guides fool you. Speak to a doctor with an asian/indian background with a matching immigrant based patient population and you will be mind boggled at the amount of money they net. I know MANY of these doctors at a personal level and the amount of money they make for a family physician is stupidly ridiculous. Our surgeons are barely making the kind of money these guys are pulling in.

I know more doctors then I can count on my hands and toes, whether it be friends, family, neighbours and classmates.


OH and also, why do you think the salary cap was lifted? Physicians were hitting the cap VERY easily and taking half the year off due to it so they had to get rid of it.

So why/how does this happen?...cause in the US primary care physicians cannot make that kind of money as a typical practitoner billing for professional services only...now if you run your own lab tests and do imaging, now thats a different matter all together.

[JayKay335i]

I think obama care will get repealed as it will do nothing but decrease the quality of care

[JayKay335i]

Originally Posted by mact3333

So why/how does this happen?...cause in the US primary care physicians cannot make that kind of money as a typical practitoner billing for professional services only...now if you run your own lab tests and do imaging, now thats a different matter all together.

Because when you get into minorities they trust people of their same race. Also, many dont have insurance and pay cash. $$$$$$$$$$$$$$$$$$$$$

[mact3333]

Originally Posted by AngelinIsRich08

Malpractice lawsuits are the worst here though. Patients sue for the dumbest shit and even if they don't win they don't have much to pay. If Obamacare was supposed to be good reform they would have addressed these suits. But no, all the lawyers would have gotten on Obama's ass so that was left out. My hopes are it gets repealed, or at least found unconstitutional in the supreme court.

I paper clip fell on my head while I was in Target...is Johnny Cochrane still alive?.....

[Dr. G]

Originally Posted by mact3333

So why/how does this happen?...cause in the US primary care physicians cannot make that kind of money as a typical practitoner billing for professional services only...now if you run your own lab tests and do imaging, now thats a different matter all together.

I should take a picture of a doctors office and how packed they become... it's like a 1 minute express service clinic at some locations. It's horrible in terms of proper healthcare and patients don't receive the attention they deserve, but some stories would SURPRISE YOU.

There was a doctor by my university who basically sold medical notes to students for $25 and the amount of patients I used to see him clear in an hour was RIDICULOUS! I would see 20 names ahead of me on the list and in NO TIME I was in and out + $25 cash on top for the note. I would see half my class waiting in the office as well on the day of midterms not to mention a ridiculous amount of patients... people would be standing around in the office, crowding up the hallways, we used to just hang around outside. One time this Doctor actually called "ALL STUDENTS" into one room and quickly banged out notes for all of them since things were getting over crowded. Now this is a VERY extreme and rare case, but it gives you an idea of how it's possible.

If I were to get into a speciality I would run south of the border VERY VERY FAST.... if I end up as a general practitioner... I'm opening up a clinic in an ethnic dominated community in the Brampton area.

[ibarry92]

Thanks for everyone's input it was very useful. I'm not really going into pre-med for the money but rather for the experience of the job and the future of medicine since it interests me. I am mostly leaning toward pre-med and pre-pharm.

Lol you guys are basically comparing the obstacles of pre-med to looking right and left at the same time. I was always average in the sciences and much stronger in math. So I guess it will be harder for me in the future.

Is anyone familiar with pre-med technology?

[JayKay335i]

I will reiterate, pre-anything is a stupid major. Schools prefer you to be versatile.

[mact3333]

Originally Posted by JayKay335i

I will reiterate, pre-anything is a stupid major. Schools prefer you to be versatile.

agreed...I was a history major.

[TiAg335i]

It's not a stupid major if that is what interests you.

If you like physics more than bio, be a physics major. You can still be "pre-med", although it's a bit harder.

[AngelinIsRich08]

I'd be a health sciences major and minor in business. Is that possible?

[1cleanm6]

Originally Posted by ibarry92

For those of you who are doing pre-med or are in med school, how do you like it so far?

Is it intense?

Is it interesting?

Where do you see yourself in the next 5 years?

How are the classes/grades?

Do you enjoy it?

I'm asking these questions because i'm a 2nd yer pre-med major.

awesome thread!!

Originally Posted by pman10

3rd year MD student here. Feel free to ask away.



