"Nursing Physicians and Clinicians"

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Old_Mil

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http://careers.unitedhealthgroup.com/career-areas/nursing-physicians-and-clinicians.aspx

So, what is a "nursing physician"?

A> A physician who was recently injured and his in rehab.
B> A female physician who just had a baby and is breastfeeding it.
C> The profession formerly known as "nurse practitioner."
D> A & B
E> None of the above.

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Ridiculous!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Only a matter of time my friends.....Only a matter of time.......
 
http://careers.unitedhealthgroup.com/career-areas/nursing-physicians-and-clinicians.aspx

So, what is a "nursing physician"?

A> A physician who was recently injured and his in rehab.
B> A female physician who just had a baby and is breastfeeding it.
C> The profession formerly known as "nurse practitioner."
D> A & B
E> None of the above.

Let's say it's "C"...will these nurse-octors finally be subject to press ganey and things like door to noctor time? Will there finally be some sort of push factor to encourage them to complete tasks, or will they have protected time for the important stuff like zappos, facebook, and candy crush?
 
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part of me thinks they are bad at grammar.... "nursing, physicians and clinicians"
 
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C- PhD in nurse practitioner, ie, "Doctor nurse." PhD in PA-ing is in the same category. "Doctor" or "physician" has been diluted to mean practically nothing anymore. The only thing anyone really understands anymore is "real doctor."

"Sir, all you really have to know is, I'm a 'real doctor'."

That actually gets the point across better than anything, and is the only description that means anything anymore or that anyone understands.
 
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part of me thinks they are bad at grammar.... "nursing, physicians and clinicians"

Yea, I don't see any other clinical categories under their career areas so I would agree that it's just a case of missing punctuation...

Edit: Then again it doesn't look like they even employ enough physicians (none listed under the careers ab on that page) to have a tab for them so maybe it is trying to coin a new term for NP's.
 
But guys. Nurses publish things. Therefore they are the educational equivalent of a physician. Haven't you read their studies that say how great they are? Here's an interesting study published by a nurse.

"Make your office alcohol exposed pregnancy prevention friendly."

*fans flames*

http://www.ncbi.nlm.nih.gov/m/pubmed/21916382/
 
there is a live chat with their "nursing physicians and clinicians" recruiter each wednesday from 10-12 CT.....someone should go on and ask them what they mean
 
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But guys. Nurses publish things. Therefore they are the educational equivalent of a physician. Haven't you read their studies that say how great they are? Here's an interesting study published by a nurse.

"Make your office alcohol exposed pregnancy prevention friendly."

*fans flames*

http://www.ncbi.nlm.nih.gov/m/pubmed/21916382/

Sadly some of the dnp/phd nurses believe that. I worked with one that got pissy that a transferring doc wanted to speak to another doc. Gets off the phone and says I know more than a physician because I had to do a thesis but they don't....smh on so many levels about that statement.

For total disclosure I had a PA colleague say something similar (not needing a SP) and I bs you not 20 mins later missed a SAH on a ct that the said person was trying to say was negative.
 
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Let's say it's "C"...will these nurse-octors finally be subject to press ganey and things like door to noctor time? Will there finally be some sort of push factor to encourage them to complete tasks, or will they have protected time for the important stuff like zappos, facebook, and candy crush?

Careful what you wish for. NP's have historically done very well with such metrics. The problem is that meaningful outcome measures (i.e. the stuff we should care about) are difficult to measure.
 
This is one of the things that frustrates me about people that go on and on about interprofessional education. Say what you want about it, but there is a reason why a physician is a physician and goes through years of training. I feel like a lot of other professions, especially nurses and PAs think they can act on the same level of physicians because they've practiced for X number of years. Sure, some doctors are a-holes, but there are plenty of other people in the healthcare field that are like that and in everyday life. If I have to hear another pre-med or someone else tell me I need to move to rural areas to take care of the most underserved areas or that we all equally contribute on a health care team, I will projectile vomit on them. There is hierarchy in medicine for a reason.

/end rant.

Back to Step 2 studying.
 
