Physcian Fired for Penning Article Questioning NP-led Care

[Goro]

Here is a some data I abstracted from the Kaiser foundation which gives the number of NP and MD per 100000 people by state. The meme that NPs are allieviating rural MD is false. MA has the highest number and per capita NP population , it also has the highest number of MDs per 100000 in any state. And this data only looks at Primary Care Doctors.



"It is also false to state that NPs are alleviating any MD shortage. They are settling in states with the highest saturation of MDs .

"

One argument with your thesis is that this is only done state by state. How do we know that the NPs aren't all in Upstate NY, and the docs ae in the burbs and cities?

We really need to see this info at the county level.

Remember, the big picture here is about the maldistribution of doctors and whether or not nurse practitioners are alleviating it by going to places where doctors are not. This is still extremely murky to me.

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[762513]

One argument with your thesis is that this is only done state by state. How do we know that the NPs aren't all in Upstate NY, and the docs ae in the burbs and cities?

We really need to see this info at the county level.

Remember, the big picture here is about the maldistribution of doctors and whether or not nurse practitioners are alleviating it by going to places where doctors are not. This is still extremely murky to me.

It's not proof of anything beyond confirmation bias. As goro said, we have no idea where these providers practice, nor are you linking the study so we can read the methodology.

 

[libertyyne]

When you cite something, you provide a link or a means to quickly locate what you are referencing. I'm not going to dig up a study you want me to look at, please provide a URL.

It was not a study. I compiled the raw data from the Kaiser foundation website. The Henry J. Kaiser Family Foundation and compared it to the the Physician and Census data from the same source.

I think we are talking past each other. Lets compare terms. What's your definition of a specialty NP?

I dont know what all the alphabet soup you qouted earlier. I assumed some were nurse midwifes, Critical Care NPs, and Psych Nps. The only one that would fall under specialty care would be Critical Care NPs.

It's not proof of anything beyond confirmation bias. As goro said, we have no idea where these providers practice, nor are you linking the study so we can read the methodology.

Its funny how you keep on claiming confirmation bias, yet cant acknowledge your own bias in rejecting the data.

 

[libertyyne]

One argument with your thesis is that this is only done state by state. How do we know that the NPs aren't all in Upstate NY, and the docs ae in the burbs and cities?

We really need to see this info at the county level.

Remember, the big picture here is about the maldistribution of doctors and whether or not nurse practitioners are alleviating it by going to places where doctors are not. This is still extremely murky to me.

This might be a valid point and the data is not provided by the county level.

However, dont you think that on a state level per capita this issue would become resolved wouldnt we see large rural states with large number of NP's to overcome the lack of primary care physicians? Per capita there are fewer NPs in states like nevada , wyoming , Utah , Idaho. If your hypothesis was correct this would be not be the case.

 

[762513]

It was not a study. I compiled the raw data from the Kaiser foundation website. The Henry J. Kaiser Family Foundation and compared it to the the Physician and Census data from the same source.

I dont know what all the alphabet soup you qouted earlier. I assumed some were nurse midwifes, Critical Care NPs, and Psych Nps. The only one that would fall under specialty care would be Critical Care NPs.

Its funny how you keep on claiming confirmation bias, yet cant acknowledge your own confirmation bias in rejecting the data.

EVERYONE has some degree of confirmation bias. I reject the data because it doesn't differentiate rural from urban NP's or specialized NP's. Psychiatric NP's don't do prostate exams. Nurse midwifes don't do dementia screenings. I could go on and on. A specialty NP is more where they work, less what their credential says. There are a lot of "family" nurse practitioners who work in an inpatient environment, a trend the AACN is trying to stop. So a specialty NP works in cards, pulm, nephrology, ID, endocrine, surgey ect. They are not independent. They truly extend the physician. Your numbers are counting these people. Thats one of the reasons why what you posted not useful.

