A nurse may soon be your Doctor.....

[MountainPharmD]

http://www.msnbc.msn.com/id/36472308/ns/health-health_care

This has been discussed heavily over in the medical forums.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.

"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."

Yep just like a Doctor except for the pay AND knowing what the hell you are doing.

Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.

The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make — and that may be just the beginning.

Wow 85% of what a Doctor gets reimbursed and for nurse midwifes 100%. So what the hell is the point if they are going to get paid the same or nearly the same as a Doctor?

"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."

This says it all. Instead of placing more under qualified people out there how about make it more attractive to become a primary care physician? No disrespect to nurses they have thier role. If they want to diagnose and prescribe then they should go to med school.

---

Members don't see this ad.

 

[jfm5958]

Oh, but they can go to med school! I had a recent nursing grad tell me that she could take the MCAT at anytime, but she just didn't want to. So I said "Oh wow. I didn't know you guys had to take 2 full years of chemistry including OChem, a full year of physics and a full year of bio." She said "Oh yeah I took all those classes in nursing school." Riiight well we went to the same small school and were in the same graduating class. Strange, I never saw her in any of those classes. It's nothing against nurses, or even her in particular, but it was frustrating that she is in the healthcare field and has no clue what it takes to actually become a doctor.

Anyways, all ranting aside, I've been to the doctor's office once a year for the last 5 years or so, and every time I've seen a NP. It's just for a yearly exam, and I don't mind. If I had a more serious condition I might request the doctor. They ask every time I call if the NP is ok, and she can usually see me way sooner than my MD so that's fine for less serious things.

 

[apteryx]

I agree.

 

[carbox]

I am all for training more MDs...However, in rural areas where I am from there are not enough MDs, these NP's and PA's have been literal lifesavers. One does not have to go to med school in order to diagnose things MOST people go to the Drs. office for...its simple tests and knowledge that anyone who goes to 7+ years of school related to healthcare could easily diagnose. Like the article states, NP's have no problem sending patients away if they are unsure or need someone in a more specialized field. Getting your BSN and then PhD in nursing (which will be required in order to practice as a NP in a few years) is a lot of school.

I know this makes some people mad, and respectfully so. But like the article states most people are fine with it for simple and routine physicals and exams. Obviously if it is something serious, you would be referred. I have seen people in rural communities have to wait for meds and care due to not being able to reach/contact a MD (as the article cited with examples). I have personally seen the good effect of this and I believe NPs role will continue to expand especially in rural communities. I'm also all for training more MDs, but not many med students go into primary care (I don't blame them) after all that school and residency. It is interesting.

 

[GamecockPharmD]

I really don't have a problem with this. As long as the NP or soon to be DNPs know their place I'm cool with it. Someone said it above as long as they refer their patients with more serious conditions to MDs I don't see the problem.

 

[MountainPharmD]

My point was to get everyone thinking about how aggressive and proactive nurses are. Agree or disagree they are using a shortage of primary care Docs as an excuse to expand their roles beyond where they should.

To bring this all back to Pharmacy I would like to point out how silent and un-aggressive our national organizations have been. I am not suggesting they should be pushing for Pharmacists to considered equal to MD's like the DNP's are. Seems to me this is a good time to get out there and push for Pharmacies role in primary care. Things like collaborative practice agreements and the like to help primary care physicians manage their patient's medications once they have diagnosed them.

 

[crazybob]

Are we going to have the option of requesting to see MD and DO physicians only?

 

[GamecockPharmD]

My point was to get everyone thinking about how aggressive and proactive nurses are. Agree or disagree they are using a shortage of primary care Docs as an excuse to expand their roles beyond where they should.

To bring this all back to Pharmacy I would like to point out how silent and un-aggressive our national organizations have been.

i couldn't agree more about our national organizations.

 

[confettiflyer]

FMG ftw

 

[Sparda29]

 

[MountainPharmD]

Sparda you are losing you touch! Get those gifs posted correctly please!

 

[thedrunkenpharm]

Is it really that bad for NP's to expand their services?

Some of my colleagues are Clinical Pharmacist Practitioners and they diagnose and prescribe all the time (albeit under the MD's supervision). Sometimes they do get flak from MD's on who should be doing what, but CPP's have generally been accepted as money, time, and life saving personnel. I think NP's should be able to expand their roles if we pharms have in my state.

 

[Sparda29]

Sparda you are losing you touch! Get those gifs posted correctly please!