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Careful what you wish for. NP's have historically done very well with such metrics. The problem is that meaningful outcome measures (i.e. the stuff we should care about) are difficult to measure.

Because looking up where a new patient is on the track board and promptly racing to that room to introduce yourself and offer a cold beverage before the patient even has a chance to gown-up is WWWAAAAAYYYYYYYYY more important than missing a SAH or any true medical outcome.

Happy patient with missed SAH >>>>>>> unhappy patient with promptly diagnosed & treated SAH every time according to the metrics.

Press Ganey scores remain in top 0.01%. Crisis averted. Prompt promotion to ED chair/director. Purple heart, silver star, key to city as well. Family of deceased patient with missed SAH ecstatic that you were there to greet patient within 3 minutes of their arrival and agree to give you patient's life insurance policy as a debt of gratitude for your resplendent customer service skills. Named president of ACEP upon which you promptly decree that not only does NP = MD, but that NPs need even LESS training and that after being an ED nurse for 1 year you can just do a 1 month online NP rotation and then be an MD/DO. Emergency Medicine as a field is saved.
 
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Let's say it's "C"...will these nurse-octors finally be subject to press ganey and things like door to noctor time? Will there finally be some sort of push factor to encourage them to complete tasks, or will they have protected time for the important stuff like zappos, facebook, and candy crush?
Don't you ever talk bad about candy crush :) It's the perfect thing for soothing the rage that comes from nothing being done on your patients for hours.
 
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Sadly some of the dnp/phd nurses believe that. I worked with one that got pissy that a transferring doc wanted to speak to another doc. Gets off the phone and says I know more than a physician because I had to do a thesis but they don't....smh on so many levels about that statement.

For total disclosure I had a PA colleague say something similar (not needing a SP) and I bs you not 20 mins later missed a SAH on a ct that the said person was trying to say was negative.

In med school I worked with an NP on my surgical rotation who just got her DNP and went around insisting that everyone refer to her as "Dr. soandso." I remember thinking that that was a great way to confused the **** out of the patients.
 
will these nurse-octors finally be subject to press ganey and things like door to noctor time?

For the people who think that the solution to all problems is more independent midlevels, I suspect that the real rude awakening will come when those midlevels start getting sued for malpractice just like physicians, start getting hit with verdicts like physicians, and start getting charged malpractice-insurance premiums just like physicians. Suddenly, it's going to look like less of a bargain to everyone involved.
 
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For the people who thinks that the solution to all problems is more independent midlevels, I suspect that the real rude awakening will come when those midlevels start getting sued for malpractice just like physicians, start getting hit with verdicts like physicians, and start getting charged malpractice-insurance premiums just like physicians. Suddenly, it's going to look like less of a bargain to everyone involved.
Amen, to that.
 
For the people who thinks that the solution to all problems is more independent midlevels, I suspect that the real rude awakening will come when those midlevels start getting sued for malpractice just like physicians, start getting hit with verdicts like physicians, and start getting charged malpractice-insurance premiums just like physicians. Suddenly, it's going to look like less of a bargain to everyone involved.

They're probably going to hide behind the coattails of the real doctors just like they do in anesthesia. High pay, low educational investment, little responsibility with the added perks of being able to ignore the doctor's orders while calling themselves doctor.
 
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Careful what you wish for. NP's have historically done very well with such metrics. The problem is that meaningful outcome measures (i.e. the stuff we should care about) are difficult to measure.

I suppose I agree to a point...especially on the current metrics being ludicrous. It's frustrating when NPs continually assert their equivalence to us despite glaringly obvious differences in training, patient load, responsibility, patient acuity/complexity...(the list could go on and on)...and, ultimately, expected outcomes in terms of morbidity and mortality. Then they try play the "patient satisfaction" card that the (bogus) metrics are designed around and then thump their chest when the "system" is allowing them more time to sit and talk with patients and over-order tests and over-prescribe medicine...both of which tend to makes patients more "happy." All the while the best data available shows that this is bad for patients ( http://www.ncbi.nlm.nih.gov/pubmed/22331982 ). Yet nobody in a position of meaningful power has the stones to highlight this in any public fashion in an attempt to change the system for the better.

