Mary Mundinger appointed to the Board of Certification in Emergency Medicine

Started by Taurus
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Taurus

Taurus

Paul Revere of Medicine
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Who is Mary Mundinger? She's the leader of the DNP movement. She thinks DNP's are better than physicians because "you get the medical knowledge of a physician, with the added skills of a nursing professional."

Who here is still so naive to think that DNP's aren't determined to force themselves into the ED and push the ED physicians out?

ABPS® Board of Certification in Emergency Medicine (BCEM) Appoints Public Member

Mary O. Mundinger Accepts Appointment to ABPS® Board of Certification (BCEM) in Emergency Medicine as Public Member

Tampa, FL (Vocus/PRWEB) December 10, 2010

Mary O'Neill Mundinger, DrPH, RN, of New York City, has been appointed to the Board of Certification in Emergency Medicine (BCEM), a Member Board of the American Board of Physician Specialties® (ABPS®). She will serve as its public member.

Dr. Mundinger earned a doctorate degree in health policy from Columbia University where she served as Dean of Columbia University School of Nursing for 25 years. Most of her work has been in health policy, including conducting a randomized trial comparing MD's and NP's in comprehensive primary care.”

“Mary will bring important matters of public interest to the board certification process in emergency medicine, said Margaret Vives-Austin, M.D.,FAAEP, chair of BCEM. “She will provide an added dimension to board certification review and planning.”

Dr. Mundinger is a nationally recognized health policy expert who served as a member of the White House's National Steering Committee on Health in 1995.

ABPS was the first certifying organization to include public members on its member boards, representing the public's interests in patient welfare. ABPS public members collaborate with medical professionals to bring critical insight to the physician certification process that contributes to the health and safety of patients.

ABPS is the official certifying body of the American Association of Physician Specialists, Inc. ® (AAPS®), headquartered in Tampa, Florida. To learn more, visit http://www.abpsus.org.​
 
Mary Mundinger is back to her no good ways.

ABPS® Board of Certification in Emergency Medicine (BCEM) Appoints Public Member

Mary O. Mundinger Accepts Appointment to ABPS® Board of Certification (BCEM) in Emergency Medicine as Public Member

Tampa, FL (Vocus/PRWEB) December 10, 2010

Mary O'Neill Mundinger, DrPH, RN, of New York City, has been appointed to the Board of Certification in Emergency Medicine (BCEM), a Member Board of the American Board of Physician Specialties® (ABPS®). She will serve as its public member.

Dr. Mundinger earned a doctorate degree in health policy from Columbia University where she served as Dean of Columbia University School of Nursing for 25 years. Most of her work has been in health policy, including conducting a randomized trial comparing MD's and NP's in comprehensive primary care.”

“Mary will bring important matters of public interest to the board certification process in emergency medicine, said Margaret Vives-Austin, M.D.,FAAEP, chair of BCEM. “She will provide an added dimension to board certification review and planning.”

Dr. Mundinger is a nationally recognized health policy expert who served as a member of the White House's National Steering Committee on Health in 1995.

ABPS was the first certifying organization to include public members on its member boards, representing the public's interests in patient welfare. ABPS public members collaborate with medical professionals to bring critical insight to the physician certification process that contributes to the health and safety of patients.

ABPS is the official certifying body of the American Association of Physician Specialists, Inc. ® (AAPS®), headquartered in Tampa, Florida. To learn more, visit http://www.abpsus.org.​
 
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Taurus said:
Who is Mary Mundinger? She's the leader of the DNP movement. She thinks DNP's are better than physicians because "you get the medical knowledge of a physician, with the added skills of a nursing professional."

Who here is still so naive to think that DNP's aren't determined to force themselves into the ED and push the ED physicians out?
ABPS® Board of Certification in Emergency Medicine (BCEM) Appoints Public Member

Mary O. Mundinger Accepts Appointment to ABPS® Board of Certification (BCEM) in Emergency Medicine as Public Member

Tampa, FL (Vocus/PRWEB) December 10, 2010

Mary O'Neill Mundinger, DrPH, RN, of New York City, has been appointed to the Board of Certification in Emergency Medicine (BCEM), a Member Board of the American Board of Physician Specialties® (ABPS®). She will serve as its public member.

Dr. Mundinger earned a doctorate degree in health policy from Columbia University where she served as Dean of Columbia University School of Nursing for 25 years. Most of her work has been in health policy, including conducting a randomized trial comparing MD's and NP's in comprehensive primary care."

