Did I go through all this to be replaced by a nurse?

[Sinnman]

---

Members do not see this ad.

Oh yeah, I’m not worried I won’t be able to find work. I think, based on my previous experiences, that the market will eventually self correct. There IS a reason that we have so much education and training. Medical education has evolved for a reason. NPs may be cheaper and may agree to live in the sticks for a while, but greed and human desires will catch up with them and this will change. Also, if they are “freed” from the oppressive bondage of physician “collaboration” they WILL get nailed with malpractice. Again, there is a reason we have so much training.

I used to work at a place that hired some NPs to cut down on physician salaries and it was a disaster. They fired them all after a few months. The money they saved by the lower salaries were way overshadowed by the loss of productivity and HUGE increase in unnecessary tests (if you don’t know a diagnosis, keep randomly shotgunning tests and hopefully it will present itself). It doesn’t take long for the cost of a few CTs that would never be ordered by someone with a true understanding of medicine to more than offset the cost difference.

So, no, I’m not worried about losing my job. I am worried that my family and friends may suffer. Also, I think it’s pretty stupid to think that primary care and maybe other specialties won’t lose reimbursement. And before anyone starts in on the “greedy doctor BS” come talk to me after you have a quarter of million in student loans and 7+ years of lost income, retirement, compounded interest and decreased work years

 

[Kubed]

Wow, I just read the admission requirements and the degree requirements for the DNP at Kentucky. I'm blown away. All the classes are online, but they require that you meet for an in person class five times a semester. … Five times a semester?!?!?!

http://www.mc.uky.edu/Nursing/academic/dnp/default.html

 

[It'sElectric]

Wow, I just read the admission requirements and the degree requirements for the DNP at Kentucky. I’m blown away. All the classes are online, but they require that you meet for an in person class five times a semester. … Five times a semester?!?!?!

http://www.mc.uky.edu/Nursing/academic/dnp/default.html

Exactly! Are people seeing a problem with this now?? I beg someone to defend this.

 

[PA-C]

Better than the upper level sugery residents? This is a pretty bold statement. These guys are studs at my institution. I have been universally impressed with their knowledge and technical skills.

I have said this before, but I will say it again. Primary care physicians are needed not to treat the obvious stuff, but not to miss the not so obvious potentially devastating disease processes. Any dummy can do a swab for strep, but the doc is there to assure that it is not something else. Is it conjuctivitis or is it Kawasaki disease? Back pain or a AAA? Post viral lymphadanopathy or NHL? A little knowledge (like mine right now) is dangerous. I am not saying that PAs are dangerous, what I am saying is that DNPs, without oversight and broader/deeper training would be dangerous for patients. It's not what we know that we do not know that is dangerous (thats when we call for a consult). It is what we do not know that we do not know that is dangerous. This whole debate is a sad situation. Lowering the standards to take care of patients is pathetic and wrong.

Just to set the record straight. If you read my statement a little more closely I never claimed to be better than upper year residents. I worked in a gen surg residency program with 13 other residents and the program director said that I function at the level of a jr. resident(aka 3rd year). I am not arrogant enough to make that statement on my own.

As far as the NP argument... I will not speak on their behalf because their training is completely different and I am not that familiar with their courses and clinical training. I do not agree with them operating independently however that is only my gut opinion. I can say that I know quite a few med students who were lucky to show up for five classes. In this day and age of computer technology a lot can be learned IN THE FIRST TWO YEARS online. Nothing can replace hands on experience, however. My true feeling is that if nurses are dangerous operating independently we will find out soon enough and they will not be able to afford their own malpractice or hospitals will not want to pay it. Secondly, i dont know if np's can bill what physicians can but PA's can only bill about 80% last time I checked. Thirdly, as I said before patients want to see doctors. I know this from being a PA. Do you think if a nurse has her own office that patients are going to choose them over you when they have a problem? I also dont beleive that they will flourish in the hospitalist role...again a gut opinion. Again, you will rest easier when you realize that there is plenty of room for everybody in medicine and your level of knowledge and comprehension will not allow you to go extinct. Medical schools are increasing enrollment exponentially. DO schools have had 300% growth! Does that sound like a trend that shows decreasing demand for physicians?

 

[Taurus]

if they are “freed” from the oppressive bondage of physician “collaboration” they WILL get nailed with malpractice.

I used to work at a place that hired some NPs to cut down on physician salaries and it was a disaster. They fired them all after a few months. The money they saved by the lower salaries were way overshadowed by the loss of productivity and HUGE increase in unnecessary tests (if you don’t know a diagnosis, keep randomly shotgunning tests and hopefully it will present itself).

I believe that this is part of the impetus behind the DNP degree. Nursing leaders were probably realizing that because NP's did not have enough education they were more prone to malpractice, especially if they practiced independently. Solution? Increase their education length. If after a while a four year DNP degree doesn't do the trick, then create nursing residencies similar to medical ones. I think that the nurses are hell bent on getting looked upon as being equals with physicians. Eventually, the nurses will try to get DNP's to be of no more malpractice risk than a physician in that practice area.

--------------------------------------------------------------------------
From http://cpmcnet.columbia.edu/dept/nursing/programs/drnpfaq.html

Why is this degree necessary?
Advanced practice nurse's practice authority and accountability are growing nationally. At the same time the public, payers, and policy makers are demanding providers be educated to assume this growing responsibility. Degree titles in the professions have long served to identify the education and abilities of its members. The DrNP title will provide a standard to identify those with the skills and knowledge to legitimately assume the highest level of clinical interaction with patients.

 

[hospitalistpac]

I think the whole DNP thing will ruin the NP profession

1. They will cave under malpractice once physician "collaboration" is done away with.

2. Physicians and hospitals will be more inclined to hire PAs

3. Their 50 internet credits will be exposed on 60 minutes and other prime time TV reporting. I'm sorry but no one wants someone who was trained online with open book tests diagnosing or treating them.

Now for the whole online thing, I don't think its terrible to have some classes online, but not core classes like Pharm, Pathophys and Clinical Medicine.
Wait, do NPs even take these classes at all?

 

[LWestenhofer]

My mom is a nurse and she will not see a NP except for minor things... checkups, sniffles... Her total care is still managed by a PCP. I hope the general public is not ignorant enough to place their health in the hands of someone who can get their degree on the internet. And I'm only saying that b/c my mother knows nurses who have gotten their NP on the net. The problem is that these guys have never been taught why we do this treatment or that treatment, they have only been taught when you see this give this. This can get ugly with seriously ill patients and the answer isn't plug and chug.

First of all, I do not endorse receiving a degree of any form or fashion online-particularly one in the incredibly complex field of healthcare. However, I do believe a little research should be performed before an opinion is shared regarding nursing education. All NP candidates are required to perform hands on training- typically a lengthy round of clinical on-site training similar to the third year of medical school- even the ones online. Basically the only difference is that lectures are not taught inperson.

Also, I live in Alabama. Many of the residents of the state of Alabama would be thrilled to have a quality nursing skill-based clinic to attend. In many cases, that would be the only option. Clearly medicine isn't encouraging primary care in successful ways- the country is incredibly short staffed when it comes to primary care.

What I don't understand is why you guys feel threatened by this? As a nurse and pre-medical student, I can tell all of you that you need to be watching and regurgitating nursing actions on a daily basis. Most nurses are bright, caring, and nurturing when given the chance. If you can do a better job after residency, then do it, but don't challenge others who are trying their best to help people.

 

[LWestenhofer]

Exactly. They do not want supervision. They want to be independent practitioners. They want the same title, the same pay, and the same privileges as us without the same education. The "doctorate" is just one more step, and perhaps the last, to finally saying that they are just like MDs or DOs. The "oversight" that they are required to have now in most states is a joke. What do think is going to happen when they are "doctors?" BTW, as the consummate wordsmiths they are, no physician can “supervise” a NP, they “collaborate” with them.

Also, in response to your statement above, I have heard many arguments supporting the role of the NPs, "they can help out a practice" "they are cheaper than doctors" or "they will work in rural areas or other places that doctors won't." This is BS. They use these arguments to convince people to accept them, but in reality they are greedy humans just like everybody else. What makes anyone think that the NPs are so philanthropic that they want to live in the middle of nowhere? They use this as an argument for their existence but as time goes on they wind up moving to the cities just like everyone else. Pay? Right now, they get played 85% (used to be 80%) what a physician does. There is a tremendous effort to increase this to 100%. They say that they're doing the same job and should get the same pay.

If you give an inch, they will take a mile. As a future physician and consumer of healthcare, you better take this seriously.

I know at least 15 NPs who are in current practice- avg salary of $45000. When compared to the hundreds of physicians in my area- only including PCPs- the avg salary is somewhere around $120000. How is that 85%?

Also, I have yet to meet an NP who behaves as obnoxiously as you have on this blog. You make valued assets to the healthcare system sound like leeches who are somehow absorbing your profits. Where I work NPs, PCPs, and specialists collaborate together exquisitely. They work together- not against each other and if anyone has these huge issues with each other- they have not been voiced in three years.

