As an IMG... (midlevel related)

[IMG69]

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I spoke to my parents recently about the future etc (i'm UK, no intention of heading to the USA) and they said oh you never know you may end up working in the US. I then had to explain to them why that's virtually impossible; sit all 3 USMLE exams, redo residency even if i'm a 10+ year consultant.

It then dawned on me that midlevels; from what I see (posts here and reddit) can just open their own practice and do as they please, while my cousin (20+ year cardiologist) would have to go through what I just mentioned above. I get the reasons for having these hoops etc but if your going to let idk 21 year old PA's who've done nothing but shadow basically function independently why wouldn't you let a Cardiologist with 20+ years experience in the UK do the same? (Am I wrong about this stuff?)

Food for thought?

 

[Splenda88]

It's pretty scary, but state legislatures here in the US are the ones that grant practice right...

Physicians with 1-yr post grad training (6000+ hrs) can not be licensed in some states, yet NP with < 1000 hours shadowing can. The system is just what it is.

 

[Dr. Anonymouss]

It’s because the AANP is a powerhouse and fights a lot harder than AMA does.

 

[zero0]

It’s because the AANP is a powerhouse and fights a lot harder than AMA does.

Not just the AANP, they'd be powerless without their corporate sugar daddies who profit off cheap midlevel labor. For example, CVS helped buy out all the lobbyists in the state to help the infamous California AB-890 bill pass. There's much bigger fish than the AANP fighting for independent midlevel practice.

 

[Dr. Anonymouss]

Not just the AANP, they'd be powerless without their corporate sugar daddies who profit off cheap midlevel labor. For example, CVS helped buy out all the lobbyists in the state to help the infamous California AB-890 bill pass. There's much bigger fish than the AANP fighting for independent midlevel practice.

If mid levels only practiced independtly in CVS or Kroger’s little clinics I would be okay with that, given that patients are made aware they are seeing a mid level provider and not a doctor. This is totally acceptable for minor illnesses. The issue is that this is not the vision set out for nurse practitioners. There goal is to gain complete autonomy and provider rights essentially giving them an MD degree in the fraction of the time...

 

[IMG69]

Isn't it just gonna take a couple more horror stories and this will all be undone though? Excuse the example/comparison but a few George Floyd like cases and the public would be right against nurses practicing without supervision? I've started to see a few already surface.

 

[FutureSurgical]

Isn't it just gonna take a couple more horror stories and this will all be undone though? Excuse the example/comparison but a few George Floyd like cases and the public would be right against nurses practicing without supervision? I've started to see a few already surface.

I listen to the “Patients At Risk” podcast each week. They keep current with everything going on beyond the book they just published last month. It’s insane how it’s more than just “one off” stories/practitioners. It’s systemic

 

[MedicineZ0Z]

Isn't it just gonna take a couple more horror stories and this will all be undone though? Excuse the example/comparison but a few George Floyd like cases and the public would be right against nurses practicing without supervision? I've started to see a few already surface.

That kind of assumes that people actually know what a PA/NP is and how it's different than a doctor.

 

[IMG69]

That kind of assumes that people actually know what a PA/NP is and how it's different than a doctor.

I just don't understand how this all started? Firstly the fact you guys all wear white coats (from what I hear) the alphabet soup after names, I don't even understand how they got the go ahead in the first place to see patients. How'd this all start?

It's crazy, in my hospital there's a clear distinction between nurses and doc's and even the mega consultants (aka the classic jeans and collared shirt). Usually there's a dress code based on your role.

For example.

 

[Matthew9Thirtyfive]

I just don't understand how this all started? Firstly the fact you guys all wear white coats (from what I hear) the alphabet soup after names, I don't even understand how they got the go ahead in the first place to see patients. How'd this all start?

It's crazy, in my hospital there's a clear distinction between nurses and doc's and even the mega consultants (aka the classic jeans and collared shirt). Usually there's a dress code based on your role.

For example.
View attachment 326116

The midlevels are actively trying to blur the lines as much as possible. There’s no law that says you can’t wear a white coat if you’re not a doctor. So they all got white coats. They started calling their clinical rotations residencies and NP or CRNA students shadowing get called residents. They put every possible initial after their name to try to distract the patient and public with fake credentials.

Unfortunately, physicians are at least partly to blame for this. When greedy physicians realized they could use midlevels to make even more money, their scruples went out the window and they started letting midlevels do things they aren’t trained to do, and now they think they are just as good as physicians at those things.

And the public doesn’t know the difference. So many patients who see midlevels for their care don’t know they aren’t seeing a doctor. Between patients assuming anyone treating them is a doctor, NPs using the dr title to confuse patients, and everyone and their mom wearing a white coat, it’s no wonder they don’t know.

And even some healthcare workers get confused because the midlevels will take advantage of assumptions. My own wife (who has been a nurse for 10 years) took our kids for a school physical and thought she saw a doctor (was an NP who didn’t correct my wife when she said Dr. because she assumed she was seeing a physician).