The first two years of school were not terrible. My school operates on a Pass/Fail system, and although making the passing cut is often challenging, you usually have enough of a margin to make it through. The workload is intense, however, and ramps up significantly with each passing year. My normal schedule involves classes and labs from 8-5, followed by studying from 5-10 or 5-11. During exam periods, I'll usually study until 3-4 am every day. This is pretty typical for my class. Things get more challenging once you start 3rd year and take the USMLE Step 1. The Step 1 is by far the hardest exam you will take in your life, and makes the MCAT look like a pre-school exam: it's 8 hours long, and 350 multiple choice questions. It was by far the most brutal process I have ever undergone in my life, including working a 60-hour-a-week job in business before med school. Also, 3rd year is when my school reverts back to a letter-grade system. That's when everyone essentially stops being friends, and turns into sharks; you have to be sharp and alert, as your classmates will often do anything to get ahead of you.

My best advice for you is to ONLY stay the course if you love medicine. The process is a major, major pain, and it doesn't end when you get your Doctor of Medicine degree. I just started my rotations, and I "lucked" out by getting OB-GYN first - if I didn't have the desire or resolve to become a physician, I would have dropped out of school on the first day. It's that disgusting/brutal/painful/ridiculous a process.

If you love medicine and can't imagine doing anything else with your life, then there is no better feeling than practicing medicine. For the most part, I absolutely love it, and enjoy learning and applying my new skills and knowledge day in and day out.

Feel free to shoot me any more questions, via PM or on this thread. Good luck, and stay strong - it's a tough process.

I'll just add that I'm aiming towards Cardiology - ideally electrophysiology. I just think arrhythmias are incredibly cool

Oh boy I would have loved to take this test, best feeling to pass it I bet.

Originally Posted by Dr. G

Derms, Ortho, Radiology, Cardio... they are all pulling in SERIOUS money.

Lots of radiologists and derms making 7 figures.

I am done my first 2 years of med school and about to start preparing for USMLE step 1... (although e90post will probably make me fail the exam)... it is one of the most BRUTAL and PAINFUL processes you will ever go through.

Med school isn't all about money, there's more to medicine then money.

If you are after money... come to Canada... move to an Indian or Asian populated area... and enjoy 350k working 5-6 hours a day 4 days a week as a FAMILY PHYSICIAN....

You know it doesnt matter what you do, if you put in work youll be successful. My dads cousin came to America with NOTHING, turned a 1 man plumbing company into one of SoCal's biggest plumbing company. Hes one hell of a hard worker. If you love what you do you'll prosper.

Originally Posted by AngelinIsRich08

My parents own a hospitalst business and have 30 physicians working for them. I remember my entire childhood was nothing but business as this was the time when they were building their business. And there were months where I would see my dad for an hour or two a day because he was working 24/7 for three months at a time. He didn't have anyone working with him so he was always on call. If you start up your own small physician group be prepared to constantly be with a pager and have no time for anything but tending to your business, patients and referral doctors. It's grueling work man.

Out of High school my goal was to be a cardiovascular surgeon, as I grew up I realized it wasnt for me. Reading your post and having spoken to some doctors before makes me confident in my decision. Im sorry however no money or respect from strangers in this world is worth not seeing my children grow up, enjoying my life, spending time with wifey, etc. I got into real estate, you can make 100x more money then any doctor if you want. No disrespect to you and your father at all, just my thoughts/opinions.

[Echo M3]

Originally Posted by mact3333

agreed...I was a history major.

+1. Econ major here.

[newdadkel]

In our area, Neurosurgery, Ortho, and Cardiology are still doing very well. Many other physicians have already had their reimbursement cut over the year so 20% is not as big a chunk as it will be for these specialties. Not to say its a good thing, but 20% of 500 is not as big as 20% of 5000.

I agree with mact3333 in that to make a lot of money in medicine these days (which BTW is not everyone's definition of success), you have to have a diffferent business model than just opening an office and seeing patients. You can invest in an ASC but do your homework on the partners, and see if there is a lot of turnover and why that may be. Remember in a group investment like this, if it doesnt meet quota for the month, you will be chipping in to pay the light bill. It can be a cash cow or a money drain; just depends on how its run and how profitable it is.
Many doctors here are also in real estate, but we all know that is not as profitable as it has been.
Of course, many are doing more cosmetic procedures since it is a cash only option, but in a downturn, it can dry up too.

