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Discussion in 'Medical Students - MD' started by W19, Oct 11, 2017.
California doesn't have enough doctors, and this bad law isn't helping
Translation: California thinks that PCP physicians are making too much money. Therefore, it's time to strip the practice rights of PCP physicians, increase the supply of PCPs, and put those PCP physicians in their place.
This is why medical students are reluctantly to go into primary care in the first place. Why go through 12 years of training to be paid the same as a NP, as this article is pushing for? Yes, I know that there is a pay difference bet NPs and PCP physicians at this moment.
Honestly, the best way to combat this stupidity is for our leadership to increase the awareness between the quality of care bet a physician, NP, and PA.
Thanks, that's all I needed to know
Until lawmakers learn how to evaluate the quality of a study, the garbage "equivalency" studies that NPs keep putting out will only support their position.
I like how the author says "NPs can prescribe medicine, so they can do everything a doctor can."
8 years for a bachelors and a masters degree?
Clearly, all primary care physicians are just pill dispensers.
I am pleasantly surprised by the comments to that article. They seem to be at least 50% of relevant comments saying "NPs are not doctors and are not adequately qualified to run independent practices".
LOL. Yeah. Like, administering a flu shot is the same as diagnosing complex medical conditions, and you can prescribe the same pills, so it's all the same, right?
To be fair to the midlevels, the.most common model of NP supervision I have seen is where the NP sees a full primary care clinic and the supervising physician never checks in. In many cases the supervising physician isn't even in the same building. If my 'supervisor' was taking half of my paycheck and providing nothing in return I would be demanding the right for independent practice as well.
We know what supervision looks like, we do it with residents. If we want to stop NPs from becoming independent, we need to start by policing ourselves. Define MD oversight legally (you see take sign out on every patient seen by an NP before the patient leaves the clinic, just like you would do with an Intern) and start taking board certifications and licenses from physicians who don't comply.
There is an argument that NPs need supervision. There is an argument that they are adequately trained and don't. There shouldn't be an argument that we should be allowed to take money for supervising midlevels without actually doing it.
I whole-heartedly agree with that thought. I think some review of charts in some manner should be mandatory. I think the proposed solution in bold is a bit over the top, however. Unfortunately there ARE greedy doctors out there who want the paycheck (and are thus willing to accept the liability of the 'supervising physician') without actually doing any additional work for it.
I haven't met a PCP who was uncomfortable with the wellness component of nursing scope.
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Most physicians have periodic reviews of a selection of their charts, if they work for any kind of a large organization. I have 20 peer reviews each quarter. That's not supervision. I would argue that, if you think it's safe for a patient to leave clinic after seeing an NP without at least getting sign out on the NPs management then you are saying the NP is safe to practice independently.
An extreme version of supervision is that you should physically see each patient before they leave clinic. A compromise is that the mid-level should be allowed to just present to you. Anything less than that is effectively independent practice.
There are a lot of health issues that just don't require a physician's insight. Young healthy people with colds/flu/scrapes/headaches/etc don't need to see a doctor. This happens to probably 50-75% of PCP visits.
I normally avoid these threads like the plague, but this:
I'm sorry, but getting a Z-pac from a "Doc in the Box" at CVS for the common cold does not meet the definition of "cost-effective" or "high-quality"...
My wife's PPD from CVS was like $20 and took her a total of 20 minutes. So for basic nursing tasks I think it might be...
If you knew which ones were simple in advance you wouldn't need a doctor at all. I will have 1-2 serious patients per day in clinic, but who it is it's always a surprise.
Vestiges of journalist integrity are long gone. Anything published is merely non-citation opinion drivel like this, the "business columnist" readily admits he knows nothing on the topic yet is advocating for something he can't comprehend. I can see him now, obnoxiously taking up space at a coffee shop, googling "how many years is np school" then writing in his notes "well trained."
Meanwhile, there's an ad on instagram for a 19-month online FNP program.
This was one of the most poorly researched articles I've ever read in a major newspaper. LA Times has really become a dumpster fire of a newspaper with all the cuts. Not many major players left that still write with journalistic integrity.
Actual quotes from the article:
"I wasn’t even aware of this issue until I stopped by a CVS MinuteClinic the other day to get my annual flu shot" (no experience, no expertise on topic)
"Many medical issues don’t require the expertise of a physician." (No citation, dangerous platitude)
Not only that, but he doesn't even talk to a physician or a physician professional organization to get a counterpoint.