So yeah, while I acknowledge that it may be "risky" to allow them to compete with us over the current backwards and meaningless metrics...there are times when I'd love for them to compete with us on a totally even playing field. Let's see how much time they'd have to talk with their patients while an admin breaths down their neck to meet a door to pt time. Let's see how loud the self-aggrandizing drums would thump if NPs who chose to practice independently needed to have their own malpractice equivalent to an MD. Trial lawyers would foam at the mouth and shift their crosshairs from us to them overnight while rates of MD's being sued would go down instantaneously. I can picture the court room now:

Trial Lawyer Bob: "So, Nurse-Doctor, you advertise yourself as being equivalent to a physician--is that correct?"
Nurse-Doctor: "Yup."
Trial Lawyer Bob: "Yet, by failing to __[insert your favorite flub here]__ you breached the standard of care followed by physicians and we have a line of doctors who went to medical school waiting to testify as such."
 
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http://careers.unitedhealthgroup.com/career-areas/nursing-physicians-and-clinicians.aspx

So, what is a "nursing physician"?

A> A physician who was recently injured and his in rehab.
B> A female physician who just had a baby and is breastfeeding it.
C> The profession formerly known as "nurse practitioner."
D> A & B
E> None of the above.
I'm guessing UnitedHealth group is an insurance company? I like how the video on the right refers to patients as "clientele". Figures as it's held by hedge fund managers: http://www.forbes.com/sites/joelkor...10-fund-managers-all-hold-unitedhealth-group/
 
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For the people who thinks that the solution to all problems is more independent midlevels, I suspect that the real rude awakening will come when those midlevels start getting sued for malpractice just like physicians, start getting hit with verdicts like physicians, and start getting charged malpractice-insurance premiums just like physicians. Suddenly, it's going to look like less of a bargain to everyone involved.
Just ask the VA which changed it's rules recently, if I remember correctly. Don't worry once they're sued they will quickly hide behind physicians and point the fingers at them for not supervising them.
 
Alright. I'm as much a supporter of a good Physician's Assistant or Nurse Practitioner as anyone, and I certainly believe midlevels play an important role. However, somebody's got to tell it like it is, since none of the rest of you will:

Despite all of the talk about "extenders" and "midlevels" being the saviors of our healthcare system, by reducing "cost," and "unnecessary" and expensive physician care, not a damn one of these hypocritical politicians, so-called policy makers and administrators themselves goes to only a midlevel, NP, PA or doctoral version thereof.

Not a single damn one. Not Barack, not Michelle and not for Sasha and Malia. Not Pelosi or Harry Reid nor the President of ACEP nor the AMA. Not Dr. Ezekiel Emanuel who they consulted to design their beloved "system of saviors" nor his brother Rahm.

This is their plan for the masses, the little people and for you, but absofrickinlutely NOT for themselves and their crew.

THEY

WANT

THE DOCTOR,


for themselves and to save "costs" at YOUR expense. Not only do they want "the doctor," they want THE BEST doctor, at the higher institution of their choosing. A real doctor. One that went to medical school and as damn many residencies and fellowships as is humanly possible.

Now that's the cold, hard, truth.
 
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Alright. I'm as much a supporter of a good Physician's Assistant or Nurse Practitioner as anyone, and I certainly believe midlevels play an important role. However, somebody's got to tell it like it is, since none of the rest of you will:

Despite all of the talk about "extenders" and "midlevels" being the saviors of our healthcare system, by reducing "cost," and "unnecessary" and expensive physician care, not a damn one of these hypocritical politicians, so-called policy makers and administrators themselves goes to only a midlevel, NP, PA or doctoral version thereof.

Not a single damn one. Not Barack, not Michelle and not for Sasha and Malia. Not Pelosi or Harry Reid nor the President of ACEP nor the AMA. Not Dr. Ezekiel Emanuel who they consulted to design their beloved "system of saviors" nor his brother Rahm.

This is their plan for the masses, the little people and for you, but absofrickinlutely NOT for themselves and their crew.

