alert the Public, protect our field from the impending deception

[yumita]

It's this kind of thinking that drives me nuts...

Just look at how far CRNAs have gone. Seriously, take a look at this job advertisement below

http://www.merritthawkins.com/job-search/job-details.aspx?job=7583&contract=15731

And from this AANA website:

http://www.aana.com/aboutaana.aspx?...SMenuTargetType=4&ucNavMenu_TSMenuID=6&id=265

"CRNAs are the primary anesthesia providers in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.
According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.*




Education and experience required to become a CRNA include:

1. A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
2. A current license as a registered nurse.
3. At least one year of experience as a registered nurse in an acute care setting.
4. Graduation with a master’s degree from an accredited nurse anesthesia educational program.

As of February 2008, there were 109 nurse anesthesia programs with more than 1,800 affiliated clinical sites in the United States. These programs range from 24-36 months, depending upon university requirements. All programs include clinical training in university-based or large community hospitals.

1. Pass a national certification examination following graduation.

In order to become recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia."


I personally would have no objection to having a CRNA attend my loved ones, would you? The median expected salary for a typical Physician - Anesthesiology in the United States is $308,238. (salary.com)


Why should doctors be the only priveleged SOB's on the planet?

---

Members don't see this ad.

 

[Excelsius]

And from this AANA website:

http://www.aana.com/aboutaana.aspx?...SMenuTargetType=4&ucNavMenu_TSMenuID=6&id=265

"CRNAs are the primary anesthesia providers in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.
According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.*




Education and experience required to become a CRNA include:

1. A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
2. A current license as a registered nurse.
3. At least one year of experience as a registered nurse in an acute care setting.
4. Graduation with a master’s degree from an accredited nurse anesthesia educational program.

As of February 2008, there were 109 nurse anesthesia programs with more than 1,800 affiliated clinical sites in the United States. These programs range from 24-36 months, depending upon university requirements. All programs include clinical training in university-based or large community hospitals.

1. Pass a national certification examination following graduation.

In order to become recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia."


I personally would have no objection to having a CRNA attend my loved ones, would you? The median expected salary for a typical Physician - Anesthesiology in the United States is $308,238. (salary.com)


Why should doctors be the only priveleged SOB's on the planet?

I find this ludicrous. This doesn't even make business sense. If CRNAs had low income and thereby saved costs in healthcare, it would be more or less ok, but what kind of business person in his right mind chooses to pay pretty much the same price and get someone with FAR LESS training to do the important job of anesthesia? I am not even talking about the safety! If I or a loved one was to be admitted to a hospital, I wouldn't want a CRNA handling my surgery because I'd want the person be as qualified as possible. That's just scary. This doesn't make business sense and it doesn't make safety sense. And if there is evidence that CRNAs are as good or better qualified than anesthesiologists, I'd like to see the training required for anesthesiologists after med school be cut in half. Right now, the implication with CRNAs is that anesthesiologists are getting too much training. I wonder if there is data showing fatalities/complications correlation with CRNAs vs anesthesioligists. If not, we need to get the study going.

 

[Frumps]

I personally would have no objection to having a CRNA attend my loved ones, would you? The median expected salary for a typical Physician - Anesthesiology in the United States is $308,238. (salary.com)


Why should doctors be the only priveleged SOB's on the planet?

Seriously....did you look at the ad. $250,000-300,000/year and be done at noon everyday. How does this make sense to keep increasing payments to midlevels and decreasing physician salaries. Good job at trying to compare 2 years of postgraduate training + a year of work to 8 years minimum for a physician. Yeah that makes sense.

 

[JeffLebowski]

Seriously....did you look at the ad. $250,000-300,000/year and be done at noon everyday. How does this make sense to keep increasing payments to midlevels and decreasing physician salaries. Good job at trying to compare 2 years of postgraduate training + a year of work to 8 years minimum for a physician. Yeah that makes sense.

But see that's the problem.

To us, it's ludicrous. We know we shouldn't be replaced. We are aware of the training differences and the potential dangers of screwing around with the system to replace us. To physicians, we've always thought, "they can't possibly think we're replaceable", but now it's coming 'round to bite us on the ass. People are starting to think maybe doctors are replaceable (in some capacities). Then you've got "professional" groups who are trying buff up their credentials and overinflate their titles and call themselves doctor and wear the white coat and do it cheaper with less training than us...who are actively and fervently lobbying to "save the nation from the healthcare crisis!" with their services filling the gaps, convincing everyone they're the answer and they're just as good and they're even better in some ways and "come on diagnosing & writing prescriptions for abx for strep throat isn't rocket science don't you want it faster cheaper and easier through us" while they get their foot in the door to displace us from the profession that we thought was untouchable. There are ramifications to taking away our sovereignty to deliver aspects of patient care. Pediatricians/FP docs dont' make jack on giving immunizations, and I'm sure it doesn't take 7 years of training to do shots. They don't do immunizations for the money, they do it to establish and maintain continuity of care. That's important for patients & physicians alike. We (and what we do) should be un-displaceable (definitely not a word), but nowadays we are.