"Mary will bring important matters of public interest to the board certification process in emergency medicine, said Margaret Vives-Austin, M.D.,FAAEP, chair of BCEM. "She will provide an added dimension to board certification review and planning."

Dr. Mundinger is a nationally recognized health policy expert who served as a member of the White House's National Steering Committee on Health in 1995.

ABPS was the first certifying organization to include public members on its member boards, representing the public's interests in patient welfare. ABPS public members collaborate with medical professionals to bring critical insight to the physician certification process that contributes to the health and safety of patients.

ABPS is the official certifying body of the American Association of Physician Specialists, Inc. ® (AAPS®), headquartered in Tampa, Florida. To learn more, visit http://www.abpsus.org.
​
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It's no longer just anestesiology. CRNAs are just a mere window to see the future of the (D)NPs. NPs are about 10 years behind politically than CRNAs.


Will an NP replace your job? Sure may seem unlikely right now, but that's what anestesiology said 15-20 years ago. Look at them now.
 
Taurus said:
Mary Mundinger is back to her no good ways.

ABPS® Board of Certification in Emergency Medicine (BCEM) Appoints Public Member

Mary O. Mundinger Accepts Appointment to ABPS® Board of Certification (BCEM) in Emergency Medicine as Public Member

Tampa, FL (Vocus/PRWEB) December 10, 2010

Mary O'Neill Mundinger, DrPH, RN, of New York City, has been appointed to the Board of Certification in Emergency Medicine (BCEM), a Member Board of the American Board of Physician Specialties® (ABPS®). She will serve as its public member.

Dr. Mundinger earned a doctorate degree in health policy from Columbia University where she served as Dean of Columbia University School of Nursing for 25 years. Most of her work has been in health policy, including conducting a randomized trial comparing MD's and NP's in comprehensive primary care.”

“Mary will bring important matters of public interest to the board certification process in emergency medicine, said Margaret Vives-Austin, M.D.,FAAEP, chair of BCEM. “She will provide an added dimension to board certification review and planning.”

Dr. Mundinger is a nationally recognized health policy expert who served as a member of the White House's National Steering Committee on Health in 1995.

ABPS was the first certifying organization to include public members on its member boards, representing the public's interests in patient welfare. ABPS public members collaborate with medical professionals to bring critical insight to the physician certification process that contributes to the health and safety of patients.

ABPS is the official certifying body of the American Association of Physician Specialists, Inc. ® (AAPS®), headquartered in Tampa, Florida. To learn more, visit http://www.abpsus.org.​
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Confused ... a nurse is sitting on a board that oversees physician certification???
 
fitting that she join a board not recognized by emergency medicine physicians who have completed an em residency and taken the real em board exam....
maybe she will push for dnp's to be able to become certed by BCEM. it's recognized in florida, isn't it?
 
emedpa said:
fitting that she join a board not recognized by emergency medicine physicians who have completed an em residency and taken the real em board exam....
maybe she will push for dnp's to be able to become certed by BCEM. it's recognized in florida, isn't it?
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She's using a backdoor option to do an end-around physician groups.

Classic strategy. Now that we recognize it, time to squash her plan.
 
I don't like it anymore than the rest of us, but the onus is on us to show that our superior education and training provides better patient outcomes. It is also our responsibility to step up to the plate and protect our turf.
 
LOL shes the so-called "public member" - this is usually supposed to be a non-healthcare professional to add a little outside perspective, to be an "advocate" for the public. And ohhhhhhhh what an advocate she will be indeed.
 
Kris1 said:
I don't like it anymore than the rest of us, but the onus is on us to show that our superior education and training provides better patient outcomes. It is also our responsibility to step up to the plate and protect our turf.
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The onus is on the newcomer to prove they are as good as the established standard

this is just part of the nursing plan to blur the lines as much as possible.
 
"Most of her work has been in health policy, including conducting a randomized trial comparing MD's and NP's in comprehensive primary care."


:barf:
 
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Dr Oops said:
The onus is on the newcomer to prove they are as good as the established standard

this is just part of the nursing plan to blur the lines as much as possible.
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Uh, this research IS being done... by Mundinger et al.