 

[libertyyne]

EVERYONE has some degree of confirmation bias. I reject the data because it doesn't differentiate rural from urban NP's or specialized NP's. Psychiatric NP's don't do prostate exams. Nurse midwifes don't do dementia screenings. I could go on and on. A specialty NP is more where they work, less what their credential says. There are a lot of "family" nurse practitioners who work in an inpatient environment, a trend the AACN is trying to stop. So a specialty NP works in cards, pulm, nephrology, ID, endocrine, surgey ect. They are not independent. They truly extend the physician. Your numbers are counting these people. That one of the reasons why what you posted not useful.

OBGYN, Pysch, Primary Care, IM are all considered primary care by the government.

If a large number of NPs are going into hospital settings and working under physicians and not fulfilling the promise of alleviating physician shortages WHY continue to advocate for independence? Even if the numbers included all the "specialty" NPs it still shows that they are displaying the tendencies that physicians display "settling in areas that are desirable to young people" like cities and suburbs of metropolitan areas. Do you not see how displaying the same patterns of settling in areas that are highly populated by physicians undermines the argument that NPs are alleviating physician shortages in rural areas? It literally is the opposite of what the NP propoganda states and the most commonly cited reason for push to full autonomy.

 

[762513]

This might be a valid point and the data is not provided by the county level.

However, dont you think that on a state level per capita this issue would become resolved wouldnt we see large rural states with large number of NP's to overcome the lack of primary care physicians? Per capita there are fewer NPs in states like nevada , wyoming , Utah , Idaho. If your hypothesis was correct this would be not be the case.

Here, let me help you. This study, a real study, not raw numbers pulled from a website, shows that in states like Maine, Vermont, Iowa, Kentucky, and Idaho NP's really are helping to alleviate the shortage of primary care in rural environments. There's some catching up to do in other states, however, the statement that "It is false to state NP's alleviate any MD shortage" is a pants on fire lie.

https://depts.washington.edu/uwrhrc/uploads/RHRC_PB143_Skillman.pdf

 

[libertyyne]

Here, let me help you. This study, a real study, not raw numbers pulled from a website, shows that in states like Maine, Vermont, and Iowa, NP's really are helping to alleviate the shortage of primary care in rural environments. There's some catching up to do in other states, however, the statement that "It is false to state NP's alleviate any MD shortage" is a pants on fire lie.

https://depts.washington.edu/uwrhrc/uploads/RHRC_PB143_Skillman.pdf

View attachment 231610

1. Your definition of a study is not my definition of a study. This is paper put out that is using public datasets like I did. LOL. No peer review involved.
2. This does nothing to compare actual shortage. What was the physican per capita prevelance in these areas?
3. This is literally not even taking into account population of these areas. what is the per capita prevelance of MD vs NPs.

Also this is clearly showing that half of All NPs are practicing in Urban areas. I would hardly call that alleviating rural shortages.

 

[762513]

1. Your definition of a study is not my definition of a study. This is paper put out that is using public datasets like I did. LOL. No peer review involved.
2. This does nothing to compare actual shortage. What was the physican per prevelance in these areas?
3. This is literally not even taking into account population of these areas. what is the per capita health care .

It's a whole lot closer to the truth than you pulling raw, statewide numbers. Rural communities are underserved more often than not. You posted a horrible conclusion from ridiculous data, I posted something much, much better.

 

[libertyyne]

It's a whole lot closer to the truth than you pulling raw, statewide numbers. Rural communities are underserved more often than not. You posted a horrible conclusion from ridiculous data, I posted something much, much better.

You sure about your data source? Because it says this

82% of NPS are in urban Areas. LOL. Man really alleviating that shortage in rural areas. Really need full practice autonomy to do so.

 

[762513]

1. Your definition of a study is not my definition of a study. This is paper put out that is using public datasets like I did. LOL. No peer review involved.
2. This does nothing to compare actual shortage. What was the physican per capita prevelance in these areas?
3. This is literally not even taking into account population of these areas. what is the per capita prevelance of MD vs NPs.

Also this is clearly showing that half of All NPs are practicing in Urban areas. I would hardly call that alleviating rural shortages.

