"DermCare" Team???

[Carbocation1]

Sounds like Derm is going the route of Anesthesia. From the website of the national academy of (militant) dermatology nurse practitioners"

"The AAD has announced their creation of a "DermCare Team". We must be vigilant and proceed with caution with this initiative. This initiative from AAD requires direct supervision of NPs and PAs in order to belong to the “DermCare Team”. This restriction of NP’s and PA’s dermatology practice comes without any formal research or statistics that support their statements and initiatives."


http://www.nadnp.net/?page=practiceissues

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[Carbocation1]

Derm no longer the crown jewel specialty for med studs in 5-10 yrs?

 

[sliceofbread136]

Debra Shelby, PhD, DNP, FNP-BC, DNC

That's a lot of letters after her name, what she says must be true

 

[wxman393]

Has anyone asked why they don't go to medical school if they want to practice independently? I know many former nurses, PA's, CRNA's and paramedics that did the work, applied, went to medical school, and are now practicing independently as physicians.

 

[TaroBubbleTea]

Derm is a recipe for disaster: great pay, great lifestyle (midlevels are already flocking to derm in droves so much so that according to the AAD, 1/3 of derm "providers" are midlevels), and dermatologists willing to "supervise" hordes of midlevels with open arms to line their pockets even more. I guarantee that in a few years, derm will definitely be overrun by midlevels.

 

[doapplicant2015]

Sad times when the easiest way into derm is to drop out of med school

 

[Psai]

Derm is a recipe for disaster: great pay, great lifestyle (midlevels are already flocking to derm in droves), and dermatologists willing to "supervise" hordes of midlevels with open arms to line their pockets even more. I guarantee that in a few years, derm will definitely be overrun by midlevels.

No way, nps only care about serving the underserved populations in primary care in rural areas because they are awesome

 

[TaroBubbleTea]

No way, nps only care about serving the underserved populations in primary care in rural areas because they are awesome

Oh yea, silly me, how could I have forgotten.

 

[TwinsFan]

Been saying midlevels would flock to derm for a couple years now. There is no logical reason they wouldn't; good hrs/pay/elective pts. Why put in the work of med school when your state government can do the work for you?

 

[Jabbed]

"The reality is that in today’s health care crisis, dermatologists need NPs and PAs to survive just as much as NPs and PAs need dermatologists."

We must work together.. for the sake of the healthcare crisis..

 

[Mad Jack]

The race to the bottom continues...

 

[W19]

I guess the joke in on us who go to school for 11+ years and accumulate so much debt when someone else can just do the same thing in 6-7 years while having a job... My gosh! I am half way thru my path class and it seems like every disease has some kind of dermatological manifestation. How the heck an NP with less than 20% of the physician training will be able to function?

People in derm gotta stop that nonsense for the good of some patients...

 

[W19]

The race to the bottom continues...

We cannot just throw our hands in the air and say: 'The race to the bottom continues'... We have to start taking some action for the good of the patients. These people are making a mockery out of the system.

 

[Mad Jack]

We cannot just throw our hands in the air and say: 'The race to the bottom continues'... We have to start taking some action for the good of the patients. These people are making a mockery out of the system.

I think I'm just content letting the people have what they want and suffering because of it.

 

[Siggy]

I guess the joke in on us who go to school for 11+ years and accumulate so much debt when someone else can just do the same thing in 6-7 years while having a job... My gosh! I am half way thru my path class and it seems like every disease has some kind of dermatological manifestation. How the heck an NP with less than 20% of the physician training will be able to function?

People in derm gotta stop that nonsense for the good of some patients...

If it's wet, dry it... if it's dry, wet it, everyone gets steroids, if no improvement, they get to see the real doctor.

 

[TaroBubbleTea]

I guess the joke in on us who go to school for 11+ years and accumulate so much debt when someone else can just do the same thing in 6-7 years while having a job... My gosh! I am half way thru my path class and it seems like every disease has some kind of dermatological manifestation. How the heck an NP with less than 20% of the physician training will be able to function?

People in derm gotta stop that nonsense for the good of some patients...

The problem is that current dermatologists are gladly enabling the degradation of their speciality for short term benefits, since they won't have to deal with midlevel encroachment once they retire.

 

[TBV]

The problem is that current dermatologists are gladly enabling the degradation of their speciality for short term benefits, since they won't have to deal with midlevel encroachment once they retire.