It was posted correctly, but SDN's profanity detector picks up when there is profanity in the actual URL, and replaces them with asterisks. Since the actual link doesn't have asterisks but has the actual word in it, the link is dead, so I'd have to go back and rename the file to a word without profanity.

 

[Neuro Surg]

If NP's want to do things that physicians do, then why don't they just go to medical school?

According to some of them it's really not that much harder than nursing school. But hey, who would want to go through all those years of medical school and residency when you could achieve the same ability to diagnose and treat diseases by spending lesser time in nursing school.

I wonder if in the nursing school interview rather than asking the candidates "why do you want to be a nurse" they ask "what don't you like about nursing, and how resolved are you to change the profession".

 

[GamecockPharmD]

Is it really that bad for NP's to expand their services?

Some of my colleagues are Clinical Pharmacist Practitioners and they diagnose and prescribe all the time (albeit under the MD's supervision). Sometimes they do get flak from MD's on who should be doing what, but CPP's have generally been accepted as money, time, and life saving personnel. I think NP's should be able to expand their roles if we pharms have in my state.

You must live in NC. Hopefully I'll be getting licensed there in the next few months. Do you know if CPPs need a residency? I'm sure they do but I could be wrong.

 

[MountainPharmD]

It was posted correctly, but SDN's profanity detector picks up when there is profanity in the actual URL, and replaces them with asterisks. Since the actual link doesn't have asterisks but has the actual word in it, the link is dead, so I'd have to go back and rename the file to a word without profanity.

All right dude I will let it slide...you stilll have made animated gif skills!

 

[GamecockPharmD]

If NP's want to do things that physicians do, then why don't they just go to medical school?

According to some of them it's really not that much harder than nursing school. But hey, who would want to go through all those years of medical school and residency when you could achieve the same ability to diagnose and treat diseases by spending lesser time in nursing school.

I wonder if in the nursing school interview rather than asking the candidates "why do you want to be a nurse" they ask "what don't you like about nursing, and how resolved are you to change the profession".

I understand your point, but roles of professionals are expanding all the time. Why should more qualified, highly-trained physicians be bothered with mundane things such as patients going to the ER for sinus infections and sprained ankles? I don't think this takes anything away from you guys. Those nurses that claim that med school is not that much harder than nursing school don't have a clue. I think in general, NPs are pretty competent. The RNs with associates degrees that think they know everything are the ones I have a problem with. There needs to be more done about the GP shortage. I know with Obama's plan their pay is going to go up, but I think health care reform in general will may sway some people in deciding not to go into health care, just because of the factor of the unknown. I feel like this plan will not do anything about the GP shortage, so roles will have to evolve.

 

[MountainPharmD]

If NP's want to do things that physicians do, then why don't they just go to medical school?

According to some of them it's really not that much harder than nursing school. But hey, who would want to go through all those years of medical school and residency when you could achieve the same ability to diagnose and treat diseases by spending lesser time in nursing school.

I wonder if in the nursing school interview rather than asking the candidates "why do you want to be a nurse" they ask "what don't you like about nursing, and how resolved are you to change the profession".

I can see it now. Nursing school interviews will be about weeding out all the candidates who actually want to be nurses.

 

[MountainPharmD]

I understand your point, but roles of professionals are expanding all the time. .

Why are health professions expanding? Are patients demanding it? Are patients out there clamoring for Doctors of Nursing because they don’t feel their nurse is qualified enough? No, they are not. The same argument can be made of the PharmD degree. The PharmD option has been around forever. Why did it become the entry level degree into the profession? Did patients demand better qualified Pharmacists? No, it was the Schools of Pharmacy jumping on the band-wagon to make more money like all the other schools.

Why should more qualified, highly-trained physicians be bothered with mundane things such as patients going to the ER for sinus infections and sprained ankles? .

Seriously? An argument for DNP and NP is so they can handle the "mundane" tasks. That is not what they are trying to do. They want to be consider on the same level as physicians. Do we then create another level that handles the "mundane" tasks? When does it stop?

There needs to be more done about the GP shortage. I know with Obama's plan their pay is going to go up, but I think health care reform in general will may sway some people in deciding not to go into health care, just because of the factor of the unknown. I feel like this plan will not do anything about the GP shortage, so roles will have to evolve.

Now you are getting the problem. There needs to be something done about the GP shortage. Pushing out more under qualified people is not an answer. Addressing the problem and increasing the supply of primary care Doc's is the answer. Addressing the pay inequity between specialists and primary care Doc's, addressing the high cost of medical school these are things to look at.