My suggestion to you is to learn to get along with others or you are really in for it in the real world of healthcare.

 

[lama]

As I find myself in the midst of study for Step 2, one thing has consistently caused me to step back and marvel at what we are doing... it's the depth of knowledge to which medicine goes and the degree to which we are expected to master it. Just when you think you have things figured out, you find they go deeper... much deeper.

I thought I had a firm knowledge on a lot of diseases. Now as I study for boards, I have come to recognize the interplay and connectivity that several diseases have with one another that I never fully understood during my first 3 years of medical school. Like someone said earlier, it's knowing the difference between conjunctivitis and Kawasaki's disease. But even more so, it's knowing that if you miss Kawasaki's by sending a kid home and that kid develops a carotid aneurysm, that kid could die. It's knowing that when a patient with infective endocarditis comes to your office and you see Oslers nodes and Janeways lesions, there is a difference in the pathophysiology of the two... one is due to immune-complex vasculitis and one is due to emboli. A young woman with a normal history and has a sudden stroke... you should check for murmurs... get a TEE to rule out a PFO. Etc. Etc. Etc.

I know for a FACT, that the PA's at my school were not taught these kinds of things. I tutored many of them in Biochemistry and Anatomy. Many of them had trouble even understanding the Krebs cycle much less understanding glycogen storage diseases. Ask one of these new PA's why Amoxicillin is given to a kid with Strep A pharyngitis. They'll probably tell you it's to help the pharyngitis, not to prevent Rheumatic Fever.

You see, any monkey can be taught cookbook medicine. That is why NPs, PAs, and CRNAs are able to practice medicine and get away with it most of the time. Yes, anyone can do a lap chole. Hell, before medical school, I saw hundreds of choles as an OR assistant. I could probably do a chole by myself just like PA-C, because I memorized the procedure. They're not hard. However, what physicians have that the midlevels dont, is an expert understanding of all the posssible complications and related issues for a patient's illness. Doctors are paid big bucks not because they can follow a cookbook or memorize a treatment protocol, we are paid to make the decisions when things don't go as planned.

Tell me you want your kid in the hands of a Dr. Nurse when his life is on the line.... 👎

 

[Old_Mil]

Wake up, you and other physicians have to be aggressive and protect your turf otherwise it won't exist.

Absolutely. In a health care industry run by MBAs and lawyers, the balance of wealth will shift in such a way as to put as much of the money in the health care system in the hands of these two groups as possible. That means using NPs and PAs to the fullest extent of the law, and then chaging the laws so you can expand their use.

An example of this is a hospital in Texas which revoked the practice priviledges of all the independent anesthesiologists in town, brought in their own group of gas people supplemented by a large number of NAs, and said all surgeries in their OR had to be done with their people. Presto, another profit center is born.

Join the AMA and your state medical society, donate generously to their PACs, and get involved in the two organizations that wields the power and respect necessary to protect your career.

 

[labcoord]

"...You see, any monkey can be taught cookbook medicine. That is why NPs, PAs, and CRNAs are able to practice medicine and get away with it most of the time. Yes, anyone can do a lap chole. Hell, before medical school, I saw hundreds of choles as an OR assistant. I could probably do a chole by myself just like PA-C, because I memorized the procedure. They're not hard. However, what physicians have that the midlevels dont, is an expert understanding of all the posssible complications and related issues for a patient's illness. Doctors are paid big bucks not because they can follow a cookbook or memorize an treatment protocol, we are paid to make the decisions when things don't go as planned.

Tell me you want your kid in the hands of a Dr. Nurse when his life is on the line.... 👎"

Well put! I couldn't agree more. 👍

In regards to an earlier post..."the REAL world of Healthcare" is and has always been...a BUSINESS.

Truth is, business drives healthcare. Without turning a profit many clinics, hospitals, health centers CLOSE. The model of perfect business is to maximize profit by lowering overhead...plain and simple.

In an ideal world, where we all want "World Peace" and everyone prances through fields of lavender without worries except for fear of eating fruit from the forbidden apple tree has passed.

Hospital admins will always find cheap labor, cut costs, and lower quality of care.

Having worked in laboratories, home nursing care, and a new med student, I see this practice every day. There are hundreds of more qualified candidates for every entry level lab positions...but with greater education comes higher commanding salaries. So, what manager or lab director will want to hire someone too qualified, when they can hire a Med Tech or MLT to mindlessly follow cook-book recipes for much, much less.

Essentially, they want someone to follow routine, adhere to cost saving protocols, and never question or think beyond the borders of the BOX.

I would agree with supervised care from a NP or PA...but NEVER from a completely autonomous mid-level practitioner. Anyone who values their lives would probably agree.

I and everyone else would want a physician who question "what else could be wrong with me"...not mindlessly following a protocol/algorithm of ...if THIS happens...then do THAT.

Sure there are tons of NP and PA with Great bedside manner. But those are not the ONLY qualities that make good physician. Knowledge matters, critical thinking matters, and above all training/education matters.

So, to contribute my opinion to the OP, if NP want complete autonomy, they can do so quite easily....go to Med School.

Disclaimer on last statement: For those who argue that NP can handle everything a PCP can...then NP can go to med school. It should be a breeze for them, right. They've been there, done that, and had the experience...

 

[Taurus]

"the REAL world of Healthcare" is and has always been...a BUSINESS.

I wouldn't say that too loud among your medical school classmates. The Mother Theresa's in your class will chew you out. Most of your peers have never stepped outside of school long enough to understand that that is how medicine really operates. In my opinion, most of us get a very sanitized view of medicine, no matter how much volunteering we do before we enter medical school. We only see the good doctor helping the patient. This is the image that has been instilled into our heads. What we don't see is the voluminous paperwork, the back and forth with insurers, the bills for supplies, rent, utilities, staff, etc. If you open up your own practice, you are starting a business. If you don't research the local demand carefully or don't operate it well, you won't turn a profiit and it will eventually close. Even if you work at a hospital, there are lots of number crunching going on in the background by the MBA's. If your department or specialty area is not profitable and there are no local or state pressure to keep it open, the hospital will close it down. ER's are huge drains to hospitals, but they stay open because they serve a necessary public service. Their costs are offset by the profits generated by other departments. Similarly, if it costs more for the hospital to keep you around than what you bring in, the hospital will eventually let you go too unless you demonstrate your value in other ways.

People need to get past this idea that medicine is somehow above the fray, that it is not affected by the same forces that affects every other industry. It is not.

 

[PlasticMan]

Here's another article I just read on this subject.

http://news.yahoo.com/s/ap/20060625/ap_on_he_me/the_nurse_is_in

 

[SOUNDMAN]

You see, any monkey can be taught cookbook medicine. That is why NPs, PAs, and CRNAs are able to practice medicine and get away with it most of the time. Yes, anyone can do a lap chole. Hell, before medical school, I saw hundreds of choles as an OR assistant. I could probably do a chole by myself just like PA-C, because I memorized the procedure. They're not hard. However, what physicians have that the midlevels dont, is an expert understanding of all the posssible complications and related issues for a patient's illness. Doctors are paid big bucks not because they can follow a cookbook or memorize a treatment protocol, we are paid to make the decisions when things don't go as planned.

Tell me you want your kid in the hands of a Dr. Nurse when his life is on the line.... 👎

As a PA this was an excellent post I believe. I've practiced for the last 3 years in orthopedics, and I know I could do some orthopedic procedures, but the key like stated is above, any monkey can do just about any procedure, it's what your going to do when things go wrong. That's where the additional training becomes highlighted and a physician is obviously who you want in that situation.

Secondly, I think all would agree that PA's are not shooting for an agenda to be without supervision. This has always been the dividing line between NP's and PA's. NP's want that autonomy and be able to hang their shingle wherever they like, and see patients. I've always known as a PA it's a partnership with my physician, and I'm there so he can see more patients, ease the burden from his workload, and extend his boundaries broader than he could without me. I'm an extension of him NOT a REPLACEMENT for him.

Oh and patients ALWAYS know that when I come into the room they are seeing the PA, there is never any doubt and I make sure they know that as I introduce myself that way to the patients everytime. They'll still call you doc occasionally, but they know you are "just" the PA.

 

[schutzhund]

I know at least 15 NPs who are in current practice- avg salary of $45000. When compared to the hundreds of physicians in my area- only including PCPs- the avg salary is somewhere around $120000. How is that 85%?

Also, I have yet to meet an NP who behaves as obnoxiously as you have on this blog. You make valued assets to the healthcare system sound like leeches who are somehow absorbing your profits. Where I work NPs, PCPs, and specialists collaborate together exquisitely. They work together- not against each other and if anyone has these huge issues with each other- they have not been voiced in three years.

My suggestion to you is to learn to get along with others or you are really in for it in the real world of healthcare.

First of all, I don't think I've been "obnoxious" one bit. I think you're just angry that I'm pointing out some serious issues facing medicine imposed by the radical nursing agenda. This is a typical response used by politicians to foster their agendas. First, have the wordsmiths slowly change the language and meaning of words of the discussion, "supervision" "collaboration," "nursing practice" vs. "medical practice" etc. Next, raise personal attacks against anyone that challenges you.