Which is fair. I mean it's hard to ask someone to jump on a grenade. If someone elects to, great. But if they do not want to take one for the team good luck persuading someone to drop their bottom line.

 

[fab4fan]

No way, nps only care about serving the underserved populations in primary care in rural areas because they are awesome

LOL...you best me to the punch!

 

[Taurus]

As I've been saying for a long time, nurse midlevels will target the low hanging fruit to claim as equivalent to physicians. Primary care, anesthesiology, ED, and derm.

 

[username456789]

If it's wet, dry it... if it's dry, wet it, everyone gets steroids, if no improvement, they get to see the real doctor.

I realize you're joking, but it's idiots who think like this who end up consulting us for bilateral lower extremity cellulitis (hint: that's not a thing).

I agree, though . . . once you've exhausted what little derm knowledge you know as illustrated above, you should send the patient to us, the real doctors. We'll bail you out.

 

[asdf123g]

As I've been saying for a long time, nurse midlevels will target the low hanging fruit to claim as equivalent to physicians. Primary care, anesthesiology, ED, and derm.

ED?! I can't see that happening...but what do I know?

 

[masaraksh]

I guess the joke in on us who go to school for 11+ years and accumulate so much debt when someone else can just do the same thing in 6-7 years while having a job... My gosh! I am half way thru my path class and it seems like every disease has some kind of dermatological manifestation. How the heck an NP with less than 20% of the physician training will be able to function?

People in derm gotta stop that nonsense for the good of some patients...

Chief complaint: rash
...

every patient

 

[masaraksh]

ED?! I can't see that happening...but what do I know?

I really hope ACORN (aka Acute Care Operation Registered Nurse) becomes a thing.

 

[NickNaylor]

ED?! I can't see that happening...but what do I know?

This is already happening. At one of the hospitals I rotated at in med school, there was an NP on staff during the days who essentially saw the less acute cases in the ED. I highly doubt you would see an NP managing someone that is hemodynamically unstable or something like that, but NPs seeing patients in the ED is already happening. Some of the attendings appreciated the work as it essentially prevented them from seeing cases that really didn't belong in the ED while other attendings (one in particular) would act as if the NP wasn't there and see all of the patients on his own.

 

[Psai]

This is already happening. At one of the hospitals I rotated at in med school, there was an NP on staff during the days who essentially saw the less acute cases in the ED. I highly doubt you would see an NP managing someone that is hemodynamically unstable or something like that, but NPs seeing patients in the ED is already happening. Some of the attendings appreciated the work as it essentially prevented them from seeing cases that really didn't belong in the ED while other attendings (one in particular) would act as if the NP wasn't there and see all of the patients on his own.

I hate getting a floor patient that was admitted by an ED NP. Usually it's a terrible H&P so you have to redo it from scratch (not that you wouldn't anyway but it would be nice to get a sense of where to go with the patient) and a terrible workup that is only useful because you can sometimes find what you need in the mess of unnecessary tests.

 

[NickNaylor]

I hate getting a floor patient that was admitted by an ED NP. Usually it's a terrible H&P so you have to redo it from scratch (not that you wouldn't anyway but it would be nice to get a sense of where to go with the patient) and a terrible workup that is only useful because you can sometimes find what you need in the mess of unnecessary tests.

Patient I admitted to the inpatient psych unit once: came in complaining of SI and suicidality, received an insane panel of labs including ESR (???????) as well as head imaging by the ED NP who saw the patient. I was so confused.

 

[asdf123g]

nurses seeing the more minor cases...is this a good thing or a bad thing? Does it not cut into one's pay/ability to land a job due to outsourcing?

 

[Dral]

The AAD is a strong force. I think Dermatology has one of the highest percent of practicing members in the society of all medical fields.

Deborah is in for a battle if she wants to practice independently in an attempt to make more money...Er, I mean to improve patient care.

 

[libraryismyhome]

alright... though I am not interested in dermatology. This is bad.

Do Dermatologist Nurse Practitioners need to work under dermatologists for certain number of hours in order to be fully licensed?

 

[TwinsFan]

As I understand it... Since NPs only report to the nursing board and not the medical board/specialty boards they can pretty much make up whatever standard they want and call it good as long as they can get reimbursed for it by insurance companies/CMS and have malpractice.