Only about 10 percent of physicians practice in rural environments: "The physician shortage remains especially problematic in rural areas, where more than 20 percent of the U.S. population resides but only 10 percent of physicians practice, according to a position paper by the American Academy of Family Physicians (AAFP)." ... Rural physician shortage | Sponsored by Remedy Direct

The chart below shows that the lowest percentage of NP's in rural areas is 10 percent, and as high as 60 percent in Vermont. NP's actually work in rural areas in much higher percentages than MD's. So these arguments I've been hearing that NP's don't work in rural environments are lies as well.

 

[762513]

You sure about your data source? Because it says this
View attachment 231612

82% of NPS are in urban Areas. LOL. Man really alleviating that shortage in rural areas. Really need full practice autonomy to do so.

Are you sure about YOUR data set? Because my data doesn't say that. LOL. For gods sake, link your url, unless you are afraid to.

https://depts.washington.edu/uwrhrc/uploads/RHRC_PB143_Skillman.pdf

 

[libertyyne]

Are you sure about YOUR data set? Because my data doesn't say that. LOL. For gods sake, link your url, unless you are afraid to.

It is literally your dataset you linked. Is math not a prereq for NP school?

 

[762513]

It is literally your dataset you linked. Is math not a prereq for NP school?

So if just under 10 percent of physicians work in rural environments, you are saying that by percentages twice as many NP's as MD's work in rural environments? Perhaps state wide variances are a better way to look at this picture than national? In Vermont, Maine, Iowa, Kentucky and Oregon, NP's are making a big difference for the lives of rural patients. You are only proving my point, a higher percentage of NP's work in rural environment than do physicians.

 

[libertyyne]

So if just under 10 percent of physicians work in rural environments, you are saying that by percentages twice as many NP's as MD's work in rural environments? Perhaps state wide variances are a better way to look at this picture than national? In Vermont, Maine, Iowa, Kentucky and Oregon, NP's are making a big difference for the lives of rural patients. You are only proving my point, a higher percentage of NP's work in rural environment than do physicians.

Do you not see the problem in applying national rates uniformly to state levels? Do you not see the hypocrisy in asking for full practice rights based on alleviating rural physician shortages if a majority 80+ percent are going to settling in high density physician areas?

 

[762513]

Do you not see the problem in applying national rates uniformly to state levels? Do you not see the hypocrisy in asking for full practice rights based on alleviating rural physician shortages if a majority 80+ percent are going to settling in high density physician areas?

Do you see that by percentage twice as many NPs work in rural environments than MD's, and help many hundreds of thousands see providers and help to save lives? Are you that much of a protectionist that these facts don’t matter to you??

 

[libertyyne]

Do you see that by percentage twice as many NPs work in rural environments than in urban, and help many hundreds of thousands see providers and help to save lives? Are you that much of a protectionist that these facts don’t matter to you??

Do you not see why uniformly assuming the national rural average across all states is problematic?

And how NPs claiming they are alleviating MD shortages is non-sense when 80% settle where there are plenty of MD's to begin with.

Still not seeing a clear argument for full autonomy considering the paltry numbers actually settling in rural settings.

Seems like it was all propaganda all along.

 

[762513]

Do you not see why uniformly assuming the national rural average across all states is problematic?

And how NPs claiming they are alleviating MD shortages is non-sense when 80% settle where there are plenty of MD's to begin with.

Still not seeing a clear argument for full autonomy considering the paltry numbers actually settling in rural settings.

Seems like it was all propaganda all along.

Your confirmation bias is astounding. Have a good rest of your day.

 

[libertyyne]

Your confirmation bias is astounding. Have a good rest of your day.

You are the one having difficulty with basic numbers/math .im sorry your lobby disseminates propoganda that isn't supported by facts. And that you bought into that propoganda. Have a good day.

 

[jrlob91]

If NPs wanted to do the work of a doctor, they should have gone to school to be a doctor. Not sure why they can’t wrap their brains around that fact. It’s baffling to me how anyone can argue otherwise.

 

[AnatomyGrey12]

4- I don't need to post anything until you post something that isn't a trash inference.

This is real rich coming from you lol

You posted a horrible conclusion from ridiculous data, I posted something much, much better.

You and the entire world of science have very different definitions of “much better.” Your own source shows that 80% of NPs settle in urban areas.