RESULTS
NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and Al C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes.
CONCLUSIONS
This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.
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Results: No significant differences were found in patients' health status (nurse practitioners vs physicians) at 6 months (P = .92). Physiologic test results for patients with diabetes (P = .82) or asthma (P = .77) were not different. For patients with hypertension, the diastolic value was statistically significantly lower for nurse practitioner patients (82 vs 85 mm Hg; P = .04). No significant differences were found in health services utilization after either 6 months or 1 year. There were no differences in satisfaction ratings following the initial appointment (P = .88 for
overall satisfaction). Satisfaction ratings at 6 months differed for 1 of 4 dimensions measured (provider attributes), with physicians rated higher (4.2 vs 4.1 on a scale where 5 = excellent; P = .05). Conclusions: In an ambulatory care situation in which patients were randomly assigned to either nurse practitioners or physicians, and where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians, patients' outcomes were comparable.
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In the sample of 406 adults, no differences were found between the groups in health status, disease-specific physiologic measures, satisfaction or use of specialist, emergency room or inpatient services. Physician patients averaged more primary care visits than nurse practitioner patients. The results are consistent with the 6-month findings and with a growing body of evidence that the quality of primary care delivered by nurse practitioners is equivalent to that by physicians.
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So maybe research from the other side of the aisle as well as a neutral party would be a good idea. Unless you're content with the results that is 😉
 
Ok - before you start a flame war, finish reading...

I agree that DNP's are likely to document better than physicians do, as the article suggests. They should document better than we do - its their job. It's what they are trained to do more than we are. I may also agree that their monitoring of disease is better than ours is - as demonstrated by their documentation. Again - this is what THEY are trained to do.

There is no difference in 6-month outcome because none of the patients selected for them to treat were acute emergencies. We can all agree (and so can Ms. Mundinger) that there is not a DNP qualified, or trained to manage acute critical care like we do. Further, we are not likely to see such a study because these would be detrimental to patient care.

Further, there is one area of Emergency Medicine where trained physicians will always excel - the management of high volume acute illness. While the DNP may be very good at documenting and monitoring, we are VERY GOOD at seeing multiple patients simultaneously, and providing the correct level of care. This cannot be taught in nursing school, and requires the combination of medical school and residency training to do safely. How many patients does the average ED nurse see in a shift? How many patients does the average MD see in a shift? The DNP will always lie somewhere in the middle.
 
Not that the public would notice or care but the in the middle quoted section there are only 2 statistically significant points....one of those in favor of physicians.
 
http://jama.ama-assn.org/content/283/1/59.full

It's a terrible study. At six months, there's no difference in peak flow? No difference in HgbA1c? No difference in mean systolic blood pressure? Oh, but diastolic was 3 mmHg in the NP group - when 5% of the physician group carried at diagnosis of HTN. Clearly clinically significant findings. Another unfortunate byproduct of the nature of these studies, is that it's very easy for NPs to show they're not statistically significantly different - because it takes huge, huge numbers to show a difference in clinical outcomes when the statistical differences in these physiologic variables are so small. Poorly designed studies simply support their position that they're not different.

What would be more interesting, unfortunately for both primary care physicians and NPs, would be to show that the tic-tac-toe playing chicken can probably generate statistically similar results for these sorts of chronic health conditions. The true weakness of NPs is "they don't know what they don't know", but it's hard to measure the detection, diagnosis, and appropriate referral of rare conditions. However, if we want to save money in healthcare, maybe we should just miss these things....

PMID: 12224199 is the other article Mundinger is attached to where she trumpets how good nurses are good at documenting. It's like reading a medical student progress note vs an attending note; all that extra documentation doesn't mean I'd rather have the medical student take care of me. They also ordered more tests without any clinical benefit.

Not like picking apart these articles in a forum on the internet is any value; she needs to be taken down a notch in public forum.
 
NinerNiner999 said:
Ok - before you start a flame war, finish reading...

I agree that DNP's are likely to document better than physicians do, as the article suggests. They should document better than we do - its their job. It's what they are trained to do more than we are. I may also agree that their monitoring of disease is better than ours is - as demonstrated by their documentation. Again - this is what THEY are trained to do.

There is no difference in 6-month outcome because none of the patients selected for them to treat were acute emergencies. We can all agree (and so can Ms. Mundinger) that there is not a DNP qualified, or trained to manage acute critical care like we do. Further, we are not likely to see such a study because these would be detrimental to patient care.