Onto the salary thing. $45,000 per year? The average salary for an NP now exceeds $70,000 with many making a lot more than that. This does not differ much for the average salary of a FP physician.

http://www.nurse.net/cgi-bin/start.cgi/salary/index.html

Next, do you really think that all (most) NPs want to work and "collaborate" together with physicians in blissful harmony? Wrong! There is a huge push for complete autonomy. That is not working together. That is, by definition, directly in competition with doctors.

"formulate and influence healthcare policy to remove barriers to Nurse Practitioner practice"
http://www.nurse.org/acnp/leg/antitrust.shtml

Which includes "Promoting the recognition of nurse practitioners as licensed, autonomous providers."
http://www.nurse.org/acnp/news/2005publicpolicy.pdf

Or all the "research" (done by nurses) as to why NPs are as good as or better than physicians:

http://www.nurse.org/acnp/facts/outcome.studies.shtml

First of all, I do not endorse receiving a degree of any form or fashion online-particularly one in the incredibly complex field of healthcare. However, I do believe a little research should be performed before an opinion is shared regarding nursing education. All NP candidates are required to perform hands on training- typically a lengthy round of clinical on-site training similar to the third year of medical school- even the ones online. Basically the only difference is that lectures are not taught inperson.

So NP school requires "a lengthy round of clinical on-site training similar to the third year of medical school" huh?
You're from Alabama? Let's see:

http://www.uab.edu/images/uabmagazine/soncatalog/2006-2008/msn_options_factsheet.pdf

It says there that:

"650 hours of clinical practice with a preceptor, who may be a FNP or a physician, are required for completion."

Did anyone else’s third year consist of 650 hours? I'm pretty sure mine was more like 4,000 (plus fourth year, internship, residency, etc.).


What does the curriculum look like at an Ivy league school?

http://www.mc.vanderbilt.edu/nursing/msn/familynpp.html

Three semesters and 39 hours. And, after all of that you can:

Advanced Practice Nurses perform these general functions:

Obtain health histories and perform comprehensive physical examinations, including psychosocial, functional, and developmental assessment
Order and interpret lab results and other diagnostic studies
Develop differential diagnoses
Develop/order therapeutic plan of care
Maintain patient records
Evaluate patient’s response to plan of care and modify as needed
Provide patient/family counseling and education
Arrange for patient referrals/consultations
Participate in research studies

Additional functions specific to the Family Nurse Practitioner:

Preconception and prenatal care
Well-woman and illness care
Well-child and illness care
Episodic care for acute conditions for all ages, including minor acute injuries
Management of chronic conditions such as HTN, diabetes, asthma
Monitoring and case management/consultation of more acute conditions such as cardiac diseases and neuromuscular conditions
Case management for any long term illness or condition


Call me what you will. The truth is I have no problem with nurses being nurses, respiratory therapists being respiratory therapists or whatever else. I appreciate the role that everyone in healthcare has.

But, it's a slap in the face to me and everyone here when groups of people with a fraction of our education and training try to obtain equal practice rights, roles and reimbursement.

I don't care if you live in rural Alabama or in NYC, lowering the standards of medicine to help underserved population is NOT the right answer. If we could take the millions of dollars that are being spent on these people’s political aspirations and ivory tower nursing dreams on opening some more medical schools and paying generalists more than a paltry wage after all their schooling and debt, then we would be making progress.

 

[schutzhund]

One more thing. LWestenhofer, I sincerely wish you luck in your endeavors. Really. But I think your opinion on this subject will change drastically once you "see the other side."

 

[PA-C]

While you all live in fear of nurses, I'll be out learning the practice of medicine. By the way... as a PA I knew how to differentiate between conjunctivitis and Kawasaki's disease. I even knew what SIADH and causes of gap acidosis were and how to treat them(that must really impress you). Maybe some PAs are not as bright being that I am at the top of my class in med school but I think some people are speaking without knowing the true level of education that SOME pa programs provide. We even read studies and knew what a p value was! That being said, I never wanted to work autonomously. Enjoy your blog...the whining sickens me too much to stick around.

 

[lama]

While you all live in fear of nurses, I'll be out learning the practice of medicine. By the way... as a PA I knew how to differentiate between conjunctivitis and Kawasaki's disease. I even knew what SIADH and causes of gap acidosis were and how to treat them(that must really impress you). Maybe some PAs are not as bright being that I am at the top of my class in med school but I think some people are speaking without knowing the true level of education that SOME pa programs provide. We even read studies and knew what a p value was! That being said, I never wanted to work autonomously. Enjoy your blog...the whining sickens me too much to stick around.

Congratulations big man! You must be a superstar!!

BTW, did you know that a pregnant woman during labor can have SIADH? Did you learn that Oxytocin and ADH have similar structures and thus increased oxytocin (pitocin during labor) can cross react with ADH receptors to cause symptoms of hyponatremia: confusion, cramps, seizures and coma? 🙄

Listen, I like PA's. My aunt is a neuro PA. She is outstanding. The point I was making is that the training is different and autonomy is not the right answer for midlevels. I agree with Soundman: NP's are the ones pushing the autonomy issue, not the PAs (as much). PA's are excellent clinicians inside their role. I intend on having PA's in my practice and I value everything they have to offer my patients. I have no beef with any PA. NP's on the other hand.... 👎

 

[Taurus]

Here's another article I just read on this subject.

http://news.yahoo.com/s/ap/20060625/ap_on_he_me/the_nurse_is_in

A 2000 study in the Journal of the American Medical Association concluded that patients who receive primary care from nurse practitioners fare just as well as those treated by doctors and report similar levels of satisfaction with their care.

Nurse practitioners also have steadily been gaining greater acceptance by insurers and in most states. In about half of the states, nurse practitioners — who frequently have lower fees for office visits than doctors — are now recognized by insurance carriers as primary care physicians.

In all but seven states, they can practice either independently or with remote collaboration with doctors. In all states except Georgia, they have some level of independent authority to prescribe medications; some states do prohibit nurse practitioners from prescribing narcotics.

This article nicely summarizes what I have been talking about. If current Master's degree NP's currently have similar outcomes for routine care as physicians, have higher patient satisfaction because they spend more time with the patient, charge less money, and have nearly the same scope of practice and prescribing privileges, then what do you suppose a doctorate will do for them? It will pretty much knock down the last barriers keeping them from being regarded as equivalent to primary care physicians.

We can talk about the leaps and bounds in knowledge that physicians have over DNP's. We spend more years training. That is all true and we can praise and pat ourselves on the back. However, let's not forget that it is the patient who makes the decision. I think that they will vote with their wallets, especially when it comes to routine visits. If one item is just as good as another and it is cheaper, why wouldn't you choose it?

This leads me to another important point. The main reason DNP's should be worrisome to physicians is because in the future economics will play an even bigger role than it does today in healthcare. In the current system with its in-network and out-network providers and co-pays, people don't have much incentive to use the healthcare system efficiently. Patients don't shop around for the best prices. Heck, the prices aren't even advertised unless you ask. We depend on the insurance companies to take care most of the bill. This is part of the reason why healthcare premiums have increased by double-digits for the last 5 or more years. If you do the math, this can't go on indefinitely! Otherwise, after a few more decades, only the wealthiest will be able to afford healthcare insurance.

How can we make the system more efficient? We make the individual responsible for finding the most cost effective treatments. How so? By health savings accounts. The gist of the program is that the employer and employee each contribute annually pre-tax money into the employee's account. Employees are then responsible for spending those healthcare dollars efficiently and wisely. Don't pay more for a visit when a comparable provider will charge less. The cost of the care would come directly out of the account until the deductible is reached. At which point, traditional insurance reimbursements for expensive treatments kick in. The deductible is set pretty high so for most people this deductible level won't be reached during most years. What is the motivation for the employee? Employees will have a huge incentive to not over-spend. Unspent money gets rolled over from year to year and employees can use that money for retirement and other purchases. What is the motivation for the employer? Employers would be able to shift the cost and burden of providing expensive healthcare insurance to their employees. If businesses jump on the health savings account bandwagon as I believe they will, this will be the biggest force that will drive their adoption in this country. As a rule, businesses are always looking for ways to lower their costs and this program allows them to offload a huge operating cost. How will this play out in the future? I envision that for routine visits like the cough, sniffles, physical exam, etc most employees won't want to spend a lot of money from their accounts. They want to minimize their annual healthcare expenditures. They will shop around for the best prices and practices will have to start to advertise them better. PA's, NP's, DNP's, and primary care physicians will compete against each other for low-amount health maintenance dollars. For serious conditions like cancer, heart condition, surgery, etc, patients would seek the best treatments, typically from specialty-trained physicians, where cost is not as large of a factor because health and life are on the line.

The health savings accounts will do for healthcare what the 401(k) did to retirement planning. It is a paradigm shift. It's questionable to me if the average person is better off with this plan than with traditional reimbursement. But if this plan becomes the standard, we won't have much choice. Health savings accounts are still pretty new so their impact has not been fully appreciated yet, but don't under-estimate this program and what it will do to the healthcare landscape. Remember that the 401(k) took decades to fully infiltrate and displace pensions as the primary retirement planning tool.