There is an easy solution to this. Only give autonomy to NPs who practice in a federally designated rural area that don’t have access to a physician. Problem solved. There is no need to give autonomy to the vast majority of NPs seeing as they don’t actually do anything to help with any maldistribution. I have a suspicion though that the nursing leaders would have a huge fit if this were brought into existence lol

 

[DubbiDoctor]

If NPs wanted to do the work of a doctor, they should have gone to school to be a doctor. Not sure why they can’t wrap their brains around that fact. It’s baffling to me how anyone can argue otherwise.

But now that there's another legal route to independently practicing primary care, they are going to school for what they intend to do. I understand your point, but asserting to them they should have gone to medical school won't stop them from practicing. And they could retort that they chose the NP route because they wanted to do primary care and the training was more lifestyle friendly. All med students seem to do is complain about how med school and residency are awful and grueling anyway.

 

[DubbiDoctor]

This is real rich coming from you lol



You and the entire world of science have very different definitions of “much better.” Your own source shows that 80% of NPs settle in urban areas.

There is an easy solution to this. Only give autonomy to NPs who practice in a federally designated rural area that don’t have access to a physician. Problem solved. There is no need to give autonomy to the vast majority of NPs seeing as they don’t actually do anything to help with any maldistribution. I have a suspicion though that the nursing leaders would have a huge fit if this were brought into existence lol

I support such legislation, but we - or preferably independent, objective researchers - need to demonstrate that NP care, when controlling for acuity and baseline health of the patient population, leads to worse outcomes. If we can't do that, then primary care physicians will be struck competing with NPs.

 

[Matthew9Thirtyfive]

Lord, if this thread is indicative of NPs’ ability to perform data analysis and form conclusions, I am scared for their patients.

 

[libertyyne]

This is real rich coming from you lol



You and the entire world of science have very different definitions of “much better.” Your own source shows that 80% of NPs settle in urban areas.

There is an easy solution to this. Only give autonomy to NPs who practice in a federally designated rural area that don’t have access to a physician. Problem solved. There is no need to give autonomy to the vast majority of NPs seeing as they don’t actually do anything to help with any maldistribution. I have a suspicion though that the nursing leaders would have a huge fit if this were brought into existence lol

This seems like a reasonable solution. I would add, why not add residency spots for FMGs IMGs in rural states which mandate 10 Years of service post residency in the underserved area. We would solve the shortage and keep the quality high at the same time.

 

[762513]

Lord, if this thread is indicative of NPs’ ability to perform data analysis and form conclusions, I am scared for their patients.

Lord, if this thread could be show any better about how medical students care more about themselves than the hundreds of thousands of patients served by NP’s, I feel sorry for all patients in the future.

 

[Matthew9Thirtyfive]

This is real rich coming from you lol



You and the entire world of science have very different definitions of “much better.” Your own source shows that 80% of NPs settle in urban areas.

There is an easy solution to this. Only give autonomy to NPs who practice in a federally designated rural area that don’t have access to a physician. Problem solved. There is no need to give autonomy to the vast majority of NPs seeing as they don’t actually do anything to help with any maldistribution. I have a suspicion though that the nursing leaders would have a huge fit if this were brought into existence lol

I would totally support this, especially if combined with legislation requiring working under supervision for a minimum period of time. But of course the nursing lobby would have a fit. It’s all about money, not patient care.

 

[Matthew9Thirtyfive]

Lord, if this thread could be show any better about how medical students care more about themselves than the hundreds of thousands of patients served by NP’s, I feel sorry for all patients in the future.

Are you capable of responding to anything without committing some sort of logical fallacy? Half of your posts are tu quoque fallacies, and the rest are a mix of misinterpreting data and straight up denying that things say what they say.

 

[DubbiDoctor]

I would totally support this, especially if combined with legislation requiring working under supervision for a minimum period of time. But of course the nursing lobby would have a fit. It’s all about money, not patient care.

I'm not sure why med students would want to pursue primary care anyway - they may actually be overtrained: Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians Are there any recent articles from reputable journals showing inferior outcomes when primary care patients are treated by NPs?