It's high time we reminded everyone in no uncertain terms that this is not a game, lives and livelihoods are at stake, and to think LONG AND HARD before you push out doctors forever from your care and the care of your loved ones. Think long and hard.

 

[Frumps]

But see that's the problem.

To us, it's ludicrous. We know we shouldn't be replaced. We are aware of the training differences and the potential dangers of screwing around with the system to replace us. To physicians, we've always thought, "they can't possibly think we're replaceable", but now it's coming 'round to bite us on the ass. People are starting to think maybe doctors are replaceable (in some capacities). Then you've got "professional" groups who are trying buff up their credentials and overinflate their titles and call themselves doctor and wear the white coat and do it cheaper with less training than us...who are actively and fervently lobbying to "save the nation from the healthcare crisis!" with their services filling the gaps, convincing everyone they're the answer and they're just as good and they're even better in some ways and "come on diagnosing & writing prescriptions for abx for strep throat isn't rocket science don't you want it faster cheaper and easier through us" while they get their foot in the door to displace us from the profession that we thought was untouchable. There are ramifications to taking away our sovereignty to deliver aspects of patient care. Pediatricians/FP docs dont' make jack on giving immunizations, and I'm sure it doesn't take 7 years of training to do shots. They don't do immunizations for the money, they do it to establish and maintain continuity of care. That's important for patients & physicians alike. We (and what we do) should be un-displaceable (definitely not a word), but nowadays we are.

It's high time we reminded everyone in no uncertain terms that this is not a game, lives and livelihoods are at stake, and to think LONG AND HARD before you push out doctors forever from your care and the care of your loved ones. Think long and hard.

Agree completely

The problem is that the midlevels are taking many of the bread and butter procedures from physicians, ie, the ones that are low liability and financially rewarding. This leaves more complex, time consuming, high liability cases for the MDs. Then they like to say that they provide the same quality of care, even though the patients they see are the easier patients, so to speak.

 

[dragonfly99]

Tired,
you are seeing things through your surgical tunnel vision.
NP's are practicing independently (primary care) in many states, with no physician oversight needed at all.

I think PA's and NP's can be an important part of the health care team, but I emphatically don't think that their training is the same as my med school (working up to 120hrs/week on some clinical rotations) and 3 years of IM residency (Q3 and Q4 overnight 30 hour + call much of the time, working 80 hrs/week a lot of the time, including taking care of sick MICU patients, etc.). I think my ability to recognize unusual and complex medical illnesses (and treat them) is going to be much better than the average NP/PA, especially one recently out of training.

This debate is pointless though. NP's and PA's are here to stay regardless of what we think or do. If we want to survive someone has to understand that physicians have added value as a result of our extra training, and right now a lot of people don't, though some do. I am worried about the role of primary care physicians in about 10-20 years...which is one reason I chose not to become one.

 

[JeffLebowski]

Whoa, time out tiger.

The majority of mid-level involvement in the procedural specialties continues to be PAs. These PAs are hired and OJT'd by the surgeons themselves, for the purpose of expanding practice volume and reimbursement. They do not practice independent of surgeons, and are not taking business from us.

NPs are far less involved in procedures, and I'm have yet to hear stories about them being independently credentialed to operate or doing large volumes of office-based procedures.

What are you specifically referring to?

I don't want to speak for him, but he might be talking about CRNA's (e.g. trying to get into pain management, etc.).

This debate is pointless though. NP's and PA's are here to stay regardless of what we think or do. If we want to survive someone has to understand that physicians have added value as a result of our extra training, and right now a lot of people don't, though some do. I am worried about the role of primary care physicians in about 10-20 years...which is one reason I chose not to become one.

No offense, but that's exactly what this thread is about. We need to fight further expansion tooth and tail, because otherwise the growth of numbers and scope of practice of these other healthcare folks is going to push us right out on our asses. We may not eliminate the whole concept of the NP or PA (or other midlevels), but we can certainly make sure they stick to the niche where their role is appropriate with proper activism and standing up for ourselves on our part, which in itself would halt the boom in # of jobs for them, the enticing scope of practice & autonomy, the rising salary, and thus the # of schools, programs, graduates, and people out there with less training trying to do the jobs we've trained so much longer and harder to do properly.