If DNP's stayed solely in primary care, I wouldn't worry about them as much because I plan to specialize and I think that specialists will see less impact from the change in paradigm. However, I believe that DNP's will try to expand their scope of practice and start to infringe on certain specialties like dermatology that have routine treatments that do not require a lot of training to learn. Unless the AMA and nursing groups restrict scope or at least require strigent training and licenses to practice in certain areas, then I don't see what would stop DNP's from doing just that.

 

[PlasticMan]

A 2000 study in the Journal of the American Medical Association concluded that patients who receive primary care from nurse practitioners fare just as well as those treated by doctors and report similar levels of satisfaction with their care.

Nurse practitioners also have steadily been gaining greater acceptance by insurers and in most states. In about half of the states, nurse practitioners — who frequently have lower fees for office visits than doctors — are now recognized by insurance carriers as primary care physicians.

In all but seven states, they can practice either independently or with remote collaboration with doctors. In all states except Georgia, they have some level of independent authority to prescribe medications; some states do prohibit nurse practitioners from prescribing narcotics.

This article nicely summarizes what I have been talking about. If current Master's degree NP's currently have similar outcomes for routine care as physicians, have higher patient satisfaction because they spend more time with the patient, charge less money, and have nearly the same scope of practice and prescribing privileges, then what do you suppose a doctorate will do for them? It will pretty much knock down the last barriers keeping them from being regarded as equivalent to primary care physicians.

We can talk about the leaps and bounds in knowledge that physicians have over DNP's. We spend more years training. That is all true and we can praise and pat ourselves on the back. However, let's not forget that it is the patient who makes the decision. I think that they will vote with their wallets, especially when it comes to routine visits. If one item is just as good as another and it is cheaper, why wouldn't you choose it?

This leads me to another important point. The main reason DNP's should be worrisome to physicians is because in the future economics will play an even bigger role than it does today in healthcare. In the current system with its in-network and out-network providers and co-pays, people don't have much incentive to use the healthcare system efficiently. Patients don't shop around for the best prices. Heck, the prices aren't even advertised unless you ask. We depend on the insurance companies to take care most of the bill. This is part of the reason why healthcare premiums have increased by double-digits for the last 5 or more years. If you do the math, this can't go on indefinitely! Otherwise, after a few more decades, only the wealthiest will be able to afford healthcare insurance.

How can we make the system more efficient? We make the individual responsible for finding the most cost effective treatments. How so? By health savings accounts. The gist of the program is that the employer and employee each contribute annually pre-tax money into the employee's account. Employees are then responsible for spending those healthcare dollars efficiently and wisely. Don't pay more for a visit when a comparable provider will charge less. The cost of the care would come directly out of the account until the deductible is reached. At which point, traditional insurance reimbursements for expensive treatments kick in. The deductible is set pretty high so for most people this deductible level won't be reached during most years. What is the motivation for the employee? Employees will have a huge incentive to not over-spend. Unspent money gets rolled over from year to year and employees can use that money for retirement and other purchases. What is the motivation for the employer? Employers would be able to shift the cost and burden of providing expensive healthcare insurance to their employees. If businesses jump on the health savings account bandwagon as I believe they will, this will be the biggest force that will drive their adoption in this country. As a rule, businesses are always looking for ways to lower their costs and this program allows them to offload a huge operating cost. How will this play out in the future? I envision that for routine visits like the cough, sniffles, physical exam, etc most employees won't want to spend a lot of money from their accounts. They want to minimize their annual healthcare expenditures. They will shop around for the best prices and practices will have to start to advertise them better. PA's, NP's, DNP's, and primary care physicians will compete against each other for low-amount health maintenance dollars. For serious conditions like cancer, heart condition, surgery, etc, patients would seek the best treatments, typically from specialty-trained physicians, where cost is not as large of a factor because health and life are on the line.

The health savings accounts will do for healthcare what the 401(k) did to retirement planning. It is a paradigm shift. It's questionable to me if the average person is better off with this plan than with traditional reimbursement. But if this plan becomes the standard, we won't have much choice. Health savings accounts are still pretty new so their impact has not been fully appreciated yet, but don't under-estimate this program and what it will do to the healthcare landscape. Remember that the 401(k) took decades to fully infiltrate and displace pensions as the primary retirement planning tool.

If DNP's stayed solely in primary care, I wouldn't worry about them as much because I plan to specialize and I think that specialists will see less impact from the change in paradigm. However, I believe that DNP's will try to expand their scope of practice and start to infringe on certain specialties like dermatology that have routine treatments that do not require a lot of training to learn. Unless the AMA and nursing groups restrict scope or at least require strigent training and licenses to practice in certain areas, then I don't see what would stop DNP's from doing just that.

😱

 

[lama]

A 2000 study in the Journal of the American Medical Association concluded that patients who receive primary care from nurse practitioners fare just as well as those treated by doctors and report similar levels of satisfaction with their care.

Nurse practitioners also have steadily been gaining greater acceptance by insurers and in most states. In about half of the states, nurse practitioners — who frequently have lower fees for office visits than doctors — are now recognized by insurance carriers as primary care physicians.

In all but seven states, they can practice either independently or with remote collaboration with doctors. In all states except Georgia, they have some level of independent authority to prescribe medications; some states do prohibit nurse practitioners from prescribing narcotics.

This article nicely summarizes what I have been talking about. If current Master's degree NP's currently have similar outcomes for routine care as physicians, have higher patient satisfaction because they spend more time with the patient, charge less money, and have nearly the same scope of practice and prescribing privileges, then what do you suppose a doctorate will do for them? It will pretty much knock down the last barriers keeping them from being regarded as equivalent to primary care physicians.

We can talk about the leaps and bounds in knowledge that physicians have over DNP's. We spend more years training. That is all true and we can praise and pat ourselves on the back. However, let's not forget that it is the patient who makes the decision. I think that they will vote with their wallets, especially when it comes to routine visits. If one item is just as good as another and it is cheaper, why wouldn't you choose it?

This leads me to another important point. The main reason DNP's should be worrisome to physicians is because in the future economics will play an even bigger role than it does today in healthcare. In the current system with its in-network and out-network providers and co-pays, people don't have much incentive to use the healthcare system efficiently. Patients don't shop around for the best prices. Heck, the prices aren't even advertised unless you ask. We depend on the insurance companies to take care most of the bill. This is part of the reason why healthcare premiums have increased by double-digits for the last 5 or more years. If you do the math, this can't go on indefinitely! Otherwise, after a few more decades, only the wealthiest will be able to afford healthcare insurance.

How can we make the system more efficient? We make the individual responsible for finding the most cost effective treatments. How so? By health savings accounts. The gist of the program is that the employer and employee each contribute annually pre-tax money into the employee's account. Employees are then responsible for spending those healthcare dollars efficiently and wisely. Don't pay more for a visit when a comparable provider will charge less. The cost of the care would come directly out of the account until the deductible is reached. At which point, traditional insurance reimbursements for expensive treatments kick in. The deductible is set pretty high so for most people this deductible level won't be reached during most years. What is the motivation for the employee? Employees will have a huge incentive to not over-spend. Unspent money gets rolled over from year to year and employees can use that money for retirement and other purchases. What is the motivation for the employer? Employers would be able to shift the cost and burden of providing expensive healthcare insurance to their employees. If businesses jump on the health savings account bandwagon as I believe they will, this will be the biggest force that will drive their adoption in this country. As a rule, businesses are always looking for ways to lower their costs and this program allows them to offload a huge operating cost. How will this play out in the future? I envision that for routine visits like the cough, sniffles, physical exam, etc most employees won't want to spend a lot of money from their accounts. They want to minimize their annual healthcare expenditures. They will shop around for the best prices and practices will have to start to advertise them better. PA's, NP's, DNP's, and primary care physicians will compete against each other for low-amount health maintenance dollars. For serious conditions like cancer, heart condition, surgery, etc, patients would seek the best treatments, typically from specialty-trained physicians, where cost is not as large of a factor because health and life are on the line.

The health savings accounts will do for healthcare what the 401(k) did to retirement planning. It is a paradigm shift. It's questionable to me if the average person is better off with this plan than with traditional reimbursement. But if this plan becomes the standard, we won't have much choice. Health savings accounts are still pretty new so their impact has not been fully appreciated yet, but don't under-estimate this program and what it will do to the healthcare landscape. Remember that the 401(k) took decades to fully infiltrate and displace pensions as the primary retirement planning tool.

If DNP's stayed solely in primary care, I wouldn't worry about them as much because I plan to specialize and I think that specialists will see less impact from the change in paradigm. However, I believe that DNP's will try to expand their scope of practice and start to infringe on certain specialties like dermatology that have routine treatments that do not require a lot of training to learn. Unless the AMA and nursing groups restrict scope or at least require strigent training and licenses to practice in certain areas, then I don't see what would stop DNP's from doing just that.