Further, there is one area of Emergency Medicine where trained physicians will always excel - the management of high volume acute illness. While the DNP may be very good at documenting and monitoring, we are VERY GOOD at seeing multiple patients simultaneously, and providing the correct level of care. This cannot be taught in nursing school, and requires the combination of medical school and residency training to do safely. How many patients does the average ED nurse see in a shift? How many patients does the average MD see in a shift? The DNP will always lie somewhere in the middle.
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Agreed. In addition to that, 90% of the pts that are seen will get better no matter what we do. My dog could see the gastroenteritis pt and that pt will have no difference in 6 month outcome when compared to the physician. That doesn't mean that my dog is equivalent to the doc in providing pt care.
 
Here's the scumbag who orchestrated this move:


MARGARET VIVES-AUSTIN, MD
1781 Parks Center Drive Suite 120
Orlando, FL 32835
(407) 297-3626

Medical School: University Of Alabama School Of Medicine
Birmingham, AL, United States
Graduated: 1983

Residency Hospital: Med College Of Virginia Hospital


I called her office and left a message asking her why she's misrepresenting herself as a "board certified" emergency room physician when in fact she has no credentialing from the ABMS, the REAL EM specialty board organization.​

I then googled her name and found all the doctor-rating websites that she's listed on. I put comments on her telling the public that she's not a real ER doc and is NOT board certified and she's misrepresenting her trade to the public.​

If I lived in that area, I'd be sure to distribute brochures at her place of work advertising to her patients that she's a charlatan and a liar.​

ABPS is a sham organization that is designed to give fake credentials to people who couldnt pass the REAL specialty boards. Their "certificiation" is a cracker jack box toy and worth nothing.​

Addendum:
It turns out that Dr Vives-Austin never completed an EM residency at all. Looks like she entered a gen surgery/neurosurgery program and burned out. This woman never completed residency and now she's masquerading as an ER doctor. We need to find out which hospital this woman works at and make sure that they know that she's a fraud.

https://ww2.doh.state.fl.us/irm00Profiling/ProfileEDUC.asp?LicId=97416&ProfNBR=1501
 
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First step, kick every NP out of the ED and urgent care setting and replace them with PA's.

The anesthesiologists were too late in recognizing the CRNA threat. They are just now supporting an alternative to the CRNA called the AA's, but the CRNA's have greatly resisted it. Don't make the same mistakes as the anesthesiologists. It won't be a problem if there are no NP's in the ED.
 
NinerNiner999 said:
There is no difference in 6-month outcome because none of the patients selected for them to treat were acute emergencies. We can all agree (and so can Ms. Mundinger) that there is not a DNP qualified, or trained to manage acute critical care like we do. Further, we are not likely to see such a study because these would be detrimental to patient care.

Further, there is one area of Emergency Medicine where trained physicians will always excel - the management of high volume acute illness. While the DNP may be very good at documenting and monitoring, we are VERY GOOD at seeing multiple patients simultaneously, and providing the correct level of care. This cannot be taught in nursing school, and requires the combination of medical school and residency training to do safely. How many patients does the average ED nurse see in a shift? How many patients does the average MD see in a shift? The DNP will always lie somewhere in the middle.
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We all know this of course but the militants will stop at nothing and will push the boundary as far as they can. Look at all the propaganda out there now. Lawmakers and administrators are dumb enough to believe all of these "studies" that are published.

Lack of studies hasn't stopped the militant CRNA's from pushing forward with idiotic ideas like independent interventional pain management.
 
ocopa said:
Now that the American Board of Emergency Medicine (ABEM) has long since successfully shut down the practice tract. Emergency Medicine has successfully inflated EM salaries compared to other very similar specialties due to their campaign to drive out non EM residency trained EM providers. While every one would agree that to it is best to have a EM residency trained physicians in the ED, If that is not available we need a mechanism for other residency trained physicians to complete a short fellowship in EM and become board eligible. If we keep excluding other residency trained individuals from becoming recognized EM providers, the advanced practice RNs will gladly step in and fill the void.
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Not to be a stickler, but it appears that they are attempting to fill the void through the same board that non-boarded EM physicians use.
 
ocopa said:
Now that the American Board of Emergency Medicine (ABEM) has long since successfully shut down the practice tract. Emergency Medicine has successfully inflated EM salaries compared to other very similar specialties due to their campaign to drive out non EM residency trained EM providers. While every one would agree that to it is best to have a EM residency trained physicians in the ED, If that is not available we need a mechanism for other residency trained physicians to complete a short fellowship in EM and become board eligible. If we keep excluding other residency trained individuals from becoming recognized EM providers, the advanced practice RNs will gladly step in and fill the void.
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Nope--there's a void of peds CT surgeons, dermatologists, cardiac anesthesiologists, etc.