 

[Excelsius]

...

This debate is pointless though. NP's and PA's are here to stay regardless of what we think or do. If we want to survive someone has to understand that physicians have added value as a result of our extra training, and right now a lot of people don't, though some do. I am worried about the role of primary care physicians in about 10-20 years...which is one reason I chose not to become one.

I agree that the most important thing is to show the importance of physicians, but I disagree that it can't be done without fighting the system at the same time. Look at it this way: if HMOs had met more resistance right at the time of their conception, their influence wouldn't be as powerful today. And if there was no resistance at all, HMOs would be much more powerful now. It's just that somehow doctors are unable to fight in an intelligent manner. I mean the oil companies raped America from alternative sources for decades now, to the point of compromising our national security (Bin Laden used OUR money to bring down USA), yet the doctors can't even do the right thing to get even their smallest points across congress. This is the impotence of AMA. Do we have *******es working there or what?

 

[Frumps]

Whoa, time out tiger.

The majority of mid-level involvement in the procedural specialties continues to be PAs. These PAs are hired and OJT'd by the surgeons themselves, for the purpose of expanding practice volume and reimbursement. They do not practice independent of surgeons, and are not taking business from us.

NPs are far less involved in procedures, and I'm have yet to hear stories about them being independently credentialed to operate or doing large volumes of office-based procedures.

What are you specifically referring to?

As an example, optometry is continually pushing for scope expansion. They put bills forward that ask for full surgical rights (surgery, lasers, intraocular injections, etc.). In reality they ask for everything in the hopes of achieving the ability to perform injections, or laser treatments. They do this because these are easier to learn, pay better, take less time, and have less liability. If this happens they will refer the complicated patients to the MDs. It is difficult for Ophthalmology to fight these legislative battles b/c there are many more optometrists. I feel that many MD specialties are facing similar situations. If MDs could stick together, I think we would be more successful. How to do this is the question.

 

[howelljolly]

History repeats itself.

The first osteopathic school opened just over 100 years ago. Decades ago, DOs have risen to earn all the rights and privileges of Medical practice.

NPs have been practicing autonomously for many years, and there has never been any objection. Who is going to create a study that MDs are better than DNPs at doing the same thing? Nobody. If someone did, they'd probably come up with nothing.

Proving that DNPs are intellectually inferior, or generate more errors than MDs will get us nowhere. Why, because they probably dont, and thats not the issue. Medicine is learned by experience. Take a 31 year old FP with five years on the job, and put them up against a DNP who has been DNP-ing for 10 years, and has 15 years of CCU experience prior to that, and 3 years in Med-Surg before that.... then try and tell the legislation that MDs are better. We will lose.

There are specific skills and abilities which allow for practice autonomy, and the NPs have adopted them, and used them to their advantage.

Question.... in the US miltary, what extra training allows a Combat Medic to be advanced to an Independent Duty Medic, thus no longer needing MD supervision? I dont know. But my point is.... there are all sorts of pathways in place to allow Midlevels of all kinds to practice autonomously.

We've ignored this issue, and not policed our borders. Now we have DNPs, CRNAs, DPM, OD, NPs who practice in every field from Peds, to Psych, to ENT, autonomously. Theres even a field that began just 100 years ago, and now has all the rights and privileges or medical practice. Im not bashing DOs im just using it as an example to show what a profession can do if they put their efforts into it.

Did you know that if a Chiropractor takes an additional certification, they can get ADMITTING PRIVILEGES?!?! Yup. They can be on service at the hospital. If a patient comes in s/p MVA, the ER doc can call the DC to come in, and prevent the impending pain from whiplash, and then admit the patient for observation.
We have done NOTHING to stop that. We just stand around doing squat... and now when a patient comes in WE call the chiro, and let them admit the patient.

History repeats itself, and we are to disinterested to do anything about it.

 

[howelljolly]

Whoa, time out tiger.

The majority of mid-level involvement in the procedural specialties continues to be PAs. These PAs are hired and OJT'd by the surgeons themselves, for the purpose of expanding practice volume and reimbursement. They do not practice independent of surgeons, and are not taking business from us.

NPs are far less involved in procedures, and I'm have yet to hear stories about them being independently credentialed to operate or doing large volumes of office-based procedures.

What are you specifically referring to?

NPs can already do C-scopes without supervision. http://www.endonurse.com/articles/6c1feat3.html

What about RNFAs? Registered Nurse First Assistants. They've been around for 20 years. What happens when they decide that theyve assisted with so many lap appys, that they can go ahead and do it themselves....
Jeez, Ive assisted with so many, that I might be able to wing it myself already.