THEY

WANT

THE DOCTOR,


for themselves and to save "costs" at YOUR expense. Not only do they want "the doctor," they want THE BEST doctor, at the higher institution of their choosing. A real doctor. One that went to medical school and as damn many residencies and fellowships as is humanly possible.

Now that's the cold, hard, truth.
true, I couldn't imagine anyone of them saying "I want your top medical provider with the least clinical training hours.....who holds an advanced degree outside of clinical medicine"
 
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They're probably going to hide behind the coattails of the real doctors just like they do in anesthesia. High pay, low educational investment, little responsibility with the added perks of being able to ignore the doctor's orders while calling themselves doctor.

Don't worry once they're sued they will quickly hide behind physicians and point the fingers at them for not supervising them.

Ah, but they're asking to be able to practice independently, which, if granted, will remove the hiding place. Here, I've seen several suits against CRNAs who had no physician to hide behind or point the finger at.

Also, in an ironic twist, we represented a PA once in a case where the plaintiff opted to simply dismiss the supervising MD, who had an expensive $200K malpractice policy (and actually did have little direct role in the alleged malpractice), in favor of pursuing the PA and his very cheap $1 million policy. But after a lawsuit or two, and certainly the more independent NPs and PAs get to practice, the more the malpractice insurers will view them as a risk, and they will price the policies accordingly.
 
Alright. I'm as much a supporter of a good Physician's Assistant or Nurse Practitioner as anyone, and I certainly believe midlevels play an important role. However, somebody's got to tell it like it is, since none of the rest of you will:

Despite all of the talk about "extenders" and "midlevels" being the saviors of our healthcare system, by reducing "cost," and "unnecessary" and expensive physician care, not a damn one of these hypocritical politicians, so-called policy makers and administrators themselves goes to only a midlevel, NP, PA or doctoral version thereof.

Not a single damn one. Not Barack, not Michelle and not for Sasha and Malia. Not Pelosi or Harry Reid nor the President of ACEP nor the AMA. Not Dr. Ezekiel Emanuel who they consulted to design their beloved "system of saviors" nor his brother Rahm.

This is their plan for the masses, the little people and for you, but absofrickinlutely NOT for themselves and their crew.

THEY

WANT

THE DOCTOR,


for themselves and to save "costs" at YOUR expense. Not only do they want "the doctor," they want THE BEST doctor, at the higher institution of their choosing. A real doctor. One that went to medical school and as damn many residencies and fellowships as is humanly possible.

Now that's the cold, hard, truth.

I am confident that things will get worse before they get better, but this - this right here, is why I'm not really that worried about my job security in the long run.
 
Do any hospitals or groups have internal regulations or guidelines on use of the term "doctor"?
good question, I know the state board of nursing does and if so they have to do a certain intro like (very proudly and loudly) "Hi I am dr bob" ....(then whisper) "your nurse practioner"
most places are requiring your title be displayed boldly on a placard as well as your ID. "attending physician, resident physician, nurse practioner, lab tech....etc" or simple as MD or RN
 
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most places are requiring your title be displayed boldly on a placard as well as your ID. "attending physician, resident physician, nurse practioner, lab tech....etc" or simple as MD or RN

It's state law where I'm at, that you must wear ID with your official title/degree on it, while in a hospital.

Personally I think it's a very bad start to the patient encounter, if you've led them to believe you're something you're not, then something goes wrong. Then they come to find out you weren't as advertised and then the imagination starts, "What if?" and "I was misled" and "Would the outcome have been different if I got to ask for the ------?" This is blood in the water for plaintiffs' attorneys and they have an amazing talent for sniffing this stuff out and feeding on it.

I personally would want no part of that. It's bad medico-legally, its unethical and just plain bad karma. It's fun being captain of the ship until the ship runs aground. Then everyone wants the captain's head. Be careful what you wish for.
 
PhD in PA-ing is in the same category.

I don't know of a single PA with a PhD who introduces him/herself as "doctor" in a clinical setting. Academic settings are, of course, different, but we know better than to do that in the clinical settings. Furthermore, the first Pharm/PT/Audiologist/NP/Plumber with a PhD in Music who introduces themselves to my patient as a "Doctor" will be quickly corrected.
 