Medicine overall has changed from its glory days (the same can be said for the law profession since most of those new grads cant even find jobs). If your parents are footing the bill, then go for it if its what you want to do. Otherwise, expect anywhere from 120-200k in student loan debt before ever getting your MD. Once your are in practice, your reimbursement is likely to continue to drop. Also, with the push of midlevels expanding their scope of practice, the primary doctor is getting pushed aside, but it is starting to expand into specialists as described above. Even if Obamacare is done away with eventually, this wheel has already been set in motion. Healthcare is driven by insurance. If they realize they can pay a midlevel less to do the same job, guess whats going to happen. Insurance could give two sh*ts if you are getting proper care as long as they only have to pay as little as possible.

OP, I would suggest shadowing or volunteer work and find out what you really like, and then make the decision for yourself.

[schoy]

My $0.02: If you're going to med school to make money, you're going for the wrong reasons. Frankly, I doubt there's anyone here who wants a doctor treating them who's in it for the money. As someone mentioned above, the money will come when you do your job (any job) well.

[JayKay335i]

Originally Posted by schoy

My $0.02: If you're going to med school to make money, you're going for the wrong reasons. Frankly, I doubt there's anyone here who wants a doctor treating them who's in it for the money. As someone mentioned above, the money will come when you do your job (any job) well.

Thats a blatant lie. Thats plenty of jobs that you can do a fantastic job at and make shit. There are plenty of jobs you can be horrible at and make millions. The only universal truth in the world is that if your parents tell you that you can do anything they are full of shit.

I do firmly believe you are born with potential, but you are born with what you are born with. No matter how much you study and how hard you work there is a ceiling. Thats why there are janitors and doctors.

Just find something you love and work your balls off at it. Things might just fall into place.

[Echo M3]

Originally Posted by newdadkel

In our area, Neurosurgery, Ortho, and Cardiology are still doing very well. Many other physicians have already had their reimbursement cut over the year so 20% is not as big a chunk as it will be for these specialties. Not to say its a good thing, but 20% of 500 is not as big as 20% of 5000.

I agree with mact3333 in that to make a lot of money in medicine these days (which BTW is not everyone's definition of success), you have to have a diffferent business model than just opening an office and seeing patients. You can invest in an ASC but do your homework on the partners, and see if there is a lot of turnover and why that may be. Remember in a group investment like this, if it doesnt meet quota for the month, you will be chipping in to pay the light bill. It can be a cash cow or a money drain; just depends on how its run and how profitable it is.
Many doctors here are also in real estate, but we all know that is not as profitable as it has been.
Of course, many are doing more cosmetic procedures since it is a cash only option, but in a downturn, it can dry up too.

Medicine overall has changed from its glory days (the same can be said for the law profession since most of those new grads cant even find jobs). If your parents are footing the bill, then go for it if its what you want to do. Otherwise, expect anywhere from 120-200k in student loan debt before ever getting your MD. Once your are in practice, your reimbursement is likely to continue to drop. Also, with the push of midlevels expanding their scope of practice, the primary doctor is getting pushed aside, but it is starting to expand into specialists as described above. Even if Obamacare is done away with eventually, this wheel has already been set in motion. Healthcare is driven by insurance. If they realize they can pay a midlevel less to do the same job, guess whats going to happen. Insurance could give two sh*ts if you are getting proper care as long as they only have to pay as little as possible.

OP, I would suggest shadowing or volunteer work and find out what you really like, and then make the decision for yourself.

Where exactly do you see midlevels pushing aside anyone? I only see them filling in for positions that doctors refuse to take (or where there are shortages). Take primary care, for example: you see FNPs entering practice in underserved/rural areas where physicians do not want to practice medicine. Furthermore, the salaries they command are not far from physician salaries, and in most states, they still require physician oversight. If you look at where American medical student graduates go following their education, a dismally low proportion choose family practice.

The only other field is anesthesiology, where CRNs (nurses with masters degrees) command salaries in excess of 170k/year. Even there, they are not taking away work from anesthesiologists - they are simply filling the current shortage. CRNs will never eradicate anesthesiologists, as these physicians themselves have branched into other areas (critical care, pain management) and have indispensable skills required for administering anesthetics - that is, until everything becomes fully computerized and automated, in which case everyone will be made redundant.


I don't envision the doctors role as disappearing, which you seem to claim. Rather, they are likely to stick to more specialized, consultative roles on the cutting edge of medicine. Even then, highly trained "gatekeepers" to medical care (NPs, family docs) will still be required, and will command salaries consistent with their important roles.