 

[howelljolly]

I was thinking, cant we even protect and restrict diagnosis to physicians?

When a NP is doing a C-scope, its therapeutic and diagnostic.

But in the pathology lab, any good cytologist can "diagnose" cancer histologically. They still require that the MD signs off on the diagnosis. Even something as simple as an automated CBC report has the pathologists signature on the bottom.

We all know CT scan techs who can identify a big honkin' brain bleed, but we still need the Radiologist to make the diagnosis. Crikey.... we dont even allow an Emergency Physician to make a radiological diagnosis.

But nurses.... who went to nursing school in order to do nursing, we allow to do diagnosing.... when the reason I went to MED school... was to do the diagnosing.

Just because you're bored of your job doesnt mean that you get to change what your responsabilities are. You should change careers. Do what thousands of other nurses have done, and go to med school. Dont change nursing to fit your fancy.

 

[BlackNDecker]

I never cease to be amazed at the incessant b!tc#ing on anonymous forums, and then back in the real world everyone just goes on about their dayjob. Threads like this ARE a grassroots movement. Look at the variety of professional backgrounds of the individuals posting in this thread. If this small group organized, and recruited locally at our own institutions we'd have 3,000 signatures by spring...seriously. 3,000 begets 10,000, 10,000 begets ?????. Just need a name and a logo
Maybe I'm overly optimistic, but with thousands of members paying modest dues, we could potentially initiate one "key" lawsuit with the potential to create a landmark decision. Seriously, all we'd have to do is just initiate the lawsuit, with the rest of the profession realizing what's at stake it'd be like "white on rice." Membership would exponentially increase, and at such a critical time in the current medical crises we'd get massive (free) media coverage.

Another sign the apocalypse is upon us: In many pharmaceutical TV ads, they now mention "health care provider" rather than doctor because of the variety of individuals now writing prescriptions.


And now back to our regularly scheduled lives

 

[howelljolly]

Who's in a position to start something? Maybe an internet based petition can start something...?

Tom Daschle, and Obama... who are actively working on fixing the broken healthcare system.... see NPs and PAs as the logical source for Americas Primary Care.
To remedy the medical workforce shortage, he supports the adoption of policies that encourage primary care -- no matter who provides it. "We need physician's assistants, nurse practitioners, primary care doctors. We need them all," he said. (ACP Advocate)

We arent doing anything, and from what the government sees, NPs and PAs are chomping at the bit to do Primary Care... so they will get it.

The government wants to ensure a primary care workforce by regulating and limiting the number of "secondary care" residency and fellowship seats. Is it going to take the Ortho and Derm hopefuls not getting what they want to get some physician advocacy?

If US schools arent cranking out enough primary care physicians, shouldnt we rather let the 10,000 foreign trained MDs in the US have a shot at it, rather than the NPs?

 

[dragonfly99]

As far as what was said about about us "needing to organize". The same crap is said on every physicians' web site I've been on.

sermo.com is for practicing docs. There are constant threads on there about issues like this.

As far as fighting against midlevels expanding scope of practice, you need to get with your state and local medical societies. Deciding scope of practice is basically a state issue, and the AMA can't do a whole lot about this. If you want to have influence, go lobby your state legislature with your state medical society (I have) or give to your state medical associations medical PAC (I have) or to the AMA's PAC (I have) if you want the AMA to continue having a seat at the table in negotations about where our health care system is going @ the national level.

I don't think signing a bunch of internet petitions is going to do much. Talking with your state rep. and state senator(s) (and/or their health care staffer) you can at least get a feel for where they stand on these issues and let them know what you think. But remember, they are ALWAYS going to care more about what the general public thinks, because there are more of the general public than there are physicians. The public just wants good medical care, and they want it on the cheap, not really caring that perhaps those two things aren't very compatible.

 

[dragonfly99]

As far as what someone posted above about an impending 20% cut in reimbursements, they are probably talking about threatened Medicare cuts by the federal government (CMS, specifically). This basically goes back to several years ago, when the gov't decided they needed to not let Medicare spending inflate/grow above a certain amount. They basically said, "We'll hold spending to 'x' dollars/year, and we'll do it by cutting reimbursements if necessary, so that if the docs order more and more tests, etc., they'll just get paid less per visit and less per test/procedure, and total spending will stay the same". The legislators are basically trying to keep Medicare spending sustainable. Theoretically it's a good goal, but it's not good for doctors. Definitely there are docs and others who try to "game" the system and/or order too many tests. However, also we have an aging population who are apt to really need more services. So we need to figure out a better funding system for Medicare. The current one is called the Sustainable Growth Rate (SGR). It's the reason behind why the legislators every year have been threatening to cut reimbursements by a few %/year (would have been a total of 20% if they'd actually done it). Instead of doing it, they always reverse the cut @ the 11th hour at the end of the year (each year for the past several years). They've done this under pressure from groups like the AMA and the AARP, etc. However, this just staves off the problem to be dealt with another year.
You could find out more by googling SGR and Medicare funding, or probably look on the AMA web site ama-assn.org to find out more. The Congressional Budget Office (CBO) I think has done some good reports on this, plus maybe the Kaiser Family Foundation, etc.