Sadly some of the dnp/phd nurses believe that. I worked with one that got pissy that a transferring doc wanted to speak to another doc. Gets off the phone and says I know more than a physician because I had to do a thesis but they don't....smh on so many levels about that statement.

For total disclosure I had a PA colleague say something similar (not needing a SP) and I bs you not 20 mins later missed a SAH on a ct that the said person was trying to say was negative.

Missing a SAH does not mean you need a SP. I'm guessing many EPs, who earned the privilege of practicing unsupervised, have missed a SAH.

There is, unfortunately, a growing number of PAs who feel they need no supervision. This is a result of chasing the politically powerful NPs who achieve that status legislatively, and the concomitant increase in administrators who would rather hire a NP over a PA exactly BECAUSE they don't have to hire a physician to supervise.
 
They're probably going to hide behind the coattails of the real doctors just like they do in anesthesia. High pay, low educational investment, little responsibility with the added perks of being able to ignore the doctor's orders while calling themselves doctor.

High pay? I make probably 1/3 of what you make. Low educational investment? While I had Uncle Sam pay for mine, many of my cohorts graduate with $150K in debt. While I believe this is about 1/2 of what the average physician graduates with, it certainly does not constitute "low educational investment". Little responsibility? I work single coverage in a community ED, with a doc on the phone. Not sure that equals "little responsibility". I am sure the hospital would LOVE to hire an BE/BC emergency physician, but they can barely make payroll as it is. Add another million a year to pay for BE/BC Docs and the community finds itself without a hospital.
 
I don't understand why Emergency Physicians allow PAs and NPs to be hired in their place of work in the first place.

Two reasons: If you manage us correctly, we can dramatically reduce your workload while making you a lot of money.
 
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Missing a SAH does not mean you need a SP. I'm guessing many EPs, who earned the privilege of practicing unsupervised, have missed a SAH.

There is, unfortunately, a growing number of PAs who feel they need no supervision. This is a result of chasing the politically powerful NPs who achieve that status legislatively, and the concomitant increase in administrators who would rather hire a NP over a PA exactly BECAUSE they don't have to hire a physician to supervise.

I agree with you about the missing a Dx can happen to any of us but being so cocky with our limited clinical education(no residency is what I mean) should let our colleagues(both PA/NP) practice with caution.
 
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If you're running around in a white coat, not making your position (doctor, NP, and PA) known is almost as bad as lying. The average person is clueless.
 
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So, one of the most common reasons I hear for supporting the expansion of mid-levels is "reduced costs". BUT, other than the fact that they are payed less, is there any consistent evidence that they actually produce decreased health care expenditures? I've done some cursory searches and the evidence appears mixed, and the majority of it seems to come from Europe. One thing that seems to be common is that they spend more time with patients, they prescribe more, and they order more tests. None of that is cheaper and has many downstream consequences that can increase healthcare cost. This aspect of mid-level care rarely gets the attention it deserves despite the fact that it could blow the whole "cheaper" argument out of the water.
 
I agree with you about the missing a Dx can happen to any of us but being so cocky with our limited clinical education(no residency is what I mean) should let our colleagues(both PA/NP) practice with caution.

Absolutely. Cockyness flies in the face of "There but for the grace of God go I".
 
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So, one of the most common reasons I hear for supporting the expansion of mid-levels is "reduced costs". BUT, other than the fact that they are payed less, is there any consistent evidence that they actually produce decreased health care expenditures? I've done some cursory searches and the evidence appears mixed, and the majority of it seems to come from Europe. One thing that seems to be common is that they spend more time with patients, they prescribe more, and they order more tests. None of that is cheaper and has many downstream consequences that can increase healthcare cost. This aspect of mid-level care rarely gets the attention it deserves despite the fact that it could blow the whole "cheaper" argument out of the water.

Another way of looking at this is asking WHO is getting the reduction in costs. I agree data is mixed on whether mid-levels reduce cost for our healthcare system overall (generally due to increased testing). However we can reduce costs for the hospitals by being paid far less than physicians, AND we can reduce the burden on physicians by helping out with jobs/shifts thus reducing burnout....a significant "cost" to the profession.