If a nurse or pharmacist or any other healthcare professional wants to diagnose and treat patients then create incentives. Incentives to encourage these highly qualified people to apply to medical school so they can became primary care Doc's. The answer is not creating a bunch of ancillary programs that let people back door into it. The bottom line if you want to practice medicine, go to med school!

 

[xiphoid2010]

Guys guys, let's be fair. This issue really boils down to at least 2 different major points.

(1) quality of practice.
(2) cost of practice.

Now (1), I think we can all agree that an NP is good enough for drawing some labs, treating some simple UTI/RTI, treat the cholesterol problems, and other minor conditions. We just need to make sure that the complicated disease states gets referred to MDs. As long as there are rules set in place to ensure that, and have consequences for not doing that, then I think that system is quite reasonable for using NPs in that capacity.

Now (2). Is it cost effective? This comes down to (a) is the cost/payment scale reasonable and (b) are there extra cost not factored into the system.

(a) the payment system probably isn't very reasonable as it stands. The cost of creating an NP = 6 years and $80K in tuitions. The cost of creating a family doc = 11 years and $200K in tuitions. Reimbursing NP at 85% (or WTF! 100%) of MD's? Somebody is laughing all way to the bank and somebody is getting ripped off. I let you guess who's who.

(b) the hidden cost. So you go to an NP, you cellulitis looks al little funny, now you have to go see another MD anyway. Now the system has to pay both. And what about other incidental conditions/findings that an MD might catch but an NP might miss? With only a 15% reimbursement difference, all it takes is 1 out of 7 patients get refered+missed to wipe out any direct cost-saving to the system. Then you pile on the indirect cost to the patient and the society, that goes way up.

Put 1 and 2 together, the system of using NPs may offer more health care access, but at a reduced quality and a disproportionally higher cost to the society. There are several ways to fix this, we can start by reducing the reimbursement rate, and use the money saved to increase the reimbursement rate of primary care physicians and students going into family practice.

 

[GamecockPharmD]

Now you are getting the problem. There needs to be something done about the GP shortage. Pushing out more under qualified people is not an answer. Addressing the problem and increasing the supply of primary care Doc's is the answer. Addressing the pay inequity between specialists and primary care Doc's, addressing the high cost of medical school these are things to look at.

If a nurse or pharmacist or any other healthcare professional wants to diagnose and treat patients then create incentives. Incentives to encourage these highly qualified people to apply to medical school so they can became primary care Doc's. The answer is not creating a bunch of ancillary programs that let people back door into it. The bottom line if you want to practice medicine, go to med school!

You're right, the patients are not demanding the expansion of roles of other professionals. I just feel that unless the root of the problem is fixed, which is increasing the amount of GPs that are available, this will continue to happen. I agree with you that pharmacists, nurses, whatever should not attempt to be on the same level as physicians. In the article, I overlooked that "these nurses with advanced degrees want the right to practice without a doctor's watchful eye." After reading the article again, it looks like they want a separate but equal status. I don't have a problem with them having a little more power, but there still should be a supervising physician and protocols in place. However, I feel if these services were valued more, other professionals would not feel the need to increase their credentials. Likewise, I won't argue your point about making the PharmD the mandatory entry-level degree. Charging students more for tuition was definitely a driving factor, and it looks like this is also the case with the DNP. Incentives for other professionals to switch over is a great idea. Getting the cost of school down would help tremendously. Cost is one of the reasons I did not go to med school.

 

[confettiflyer]

A lot of my friends opted into NP programs because it's more cost-effective on their end. They had the credentials to get in and get into practice sooner whereas applying into an MD program would have added 2-3 years on top of their 4 years of undergrad just to get in (their GPA's were mediocre for MD standards, median for NP admissions) + residency, etc...

People make rational choices, so yes, the system needs to be changed to give incentives to go into primary care. Not just money...QOL comes into play as well.

Didn't the same thing happen with anesthesia? There was a ridiculous shortage and that got filled in by mid-levels (if I remember correctly, I might not be).

Secondary discussion is...can the same thing happen to pharmacy? Maybe the end of the shortage is a good thing, imagine....PNP - Pharmacy Nurse Practitioner coming in to fill the gap had the shortage expanded and continued, who the hell knows.

 

[Ilikechemicals]

Seeing a NP (as a pharmacist) isnt a bad thing since you can cut to the chase and tell them what to prescribe for you. Not like those MDs that have to poke and prod everything.