 

[zeloc]

I agree with most of what has been said, and I have hard time understanding how the NPs are justifying their title of "doctor." I mean, the term doctor was, by default, reserved for medical doctorate. Now when they are coming up with the new term-doctorate of NP, what are they trying to say? The nurse doctors have equal knowledge base and competence as other "doctors?" If those few individuals that make it to DNP are so smart and hard working, why not just let them get through medical doctorate instead from the first place?

Now, what catches my interest was this statement posted by OP.



I agree with the sentiment completely. Even with the feeling I just expressed, I really don't see physicians acting strongly against this problem. I think most of medical students don't even know about this. The thing about being in medicine is that many people think they are above the political changes or are shielded from atmosphere. I guess some are thinking that they can always opt to derm/plastics. Some just don't care. Some are actually fighting among themselves within the turf of medicine (cardiothoracic surgeons vs. cardio interventionlists, anyone?). And then, lastly, but with a serious relavance, there will BE some people with MDs that will say, well, if it helps patients, why not???

Although this may be a bit exaggerated, I always felt that people in medicine are generally the more hardworking and more brilliant that other professions, generally (yes, that "generally" is an important disclaimer). However, we are always low-balled and always spanked by some extra groups, and I always thought this was because we don't stick together when someone is pushing us. Yes, I guess it is awkward to "fight back" when 99% of people repeat (truthfull or untruthfully) that they are doing this because they want to help others. Maybe we have too many elites in our groups, and everyone wants to be leaders. So no one end up being leader and everyone does his or her own thing.

I really hope this does not go unchecked. I am not interested in anestheology, but I was honestly disturbed enough as I heard things about CRNAs encroaching into the medical field already.

One of the big problems is time. I work 80 hours/week. That's barely enough time to eat, sleep, and do laundry, and in my spare time I'm going to do research and read UpToDate. How am I going to make the time to lobby at my state medical association? The average medical student has more time, but still works a great number of hours. Compare this to the amount of time people lobbying for DNP programs and rights have. Multiply this by the number of people they have and they have a gigantic advantage over us. They are basically taking advantage of us while we are working toward and making great sacrifices for patient care.

Agree with BlackNDecker, in this thread there have been some terrific points raised and many with diverse backgrounds. We can all lobby in our respective organizations, but as someone else mentioned, why don't we ourselves form a group and begin to make some progress. Someone could write a letter to the AMA and we could sign it with our REAL names, titles, and organizations with perhaps even an inquiry into what is being planned by the AMA (or ACP), if anything. A quick search on Google has only turned up statements by the AMA denouncing aspects of DNP, but I have not seen any lawsuits or really anything remotely effective.

I also think it's ridiculous that there are 10,000 people with MDs who have passed Step 1/2 and cannot work as a physician while other less qualified people are stepping up...

 

[Good Solutions]

Do what you can now.

1) letters to representatives
2) money to med pacs
3) spread the word to your colleagues
4) Don't Train them
5) Don't hire them
6) Don't have your blinders on. Support each medical specialty that is under attack
7) Work with PA's and AA's

 

[zoondel]

Is lack of time really an issue for us as far as lobbying for ourselves?

I suspect the answer is yes, but we either:
a) won't admit it, or
b) don't have time to realize what it is that we're missing


That being the case, I agree with the above poster that we should form a group (or create a "committee" of some sort within a larger group, if feasible.)

However, more than that, we would need PR. It may behoove us to create/work with an organization to raise the funds necessary to pay someone to represent our interests, across specialty lines.

Just an idea. Any takers? Anyone with a clue as to how to go about doing such a thing?

 

[Doowai]

I think its inevitable that nurses do this - at best you can forestall them. But in reality you would not care - if you were confident in your game you would let them do it, and then just beat them at the game.

The big problem with the auto industry bail out is US cars suck. if they produced good cars they would not need a bail out. We are told we are bailing out the "backbone" of the economy -

Lets see - I start a business and it fails, goes bankrupt.... how is that the backbone of anything? In 2008 the Texas Rangers had the worst win loss record in baseball - maybe we ought to bail them out as they are the "backbone" of baseball? If you suck you suck.......may the best man win.