As an aside, I am often forced to overtest simply because I have to call my attending (ie: SP for the day/night) to convince him/her that the patient needs to be admitted or shipped. I would assume most EM docs can relate to this due to their time in residency.
 
Two reasons: If you manage us correctly, we can dramatically reduce your workload while making you a lot of money.
Except Emergency Physicians don't OWN a hospital ER. The hospital does. So then physicians shouldn't be surprised when hospital admins want to replace physicians themselves with PAs and NPs.
 
So, one of the most common reasons I hear for supporting the expansion of mid-levels is "reduced costs". BUT, other than the fact that they are payed less, is there any consistent evidence that they actually produce decreased health care expenditures? I've done some cursory searches and the evidence appears mixed, and the majority of it seems to come from Europe. One thing that seems to be common is that they spend more time with patients, they prescribe more, and they order more tests. None of that is cheaper and has many downstream consequences that can increase healthcare cost. This aspect of mid-level care rarely gets the attention it deserves despite the fact that it could blow the whole "cheaper" argument out of the water.
Why in God's name would hospital executives want DECREASED expenditures? If anything they're perfect: They tend to overprescribe, order more tests, order more imaging. They're a radiologists dream.
 
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Except Emergency Physicians don't OWN a hospital ER. The hospital does. So then physicians shouldn't be surprised when hospital admins want to replace physicians themselves with PAs and NPs.

The the EDs in larger hospitals in my area, the only ones who have BE/BC EM docs, are run by EM physician groups who hire the mid-levels. They also bill for the mid-level while taking their "cut".

The community hospital EDs I work in are run by the hospital. If PAs didn't help cover, the docs would quickly burn out.
 
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Why in God's name would hospital executives want DECREASED expenditures? If anything they're perfect: They tend to overprescribe, order more tests, order more imaging. They're a radiologists dream.
Depends on payor mix. Over-testing only works financially in a situation where there is a minimal self-pay/Medicaid population. Otherwise you're generating lots of bills but consuming lots of expensive resources that won't be reimbursed. Also, LOS concerns are going to make it uncomfortable in the future for the usual "labs-CT-U/S-then pelvic" belly pain w/u to continue in it's current state of viability.
 
Depends on payor mix. Over-testing only works financially in a situation where there is a minimal self-pay/Medicaid population. Otherwise you're generating lots of bills but consuming lots of expensive resources that won't be reimbursed. Also, LOS concerns are going to make it uncomfortable in the future for the usual "labs-CT-U/S-then pelvic" belly pain w/u to continue in it's current state of viability.

This seems to be very true in rural hospitals(at least where I worked-> we had very large uninsured populations).

I remember something on the ct scanner broke and there was a 20k bill which was a big deal because the facility didn't have a huge cash reserve.
 
Except Emergency Physicians don't OWN a hospital ER. The hospital does. So then physicians shouldn't be surprised when hospital admins want to replace physicians themselves with PAs and NPs.

This.
 
Except Emergency Physicians don't OWN a hospital ER. The hospital does. So then physicians shouldn't be surprised when hospital admins want to replace physicians themselves with PAs and NPs.

THIS.
 
Except Emergency Physicians don't OWN a hospital ER. The hospital does. So then physicians shouldn't be surprised when hospital admins want to replace physicians themselves with PAs and NPs.

And THIS!!!!!!!!!!!!!!!!

It is idiotic to think otherwise! Anesthesia thought they were safe too! We need to take a collective stand! PAs for most part recognize their role...But NPs!?!?!?!?

IMHO, this is a huge elephant in the room and simply saying "we have more experience, training, intelligence, ________ (whatever) and we're irreplaceable" is absurd, yet I hear it all the time from many of my faculty.