 

[sloop]

I hate getting a floor patient that was admitted by an ED NP. Usually it's a terrible H&P so you have to redo it from scratch (not that you wouldn't anyway but it would be nice to get a sense of where to go with the patient) and a terrible workup that is only useful because you can sometimes find what you need in the mess of unnecessary tests.

In all fairness, most of the E.R. admissions to general IM I've seen have sort of been cookbook medicine: Pt with atypical CP, reproducible on exam likely MSK; CXR, ECG, q6 troponins x 3 then d/c with follow-up outpatient. Pt. with epigastric pain and intractible vomiting, stable; antiemetics, fluids, NPO, HCG, lipase, admit, likely GI consult + EGD, blah blah. Stuff I actually think an NP could potentially handle (though not ideal). I haven't had too much of a problem with terrible ED NPs.

I guess I have seen some complicated patients come out of the ER, but the real cluster**** patients I have seen were all MICU transfers. Nothing good ever goes in there and when they come out they have a transfer note a mile long. Perfectly competent people writing them too—just the worst patients to get stuck with.

 

[username456789]

The AAD is a strong force. I think Dermatology has one of the highest percent of practicing members in the society of all medical fields.

Deborah is in for a battle if she wants to practice independently in an attempt to make more money...Er, I mean to improve patient care.

Although I hate the AMA, I have been very impressed with the AAD in my years as a Derm resident (which are coming to a close soon). I've particularly enjoyed listening to Brett Coldiron speak, even if he is sometimes a bit sensationalist - it's what we need to ensure we don't become too complacent or passive.

 

[WingedOx]

This shouldn't bee too surprising. Derm has been the manifest destiny of NPs for a long time.

 

[Taurus]

Lol. The moderator in the derm forum deleted my post bc they are living in denial. I've been talking about this issue for more than 10 years now. Every year, my fears get closer to reality. I've been saying for a long time that derm was in the cross hairs of nursing midlevels.

Always ask yourself about a nonsurgical specialty, what is the barrier to entry? If it is low and the field is lucrative, that's like inviting the fox into the henhouse. There must be clear and distinct roles between physicians and midlevels. If the midlevel does the exact same job as you, your field is in trouble long term. Look at primary care, anesthesiology, ED, and derm.

 

[W19]

@Taurus You forgot psych...

There will be a day when NP will be reading images and physicians will be treating patients based on NP impressions...

 

[TBV]

@Taurus You forgot psych...

They can keep psych though

 

[W19]

They can keep psych though

I agree... I have already proposed phasing out of some specialties (derm, psych, FM, Gas etc...) and leave them for NP.

 

[WingedOx]

I agree... I have already proposed phasing out of some specialties (derm, psych, FM, Gas etc...) and leave them for NP.

Your proposals were dumb then and they're dumb now.

 

[W19]

Your proposals were dumb then and they're dumb now.

I am pretty sure PC and psych docs said the same 10+ years ago... Look at what is happening to these fields now.

Why do you think NP don't go after surgical specialties, radiology, pathology etc...?

 

[asdf123g]

Lol. The moderator in the derm forum deleted my post bc they are living in denial. I've been talking about this issue for more than 10 years now. Every year, my fears get closer to reality. I've been saying for a long time that derm was in the cross hairs of nursing midlevels.

Always ask yourself about a nonsurgical specialty, what is the barrier to entry? If it is low and the field is lucrative, that's like inviting the fox into the henhouse. There must be clear and distinct roles between physicians and midlevels. If the midlevel does the exact same job as you, your field is in trouble long term. Look at primary care, anesthesiology, ED, and derm.

@Taurus so what do you do if you have no interest in any surgical specialty then?..

 

[Taurus]

Why do you think NP don't go after surgical specialties, radiology, pathology etc...?

Simple. Surgical and fields like radiology, pathology, etc are not big parts of nursing midlevel training. Primary care, ED, and anesthesiology are. Derm is in danger because it can easily be integrated within the scope and training of nursing midlevels.

Can nursing midlevels be trained to read CTs in radiology? Sure, but can you see it be done as part of a nationwide push without the support of national radiology leadership? No.

Can nursing midlevels be trained to do surgery or read path slides? Sure, but can it be done without the blessing of the surgeons or pathologists? Nope.

Anesthesiology screwed the pooch because their leaders embraced and supported the CRNAs. They created their own monster and now they can't control what they have wought.

 

[Taurus]

@Taurus so what do you do if you have no interest in any surgical specialty then?..

Think twice about medical school. Lol. Just kidding.