This is a free capitalist economy. Let everyone compete and may the best man win. All this democratic artificial trade restriction is virtually communistic. Trade restrict this and trade restrict that. China has learned how great capitalism is - and yet this country (USA) wants to become socialistic and/or communistic. In the old china or the old soviet union, the government controlled the industries (like you are asking them to do in healthcare) and as a result Chinese cars and Russian cars (and everything else) sucked. There was no captialistic competition in old China or Russia and everything they made sucked. If the USA government restricts competition in health care it will suck way more than it does now. Put on your big boy pants and fix yourself - improve your game, don't ask for socialist control of health care.,

If the American Auto industry stopped making crappy cars they would not have to be bailed out. When I was a kid (a long long time ago) "Made in Japan" was a joke. It was something you said to describe something crappy. But Japan worked hard, studied the problem, and made quality cars that became more popular than American made cars. Now the US auto industry is wahh wahh wahhh - instead of making good cars they want a bail out.

If you want to solve the problem, improve your quality. Be competitive instead of asking lawmakers to bail you out and protect you.

oh I am sorry..... I guess that is not a popular view point. Yeah pass a law that anyone who gets in our way gets punished. Don't let chiropractors have an equal footing, don't let nurses have an equal footing - dont let the public have a say - lets regulate everything so that we can just coast with no threats to our protected status.

Truth is - let them do it. If they do not have the quality, time will tell and the market will regulate itself. If they have the quality then you better improve your game and get competitive. but I actually do not get the feel that those for regulation are really concerned with quality control or serving the public - its just one of those turf war gang-related activities. The type of environment the likes of lawyers thrive in. I say let them go and may the best profession win. If its not the MD's then that is the best thing

 

[JeffLebowski]

The big problem with the auto industry bail out is US cars suck. if they produced good cars they would not need a bail out. We are told we are bailing out the "backbone" of the economy -

Lets see - I start a business and it fails, goes bankrupt.... how is that the backbone of anything? In 2008 the Texas Rangers had the worst win loss record in baseball - maybe we ought to bail them out as they are the "backbone" of baseball? If you suck you suck.......may the best man win.

This is a free capitalist economy. Let everyone compete and may the best man win. All this democratic artificial trade restriction is virtually communistic. Trade restrict this and trade restrict that. China has learned how great capitalism is - and yet this country (USA) wants to become socialistic and/or communistic. In the old china or the old soviet union, the government controlled the industries (like you are asking them to do in healthcare) and as a result Chinese cars and Russian cars (and everything else) sucked. There was no captialistic competition in old China or Russia and everything they made sucked. If the USA government restricts competition in health care it will suck way more than it does now. Put on your big boy pants and fix yourself - improve your game, don't ask for socialist control of health care.,

If the American Auto industry stopped making crappy cars they would not have to be bailed out. When I was a kid (a long long time ago) "Made in Japan" was a joke. It was something you said to describe something crappy. But Japan worked hard, studied the problem, and made quality cars that became more popular than American made cars. Now the US auto industry is wahh wahh wahhh - instead of making good cars they want a bail out.

If you want to solve the problem, improve your quality. Be competitive instead of asking lawmakers to bail you out and protect you.

oh I am sorry..... I guess that is not a popular view point. Yeah pass a law that anyone who gets in our way gets punished. Don't let chiropractors have an equal footing, don't let nurses have an equal footing - dont let the public have a say - lets regulate everything so that we can just coast with no threats to our protected status.

Truth is - let them do it. If they do not have the quality, time will tell and the market will regulate itself. If they have the quality then you better improve your game and get competitive. but I actually do not get the feel that those for regulation are really concerned with quality control or serving the public - its just one of those turf war gang-related activities. The type of environment the likes of lawyers thrive in. I say let them go and may the best profession win. If its not the MD's then that is the best thing

It's not as simple as that with medicine, however, you can't just let underqualified people do things they shouldn't and decide afterwards it was a mistake. The burden of proof is on the ones trying to barge in on the status quo to demonstrate equal or better performance when lives are at stake.

And it's not like it's just the MD's trying to put up bureaucratic roadblocks just to protect our turf. They're the ones who are resorting to lobbying and regulatory mechanisms to get their way. We're merely responding to their assault on our profession and potentially the safety of the public. If they're really as good as we are and deserve to share our scope of practice, we should make that decision based on clinical evidence, not money and lobby power.

 

[Raggaman]

History repeats itself.

The first osteopathic school opened just over 100 years ago. Decades ago, DOs have risen to earn all the rights and privileges of Medical practice.