(another anecdote which occurred on shift yesterday: adolescent male comes in with SEVERELY altered mental status (didn't know where he was, non-sensical fragmented speech, GCS well below 15), bilateral battles signs, ecchymosis all over face, neck pain, etc after pretty bad bicycle accident....From the doorway (Re: less than 3 seconds of seeing patient) I whisper to staff that patient needs head CT and cervical CT (at minimum). But this is an NPs patient......NP is in room for about 20ish minutes and comes out and says "patient looks pretty stable, probably just needs a neck x-ray." Well, kid had a large open, depressed skull fracture amongst many other findings....so after he was admitted to Neurosurgery and booked for urgent OR case by the attending physician the NP says to one of the nurses that "I feel like I can handle most any trauma patients."

Sure, this is N=1. But there is a HUGE difference between a residency trained MD/DO and an NP...Especially as things start to "get real."
 
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And THIS!!!!!!!!!!!!!!!!

It is idiotic to think otherwise! Anesthesia thought they were safe too! We need to take a collective stand! PAs for most part recognize their role...But NPs!?!?!?!?

that's an excellent point. it use to be NP had a limited role, just 4-5 specialties. now they're >26 specialties and wanting equality, including prescriptive authority without putting in the time.....but not the responsibility of solo practice.
Two reasons: If you manage us correctly, we can dramatically reduce your workload while making you a lot of money.
all the PA's I've spoke with have a similar thought process which is, we're here to assist. use us, teach us, manage us. but i a not getting this from the DNP side. last mo we were discussing a case and I had a NP say to me "although i just graduated last year, I am equivocal to a 2nd yr EM resident b/c I worked 1 yr at an urgent care clinic." I corrected that s&*t real quick.

physicians opinions are all over SDN on this topic but I haven't seen posting from a PA. boatswain, what's your take on this?
 
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Why in God's name would hospital executives want DECREASED expenditures? If anything they're perfect: They tend to overprescribe, order more tests, order more imaging. They're a radiologists dream.
Hospital exec absolutely don't want decreased expenditures. If you ever hear one claim that, its bulli**** public relations and marketing to sound politically correct. The more money spent, made, the better. People running the Medicare and Medicaid programs want less expenditures, in theory, but I don't think they really care that much, because its not their money (its the taxpayers') and they have an easy solution: just cut payments to doctors as a correction.
 
Why the heck are you guys so worried about mid-levels? Do you have an inferiority complex? Are you afraid they are "just as good" and you won't be needed?

I'm 100% all for independent practice for midlevels. ABSOFRICKINLUTELY. The more independent the better. Go out there, man up, be on your own, buy your own malpractice policy without the name of any "supervising Physician" on it, run your own practice, hire your own staff, run your own add in the paper, contract with insurance companies, build your practice, market yourself, fight for referrals, claw and scratch to get and keep your midlevel-only-group ED contract and,

DONT ASK ME TO COSIGN ANY OF YOUR S--T

Or take any of the liability off your back, or cosign any of your charts, or sign off on any of your billing, or defend you in a Medicare billing audit or investigation, or defend you in court, or hire you, or fire you, or set up a cozy little work environment for you to work in, or pay for your health insurance or malpractice insurance or share overhead, or hire staff for you, or front you any salary while your practice struggles to get out of the doldrums during it's start up phase like all physicians who start a practice must do.

Work independently,

and be independent. Yes,


BE INDEPENDENT.


Man up.

How come so many PAs and NPs always want to have it both ways? How come so many want to cozy protected environment of supervision with the luxury of doctor back up, in a ready made practice environment set up for them, yet want to be considered equal, independent and interchangeable?

Why?

I'm all for it. Welcome to the club. Practice on your own.

Play ball and play it on a level playing field.

Do that and you have every pound, ounce, or gram of my respect.

But as long as somewhere in that chain of paperwork, anywhere, anytime, here, there, at the administrative office or buried in a pile in the hospital credentials office or State Medical Practice Act it says, "Supervising Doctor Birdstrike" for the lawyers to sink their teeth into, there will be a hopeless impasse between doctors like myself and midlevels that want to practice "independently."

I'm 100% in support of midlevel "independent" practice, but it needs to be exactly that and absolutely sterilized and 100% devoid of anything that resembles the riding on the coattails of physicians, or anything that involves any physician back up, liability sharing or responsibility sharing whatsoever.
 