[schoy]

Originally Posted by JayKay335i

Thats a blatant lie. Thats plenty of jobs that you can do a fantastic job at and make shit. There are plenty of jobs you can be horrible at and make millions. The only universal truth in the world is that if your parents tell you that you can do anything they are full of shit.

I do firmly believe you are born with potential, but you are born with what you are born with. No matter how much you study and how hard you work there is a ceiling. Thats why there are janitors and doctors.

Just find something you love and work your balls off at it. Things might just fall into place.

Disagree. Give me an example of any job, and I can tell you how one can possibly make $$$ doing it. Janitor (per your example)? Do it well, get recognized, promoted to manager, streamline expenses/boost profits or sales, get recognized, become COO/CEO/President, get recognized, become CEO/President of a larger company, etc. I suppose when I mean doing something "well", I mean doing it better than the next guy (and everybody else).

Of course, one can make $$$ being horrible at a job, but that wasn't the point of my post. Even you have to admit that doing a job well has a significantly higher chance of making $$ than doing a job horribly.

[JayKay335i]

Originally Posted by schoy

Disagree. Give me an example of any job, and I can tell you how one can possibly make $$$ doing it. Janitor (per your example)? Do it well, get recognized, promoted to manager, streamline expenses/boost profits or sales, get recognized, become COO/CEO/President, get recognized, become CEO/President of a larger company, etc. I suppose when I mean doing something "well", I mean doing it better than the next guy (and everybody else).

Of course, one can make $$$ being horrible at a job, but that wasn't the point of my post. Even you have to admit that doing a job well has a significantly higher chance of making $$ than doing a job horribly.

Sure, there is that chance that you go from Janitor to CEO but statistically your chances are crappy and you'd be better off begging on the UWS.

[newdadkel]

Originally Posted by pman10

Where exactly do you see midlevels pushing aside anyone? I only see them filling in for positions that doctors refuse to take (or where there are shortages). Take primary care, for example: you see FNPs entering practice in underserved/rural areas where physicians do not want to practice medicine. Furthermore, the salaries they command are not far from physician salaries, and in most states, they still require physician oversight. If you look at where American medical student graduates go following their education, a dismally low proportion choose family practice.

The only other field is anesthesiology, where CRNs (nurses with masters degrees) command salaries in excess of 170k/year. Even there, they are not taking away work from anesthesiologists - they are simply filling the current shortage. CRNs will never eradicate anesthesiologists, as these physicians themselves have branched into other areas (critical care, pain management) and have indispensable skills required for administering anesthetics - that is, until everything becomes fully computerized and automated, in which case everyone will be made redundant.


I don't envision the doctors role as disappearing, which you seem to claim. Rather, they are likely to stick to more specialized, consultative roles on the cutting edge of medicine. Even then, highly trained "gatekeepers" to medical care (NPs, family docs) will still be required, and will command salaries consistent with their important roles.

Since I am a doctor and work in medicine everyday, I know exactly what I'm talking about. The altruistic idea is that these honorable FNP's are riding out into the desert to serve some poor village outside the big metro area is not all that. It is true that they are serving as the healthcare in some areas but that it not the case for the majority. As reimbursements diminish, healthcare facilities have to reduce costs to remain viable. One very popular method is to hire midlevels for positions that would have been offered to a physician just a few years ago. Simple economics: pay someone half to do almost the same job. Same thing with PA's associated with some hopsitals. A PA can simply be hired and put under a hospitalist or IM instead of hiring another physician. And you mentioned CRNA's which have become much more ubiquitous in the OR. And YES they are taking away positions from anesthesiologists. I work with both CRNA's and anesthesiologists and know the difference first hand. Now there are some excellent CRNA's but if you ever have any procedure or surgery go south, they are in no way as able to handle it as well as an anesthesiologist. The quality of care is entirely different. Personally I prefer working with an anesthesiologist because I work with older people who can be very sick, and I need someone who can handle that.
And I in no way stated that physicians are on the way out. One of the problems in medicine is that there is a shortage of primary care doctors, but who would go into primary care when you can have your position taken away by a midlevel? If you are in private practice, make your own rules. If you work for a hospital or large insurance-based facility, good luck with that and job security. The conundrum is that primary care is still necessary in most cases to get a referral to a specialist. And these "highly trained gatekeepers" keep getting paid less and less to do the same amount of work.

