People,
Why respond to such forum trolls?
In medicine, there will always be people practicing as:
1) Board certified, fully accredited, licensed physicians in their area of expertise and practicing within their scope and fund of knowledge (i.e. a cardiologist, a Cardiothoracic surgeon)
2) Those physicians who are licensed, (and perhaps board certified in something), but not necessarily practicing within their scope of expertise or knowledge. An example is a general practitioner who is doing liposuction. Most people would go to a board certified plastic surgeon--someone who is well trained in anatomy and physiology, and one who knows the vascular plains and risks associated with even the most routine procedures (i.e. pneumothorax for lipo), and how to deal with them should the worse happen.
3) Without a medical license (illegal, but unfortunately it happens)
or
4) So called mid-levels and/or non physicians. Included are dentists, NPs, PA's, CRNAs, chiropracters, PTs, OTs, and everyone else that can be called "doctors," etc. Many can practice independently, depending on the state and more importantly the hospital/clinic. Most, however, have physicians who are either "overlooking" what they do, or have to answer in some way to a physician. True, in a rural setting, FP's and NP's probably have the same job description. True, perhaps in some health clinics and even some community hospitals, NPs have more autonomy. But the vast majority of university hospitals and academic centers have physicians running the show. Period. Despite local law. Hospitals can hire/fire and set policies as they see fit. Most hospitals (due to legal implications) require physicians be the ultimate ones responsible for pt well being. Otherwise, NPs mostly practice in office-based settings and smaller, private community hospitals, or ERs that have a fast track type system.
Take home message:
I believe that NPs and all non-physicians in health care are integral. They should ideally work as a team, to utilize resources and labor appropriately. Not be in competition. It is up to the primary care provider to refer appropriately--to specialists or other. Ultimately, it is up to the patient to seek out and find someone they trust as their PCP, whether it is a RN or MD, or friend's mom across the street. I know many competent PAs and NPs who do a great job caring for patients. That being said, they will never replace physicians, and nor will physician salaries fall dramatically. They all serve a purpose in our twisted health care system. Why worry or respond to trolls who post messages intended to start a silly flame war?
(for the record, I am just posting to alleviate this problem in the future). No worries!!!!