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Why the heck are you guys so worried about mid-levels? Do you have an inferiority complex? Are you afraid they are "just as good" and you won't be needed?

I'm 100% all for independent practice for midlevels. ABSOFRICKINLUTELY. The more independent the better. Go out there, man up, be on your own, buy your own malpractice policy without the name of any "supervising Physician" on it, run your own practice, hire your own staff, run your own add in the paper, contract with insurance companies, build your practice, market yourself, fight for referrals, claw and scratch to get and keep your midlevel-only-group ED contract and,

DONT ASK ME TO COSIGN ANY OF YOUR S--T

Or take any of the liability off your back, or cosign any of your charts, or sign off on any of your billing, or defend you in a Medicare billing audit or investigation, or defend you in court, or hire you, or fire you, or set up a cozy little work environment for you to work in, or pay for your health insurance or malpractice insurance or share overhead, or hire staff for you, or front you any salary while your practice struggles to get out of the doldrums during it's start up phase like all physicians who start a practice must do.

Work independently,

and be independent. Yes,


BE INDEPENDENT.


Man up.

How come so many PAs and NPs always want to have it both ways? How come so many want to cozy protected environment of supervision with the luxury of doctor back up, in a ready made practice environment set up for them, yet want to be considered equal, independent and interchangeable?

Why?

I'm all for it. Welcome to the club. Practice on your own.

Play ball and play it on a level playing field.

Do that and you have every pound, ounce, or gram of my respect.

But as long as somewhere in that chain of paperwork, anywhere, anytime, here, there, at the administrative office or buried in a pile in the hospital credentials office or State Medical Practice Act it says, "Supervising Doctor Birdstrike" for the lawyers to sink their teeth into, there will be a hopeless impasse between doctors like myself and midlevels that want to practice "independently."

I'm 100% in support of midlevel "independent" practice, but it needs to be exactly that and absolutely sterilized and 100% devoid of anything that resembles the riding on the coattails of physicians, or anything that involves any physician back up, liability sharing or responsibility sharing whatsoever.

99.5% of time I agree with Birdstrike. Not this time. This is the typical "Bravado" response.

I'm EXTREMELY pro-physician and pro-EM physician because like most on this board, I have paid the cost to be the boss. The extremely competitive pre-medical world, competing against a lot of the best and brightest just for a chance to get in. The extremely rigorous 4 years of medical school. The non-stop intensity of residency training. I see how hard my fellow medical students, residents and attendings have worked to get to where they're at. And I respect the hell out of them for it. I respect what they've done and who they've become. I understand and appreciate how far they've come in their knowledge and skills.

So yes, I have a problem that a large cohort of people think they can be an RN, take some online courses on health law, policy and leadership, put in a few hundred light hours of patient contact and call themselves my equal. Doesn't matter that they obviously aren't. Why go to medical school? Why do residency? If all you need to do in order to independently practice medicine is to get your DNP. What of this specialty that I've grown to love? What do I tell medical students who seem equally excited about pursing EM? What about the scores of future EM physicians with 300K+ debt? Be a fully independent and EQUAL Nursing Physican (and, yes, I've gotten word that our own university NP program is now marketing themselves as Nursing Physicans) for ONE TENTH (at best) the time/skill and cost investment?

We are completely minimizing ourselves!

Again, we are hurting future EM physicians! Are Academic faculty going to care? No, they think (Re: Think) they're safe and protected in their ivory towers. They're sold a false bill of goods by administration that they're somehow helping the greater public at large by churning out more and more mid-level providers.

To think otherwise is extremely arrogant.

This isn't a question of being insecure, that's ridiculous. This is a question of an extremely cheap alternative that is pseudo-equivalent enough for MOST things in the eyes of administrators (Re: Better bottom line).

What are administrators really concerned with? Clinical outcomes.....or....The financial bottom line?

Sure, call it whatever you want. Just SAVE THIS POST. Because it is coming unless we protect ourselves. Like Anesthesia, we are minimizing ourselves. At least I'll be able to say I told you so. Though I dread the day.

I sincerely hope that I am wrong, but I fear that ultimately I won't be.
 
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