If I were to share my full thoughts about the whole midlevel issue, I would surely be banned with just one post. I will keep things to a civil summary: I have been in private practice for 12 years and worked with many ARNPs and PA-Cs. There is no comparison between an MD and a midlevel in the ability to care for patients. Why a human would subject themselves to an inferior level of care with the same cost to them is an issue I can not quite get around. I have yet to find a single midlevel that I consider to practice at an acceptable level. Not one. I will disclaim that about 20% of the physicians I have worked with are not up to par in my book either. It is an issue I have been collecting data on for years with great interest. I do not feel threatened as I seem to always stay busier than I ever want to be. I am, however, actually quite pissed off that this situation even exists as I remember several college classmates that just did not quite have the right stuff to make it into medical school and had to choose other fields. Only about five percent of entering freshman with a declared premed major actually are accepted into medical school. We have plenty of candidates willing to invest the years of hard training so why are we allowing inferior practitioners to care for our loved ones?
I agree. As I have shared before, my mother is a complex patient, and while she and I both have a great rheumatologist, we can't see him foe everything. First of all, the man is so busy, I doubt he ever gets decent sleep. You have to make an appointment with him, usually, 6 mos in advance. So, even though people may need specialists, they still need sound primary care physicians. No offense to my fellow nurses in advanced practice, but they aren't seeing my mom. I'd the pcp doesn't seem sharp or caring enough, my mom is not going to keep seeing him or her. We both have SLE. Moms worse than me. My biggest problem, from my perspective anyway, had been carrying pregnancies to full-term. My OB and I worked to figure things out, and he was smart enough to send me to an excellent specialist...finally with some Asa and heparin, I was able to carry to term. It literally took years to figure out what was going on with my body. Same thing with mom. Even the sharpests docs could have missed things with us. The primary thing, however, was that each of our sharp docs were also good listeners...they didn't blow off what they pt understood about her own body. Nps might say they are more holistic in this way, but if they don't have the education and insight to analyze things more deeply, or realize they are out of their element, the patients suffer. My mom can't afford to have someone fool around with her. It's that simple. And though as a RN I had insights into my body, I still needed someone with more education and insight to help me figure things out. IMHO, most NPs probably would have blown things off, and I would not have had the privilege od safely having children. After losing so many pregnancies, I was dead serious about finding out what was going on with me. I see people everyday that were not perfectly "typical" patients. I think this is the main advantage of a good medical education. Sure you may be taught not to jump to zebras, but that doesn't me you don't learn about variations that are atypical. I don't see most NPs getting this education and experience...especially when you have RN s heading straight for np programs directly have completing their undergrad and passing their NCLEX boards.
Back to the issue of the thread, I wonder if FP will have to step up its field by making it somehow more highly specialized...whatever that might mean. People need to respect it as its own area of specialization beyond taking care of sniffles. Like it or not, that's how enough of a percentage of people may view it. As such, a fair enough number of people are OK with visiting a NP. Those with more underlying issues, which make up a good percentage of the population will lose out in many cases. Until this is demonstrated with evidence, however, people will want immediate appointments with local NPs. That's a big issue for folks...having to wait to get in to see a doc. So, they take the NP. In fact, many PCphysicians are too quick to use the NPs. Fine for straight forward cases, but their office personnel don't have the education and insight to try to work these kind of pts in with the physician. I have seen this too many times. They need to have insightful and highly experienced RNs with strong acute care experience working these people in with the physician, rather than having some receptionist or 6 mo.s trained MA slotting them for the NP or PA. Pay for some sound office case mgt RNs rather than med assistants with this. Problem is, MAs and receptionists are cheaper than the kind of experienced RNs To which I am referring, but the difference is often only $400 to $500 more per week. If you gets some strongly experienced RNs, to me it would be worth it. That's just my humble opinion.