 

[thedrunkenpharm]

You must live in NC. Hopefully I'll be getting licensed there in the next few months. Do you know if CPPs need a residency? I'm sure they do but I could be wrong.

CPP's do not need a residency. You just need 3 years of experience after Pharm.D and develop a relationship with a physician. You work under a certain protocol (e.g. anti-coag clinics).

Only caveat to CPP: you need 35 hours of CE to maintain liscensure. 8 of those hours must be live. Alternatively, you could use a Continuing Professional Development program to meet all hours.

 

[pinksparkly]

Here is a comment from a patient's point of view:

I see a CNM (certified nurse midwife) for all of my well-woman care. She does not just attend births - she does pap smears, inserted my IUD, sore throats, maintenance meds, etc. She is awesome.

The reason that I choose to see her (or the other two CNMs in the practice) is that she actually listens to what I have to say and addresses my concerns. She does not look at her watch constantly. She will sit down and explain things, ask how my life is going. She is respectful and gentle when doing internal exams. These are all things that are not of the same quality when I see an MD. When I see my midwife, I don't feel like another widget on the medical assembly line.

If nurses are a growing segment of the healthcare sector, it does not surprise me in the least. As a patient, it is nice to feel like you are getting patient care.

 

[Carboxide]

Here is a comment from a patient's point of view:

I see a CNM (certified nurse midwife) for all of my well-woman care. She does not just attend births - she does pap smears, inserted my IUD, sore throats, maintenance meds, etc. She is awesome.

The reason that I choose to see her (or the other two CNMs in the practice) is that she actually listens to what I have to say and addresses my concerns. She does not look at her watch constantly. She will sit down and explain things, ask how my life is going. She is respectful and gentle when doing internal exams. These are all things that are not of the same quality when I see an MD. When I see my midwife, I don't feel like another widget on the medical assembly line.

If nurses are a growing segment of the healthcare sector, it does not surprise me in the least. As a patient, it is nice to feel like you are getting patient care.

Maybe you just need a better doctor. Mine knows me by name and face. I can always get a same-week appointment, and usually a same-day. I've never, ever felt rushed out of her office. She's super awesome, and I'm devastated that I have to get a new one when I move in August...

 

[pinksparkly]

Maybe you just need a better doctor.

I have seen many doctors - it took until the age of 27 to find a good care provider.

In reality, a lot of it has to do with the pressure for doctors to see X amount of patients/hour - around here almost all doctors are part of one health system or another. The place I go to is run by one CNM that was a sole practitioner for years, now she has two additional CNMs to spread out call. She runs things how she sees fit, and that includes scheduling plenty of time for each patient.

 

[Sparda29]

Maybe you just need a better doctor. Mine knows me by name and face. I can always get a same-week appointment, and usually a same-day. I've never, ever felt rushed out of her office. She's super awesome, and I'm devastated that I have to get a new one when I move in August...

I need to find a new MD as well. I usually go in to the office with a list of things that I want to discuss but every ****ing time I omit a couple of things because the MD seems to be in a rush and then you feel guilty for slowing them down. The practice that I go to is just way too big and I hate the waiting room at the office because:

#1 - The TV always has Fox News on it. (Are they purposely trying to stress out the patients? They should put something like ESPN on.)

#2 - Most of the patients are geriatrics.

 

[RNtoPharmD]

I know. In reality, NPs are still needed to provide care for people who can not afford the elite care from MD as long as they are adequately trained.

As a middle-class pharmacist, you probably can afford to pay higher to see a physician.

"Doctors charge anywhere from $1,500 per person per year up to $25,000 or more for a family." I think pharmacist probably can afford that amount with >$90,000 salary.

http://www.msnbc.msn.com/id/34019606/ns/health-health_care/

So, don't worry, if you can afford it, they will make sure that you will always see a physician, not a nurse practitioner.
I am sorry to be sarcastic but I am just tired of seeing turf-war in healthcare.

 

[OldPharm]

America should follow what Germany does with titles. Only people with PhDs can use the title "Dr."

 

[clachan3]

To bring this all back to Pharmacy I would like to point out how silent and un-aggressive our national organizations have been. I am not suggesting they should be pushing for Pharmacists to considered equal to MD's like the DNP's are. Seems to me this is a good time to get out there and push for Pharmacies role in primary care. Things like collaborative practice agreements and the like to help primary care physicians manage their patient’s medications once they have diagnosed them.

I couldn't agree more either