There's so way that I should be able to do a short little training program and be on the same branch of the decision making tree as them regarding their specific areas.

Likewise, we are the foremost experts in resuscitation and treating life threatening emergencies (even though we get sucked into the care of acute on chronic . . . or just chronic) conditions.

There's absolutely no way that a family doc or an NP should be able to do a little course and then perform the role of an independent EM practitioner. That's what residency is for.
 
ocopa said:
Now that the American Board of Emergency Medicine (ABEM) has long since successfully shut down the practice tract. Emergency Medicine has successfully inflated EM salaries compared to other very similar specialties due to their campaign to drive out non EM residency trained EM providers. While every one would agree that to it is best to have a EM residency trained physicians in the ED, If that is not available we need a mechanism for other residency trained physicians to complete a short fellowship in EM and become board eligible. If we keep excluding other residency trained individuals from becoming recognized EM providers, the advanced practice RNs will gladly step in and fill the void.
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This post is full of fail. "Now" and "long since" contradict each other in the first sentence fragment. I don't know how inflating EM salaries would drive non-EM trained physicians out of EDs. If anything, it seems like having to pay more for an EM trained physician would open the door to cheaper competition. Fellowship is not required for BCEM, and it would be interesting to see what percentage of BCEM physicians have done a formal fellowship. I've discussed in other posts the qualitative difference in EM fellowship training versus EM residency.

Finally, the solution to lack of EM physicians is not to water down the skillset required but to increase the number of residents trained in EM. Having more poorly trained MDs staffing the ED is not a win for anyone except for the IM/FM who's making far more money than their training would otherwise allow.
 
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ocopa said:
Now that the American Board of Emergency Medicine (ABEM) has long since successfully shut down the practice tract. Emergency Medicine has successfully inflated EM salaries compared to other very similar specialties due to their campaign to drive out non EM residency trained EM providers. While every one would agree that to it is best to have a EM residency trained physicians in the ED, If that is not available we need a mechanism for other residency trained physicians to complete a short fellowship in EM and become board eligible. If we keep excluding other residency trained individuals from becoming recognized EM providers, the advanced practice RNs will gladly step in and fill the void.
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😱Holy Crap! I can't disagree with this strongly enough. It would be grossly inappropriate for anyone to do "a short fellowship" and then practice EM let alone be board eligible. No one would ever make the argument that residency trained EPs should be able to do a short fellowship and then branch off into other specialties. That's just outrageous.
 
I took the "fellowship" comment to mean if there is a shortage of EM providers and the two choices are:

1. Let a bunch of militant DNPs who have 1/10th the training of physicians (yet are convinced their superior charting skills and higher patient satisfaction ratings make up for this) work side by side with BC EM docs AND introduce themselves as Dr. Noctor to unsuspecting patients

2. Or offer some sort of fellowship to, say, IM and FM physicians and let them work in some capacity within the ER

then obviously it is a far better choice to go with the individual who has been through medical school and has a license to practice medicine. Granted, this seems like a complete hypothetical, and I don't think IM/FM guys are really interested in a turf war or taking your positions ... I can't say the same about the other group.

I highly recommend that people complain to this board (fake or not). DNP/NPs continually use the 'gap in care' excuse to get their foot in the door, and with this particular woman on the board ... I foresee nothing but a push for more NP/DNP involvement in the ER. It's already happening in gas, FM, IM, and Derm ... fight it.
 
loveoforganic said:
Uh, this research IS being done... by Mundinger et al.



So maybe research from the other side of the aisle as well as a neutral party would be a good idea. Unless you're content with the results that is 😉
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Those garbage studies are just that. Their main purpose is just to say "hey politicians, Lawmakers & general public we are the same" they don't hold up to good scientific practice. We shouldn't have to do studies, it should be commonsense that the person w/ a decade of training is better. The problem is people are ignorant to the training we go through & measure medical quality by standards that don't necessarily mean better care

Plain & simple this is a PR Battle. The more people know about the length & difficulty of medical training the better off we will stand.
 