On a side note, the DO profession was started by an MD. DO's have exactly the same curriculum as MD schools PLUS osteopathic lab and lecture! Info for those who might not know.

 

[Taurus]

Truth is - let them do it. If they do not have the quality, time will tell and the market will regulate itself. If they have the quality then you better improve your game and get competitive. but I actually do not get the feel that those for regulation are really concerned with quality control or serving the public - its just one of those turf war gang-related activities. The type of environment the likes of lawyers thrive in. I say let them go and may the best profession win. If its not the MD's then that is the best thing

If this is a true free marketplace, information is accurate and timely for the consumer to make informed decisions.

However, what if that information is wrong, or deceptive?

Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting. APNs who've had a lot of claims against them and have settled out of court can often work in different states without fear of retribution because of confidentiality agreements.​

What if there is a conflict of interest between the APN's and the board that is supposed to regulate them but also has strong interests in seeing an expansion in scope?

regulators [Board of Nursing] acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.​

What if Mundinger, the leader of the DNP's, puts out misleading statements in leading magazines to explain to the public what a DNP is?

you get the medical knowledge of a physician, with the added skills of a nursing professional.​

Do you want to compete with a group that uses propaganda and lies to reach its goals?

 

[Doowai]

What if Mundinger, the leader of the DNP's, puts out misleading statements in leading magazines to explain to the public what a DNP is?

you get the medical knowledge of a physician, with the added skills of a nursing professional.
​

Do you want to compete with a group that uses propaganda and lies to reach its goals?

No, but DNP's are not the same thing as CRNA's, which is what I was discussing - so it really does not apply to what I had to say about CRNA's. DNP's have not been around decades, and do not have the training or "medical knowledge" of physician - so that is another matter

 

[Doowai]

It's not as simple as that with medicine, however, you can't just let underqualified people do things they shouldn't and decide afterwards it was a mistake. The burden of proof is on the ones trying to barge in on the status quo to demonstrate equal or better performance when lives are at stake......We're merely responding to their assault on our profession and potentially the safety of the public. .

Nurse anesthestists have been around for decades and have done fine. They are not suddenly "barging" in on "your" profession.

 

[JeffLebowski]

Nurse anesthestists have been around for decades and have done fine. They are not suddenly "barging" in on "your" profession.

Okay, then they should be totally satisfied with the current system, right? We shouldn't expect to see any CRNA's pushing for scope expansion?

And incidentally, medicine is our profession. Midlevels can chip away piece by piece if they want and start claiming it's not ours anymore and for us to stop whining and squatting selfishly on the field, but I believe with all my heart that taking away more and more of physicians' practice hurts us all, and I'm going to fight it.

 

[8744]

But see that's the problem.

....Then you've got "professional" groups who are trying buff up their credentials and overinflate their titles and call themselves doctor ....

Which leads us to Panda's Fourth Law:

"The depth of your knowledge and the level of trust that should be placed in you is inversely proportional to the number of initials after your name."

I saw a mid-level providor with about six initials for one thing or another.

Scary.

 

[howelljolly]

Nurse anesthestists have been around for decades and have done fine. They are not suddenly "barging" in on "your" profession.

Actually... Nurse Anesthetists have been around longer than MD Anesthesiologists. When Anesthesia used to be limited to chloroform, ether, or whiskey and rawhide, it was managed by a "CRNA".
Once anesthesia became more complex, Medicine took it over... just a bit of historical triva....

OK... back to business...

 

[Raggaman]

I saw a mid-level providor with about six initials for one thing or another.
Scary.

Hey I got many initials after my name!

Raggaman HSD, BSc, PVG, ONP, DO


HSD= high school diploma
PVG= pro video gamer
ONP=overall nice person
DO (soon!)

Now I sure am qualified! Bring me that brain transplant......

 

[JeffLebowski]

Actually... Nurse Anesthetists have been around longer than MD Anesthesiologists. When Anesthesia used to be limited to chloroform, ether, or whiskey and rawhide, it was managed by a "CRNA".
Once anesthesia became more complex, Medicine took it over... just a bit of historical triva....

OK... back to business...

And there was no reason for the emergence of anesthesiologists? Just because something was historically done by someone doesn't mean it should be today.

 

[howelljolly]

And there was no reason for the emergence of anesthesiologists? Just because something was historically done by someone doesn't mean it should be today.

I absolutely positively did NOT say that. I just thought that it was an interesting bit of historical trivia.... as well as the emergence of Surgeons from the Barbers guild, and those sorts of things.