Bogus study. Probably placebo... you could put an MS3 in a clinic, lower the copay, give him/her a stethoscope and a pad and you'd have the same study. Just curious if they controlled for sample size and severity of illness. (I would like to know if the NP's were taking care of patients that were just as sick as the PCP's.)

People will see a nurse for their nail fungus or ear ache, but would they see one to manage their diabetes with concurrent CHF and renal failure?... Sometimes that copay is worth it.

Great points on the economics.

 

[Taurus]

Bogus study. Probably placebo... you could put an MS3 in a clinic, lower the copay, give him/her a stethoscope and a pad and you'd have the same study. Just curious if they controlled for sample size and severity of illness. (I would like to know if the NP's were taking care of patients that were just as sick as the PCP's.)

You may be right, but that won't stop the nurses from shoving this study in the faces of politicians who don't know any better and pressuring lawmakers to change laws to give them more autonomy.

People will see a nurse for their nail fungus or ear ache, but would they see one to manage their diabetes with concurrent CHF and renal failure?...

That's what we will find out when health savings accounts become more popular. How will people respond when people see it's their money going out the door and not somebody else's, i.e., the insurers? I think in general people are more careful when it's their money than when it's someone else's. That's an important and reasonable assumption about human behavior that the plan has.

 

[lama]

You may be right, but that won't stop the nurses from shoving this study in the faces of politicians who don't know any better and pressuring lawmakers to change laws to give them more autonomy.



That's what we will find out when health savings accounts become more popular. How will people respond when people see it's their money going out the door and not somebody else's, i.e., the insurers? I think in general people are more careful when it's their money than when it's someone else's. That's an important and reasonable assumption about human behavior that the plan has.

In the various medical specialties that are fee-for-service, we already see what will happen when people spend their own money on healthcare. Look at plastic surgery for example... you want a nice boob job, you go to Beverly Hills or Scottsdale, you pay top dollar. You want scarring and poor aesthetics, you go to Omaha, you pay low dollar to a dentist impersonating a board certified plastic surgeon.

Moral of the story: don't short change yourself when shopping for your boob job.

 

[PA-C]

As I find myself in the midst of study for Step 2, one thing has consistently caused me to step back and marvel at what we are doing... it's the depth of knowledge to which medicine goes and the degree to which we are expected to master it. Just when you think you have things figured out, you find they go deeper... much deeper.

I thought I had a firm knowledge on a lot of diseases. Now as I study for boards, I have come to recognize the interplay and connectivity that several diseases have with one another that I never fully understood during my first 3 years of medical school. Like someone said earlier, it's knowing the difference between conjunctivitis and Kawasaki's disease. But even more so, it's knowing that if you miss Kawasaki's by sending a kid home and that kid develops a carotid aneurysm, that kid could die. It's knowing that when a patient with infective endocarditis comes to your office and you see Oslers nodes and Janeways lesions, there is a difference in the pathophysiology of the two... one is due to immune-complex vasculitis and one is due to emboli. A young woman with a normal history and has a sudden stroke... you should check for murmurs... get a TEE to rule out a PFO. Etc. Etc. Etc.

I know for a FACT, that the PA's at my school were not taught these kinds of things. I tutored many of them in Biochemistry and Anatomy. Many of them had trouble even understanding the Krebs cycle much less understanding glycogen storage diseases. Ask one of these new PA's why Amoxicillin is given to a kid with Strep A pharyngitis. They'll probably tell you it's to help the pharyngitis, not to prevent Rheumatic Fever.

You see, any monkey can be taught cookbook medicine. That is why NPs, PAs, and CRNAs are able to practice medicine and get away with it most of the time. Yes, anyone can do a lap chole. Hell, before medical school, I saw hundreds of choles as an OR assistant. . However, what physicians have that the midlevels dont, is an expert understanding of all the posssible complications and related issues for a patient's illness. Doctors are paid big bucks not because they can follow a cookbook or memorize a treatment protocol, we are paid to make the decisions when things don't go as planned.

Tell me you want your kid in the hands of a Dr. Nurse when his life is on the line.... 👎

Wow! This post sums up what I initially thought of you when I read your earlier posts. You are going to be the type of Doctor who walks around with an arrogant attitude thinking they're GOD because they went to medical school and everyone in the hospital will think you're a total jackass. I find it funny that these PAs you tutored couldnt understand biochemistry and anatomy(what is there to understand in anatomy) being that I was a PA and I had a 3.9 average in medical school without working that damn hard. You are implying that what you choose to do with your life dictates your level of intelligence? That is idiotic thinking. There are people in all walks of life who didn't grow up with the silver spoon you probably had who just never had the chance to do what you are doing right now... But you are going to assume that you are smarter than they are because your parents could fork up the dough for med school. A mechanic makes 30,000 a year but could rebuild an engine from scratch. Are you an idiot because you can't? Lama is a great name for you. The OR assistants in my hospital don't usually get to stand around and watch surgeries. They were busy moving patients around. I would love to see you do any surgery.

'I could probably do a chole by myself just like PA-C, because I memorized the procedure. They're not hard.'

Does that mean if I tape a cirque de soleil performance and watch it 100 times I should be able to do it. Until you get your hands in there you don't know $h!t. Im predicting that at some time in the future humility is going to slap you in the face and I want you to think of me when it does. YOU ARE NOT GOD! YOU ARE NOT BETTER THAN ANYONE ELSE BECAUSE YOU KNOW MORE! Dont be such a tool.

 

[lama]

Wow! This post sums up what I initially thought of you when I read your earlier posts. You are going to be the type of Doctor who walks around with an arrogant attitude thinking they're GOD because they went to medical school and everyone in the hospital will think you're a total jackass. I find it funny that these PAs you tutored couldnt understand biochemistry and anatomy(what is there to understand in anatomy) being that I was a PA and I had a 3.9 average in medical school without working that damn hard. You are implying that what you choose to do with your life dictates your level of intelligence? That is idiotic thinking. There are people in all walks of life who didn't grow up with the silver spoon you probably had who just never had the chance to do what you are doing right now... But you are going to assume that you are smarter than they are because your parents could fork up the dough for med school. A mechanic makes 30,000 a year but could rebuild an engine from scratch. Are you an idiot because you can't? Lama is a great name for you. The OR assistants in my hospital don't usually get to stand around and watch surgeries. They were busy moving patients around. I would love to see you do any surgery.

'I could probably do a chole by myself just like PA-C, because I memorized the procedure. They're not hard.'

Does that mean if I tape a cirque de soleil performance and watch it 100 times I should be able to do it. Until you get your hands in there you don't know $h!t. Im predicting that at some time in the future humility is going to slap you in the face and I want you to think of me when it does. YOU ARE NOT GOD! YOU ARE NOT BETTER THAN ANYONE ELSE BECAUSE YOU KNOW MORE! Dont be such a tool.

I stand corrected!
1. It took you a day and a half, and one post in between to respond to my post? Did it take you that long to think something up, or just that long to figure out what I said?
2. YOU were the one claiming "TOP OF MY CLASS", "BETTER THAN ALL OF THE RESIDENTS" and "3.9 GPA", I'll let the audience decide who has the ego. More like inferiority complex... or small penis.
3. OR assistant = assistant to the surgeon, INSIDE the OR. OR assistant does NOT = orderly.
4. Im not smater than everyone in the hospital, just smarter than you. And thats all that matters.
5. Id kick your @ss in the OR, anyday, anytime... Mr. Big Time Lap Chole.
"Hey guys... I did a chole... Im important, listen to me..."
6. Oh... I've had "my hands in it".

 

[It'sElectric]

Wow! This post sums up what I initially thought of you when I read your earlier posts. You are going to be the type of Doctor who walks around with an arrogant attitude thinking they're GOD because they went to medical school and everyone in the hospital will think you're a total jackass. I find it funny that these PAs you tutored couldnt understand biochemistry and anatomy(what is there to understand in anatomy) being that I was a PA and I had a 3.9 average in medical school without working that damn hard. You are implying that what you choose to do with your life dictates your level of intelligence? That is idiotic thinking. There are people in all walks of life who didn't grow up with the silver spoon you probably had who just never had the chance to do what you are doing right now... But you are going to assume that you are smarter than they are because your parents could fork up the dough for med school. A mechanic makes 30,000 a year but could rebuild an engine from scratch. Are you an idiot because you can't? Lama is a great name for you. The OR assistants in my hospital don't usually get to stand around and watch surgeries. They were busy moving patients around. I would love to see you do any surgery.

'I could probably do a chole by myself just like PA-C, because I memorized the procedure. They're not hard.'

Does that mean if I tape a cirque de soleil performance and watch it 100 times I should be able to do it. Until you get your hands in there you don't know $h!t. Im predicting that at some time in the future humility is going to slap you in the face and I want you to think of me when it does. YOU ARE NOT GOD! YOU ARE NOT BETTER THAN ANYONE ELSE BECAUSE YOU KNOW MORE! Dont be such a tool.