So we appreciate your opinion, but you cant get all the facts from Time magazine

[whyrms]

Originally Posted by newdadkel

Since I am a doctor and work in medicine everyday, I know exactly what I'm talking about. The altruistic idea is that these honorable FNP's are riding out into the desert to serve some poor village outside the big metro area is not all that. It is true that they are serving as the healthcare in some areas but that it not the case for the majority. As reimbursements diminish, healthcare facilities have to reduce costs to remain viable. One very popular method is to hire midlevels for positions that would have been offered to a physician just a few years ago. Simple economics: pay someone half to do almost the same job. Same thing with PA's associated with some hopsitals. A PA can simply be hired and put under a hospitalist or IM instead of hiring another physician. And you mentioned CRNA's which have become much more ubiquitous in the OR. And YES they are taking away positions from anesthesiologists. I work with both CRNA's and anesthesiologists and know the difference first hand. Now there are some excellent CRNA's but if you ever have any procedure or surgery go south, they are in no way as able to handle it as well as an anesthesiologist. The quality of care is entirely different. Personally I prefer working with an anesthesiologist because I work with older people who can be very sick, and I need someone who can handle that.
And I in no way stated that physicians are on the way out. One of the problems in medicine is that there is a shortage of primary care doctors, but who would go into primary care when you can have your position taken away by a midlevel? If you are in private practice, make your own rules. If you work for a hospital or large insurance-based facility, good luck with that and job security. The conundrum is that primary care is still necessary in most cases to get a referral to a specialist. And these "highly trained gatekeepers" keep getting paid less and less to do the same amount of work.

So we appreciate your opinion, but you cant get all the facts from Time magazine

Just to harp on this point. I'm not in anyway saying that, as a whole, midlevel care is flaw or that they all are trying to take over doctors job. However, the small minority of them, who are very vocal and who command a lot of lobying power is swaying the politician and this is dangerous in the quality of care in general. I talked to a lot of physicians and the general consensus is that they feel threaten by the ways the ANA is pushing their agenda. So far, everything they pushed for, they got, and they don't seem to be content with what they have so far. Not content with serving as a midteir healthcare provider, always pushing for more rights/more procedure. And there's a hidden agenda that involves money, always pushing for the cash cow procedures, expanding roles that they think would make a lot of money. If they were truly thinking about helping the primary care shortage they would not push for fields such as Dermatology.
http://health.usf.edu/nocms/nursing/...ions_derm.html

Pman, I know that you think that midteir level can just take over the role of physicians because there is a shortage, but that line of thinking is wrong, and this is exactly the type of thinking the Obama administration has. There is no way a RNA or a DNP will ever have as much didactic/clinical education as a physician, and by filling the role of physicians they are decreasing the quality of care. Who suffers at the end? The patients.
It's like thinking that you didn't have enough concrete to make a bridge, so why not use muds instead? (I'm not trying to play on word and secretly comparing midlevel providers with mud, it's just the only analogy i have right now).

Why not provide more inventives for doctors to go into primary care? decreasing the debt that doctors has if they go into primary care for example. By filling the role of Family Physicians with Nurses, they made the already unpopular field into an even more unpopular field. In the end, the patient suffers.

[Echo M3]

Originally Posted by newdadkel

Since I am a doctor and work in medicine everyday, I know exactly what I'm talking about. The altruistic idea is that these honorable FNP's are riding out into the desert to serve some poor village outside the big metro area is not all that. It is true that they are serving as the healthcare in some areas but that it not the case for the majority. As reimbursements diminish, healthcare facilities have to reduce costs to remain viable. One very popular method is to hire midlevels for positions that would have been offered to a physician just a few years ago. Simple economics: pay someone half to do almost the same job. Same thing with PA's associated with some hopsitals. A PA can simply be hired and put under a hospitalist or IM instead of hiring another physician. And you mentioned CRNA's which have become much more ubiquitous in the OR. And YES they are taking away positions from anesthesiologists. I work with both CRNA's and anesthesiologists and know the difference first hand. Now there are some excellent CRNA's but if you ever have any procedure or surgery go south, they are in no way as able to handle it as well as an anesthesiologist. The quality of care is entirely different. Personally I prefer working with an anesthesiologist because I work with older people who can be very sick, and I need someone who can handle that.
And I in no way stated that physicians are on the way out. One of the problems in medicine is that there is a shortage of primary care doctors, but who would go into primary care when you can have your position taken away by a midlevel? If you are in private practice, make your own rules. If you work for a hospital or large insurance-based facility, good luck with that and job security. The conundrum is that primary care is still necessary in most cases to get a referral to a specialist. And these "highly trained gatekeepers" keep getting paid less and less to do the same amount of work.