 

[Taurus]

No, but DNP's are not the same thing as CRNA's, which is what I was discussing - so it really does not apply to what I had to say about CRNA's. DNP's have not been around decades, and do not have the training or "medical knowledge" of physician - so that is another matter

You're right. CRNA's are not DNP's. They're even worse. CRNA's are the most militant group in nursing and they have achieved the most success because they use the most blatant propaganda and lies. They are a powerful lobbying force. They are consistently in the top 10 for healthcare lobbying groups in Washington, DC.

 

[zeloc]

So now that there are several of us interested in aligning, I say we elect Law2MD as our organizer due to his knowledge of how the legal profession protected themselves in the face of attacks considering that the medical profession has done nothing except make statements so far.

Regarding the free market society issue, it is potentially dangerous to let others without experience practice as has been mentioned by others. It seems the medical profession has seen a steady erosion over the past few decades from a number of directions and due to a lack of defense.

 

[madtowngirl]

Nursing has Unions.

Doctors have . . . the AMA.

Until we can either unionize or figure out a way to become similarly united, its unlikely that we're going to be able to fight for what we want. Whether that's other specialties off our turf, better compensation, or any other issue that's bound to come up when this health care crisis reaches a head.

 

[UMED122]

Unions would be nice, but the AMA is fine for the issues we're talking about in this thread (reimbursement is probably another issue). The AMA is a fairly strong lobbying group, and they have a loud voice as to how medicine is regulated.

 

[mmmcdowe]

I think the biggest problem with the whole "DO's did it, it'll happen again" argument is the fact that DO's ALSO have all of the training that comes with an MD. While I hear it is a little cheaper, DO school has conformed to the standards of MD schools in order to be able to earn all of their rights. If anything, this validates MD arguments even more. It seems that if it were possible to practice as well as an MD with a shorter (and thus cheaper) education, that DO schools wouldn't have continued to take on all of the requirements of an MD school. Why would they? To validate themselves in the eyes of allopaths? That just sounds like poor business practice to me. If it could be done faster, better, or cheaper, I think it would have been done that way.

Maybe I'm just starry eyed, but I have no problem with NPs evolving into something like DO's and MD's. As long as they have the name training and knowledge, I think another avenue for competent physicians would be ok. My problem is that they are currently NOT at the standards of physicians. It might look good on the balance sheet, but if people are suffering for it then that's a no no. I have personal experience with this as a patient. I had a problem a while back that I went into a clinic about. A NP introduced himself as a doctor, and then proceeded to misdiagnose my problem. My father, who is a doc, accepted the diagnosis on the basis of the NP's supposed credentials, despite the fact that he had come up with a different diagnosis on the phone (we live in separate parts of the country). I went in a few months later because of reccuring problems, and another doctor correctly diagnosed me (which was, by the way, my father's as well). She also informed me that the NP was not a doctor, and had quit due to complaints about misrepresentation. I went ahead and filed one for good measure, but the bottom line is the NP got away with it. My problem wasn't serious, but what if it had been someone else with a serious problem?

I hadn't even heard of this problem until recently. It clearly has spread far and wide. My rural hometown's hospital recently had a group of ER docs band together to protest the fact that a NP had finished her DNP, and was now introducing herself as doctor. At the moment, nothing has been said or done by the administration or even the head of the department.

 

[JeffLebowski]

Maybe I'm just starry eyed, but I have no problem with NPs evolving into something like DO's and MD's. As long as they have the name training and knowledge, I think another avenue for competent physicians would be ok.

Yeah, but what's the point of that? We already have a darn good system for training physicians, why would we have to have several seemingly parallel and identical means to become a physician, with apparently the same training, but different degrees and different confusing letters? Why would we do that, it's presumably redundant (if it's all really equal as you propose), and just confusing and unnecessary. Come on. If we had 5 different professionals all with the scope of practice of a physician introducing themselves as "doctor" seeing patients independently, ordering lab tests, imaging studies, all in the context of the already confusing alphabet soup that everyone and their mother in the hospital insists on tacking on the end of their name "Suzie Smith, RN, MS, DNP, ACN, etc.", no one will have a clue who's who, least of all the patients.

Should I see a DNP for my cough? Should I see an MD for my knee pain? Should I see a DO for my eye problem? ...or is it OD? Who are the ones that do feet? Are you my doctor? What's a DNP? Man I'm really hoping that the DO's just switch their degree to MD and we all take on the other health professions trying to lobby their way into our patients' bedsides.

 

[sirus_virus]

Nursing has Unions.

Doctors have . . . the AMA.
Until we can either unionize or figure out a way to become similarly united, its unlikely that we're going to be able to fight for what we want. Whether that's other specialties off our turf, better compensation, or any other issue that's bound to come up when this health care crisis reaches a head.

Enough said.