You're a joke, PA-C. I went ahead and re-read through your posts in this thread to see if you ever really had anything insightful to add to the conversation, but lo and behold, Nothing. You've attacked various individuals on this thread and built YOURSELF up to be some sort of elitist. Apparently you're a top of the line, world class PA who is now in med school and performing at the top of his class. No one cares, because it has nothing to do with the conversation. It's anecdotal and pointless. So thank you for filling us all in on your life, but we'll go ahead and continue on with the real conversation.

Thank you.

 

[PA-C]

I stand corrected!
1. It took you a day and a half, and one post in between to respond to my post? Did it take you that long to think something up, or just that long to figure out what I said?
2. YOU were the one claiming "TOP OF MY CLASS", "BETTER THAN ALL OF THE RESIDENTS" and "3.9 GPA", I'll let the audience decide who has the ego. More like inferiority complex... or small penis.
3. OR assistant = assistant to the surgeon, INSIDE the OR. OR assistant does NOT = orderly.
4. Im not smater than everyone in the hospital, only smarter than you. And thats all that matters.
5. Id kick your @ss in the OR, anyday, anytime... Mr. Big Time Lap Chole.
"Hey guys... I did a chole... Im important, listen to me..."

Heres a little job description I found online

Medford, Oregon-Providence Medford Medical Center, Surgery. Position is full-time, varied shifts, Mon-Fri. High School diploma or G.E.D. Certificate preferred. Experience in a hospital nursing setting. Experience in the Operating Room is preferred. Able to move patients. The OR Assistant is responsible for the safe movement of patients. Prepares the operating rooms for surgery between cases. Orders and maintains supplies and equipment as needed. Cleans and maintains certain items and areas of surgery. Performs all duties in a manner that promotes team concept and reflects Providence Health System mission, philosophy and core values. Minimum $11.21/hr Maximum $16.11/hr.

Sounds like a lot of hands on experience...

I dont spend my life in these blogs and wouldnt even be posting if I didnt come across these whiney posts about the insecurities of certain people so if I dont reply its because I have a life.

Next, I only self promote to show that people who choose to be PAs, NPs, etc. arent necessarily dumber than those who choose medical school so saying they have a harder time learning things is idiotic on your part... Mr. Janeway lesions and Oslers nodes. By the way, you bringing up ******ed things like glyogen storage diseases and these endocarditis findings only show your lack of true medical experience and knowledge. Ask a practicing clinician how often they run in to these things. Im sure noticing a janeway lesion is going to completely change the management of your patient. Dude...people with your attitude were typically dorks in highschool and need to compensate now by being in an authority position. Take a step back and look at yourself... Say these words slowly... "I AM A 4th Year medical student telling someone they have a small penis because they realize Im an inexperienced, arrogant tool." Oh yeah...your little smilies icons are cute. That alone speaks for itself...orderly.

 

[lama]

Heres a little job description I found online

Medford, Oregon-Providence Medford Medical Center, Surgery. Position is full-time, varied shifts, Mon-Fri. High School diploma or G.E.D. Certificate preferred. Experience in a hospital nursing setting. Experience in the Operating Room is preferred. Able to move patients. The OR Assistant is responsible for the safe movement of patients. Prepares the operating rooms for surgery between cases. Orders and maintains supplies and equipment as needed. Cleans and maintains certain items and areas of surgery. Performs all duties in a manner that promotes team concept and reflects Providence Health System mission, philosophy and core values. Minimum $11.21/hr Maximum $16.11/hr.

Sounds like a lot of hands on experience...

I dont spend my life in these blogs and wouldnt even be posting if I didnt come across these whiney posts about the insecurities of certain people so if I dont reply its because I have a life.

Next, I only self promote to show that people who choose to be PAs, NPs, etc. arent necessarily dumber than those who choose medical school so saying they have a harder time learning things is idiotic on your part... Mr. Janeway lesions and Oslers nodes. By the way, you bringing up ******ed things like glyogen storage diseases and these endocarditis findings only show your lack of true medical experience and knowledge. Ask a practicing clinician how often they run in to these things. Im sure noticing a janeway lesion is going to completely change the management of your patient. Dude...people with your attitude were typically dorks in highschool and need to compensate now by being in an authority position. Take a step back and look at yourself... Say these words slowly... "I AM A 4th Year medical student telling someone they have a small penis because they realize Im an inexperienced, arrogant tool." Oh yeah...your little smilies icons are cute. That alone speaks for itself...orderly.

Im speechless... You told me!

 

[PA-C]

Im speechless...

It was nice talking with the future toolsheds of america that I am going to have to deal with in practice. Keep whining. Keep thinking you are GOD( in lama's case) and completely expendible (in Kfed/electrics case) By the way, you want me to take you serious with a KFed quote below your signature? Have fun posting and putting these everywhere 🙂 😳 😉 😎 ... and please...someday...grow up and realize that life is too short to worry about things like this.

 

[lama]

It was nice talking with the future toolsheds of america that I am going to have to deal with in practice. Keep whining. Keep thinking you are GOD( in lama's case) and completely expendible (in Kfed/electrics case) By the way, you want me to take you serious with a KFed quote below your signature? Have fun posting and putting these everywhere 🙂 😳 😉 😎 ... and please...someday...grow up and realize that life is too short to worry about things like this.

Dont let the door hit you in the ass on the way out.

Here's a definition for you that I found online:

douche bag

somebody who you think is a complete ****** and doesn't know anything about what they're talking about. ie.
PA-C is a ...

 

[allendo]

The bottom line to all of this is that we go through hell to become doctors. Years of training, sacrafice, hugh debt and for what, so some idiot who took online classes can walk into a room and call themselves doctor so and so! That's rediculous! One night I was studying at Starbucks and a bunch of NP's were sitting beside me talking about various topics. The started talking about undergrad level microbiology that they did not understand???? Then they continued talking about many of the other common medical problems that they did'nt understand??? Therefore, I would never let anyone in my family be seen by a NP. We go through hell to b/c doctors, we earn the right to be an ass if we want. We play the game and earn it, these internet course bitches did'nt earn anything and I will not respect that. In the future I will probably work with them, but when they try to pull that I'm doctor so and so bull$hit I will call them on it. I will make it a point to hire PA's above NP's. Nurses continually try to overstep their knowledge base. I was recently on a mission trip and a nurse on the trip try to play question the med student. I consistently beat her @$$ with my knowledge. If you want to be a freaking doctor then go to med school bitches!

 

[It'sElectric]

It was nice talking with the future toolsheds of america that I am going to have to deal with in practice. Keep whining. Keep thinking you are GOD( in lama's case) and completely expendible (in Kfed/electrics case) By the way, you want me to take you serious with a KFed quote below your signature? Have fun posting and putting these everywhere 🙂 😳 😉 😎 ... and please...someday...grow up and realize that life is too short to worry about things like this.

It's so incredibly ironic that you continue to spew these immature remarks, sinking to the lowest common denominator, while at the same time claiming that you are some sort of martyr. Give me a break, dude. No one's buying it, and believe me, you're not half as cool as you think. I'm glad you everyone figured out.

To reiterate the point one more time, people aren't knocking the intelligence of NPs/PAs or whoever (Because there is no doubt that there highly intelligent people in every profession in America). We're knocking the level of training they go through in conjunction with their desire to become autonomous care givers. Apparently that continues to go over your head.

Furthermore, there is a little thing called a sense of humor. The quote in my signature is a joke, much like Mr. Britney Spears and you. The line is a quote from one of his ridiculous songs, and it serves to show just how ridiculous he is. Thankfully, I won't need to quote you. You've shown you true colors over the course of this thread. Once again, thank you for contributing nothing, but the conversation would like to continue without you.

 

[PA-C]

The bottom line to all of this is that we go through hell to become doctors. Years of training, sacrafice, hugh debt and for what, so some idiot who took online classes can walk into a room and call themselves doctor so and so! That's rediculous! One night I was studying at Starbucks and a bunch of NP's were sitting beside me talking about various topics. The started talking about undergrad level microbiology that they did not understand???? Then they continued talking about many of the other common medical problems that they did'nt understand??? Therefore, I would never let anyone in my family be seen by a NP. We go through hell to b/c doctors, we earn the right to be an ass if we want. We play the game and earn it, these internet course bitches did'nt earn anything and I will not respect that. In the future I will probably work with them, but when they try to pull that I'm doctor so and so bull$hit I will call them on it. I will make it a point to hire PA's above NP's. Nurses continually try to overstep their knowledge base. I was recently on a mission trip and a nurse on the trip try to play question the med student. I consistently beat her @$$ with my knowledge. If you want to be a freaking doctor then go to med school bitches!

It frankly scares me that someone like this is going to be a doctor. Thank God for karma. The kid can't even place an apostrophe in the right place and he is insulting others. You call me a martyr because I call you on your ridiculous insecurities? You continually tell me noone is insulting others...read the above post. You tell me my information is anecdotal...read the above post. Yes, nurses do sometimes try to overstep their boundaries but so do doctors. Let me know if you make it through your career without doing something that is beyond your scope at that time. This ****** above will certainly be sued eventually because people who act like this are sued the most. Maybe I should post some of these quotes in the PA/NP, nursing blogs... You all have balls to talk behind an alias.