 

[Matthew9Thirtyfive]

I'm not sure why med students would want to pursue primary care anyway - they may actually be overtrained: Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians Are there any recent articles from reputable journals showing inferior outcomes when primary care patients are treated by NPs?

No good studies have been done. The only studies done measure stupid things like systolic bp or a1c. I would hope a midlevel seeking independent practice could follow guidelines well enough to control uncomplicated hypertension.

 

[AnatomyGrey12]

care more about themselves than the hundreds of thousands of patients served by NP’s

 

[AnatomyGrey12]

care more about themselves than the hundreds of thousands of patients served by NP’s

 

[Goro]

This might be a valid point and the data is not provided by the county level.

However, dont you think that on a state level per capita this issue would become resolved wouldnt we see large rural states with large number of NP's to overcome the lack of primary care physicians? Per capita there are fewer NPs in states like nevada , wyoming , Utah , Idaho. If your hypothesis was correct this would be not be the case.

Possibly, but also keep in mind that even the wealthy states have very rural, if not even impoverished areas. There's a reason why PA is referred to as Pittsburgh and Philly with Alabama in between. The divide between upstate NY (and I don't mean Albany or the Catskills) and the tri-state region is quite stark as well.

I'm not sure why med students would want to pursue primary care anyway - they may actually be overtrained: Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians Are there any recent articles from reputable journals showing inferior outcomes when primary care patients are treated by NPs?

Because it's not the 7th Circle of Hell ignorant pre-meds make it out to be.

 

[deleted103644]

Possibly, but also keep in mind that even the wealthy states have very rural, if not even impoverished areas. There's a reason why PA is referred to as Pittsburgh and Philly with Alabama in between. The divide between upstate NY (and I don't mean Albany or the Catskills) and the tri-state region is quite stark as well.

Even within urban areas, some zipcodes can be relatively “underserved”.

I'm not sure why med students would want to pursue primary care anyway

Because it's not the 7th Circle of Hell ignorant pre-meds make it out to be.

Now you’re just lying...

 

[libertyyne]

Possibly, but also keep in mind that even the wealthy states have very rural, if not even impoverished areas. There's a reason why PA is referred to as Pittsburgh and Philly with Alabama in between. The divide between upstate NY (and I don't mean Albany or the Catskills) and the tri-state region is quite stark as well.

Because it's not the 7th Circle of Hell ignorant pre-meds make it out to be.

Please take a look at the rural health research center data above. 82% of NPs are practicing in urban areas in those 12 states. This is further in agreement with the hypothesis that NPs are settling and practicing in areas where there are already a sufficient number of physicians. This is also in agreement with the data I showed earlier displaying states with lower physicans also have lower numbers of NPs per capita. I dont think it is a far fetched to think that NPs want the same thing physicans want . better schools for their kids and a higher quality of life in suburban and urban areas. The whole propaganda that they are alleviating physician shortages in rural areas so society should give them full practice rights is just a hollow talking point.

 

[deleted103644]

Are you capable of responding to anything without committing some sort of logical fallacy? Half of your posts are tu quoque fallacies, and the rest are a mix of misinterpreting data and straight up denying that things say what they say.

There is ~1 NP posting in this thread, getting ganged up on by a bunch of physicians.

From the looks of what’s been posted, there isn’t good evidence for any side to claim victory and honestly - would you expect there to be? And if that’s your only argument for getting a job, good luck.

Want to protect your job from the encroachment of midlevels? Be better than them. Provide additional services that an NP wouldn’t provide. Do a fellowship. If you’re actually sure that MDs are better, you should not be insecure about this.

The only real advantage that MDs have is that because we had to jump higher hurdles than they do, we’re on average smarter. But that is by no means guaranteed and intelligence isn’t everything. Most of medical school is irrelevant or redundant, so it’s not like the lack of 4 years of expensive tuition is a huge difference.

A decent physician will rarely be competing with a midlevel for a spot, and a good NP with solid training and experience will easily get a job over an online degree no experience one. Put a little trust in the job market place not to make irrational decisions.