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Yes, they pander to the people who will govern their ability to practice. I don't think that's surprising. I also don't think "the length and difficulty" of medical training alone is enough to combat research that few politicians are reasonably going to be able to detect the flaws in.
 
loveoforganic said:
Yes, they pander to the people who will govern their ability to practice. I don't think that's surprising. I also don't think "the length and difficulty" of medical training alone is enough to combat research that few politicians are reasonably going to be able to detect the flaws in.
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Politicians can't even detect flaws in the very laws they write, you really think they will be able to pick bad scientific method in journal articles?
 
loveoforganic said:
Attached. Can't upload the third, too large.
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Your first link is a document of abstracts, that doesn't do me any good.

As for the second study...

First, the study itself admits to having a low statistical power which "may have contributed to the finding of few nurse practitioner-physician differences".

Second, none of these patients are anywhere near complicated. Isolated HTN, DM, and asthma are quite easily to manage 95% of the time. In order: ace, metformin, advair. Hell, the AAP has a recommended flow sheet for diagnosing and treating asthma and JNC-7 has one for HTN while the ADA has one for diabetes. I can quite comfortably manage those patients myself and I'm only an intern. Let's throw a few of my uncontrolled DM, resistant HTN, COPD, on coumadin, morbidly obese patients into the mix and see what happens.

Third, this study doesn't look at patient oriented outcomes - this thing as is bad as a drug company study. I don't care if the A1c's were the same, I want to know which patient group had less complications. Who had fewer patients getting their toes amputated? We don't know.

Fourth, I want to see how patients with each disease were worked up by each provider group to check for secondary causes or any of the possible metabolic abnormalities that can exist with these conditions.
 
As the number of annual ER visits increase (without a comparable increase in EM residency spots), the providers are going to have to come from somewhere. There appear to be 3 options:

1) Midlevels: discussed ad nauseum above. Main question that remains seems to be what's going to be done about it.

2) Physicians from other specialities: still looks like a debate to me.

3) FMGs: get ACGME International+ABEM to come up with a way of accrediting good EM training programs abroad (there are some) and come up with some sort of certification (obviously not identical to ABEM's BC) that could become an 'equivalent' so that foreign residency trained physicians can fill up those rural EM spots.
 
When I read the title, I thought that the ABMS had brought her on board and vomited a little in my mouth. In the end, the debate about midlevels is a debate about RVU. A physician who is paid a salary, or paid by the hour, has little incentive to allow the encroachment of midlevel providers onto his turf. A physician who is paid with the RVU or on a productivity model has immensive financial incentive to bring as many midlevels on board as possible and extend his ability to see patients.

There's a story I heard about this when I was a kid, something about a goose that laid golden eggs. It didn't end well.
 
Dr Oops said:
Politicians can't even detect flaws in the very laws they write, you really think they will be able to pick bad scientific method in journal articles?
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I think we're talking past each other. That's exactly my point. Something that has the appearance of being scientific, whether it is or not, is going to hold more weight than "we train a lot more," because politicians aren't going to be able to judge the validity of studies with any amount of skill.

VA Hopeful Dr said:
Your first link is a document of abstracts, that doesn't do me any good.

As for the second study...

First, the study itself admits to having a low statistical power which "may have contributed to the finding of few nurse practitioner-physician differences".

Second, none of these patients are anywhere near complicated. Isolated HTN, DM, and asthma are quite easily to manage 95% of the time. In order: ace, metformin, advair. Hell, the AAP has a recommended flow sheet for diagnosing and treating asthma and JNC-7 has one for HTN while the ADA has one for diabetes. I can quite comfortably manage those patients myself and I'm only an intern. Let's throw a few of my uncontrolled DM, resistant HTN, COPD, on coumadin, morbidly obese patients into the mix and see what happens.

Third, this study doesn't look at patient oriented outcomes - this thing as is bad as a drug company study. I don't care if the A1c's were the same, I want to know which patient group had less complications. Who had fewer patients getting their toes amputated? We don't know.

Fourth, I want to see how patients with each disease were worked up by each provider group to check for secondary causes or any of the possible metabolic abnormalities that can exist with these conditions.
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Sorry about the first one - just pulled up and saved the full text, didn't look at it first. Thanks for the critique of the second one.
 
loveoforganic said:
Something that has the appearance of being scientific, whether it is or not, is going to hold more weight than "we train a lot more," because politicians aren't going to be able to judge the validity of studies with any amount of skill.
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That's the catch-22. NPs only need to show non-inferiority, so garbage studies showing no significant difference in urgent care type settings are exactly what they need. EPs would have to show that important outcomes are better with BC EPs vs NPs. However, that would require something like an RCT of sick patients randomized to either NP or EP treatment, which OBVIOUSLY no IRB would allow. Hence, no studies.
 