 

[It'sElectric]

It frankly scares me that someone like this is going to be a doctor. Thank God for karma. The kid can't even place an apostrophe in the right place and he is insulting others. You call me a martyr because I call you on your ridiculous insecurities? You continually tell me noone is insulting others...read the above post. You tell me my information is anecdotal...read the above post. Yes, nurses do sometimes try to overstep their boundaries but so do doctors. Let me know if you make it through your career without doing something that is beyond your scope at that time. This ****** above will certainly be sued eventually because people who act like this are sued the most. Maybe I should post some of these quotes in the PA/NP, nursing blogs... You all have balls to talk behind an alias.

First of all, you're the one who continues to lash out with childish insults and ridicule, yet you state that I have the balls to talk behind an alias. Give me a break.

Secondly, I in no way condone what the previous person posted that you quoted. Not once have I or the numerous other individuals on this thread agreed with his comments. If you search back through the posts, the majority of the comments contained none of the BS that he just posted, so please don't refer to one post at the end of a string of wonderful posts as your proof that people just think they're God. This has absolutely nothing to do with that. And yes, your information is entirely anecdotal. At least other people have posted links to nursing schools, articles, etc., while you just conitnue to post your GPA and accolades. That, my friend, is anecdotal.

By the way, I thought you were leaving this thread a long time ago?

 

[Empress]

The bottom line to all of this is that we go through hell to become doctors. Years of training, sacrafice, hugh debt and for what, so some idiot who took online classes can walk into a room and call themselves doctor so and so! That's rediculous! One night I was studying at Starbucks and a bunch of NP's were sitting beside me talking about various topics. The started talking about undergrad level microbiology that they did not understand???? Then they continued talking about many of the other common medical problems that they did'nt understand??? Therefore, I would never let anyone in my family be seen by a NP. We go through hell to b/c doctors, we earn the right to be an ass if we want. We play the game and earn it, these internet course bitches did'nt earn anything and I will not respect that. In the future I will probably work with them, but when they try to pull that I'm doctor so and so bull$hit I will call them on it. I will make it a point to hire PA's above NP's. Nurses continually try to overstep their knowledge base. I was recently on a mission trip and a nurse on the trip try to play question the med student. I consistently beat her @$$ with my knowledge. If you want to be a freaking doctor then go to med school bitches!

Oh, the rending of the chest, oh the entitlement. 🙄

If you seriously think as doctors you earn the right to be an ass, you are going to have a very unfulfilling career. Good luck to you, you'll need it.

 

[allendo]

Oh, the rending of the chest, oh the entitlement. 🙄

If you seriously think as doctors you earn the right to be an ass, you are going to have a very unfulfilling career. Good luck to you, you'll need it.

All I can say is if you want to be a doctor then go to medical school. I will have a very fulfilling career b/c I care about people and love taking care of them. What I don't like is the false advertisement that NP's try to pull off claiming they are competent providers. As long as I'm nice to my patients and my peers thats all that matters. I have no problem getting along with others as long as they know their place. We go to MED School, the place where they make doctors, not NP internet university (they don't make doctors at NP internet university). SO KISS MY @$$

 

[LWestenhofer]

The bottom line to all of this is that we go through hell to become doctors. Years of training, sacrafice, hugh debt and for what, so some idiot who took online classes can walk into a room and call themselves doctor so and so! That's rediculous! One night I was studying at Starbucks and a bunch of NP's were sitting beside me talking about various topics. The started talking about undergrad level microbiology that they did not understand???? Then they continued talking about many of the other common medical problems that they did'nt understand??? Therefore, I would never let anyone in my family be seen by a NP. We go through hell to b/c doctors, we earn the right to be an ass if we want. We play the game and earn it, these internet course bitches did'nt earn anything and I will not respect that. In the future I will probably work with them, but when they try to pull that I'm doctor so and so bull$hit I will call them on it. I will make it a point to hire PA's above NP's. Nurses continually try to overstep their knowledge base. I was recently on a mission trip and a nurse on the trip try to play question the med student. I consistently beat her @$$ with my knowledge. If you want to be a freaking doctor then go to med school bitches!

Ok- please calm down. No need to name call. Please don't pass judgement of an entire profession on a group of idiots you overheard in a coffee shop. I work in a teaching hospital for a well established allopathic school, and, believe me, there are idiots in every profession who manage to pass their classes.

 

[schutzhund]

PA-C, gotta a chip on your shoulder?

Remind us all again why you're on studentDOCTOR.net telling us all how arrogant WE are while trying to make yourself look special. Hmmm.

BTW, allenDO can't "overstep his bounds." Physician = unrestricted license. 🙂 🙁 😳 😀 😉 😛 😎 🙄

 

[LWestenhofer]

One more thing. LWestenhofer, I sincerely wish you luck in your endeavors. Really. But I think your opinion on this subject will change drastically once you "see the other side."

I must say your arguement is lucid and well thoughout. I also appreciate your kind words regarding my future endeavors. I wish you well with yours. And you could be right. I am not presumptive enough to say that my opinion will not change as my career proceeds. However, please keep in mind and that the VAST MAJORITY of nurses are not ignorant or power hungry, even though those making strategical decisions might be.

I also realize I am incredibly lucky to be working in a environment where all professionals really do get along well and "collaborate." I know it is not always like this, but it should be.

Maybe you are right and NPs and PAs need to keep their current positions and not make effort to equilibrate with physicians. In truth I don't know. I don't think any of us do...

 

[PA-C]

I must say your arguement is lucid and well thoughout. I also appreciate your kind words regarding my future endeavors. I wish you well with yours. And you could be right. I am not presumptive enough to say that my opinion will not change as my career proceeds. However, please keep in mind and that the VAST MAJORITY of nurses are not ignorant or power hungry, even though those making strategical decisions might be.

I also realize I am incredibly lucky to be working in a environment where all professionals really do get along well and "collaborate." I know it is not always like this, but it should be.

Maybe you are right and NPs and PAs need to keep their current positions and not make effort to equilibrate with physicians. In truth I don't know. I don't think any of us do...

Finally after all this one person speaks with some sense... This guy gets it. We dont know what the future holds. We dont know if DNPs will be trained well enough. Stereotyping an entire profession is dangerous and irresponsible...and as I said before lacks class and confidence in our own profession. If you are going to discuss this issue in a blog do it as if all parties are present. Dont start this...i know a nurse practitioner and she couldn't treat a nail fungus bit. Thank you westenhofer for being diplomatic enough to make this very insightful statement. That being said, I have no regrets for making the statements I made in this post. There is no chip on my shoulder. I live in a family with 2 PAs, 2 nurses and myself a PA/MS3 so Im not going to let a bunch of people who don't honestly know the level of their knowledge call them power hungry wanna be doctors who dont know ****. Throughout your career, your ass will be saved at least once by a nurse, a pharmacist, a PA,NP, or medical student. When that happens you won't be so quick to jump to conclusions about their knowledge and abilities. By the way, Doctors do have boundaries...I know you'd like to think you can do anything whenever you'd like but at some point someone will come to you and say " are you proficient at doing this" and you'll say "sure"(knowing that you've only seen it done once) and you will screw it up and potentially cause some morbidity or mortality. Boundaries don't have to be legal...they can be based on scope of knowledge and experience. But of course, i am too lazy to find a source for this so I apologize... it is anecdotal. (GOD! Im never going to get any papers published if I just keep speaking out of my ass without a source.)Anyway... no bitter feelings 🙂 . Rock on... Im a last word freak so if you really want me out of here you need only ignore me. 😍

 

[oldpro]

if you're interested... http://www.aacn.nche.edu/DNP/pdf/DNP.pdf it's a policy statement by the American Association of colleges of nursing...

my feeling its something we're not going to get away from, so a good option would be to work as physicians with them to provide some oversight in help in setting up practice guidelines. If the standards of practice are up to par with what other providers are required to do, which is what we need make sure of, then they should be able to fill the care gap.

Hey, when I went to Nursing school back in 1985, we had a Nurse that was a PHD, yea we called her Dr. but.............in the clinical setting a NP or PA is a NP or PA PHD not Dr. that is reserved for MD/DO's in the clinical setting. Period. I think that should be the law too, Oh it is a NP who wants to be called Dr. in a clinical setting and "leads patients on" that they are a physcian either on purpose or not is "Practicing medicine without a lic" Since they are not Lic as a Physcian but as a NP or PA. Seems clear to me here.

No matter how you cut it it is fraud too.

 

[bustbones26]

Why do these post about midlevel providers always start out as serious question, and then turn into six pages of pissing matches? Why argue about this? It like beating a dead horse, burying it, digging up the body, and then beating it again!

I for one am not concerned about being replaced by a midlevel provider. If somebody wants to be a PA-C or CRNP, then good for them! I do not subscribe to the fact that they are all people that were too dumb for medical school, there are many reasons why choosing a profession as a midlevel over medical school is ideal.