If you feel threatened by NPs, it’s your fault, not theirs.

And maybe show a bit more civility towards @IknowImnotadoctor - he/she’s entering enemy territory and being far more civil about it than I would be (just see my interactions with the gun nuts). Even the username is showing humility.

So maybe value the diversity of viewpoints instead of coming here to feel better about yourselves in a masturbatory echo chamber?

 

[VA Hopeful Dr]

Even within urban areas, some zipcodes can be relatively “underserved”.





Now you’re just lying...

Hey! Its only 5th Circle at worst

 

[deleted103644]

Is there ever such a thing as being overtrained for the field in which you handle dozens of completely different complaints every week? In which you need to be able to recognize when something might be a zebra or when somebody might need to be admitted for any number of different conditions? Be able to understand and coordinate your patients' specialist care in addition to managing their multiple primary care level comorbidities? Yeah, a lot of primary care is bread and butter stuff. But there are enough cases where things are complex or don't go by the book that practicing high quality primary care is HARD.

If you think your most important training was during medical school, or even residency, you will be a bad doctor.

EDIT: Went a little too hyperbolic here, particularly re:residency. Point is still that you need to continue learning through your entire career.

 

[QueenJames]

I'm not sure why med students would want to pursue primary care anyway - they may actually be overtrained: Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians Are there any recent articles from reputable journals showing inferior outcomes when primary care patients are treated by NPs?

Relax premed.

We get it.

You probably did scribing and now want to do EM... be a "badass". LOL

You wanna know where the patients who aren't seen in primary care offices go after hours?

In the same ER you will probably work at .... treating the same crap that Primary Care docs do.

Except y'all drive up costs and get everybody a CT and chest X-ray because why not.... right?

The ER is the new primary care office lol

For every stroke and MVA, you will be have to sort out the 5 URIs, the 5 UTIs, and the 5 chronic pain patients that your primary care brethren had to deal with all day lol

GTFOH.

 

[NeuResurgens]

If you think your most important training was during medical school, or even residency, you will be a bad doctor.

Godwin's law of SDN fulfilled.

What is the most important training then?

 

[Matthew9Thirtyfive]

There is ~1 NP posting in this thread, getting ganged up on by a bunch of physicians.

Part of why the NP is getting called out is because she is literally refusing to accept data that doesn't support her position and posting data that still doesn't support her position, while simultaneously attempting to paint it like it does. Intellectual dishonesty should not be tolerated no matter who it's coming from, physician, NP, nurse, PhD, or whomever.

From the looks of what’s been posted, there isn’t good evidence for any side to claim victory and honestly - would you expect there to be? And if that’s your only argument for getting a job, good luck.

Absence of evidence isn't evidence of absence. There is no evidence NPs are equivalent to physicians outside of straightforward BP and A1C control, but there are no studies showing physicians are superior over the long term, since there are no studies that have been done over the long term. There is, however, evidence that NPs flock to urban centers and practice where there are already large numbers of physicians. If the meme that NPs are filling a gap is true, which is what the NP in this thread keeps harping on, then that flies in the face of all the data presented.

Want to protect your job from the encroachment of midlevels? Be better than them. Provide additional services that an NP wouldn’t provide. Do a fellowship. If you’re actually sure that MDs are better, you should not be insecure about this.

This is a false equivalence. The point is that NPs shouldn't be directly competing with physicians in the first place, as they have a fraction of the training and qualifications. It's like saying paralegals and attorneys should be in competition. It's absurd, but somehow it's come to be accepted as legitimate because of all the nursing propaganda.

The only real advantage that MDs have is that because we had to jump higher hurdles than they do, we’re on average smarter. But that is by no means guaranteed and intelligence isn’t everything. Most of medical school is irrelevant or redundant, so it’s not like the lack of 4 years of expensive tuition is a huge difference.

First of all, if you really think that 4 years of medical school doesn't make a difference between the quality of provider, you are delusional. Second, no one is comparing a freshly minted MD and an NP. We are talking about attendings and NPs. An attending has 4 years of medical school and 3 years of residency training, accumulating over 20,000 hours of clinical experience. NPs can graduate and start practicing with like 500 hours. There is no comparison.