Old_Mil said:
When I read the title, I thought that the ABMS had brought her on board and vomited a little in my mouth. In the end, the debate about midlevels is a debate about RVU. A physician who is paid a salary, or paid by the hour, has little incentive to allow the encroachment of midlevel providers onto his turf. A physician who is paid with the RVU or on a productivity model has immensive financial incentive to bring as many midlevels on board as possible and extend his ability to see patients.

There's a story I heard about this when I was a kid, something about a goose that laid golden eggs. It didn't end well.
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Sounds great ... just make sure they are PAs, not NPs.
 
JaggerPlate said:
Sounds great ... just make sure they are PAs, not NPs.
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thanks for the plug...
FWIW my group of 15 pa's makes our physician partners 200,000 dollars/mo in profit above and beyond what they give us in salary/benefits/bonuses. 2.4 million/yr x 20 yrs that our group has used pa's = 48 million dollars. basically the pa's in our group have purchased a very nice house and high end sports car for each physician partner over the years...
 
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Which major EM organization out there are truly fighting this? ACEP? AAEM? I like to make a reasonable donation to help the cause.
 
december07 said:
Which major EM organization out there are truly fighting this? ACEP? AAEM? I like to make a reasonable donation to help the cause.
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AAEM are the big ones fighting this stuff...hence why their founding principle for fellowship is ABEM certification. ACEP as we all know still has some fellows that are not ABEM-certified. Both organizations fight for EM but have different strengths. This issue falls more with AAEM's strength though. ACEP is kind of inbred and penetrated by large contract management groups that love staffing with midlevels to increase the profit so their reach is a bit limited if they want to continue their funding from CMGs. ACEP is far superior with other EM efforts though due to size (health policy advocacy, grant funding, CME, etc).
 
Hmm. Seems like some folks on this post are throwing out the baby with the bath water. Not all NPs are Mundingers. Nor are all of us incompetent.

I know my place in the "food chain", and I have no desire to be a Noctor whatsoever. NP education is, quite frankly, sub-standard. I recognize this fact and constantly work my butt off to try and close the gap as much as realistically possible so that I can provide the highest level of service that I can within my scope of practice.

And I loathe Mundinger. She single-handedly is driving a wedge between physicians and NPs. Furthermore, she took what could have been a great idea, the practice doctorate, and watered it down into a complete joke. What we needed was a doctorate that combined a more thorough curriculum of hard science courses for one year followed by a year of clinical "residency" within our chosen specialty. What we got was a totally worthless degree. I, for one, ain't gettin my DNP. Thanks Mundinger.

Oh, and, at least in my experience, most physicians don't resent my presence in the ED.
 
Oh, and for the record, I am, in no way, implying that a perfectly designed DNP program would yield an MD/DO level provider. That is ridiculous. All I am saying is that it would have given us a better mid-level eduction.

Nuff said.
 
browndog1 said:
Hmm. Seems like some folks on this post are throwing out the baby with the bath water. Not all NPs are Mundingers. Nor are all of us incompetent.

I know my place in the "food chain", and I have no desire to be a Noctor whatsoever. NP education is, quite frankly, sub-standard. I recognize this fact and constantly work my butt off to try and close the gap as much as realistically possible so that I can provide the highest level of service that I can within my scope of practice.

And I loathe Mundinger. She single-handedly is driving a wedge between physicians and NPs. Furthermore, she took what could have been a great idea, the practice doctorate, and watered it down into a complete joke. What we needed was a doctorate that combined a more thorough curriculum of hard science courses for one year followed by a year of clinical "residency" within our chosen specialty. What we got was a totally worthless degree. I, for one, ain't gettin my DNP. Thanks Mundinger.

Oh, and, at least in my experience, most physicians don't resent my presence in the ED.
Click to expand...

browndog1 said:
Oh, and for the record, I am, in no way, implying that a perfectly designed DNP program would yield an MD/DO level provider. That is ridiculous. All I am saying is that it would have given us a better mid-level eduction.

Nuff said.
Click to expand...

Tell that to the 20-or-so (and growing) states where a NP is 100% equivalent to a FP and are 100% independent.

Also, if you read any of the AANA position on NP/CRNAs, you would know that your organization takes offense to even the word "mid-level".
 
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