Since everybody has offered their opinion, I will offer mine too. Midlevels do the jobs that doctors don't want to do and the midlevels are more than happy to do this. Why complain?

All of those midlevels at primary care clinics without supervision are there because the docs don't want to be there. Do people deserve not to be offered basic primary care just because docs don't want to practice in their town?

I once worked with a neurologist that had a CRNP do his inpatient rounds and report back to him afterward while he was seeing patients in the clinic. He would just go tidy up loose ends after this. Saved him money versus hiring a partner.

I once worked in an ED that had a fast track clinic, people that walked in with urgent, yet not life threatening complaints: runny noses, scraped knees, etc., yes, this part of the ED was run by a midlevel, if things got too complicated, he came over to the other side to ask one of the docs for advice. Why? So docs could be seeing more interesting things in their ED: trauma, ACS, strokes, respiratory distress, etc. Is this such a bad set up?

Some of those simple surgeries that some of you out there claim that you could do in your sleep, how do you think a seasoned surgeon feels? Bored! They are more than happy to let a midlevel scrub in and help out. Do you think a seasoned midlevel is less qualified to scrub in on a surgical case, assist, maybe even do some cutting than an MS-3/MS-4 on a surgery rotation?

Being an Army Physician, I am more than happy that they give our Emergency Medicine and primary care PA's lots of autonomy and the chance to do hands on procedures. Because these are the men/women going out to battalion aid stations when deployed. If it weren't for them, a lot more people would be coming back from the mid-east in a box drapped by the american flag! These midlevels have my respect and have earned it!

Bottom line, why argue, if you are a doc, good for you, don't fera the midlevels, they are not going to replace you or take your job, getover yourself.

 

[oldpro]

Hey My post was not a pissing nor attacking just plain and simple that NP and PA should never be called "Doctor" in a clinical setting, It's Like calling a Doctor a Nurse, they are not They are PHD's if they work for one and thats that. Doctor is also a legal term when it comes to medicine, this has nothing to do with respect. I do not know why people thinks it does.

 

[oldpro]

Hey My post was not a pissing nor attacking just plain and simple that NP and PA should never be called "Doctor" in a clinical setting, It's Like calling a Doctor a Nurse, they are not They are PHD's if they work for one and thats that. Doctor is also a legal term when it comes to medicine, this has nothing to do with respect. I do not know why people think it does.

 

[PA-C]

Why do these post about midlevel providers always start out as serious question, and then turn into six pages of pissing matches? Why argue about this? It like beating a dead horse, burying it, digging up the body, and then beating it again!

I for one am not concerned about being replaced by a midlevel provider. If somebody wants to be a PA-C or CRNP, then good for them! I do not subscribe to the fact that they are all people that were too dumb for medical school, there are many reasons why choosing a profession as a midlevel over medical school is ideal.

Since everybody has offered their opinion, I will offer mine too. Midlevels do the jobs that doctors don't want to do and the midlevels are more than happy to do this. Why complain?

All of those midlevels at primary care clinics without supervision are there because the docs don't want to be there. Do people deserve not to be offered basic primary care just because docs don't want to practice in their town?

I once worked with a neurologist that had a CRNP do his inpatient rounds and report back to him afterward while he was seeing patients in the clinic. He would just go tidy up loose ends after this. Saved him money versus hiring a partner.

I once worked in an ED that had a fast track clinic, people that walked in with urgent, yet not life threatening complaints: runny noses, scraped knees, etc., yes, this part of the ED was run by a midlevel, if things got too complicated, he came over to the other side to ask one of the docs for advice. Why? So docs could be seeing more interesting things in their ED: trauma, ACS, strokes, respiratory distress, etc. Is this such a bad set up?

Some of those simple surgeries that some of you out there claim that you could do in your sleep, how do you think a seasoned surgeon feels? Bored! They are more than happy to let a midlevel scrub in and help out. Do you think a seasoned midlevel is less qualified to scrub in on a surgical case, assist, maybe even do some cutting than an MS-3/MS-4 on a surgery rotation?

Being an Army Physician, I am more than happy that they give our Emergency Medicine and primary care PA's lots of autonomy and the chance to do hands on procedures. Because these are the men/women going out to battalion aid stations when deployed. If it weren't for them, a lot more people would be coming back from the mid-east in a box drapped by the american flag! These midlevels have my respect and have earned it!

Bottom line, why argue, if you are a doc, good for you, don't fera the midlevels, they are not going to replace you or take your job, getover yourself.

Refreshing to hear from someone with real life experience. I agree with everything that you have said. The utter lack of respect that these young, inexperienced future doctors have for other health professions is the only reason I am in here blowing smoke. I wish I had summed things up in your words. It is a noble quality to be modest and to respect people under you (on the totem pole) even though you are the 'captain of the ship' in healthcare. Well put.

 

[It'sElectric]

PA-C-

I've honestly never come across someone with such a "holier than thou" attitude in my entire life. It's priceless. You can continue to act individuals, but never turly address the issue.

Is it right for Nurses who receive a supposed doctorate to practice autonomously with the title of Doctor despite the fact that they will be required to have less than 400 hours of clinical experience upon initial entry?

If you think that is perfectly fine, then so be it. I'm confident that I would never be able to convince you otherwise.

Best of luck. I have no doubt you'll make a fine doctor one day like so many others who have already spoken (no matter what opinion they held), we just have widely different opinions on this particular issue and likely others.

 

[PA-C]

PA-C-

I've honestly never come across someone with such a "holier than thou" attitude in my entire life. It's priceless. You can continue to act individuals, but never turly address the issue.

Is it right for Nurses who receive a supposed doctorate to practice autonomously with the title of Doctor despite the fact that they will be required to have less than 400 hours of clinical experience upon initial entry?

If you think that is perfectly fine, then so be it. I'm confident that I would never be able to convince you otherwise.

Best of luck. I have no doubt you'll make a fine doctor one day like so many others who have already spoken (no matter what opinion they held), we just have widely different opinions on this particular issue and likely others.

You can label it 'holier than thou' but in reality you and others were just called out for being stereotypical judgemental dicks. If I thought I was better than everyone I wouldnt be defending nurses and midlevels... I would act like you guys. Admit that you were wrong and move on... I can see you are a last word freak too.

 

[TBforme]

.

 

[bustbones26]

One night I was studying at Starbucks

I love LECOM people. Back in my days at LECOM, I studied at home. I didn't feel it necessary to go to Mercyhurst Library, Barnes&Nobles and show off to the Erie community, they are not impressed by the way.

Finish up med school and when you go out and start your internship you will be more than happy that there are midlevels there to help you out. Do you think when I did my CCU rotation as an intern do you think that my cardiology attendings sat down with me and showed me in detail how to perform GXT's. Do you think that any of my attendings even did GXT's? Oh hell no! They were in the cath lab doing more fascinating stuff. If anybody comes to my hospital with the attitude that they deserve to treat midlevels like a$$ because medical school was hell, they are going to look like a highly educated ***** in front of a patient if the PA-C doesn't show them how to run the treadmill equipment.

I will be the first to admit here that any CRNA at my hospital could kick my a$$ at putting in lines and intubating people. However, they are more than happy to show me their skills and help me if I want it. Try to pull the "leave me alone I know what I am doing, after all, I am a doc and you're not $hit on them", well, just stand back and watch how many lines you F$%k up!

As I have progressed in my career as a resident in the military, I am now welcomed with the skill of coding my own inpatient consults and admissions, arranging follow up appointments for patients after discharge, and doing all of that social crap like arranging transfers, rehabs, etc. Boy, I would sure appreciate one of those midlevels that does all of this like I have seen on other various inpatient teams.

I can't explain it to you, but just you wait and see how damn scary it is to be in the ICU and trying to manage a ventilator without the help of an RT. They will be the first to let you know how idiotic you are at managing a vent even though your education level doubles theres, that is of course, if you give them attitude and treat them like a$$. Respect them, say, "I am a resident that needs help" they will kindly help you.

Medical school is tough, yes we do go through hell. But no, its not a license to treat people like $hit! There are bad apples on both ends of the table. Yes, there are midlevels out there that think they're doctors, and yes, there are doctors out there that think they are God. But for the most part, you will find that midlevels are there to be helpful and docs value them as part of the team. That's right, team! In case you forgot, medicine is a team approach because nobody, no matter how educated or how much hell he went through, can do it himself.

Don't worry, midlevels are never going to take over your six figure job. But they will always be there to help out when needed, that is there role, and most of them know this.

 

[It'sElectric]

You can label it 'holier than thou' but in reality you and others were just called out for being stereotypical judgemental dicks. If I thought I was better than everyone I wouldnt be defending nurses and midlevels... I would act like you guys. Admit that you were wrong and move on... I can see you are a last word freak too.

I honestly think that you're just confusing me with someone else. If you will kindly re-read my previous posts from this thread, you'll see that I never made a single judgmental attack on PAs or NPs. I discussed the issue and gave my opinion on the idea of a doctorate of nursing, but never made stereotypical remarks. If you can find a single post where I did this, please show me.

Furthermore, you continue to avoid the question. Why won't you just answer my question?