A decent physician will rarely be competing with a midlevel for a spot, and a good NP with solid training and experience will easily get a job over an online degree no experience one. Put a little trust in the job market place not to make irrational decisions.

Except that game theory shows time and again that you cannot trust people to make rational decisions. Do you really think administrators will care that a new NP with an online degree is ill-equipped to handle independent practice when he costs half the price?

If you feel threatened by NPs, it’s your fault, not theirs.

I guess if I feel threatened by the enemy on deployment, it's my fault too. That mindset is absurd. Complacency kills, and complacency in healthcare politics is why we're in the situation we're in.

And maybe show a bit more civility towards @IknowImnotadoctor - he/she’s entering enemy territory and being far more civil about it than I would be (just see my interactions with the gun nuts). Even the username is showing humility.

Calling someone out for intellectual dishonesty isn't uncivilized.

So maybe value the diversity of viewpoints instead of coming here to feel better about yourselves in a masturbatory echo chamber?

I value diversity of viewpoints when they are backed by actual data and not biased opinions.

Edit: Just to add, I actually don't think the situation is as apocalyptic as SDN makes it seem. My n is obviously small compared to the entire country, but even having worked in states where independent practice is a thing, it seems like most people still want to see the doctor when it's anything other than a URI, and sometimes even then.

 

[762513]

Part of why the NP is getting called out is because she is literally refusing to accept data that doesn't support her position and posting data that still doesn't support her position, while simultaneously attempting to paint it like it does. Intellectual dishonesty should not be tolerated no matter who it's coming from, physician, NP, nurse, PhD, or whomever.



Absence of evidence isn't evidence of absence. There is no evidence NPs are equivalent to physicians outside of straightforward BP and A1C control, but there are no studies showing physicians are superior over the long term, since there are no studies that have been done over the long term. There is, however, evidence that NPs flock to urban centers and practice where there are already large numbers of physicians. If the meme that NPs are filling a gap is true, which is what the NP in this thread keeps harping on, then that flies in the face of all the data presented.



This is a false equivalence. The point is that NPs shouldn't be directly competing with physicians in the first place, as they have a fraction of the training and qualifications. It's like saying paralegals and attorneys should be in competition. It's absurd, but somehow it's come to be accepted as legitimate because of all the nursing propaganda.



First of all, if you really think that 4 years of medical school doesn't make a difference between the quality of provider, you are delusional. Second, no one is comparing a freshly minted MD and an NP. We are talking about attendings and NPs. An attending has 4 years of medical school and 3 years of residency training, accumulating over 20,000 hours of clinical experience. NPs can graduate and start practicing with like 500 hours. There is no comparison.



Except that game theory shows time and again that you cannot trust people to make rational decisions. Do you really think administrators will care that a new NP with an online degree is ill-equipped to handle independent practice when he costs half the price?



I guess if I feel threatened by the enemy on deployment, it's my fault too. That mindset is absurd. Complacency kills, and complacency in healthcare politics is why we're in the situation we're in.



Calling someone out for intellectual dishonesty isn't uncivilized.



I value diversity of viewpoints when they are backed by actual data and not biased opinions.

Edit: Just to add, I actually don't think the situation is as apocalyptic as SDN makes it seem. My n is obviously small compared to the entire country, but even having worked in states where independent practice is a thing, it seems like most people still want to see the doctor when it's anything other than a URI, and sometimes even then.

The statement being called out as a bald face lie is "It is false to state NP's alleviate any MD shortage." That is a completely unsupportable position. Further more, roughly twice as many NP's as physicians by percentage practice in rural populations, in one state, as many as 60% of NP's work in rural environments.

Continue to condescend. I just want to hear you defend the point I was arguing against, the statement "It is false to state NP's alleviate any MD shortage."

 

[Perrotfish]

If you think your most important training was during medical school, or even residency, you will be a bad doctor.

Your most important training is in residency. What are you talking about?

 

[AnatomyGrey12]

Continue to condescend. I just want to hear you defend the point I was arguing against, the statement "It is false to state NP's alleviate any MD shortage."

