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Has anyone read the digesting self promoting nurse article in this weeks new england journal?
Disgusting article in NEJM
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Same ole' same ole...nurses saying nurses should be practicing medicine. Yes, one MD on the article, per the usual.
There have already been a couple well-reasoned responses which, among other things, highlight the deficiencies that the IOM itself stated in its report. Just about everyone wants to see a physician when they come to the hospital. Just about everyone believes the physician-led team approach should predominate in healthcare. Nurses don't like it, but not because it's not the safest approach. They don't like it because it limits their income. And that's the bottom line.
It's the same with CRNA independent practice. Most, if given the choice, will choose to be cared for by a physician. You see it everyday in practice as NPs are available in many, many primary care practices. Your wait is much shorter, often getting in the same day, if you elect to see a NP as opposed to a physician. People will wait to be treated by a physician.
I believe that if nurses elect to practice medicine, which is being allowed today, and is becoming more common, they should be forced to carry equivalent malpractice to a physician, and they should pass physician board exams. That doesn't make them a physician, it simply makes them a nurse who has chosen to practice medicine. Patients deserve the best, and that's the only way to ensure it.
And by the way, every study that says it's cheaper to train a nurse compared to a physician, completely ignores the obvious, huge cost savings that resident physicians provide every day in every teaching hospital across this country by working much longer hours for much less pay to care for a population dominated by the uninsured, Medicare, and Medicaid. And if you take those residents out of the equation, you must toss in advanced practice nurses who demand much higher pay for much fewer hours of work, with attending physicians still leading the teams, and suddenly your 'cost savings' has vanished and you've arrived at a massive cost burden. But of course, that 'elephant in the room' would crush arguments of 'cost savings', so the pro-noctor movement chooses time and time again to conveniently ignore it.
There have already been a couple well-reasoned responses which, among other things, highlight the deficiencies that the IOM itself stated in its report. Just about everyone wants to see a physician when they come to the hospital. Just about everyone believes the physician-led team approach should predominate in healthcare. Nurses don't like it, but not because it's not the safest approach. They don't like it because it limits their income. And that's the bottom line.
It's the same with CRNA independent practice. Most, if given the choice, will choose to be cared for by a physician. You see it everyday in practice as NPs are available in many, many primary care practices. Your wait is much shorter, often getting in the same day, if you elect to see a NP as opposed to a physician. People will wait to be treated by a physician.
I believe that if nurses elect to practice medicine, which is being allowed today, and is becoming more common, they should be forced to carry equivalent malpractice to a physician, and they should pass physician board exams. That doesn't make them a physician, it simply makes them a nurse who has chosen to practice medicine. Patients deserve the best, and that's the only way to ensure it.
And by the way, every study that says it's cheaper to train a nurse compared to a physician, completely ignores the obvious, huge cost savings that resident physicians provide every day in every teaching hospital across this country by working much longer hours for much less pay to care for a population dominated by the uninsured, Medicare, and Medicaid. And if you take those residents out of the equation, you must toss in advanced practice nurses who demand much higher pay for much fewer hours of work, with attending physicians still leading the teams, and suddenly your 'cost savings' has vanished and you've arrived at a massive cost burden. But of course, that 'elephant in the room' would crush arguments of 'cost savings', so the pro-noctor movement chooses time and time again to conveniently ignore it.
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Its all about money and playing doctor.
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Absolutely. There is a penn study I'm too lazy to look up that looked at how much money it cost to implement the 80 hour workweek. It costs 4x a resident salary to replace one resident because midlevels earn 2x as much and work half the hours. Thsi is not even including the cost of bennies/malpractice for the extra midlevels. How is this cost-saving?
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that was supposed to say disgusting up there in my first post by the way.
but, let me tell you another interesting perspective. i actually started out in another specialty before i went into anesthesia. on call when i took ER consults, they had a np side and a physician side. i had at least 2x the number of calls from the np side and 99% of those would have been handled by a competent ER physician. where do cost savings factor into THAT? i mean, a consultation fee isn't cheap!
nurses are just ridiculous. i have a good friend who is now an anesthesiologist who used to be a nurse. she said the difference in training is just unimaginable. nurses have no idea what they do not know. i'm not bashing all of them because we need rn for a lot of things. but this "advanced practice" bullsh*t is just unbelievable.
but, let me tell you another interesting perspective. i actually started out in another specialty before i went into anesthesia. on call when i took ER consults, they had a np side and a physician side. i had at least 2x the number of calls from the np side and 99% of those would have been handled by a competent ER physician. where do cost savings factor into THAT? i mean, a consultation fee isn't cheap!
nurses are just ridiculous. i have a good friend who is now an anesthesiologist who used to be a nurse. she said the difference in training is just unimaginable. nurses have no idea what they do not know. i'm not bashing all of them because we need rn for a lot of things. but this "advanced practice" bullsh*t is just unbelievable.
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I'm curious about the whole "costs more to train" thing. How much did it cost the system or government or anybody else to train me?
I paid for all of it? I paid the tuition for medical school. I provided 4 years of care as a resident that would have been far more expensive if provided by a CRNA or NP.
The only person it is more expensive to is ME. It doesn't cost the government anything to train me. Medicare provides what, roughly 100K a year to the hospital I trained at as a resident? For 60-80 hours of work a week including benefits, they'd pay triple that rate to hire a midlevel provider.
I paid for all of it? I paid the tuition for medical school. I provided 4 years of care as a resident that would have been far more expensive if provided by a CRNA or NP.
The only person it is more expensive to is ME. It doesn't cost the government anything to train me. Medicare provides what, roughly 100K a year to the hospital I trained at as a resident? For 60-80 hours of work a week including benefits, they'd pay triple that rate to hire a midlevel provider.
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I also don't understand their logic. Still waiting for my $250K tuition reimbursement check from the gov.
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Why does the NEJM publish this garbage? Who at NEJM is super pro-nurse?
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look at those vertebroplasty articles earlier this year. NEJM isnt what it used to be...
i have an amazing NP, and very often i find mistakes, mis-diagnosis, or treatment options that never occurred to her. And she knows this, and runs most things by me. The point of an NP is to handle the "routine things" problem is, not all things that look routine are. Things get missed and wrong diagnosis are made, and wrong treatment comes out...
as reimbursement gets cut, patients will get "penalized" by seeing the NP, as I am delegate more...My patients complain when they dont get to to see, and have to see the NP, if they dont already see her. If they are equal in quality, i dont wanna hear the complaining...
Seems like an oxymoron.