If you are interested in a field that is in the cross hairs of midlevel nurses, then you must be the type of person who does not mind working with someone who has lesser training than you but gets the same title and nearly the same/identical pay as you. You must check your ego at the door. For me, that's unacceptable. It makes you look like a fool for going the medicine route.

I would say pick a field/type of work that has clear distinctions between physician and midlevel. I would go further and even say pick a field where only your specialty does it. For example, IR has lost turf because they have not historically seen patients and now these clinical services such as vascular surgery, cardiology, neurology, and neurosurgery want a piece of the action. I am in a field where only my sub specialty does it and there's no concern of encroachment.

Of all the fields, surgery is most protected from midlevel encroachment, but it's a long and hard path to being a surgeon. Lifestyle sucks. For example, I am not a surgeon and I am in a job where I work 45 hours per week, on call one weekend (1-2 days) per month for 9-10 hours per day, 12 weeks vacation, and getting paid like a neurosurgeon. No one is impressed by my job title. They are even surprised I'm a physician. I'm laughing all the way to the bank. I'm not worried about midlevel encroachment in my field either.

 

[repititionition]

Think twice about medical school. Lol. Just kidding.

If you are interested in a field that is in the cross hairs of midlevel nurses, then you must be the type of person who does not mind working with someone who has lesser training than you but gets the same title and nearly the same/identical pay as you. You must check your ego at the door. For me, that's unacceptable. It makes you look like a fool for going the medicine route.

I would say pick a field/type of work that has clear distinctions between physician and midlevel. I would go further and even say pick a field where only your specialty does it. For example, IR has lost turf because they have not historically seen patients and now these clinical services such as vascular surgery, cardiology, neurology, and neurosurgery want a piece of the action. I am in a field where only my sub specialty does it and there's no concern of encroachment.

Of all the fields, surgery is most protected from midlevel encroachment, but it's a long and hard path to being a surgeon. Lifestyle sucks. For example, I am not a surgeon and I am in a job where I work 45 hours per week, on call one weekend (1-2 days) per month for 9-10 hours per day, 12 weeks vacation, and getting paid like a neurosurgeon. No one is impressed by my job title. They are even surprised I'm a physician. I'm laughing all the way to the bank. I'm not worried about midlevel encroachment in my field either.

But you're going to keep the (sub) specialty a secret?

 

[2maitaisplease]

With all the newly insured patients entering the healthcare system s/p the affordable care act, and the new amounts of time necessary to document everything in EMRs, there is definitely a place for midlevels in derm. Dermatologists should work at the highest levels of our abilities and manage the complex med derm problems (albeit while being allotted more time to do so) while midlevels take care of the common things. There will still be more than enough patients for everyone.

 

[TBV]

But you're going to keep the (sub) specialty a secret?

The people being surprised that he is a physician part makes me think pathology? Probably way off.

 

[Taurus]

But you're going to keep the (sub) specialty a secret?

Yeah, I like to keep my anonymity. A lot of it has to do with luck. I could also find a job where I get half the pay and vacation time and working my ass off too.

You can do well in a lot of fields. Have a good game plan, work hard, and keep your eyes open for opportunities.

 

[W19]

.

 

[Taurus]

With all the newly insured patients entering the healthcare system s/p the affordable care act, and the new amounts of time necessary to document everything in EMRs, there is definitely a place for midlevels in derm. Dermatologists should work at the highest levels of our abilities and manage the complex med derm problems (albeit while being allotted more time to do so) while midlevels take care of the common things. There will still be more than enough patients for everyone.

Yeah, that's how primary care, anesthesiology, and ED screwed themselves. They thought they could control the monster they created. They thought their monster would not have a mind of its own, that it would never want to be free of the leash around its neck.

Don't be a fool. Give a midlevel nurse an inch and they want to take a mile.

 

[asdf123g]

Yeah, that's how primary care, anesthesiology, and ED screwed themselves. They thought they could control the monster they created. They thought their monster would not have a mind of its own, that it would never want to be free of the leash around its neck.

Don't be a fool. Give a midlevel nurse an inch and they want to take a mile.

are nurses not a necessary component to ED care though? I feel like its very team based.

 

[67552931811]

are nurses not a necessary component to ED care though? I feel like its very team based.

The whole notion of "team based" and "collaboration" is a concept invented by administration and nursing serpents. Nurses have their roles as nurses. An ED doc doesn't need a nurse practicing medicine for him or her