So we appreciate your opinion, but you cant get all the facts from Time magazine

Very clever. There was no need to throw in that condescending blip at the end of your rant. For your knowledge, I'm a 3rd year medical student with a background in economics, so I'm not exactly "Time magazine" clueless on this topic.

So, getting beyond the strutting and title-bearing - show me ONE family doctor or anesthesiologist who cannot find a job placement. You fail to understand the difference between 'qualified' and 'displacing physicians'. You clearly stated in your initial post that mid-level providers are DISPLACING doctors, which is absolutely not true (at least for US graduates - FMGs are an entirely different basket). They are, however, taking up positions they never took before, that American physicians refuse to take - this is because American physicians prefer to enter higher-paying specialties.

I never said that I preferred mid-level practitioners, nor are they qualified enough for the role. It is obviously in my best interest that mid-level practitioners do NOT take on this role. That being said, stating that they are stealing or taking away jobs from family physicians is ludicrous.

I simply don't see mid-level practitioners taking over the role of physicians; the only way is if physicians cannot prove that they have better outcomes than mid-level practitioners. Add to this the additional knowledge that a medical doctor brings to the table, and I fail to see how they would be outcompeted. Cost is a major factor under consideration, but insurance companies and patients also take into consideration quality of care. Are doctors that low on self-esteem that they do not think they bring in value-add over a mid-level practitioner? All it would take is one simple study showing an increase in mortality or health events associated with shifting to mid-level practitioners; this would ensure that patients demand to see physicians instead of FNPs and advanced-degree nurses.

Here is how to solve the issue:

1.) Increase the incentives for entering family medicine. Debt forgiveness, subsidies, reduced taxes, whatever is necessary to provide a monetary incentive for physicians to return to this critical field.

2.) A concerted effort by the AMA and various physician groups to show the value-add they provide over the mid-level practitioners. Nurses can readily form strong unions - why won't doctors do the same? I hear that hardly 25% of physicians are AMA members, which is pathetic. Use this collective bargaining group to establish clear lines of practice between physicians and other practitioners, and counter the growing influence of the ANA.

3.) Fundamental change to the way patients pay for their healthcare. The largest issue is this insurance-fueled healthcare model. We need to move to healthcare saving accounts and DIRECT payment of services by patients. Something along the lines of a social security account. Provide disaster insurance coverage to all, and government insurance coverage to means-tested individuals (unemployed for a certain period of time, income and assets below a certain level, children with parental income below a certain level, etc). When people start paying directly for their services, they will have more flexibility in choosing providers based on quality as well as cost.

PS - the new healthcare plan puts in place an increase in reimbursement for family practitioners. In my opinion, the only positive aspect about Obama's healthcare plan.

Cheers,

Your clueless M3post member

[Echo M3]

Originally Posted by whyrms

Pman, I know that you think that midteir level can just take over the role of physicians because there is a shortage, but that line of thinking is wrong, and this is exactly the type of thinking the Obama administration has. There is no way a RNA or a DNP will ever have as much didactic/clinical education as a physician, and by filling the role of physicians they are decreasing the quality of care. Who suffers at the end? The patients.
It's like thinking that you didn't have enough concrete to make a bridge, so why not use muds instead? (I'm not trying to play on word and secretly comparing midlevel providers with mud, it's just the only analogy i have right now).

Why not provide more inventives for doctors to go into primary care? decreasing the debt that doctors has if they go into primary care for example. By filling the role of Family Physicians with Nurses, they made the already unpopular field into an even more unpopular field. In the end, the patient suffers.

We agree more than you realize. In no way did I claim that nurses provide care commensurate to physicians.

You are right, that the ANA is trying to expand the roles that nurses can wield in the field. See my post above for my thoughts on this and how to counter this. I just thought that the poster above you was overplaying the issue, with his claim that they were forcing physicians out of medicine.