 

[IMG69]

The midlevels are actively trying to blur the lines as much as possible. There’s no law that says you can’t wear a white coat if you’re not a doctor. So they all got white coats. They started calling their clinical rotations residencies and NP or CRNA students shadowing get called residents. They put every possible initial after their name to try to distract the patient and public with fake credentials.

Unfortunately, physicians are at least partly to blame for this. When greedy physicians realized they could use midlevels to make even more money, their scruples went out the window and they started letting midlevels do things they aren’t trained to do, and now they think they are just as good as physicians at those things.

And the public doesn’t know the difference. So many patients who see midlevels for their care don’t know they aren’t seeing a doctor. Between patients assuming anyone treating them is a doctor, NPs using the dr title to confuse patients, and everyone and their mom wearing a white coat, it’s no wonder they don’t know.

And even some healthcare workers get confused because the midlevels will take advantage of assumptions. My own wife (who has been a nurse for 10 years) took our kids for a school physical and thought she saw a doctor (was an NP who didn’t correct my wife when she said Dr. because she assumed she was seeing a physician).

Closest scenario i've seen to this/independent practice was a wound care clinic, however they would literally change bandages and sterilize the wounds, no diagnosing or prescribing. The surgeon was just across the road and would receive pics of all the wounds, we'd only come across for more complicated diabetic feet etc.

I can't believe they're allowed to see children, I remember the first thing I learnt in paeds is that kids can seem relatively ok and are incredibly resilient but then can rapidly and out of the blue deteriorate/decompensate; that's incredible they can skip a whole paeds residency. I'm scared to death whenever i'm on paeds lol, sepsis sepsis sepsis.

 

[Matthew9Thirtyfive]

Closest scenario i've seen to this/independent practice was a wound care clinic, however they would literally change bandages and sterilize the wounds, no diagnosing or prescribing. The surgeon was just across the road and would receive pics of all the wounds, we'd only come across for more complicated diabetic feet etc.

I can't believe they're allowed to see children, I remember the first thing I learnt in paeds is that kids can seem relatively ok and are incredibly resilient but then can rapidly and out of the blue deteriorate/decompensate; that's incredible they can skip a whole paeds residency. I'm scared to death whenever i'm on paeds lol, sepsis sepsis sepsis.

Yes, they have killed kids with negligence and straight up murdered them with incompetence. And yet their scope is just expanding.

 

[IMG69]

Yes, they have killed kids with negligence and straight up murdered them with incompetence. And yet their scope is just expanding.

I'm no lawyer but out of curiosity does this not fall under gross negligence manslaughter? (idk if the USA has a law like that?) or involuntary manslaughter? Something along those lines?

I paid no attention during our legal medicine lectures 🙃

 

[Matthew9Thirtyfive]

I'm no lawyer but out of curiosity does this not fall under gross negligence manslaughter? (idk if the USA has a law like that?) or involuntary manslaughter? Something along those lines?

It is malpractice. And they do get sued. But midlevels are more likely to have the lawsuit eaten up by the hospital. The board of medicine also does not govern them. They are governed by the board of nursing (NPs anyway), which often times will be just RNs, and they will literally ignore NPs harming and killing patients until they have negative press on them. The whole thing is disgusting.

 

[IMG69]

It is malpractice. And they do get sued. But midlevels are more likely to have the lawsuit eaten up by the hospital. The board of medicine also does not govern them. They are governed by the board of nursing (NPs anyway), which often times will be just RNs, and they will literally ignore NPs harming and killing patients until they have negative press on them. The whole thing is disgusting.

What's the future then? Obviously it's gonna hit a wall where nurses and docs are competing for the same role (I assume?) What happens when it reaches that point? Doc's lose and patients die? Then a gigantic medical reform because the public gets involved? If I had to guess they're not gonna lower consult prices etc if your seeing a nurse lol

 

[Matthew9Thirtyfive]

What's the future then? Obviously it's gonna hit a wall where nurses and docs are competing for the same role (I assume?) What happens when it reaches that point? Doc's lose and patients die? Then a gigantic medical reform because the public gets involved? If I had to guess they're not gonna lower consult prices etc if your seeing a nurse lol

Yeah hard to say. What seems to be most likely is a two-tiered health system where t he wealthy can afford to see doctors and the poor have to get their care from midlevels. The wealthy are the people who keep expanding midlevel scope, and since they don’t have to deal with the fallout of those decisions, they aren’t likely to change them. A bunch of lobby money from CVS and the AANP is very convincing.

 

[IMG69]

Yeah hard to say. What seems to be most likely is a two-tiered health system where t he wealthy can afford to see doctors and the poor have to get their care from midlevels. The wealthy are the people who keep expanding midlevel scope, and since they don’t have to deal with the fallout of those decisions, they aren’t likely to change them. A bunch of lobby money from CVS and the AANP is very convincing.

Man that's crazy, I hope some kind of reform happens before it's too late, otherwise I assume residents will be the ones who suffer.