Honest question, where do you plan on practicing?

 

[WheezyBaby]

It's SDN. The hate comes from med students and some residents. The Attendings know better.

And the hate is motivated not by concerns about patient safety (an honest concern), nor the threat of job competition, but pure old elitism from people who think that because they went to school for ten years, they're better than their peers, and God forbid those inferiors over there rise above their station.

Your exposure is very limited if you aren't seeing attending concerns regarding midlevel practice

 

[BidingMyTime]

Further more, roughly twice as many NP's as physicians by percentage practice in rural populations, in one state, as many as 60% of NP's work in rural environments."

And while this may be true, it's still meaningless without further information.

For example, say Drug A may have twice the fatality rate of Drug B, should Drug A be removed from the market since it's obviously twice as dangerous as Drug B? What if the fatality rate of Drug A is 0.004% compared to 0.002% of Drug B? Saying something is twice as much as something else sounds impressive, but without knowing the base number, the twice is meaningless.

Likewise, knowing that 60% of NP's work in a rural environment in 1 state, doesn't tell us anything. Perhaps 60% of MD's/DO's work in a rural environment in that state as well, because that state has a high rural area.

 

[nowaysanjose]

I don't understand how goro defends these people. You would think someone who teaches anatomy would value their discipline high enough to make sure the person taking care of them is well-trained in it. But since they use an np for their 'provider,' we know that's not the case.

Well, if anatomy isn't necessary to practice medicine that makes you kind of expendable, right goro?

Who will be posting those "Taking R jobs" quips then...

And btw , even if us being pissed about incompetent people taking our jobs was the primary motivating factor against np independence--instead of pt safety--THERES NOTHING WRONG WITH THAT.

You're damn right I'm pissed about spending the best years of my life
studying, training, and accumulating hundreds of thousands of dollars in debt to practice medicine, only to see some 24 year old direct-entry grad with 400 hours of clinical 'experience' sitting at a computer next to me making 150k a year while they continually mismanage pts, snapchat their day and talk to their friends about how great their life is.

Yeah, well F*** THAT

 

[Waldeinsamkeit]

It's SDN. The hate comes from med students and some residents. The Attendings know better.

And the hate is motivated not by concerns about patient safety (an honest concern), nor the threat of job competition, but pure old elitism from people who think that because they went to school for ten years, they're better than their peers, and God forbid those inferiors over there rise above their station.

Uhhhhhh... I am concerned about the job competition

 

[Waldeinsamkeit]

Lord, if this thread could be show any better about how medical students care more about themselves than the hundreds of thousands of patients served by NP’s, I feel sorry for all patients in the future.

You keep saying how it will help the patients.

The solution you proposed, does not help the patients. It is at best, unuseful.

At worst it will:
(1) endanger patients with less qualified care
(2) disincentivize doctors from entering the field, adding to the shortage
(3) create "ignorance creep" in instructional pedagogy - it's an interesting concept I read about whereby if you have someone who is not an expert teach a student, by virtue, the learner will not become an expert. This carried on a grand scale leads to a significant loss of knowledge.

 

[DubbiDoctor]

You keep saying how it will help the patients.

The solution you proposed, does not help the patients. It is at best, unuseful.

At worst it will:
(1) endanger patients with less qualified care
(2) disincentivize doctors from entering the field, adding to the shortage
(3) create "ignorance creep" in instructional pedagogy - it's an interesting concept I read about whereby if you have someone who is not an expert teach a student, by virtue, the learner will not become an expert. This carried on a grand scale leads to a significant loss of knowledge.

Y

At worst it will:
(1) endanger patients with less qualified care
(2) disincentivize doctors from entering the field, adding to the shortage
(3) create "ignorance creep" in instructional pedagogy - it's an interesting concept I read about whereby if you have someone who is not an expert teach a student, by virtue, the learner will not become an expert. This carried on a grand scale leads to a significant loss of knowledge.

Should we really be speculating about potential discouragement of qualified applicants from pursuing medicine when the demand for medical school enrollment among qualified applicants far exceeds the supply of medical school spots?