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That isn't the case where I'm at. Maybe at an urgent care, but in a primary care office, flus/colds, headaches are minimal, and probably make up 10% of an office day, probably less. Lots of different pathology, many with multiple co-morbidites. Sure, you get a lot of DMII, HTN, Mood disorders, but there is quite a wide variety.
this is scary....doctors have always been tolerant of NPs and nurses. If what's in this article is accurate then that respect has not been reciprocated. I mean the NPs and its lobby are blaming everything on the doctors: "doctors are reasons people are dying and not getting care." Like wtf.
It's a biased puff piece probably paid for by the AANP.
I’ve said this before and will say this again - the outrage on physicians’ end rarely goes beyond SDN comments. Everyone is mostly on the same page (in theory), but nobody wants to do the leg work and take a public stand on the issue.
I’ve read some of NP “literature/peer reviewed evidence”. It has a lot of holes that can easily be exploited to show how biased the results and conclusions are. The problem is that, aside from just figuring out what’s best for the patient, there are no incentives for anyone to dig deeper and publish anything on the subject. Those of you with muscle, why not at least try to set aside some funding for this type of work?
It's pretty easy to understand that healthcare administrators, politicians, and insurance companies want the cheapest care they can get away with, and getting patients to see an NP is a great way to save them money. Doctors are expensive to make and are a power needing to be "dealt" with, NPs aren't. It's also easy to understand patients, in a country that has always been anti-elitist/intellectual, are frustrated with expense and lack of access to care, and if a young energetic NP is enthusiastic about getting you in to handle your "wellness" we will be seeing much more of these corporate "minute clinics" (I'm not lost on the ironic naming).
Problem is, an "easy" case is easy until it isn't, if you can't recognize something complex, rare, or simply outside typical protocol, the patient will suffer.
Besides educating, you can tell others that they have the power to refuse to be seen by NPs, especially since you're probably getting billed the same either way.
I don't want to beat the dead horse, but I am still a lowly pre-med who is trying to figure things out. During undergrad I volunteered in underserved areas with kids and would LOVE to pursue pediatrics, but issues like these scare the crap out of me. Is it better to specialize and hope the NP encroachment doesn't affect pediatrics or suck it up and enjoy life? This is a subject I am uneducated on and was hoping for some help! Thank you guys.
Ok... so we let NPs open their own clinics. But once they realize they have nobody to turn to and they risk THEIR licenses by opening up their own clinics... I'm sure less will be reluctant to do so and still prefer the safety net provided by a physician.
Nice, thank for. I will go too
They'll just do a ton of referring
Both patients AND the doctors will eventually get fed up.. no?
Patients will want to see a "real" doctor who can give them an answer instead of constantly being referred around.
If I was the doctor that was constantly being referred, I would eventually tell my patient they did not have to waste another copay to come see me if their nurse practitioner was not able to deal with their matters.
NPs don't want the liability. Eventually patients will get fed up.
Aka we're screwed.
Until that cold turns out to be Mycoplasma, that flu turns out to be PCP jiro, or that headache turns out to be a subarachnoid...
This x 1000
Jesus I feel like these mid-levels have no professional integrity at all. In their heart of hearts do they really believe that they can do everything a doctor can do with half the training? Or are they just so hell-bent on getting the next salary, respect & autonomy bump that they don't care about the difference?
It feels like doctors are scared of fighting with nurses. Not sure why that is but it almost seems non-PC for the "big-bad white coats" to pick on the "little ol' nurses".
The issue is going to be if people start dying from seeing fully independent mid-levels.
I actually really wonder specifically about peds. If I was a parent, I would never want my child to see anyone but a doctor, but there seem to be a high concentration of mid-levels in the field.
Thats my biggest question. Are NPs delusional or just so power-hungry that they can't see the obvious difference between 2 years and 7?
Yeah but then you have to pay the consultant and the NP, driving down their biggest advantage in cost savings.
I dont know, the sick patients may get fed up, but the easy patients wont. Then the NP will just make the most money w least liability. If all your patients are coming in for check up, or a sore throat, or a minor headache, you can get thru them fast, and still bill well. You get paid more seeing 3 healthier patients in 45 min than 1 sick patient.
Yea but once it happens, its highly unlikely we go back and take away their privileges. The AANA will just blame doctors for driving up cost. They'll point to the doctors salaries or something
Agreed. Seems like we're screwed because neither the people in charge nor the people who elected them understand what the problem is or how to fix it, so they need someone to blame. They google our salaries and then thats when the trouble starts.
We as future doctors need to come together and fight fire with fire.
This may be a stupid question, but who is our representative for physicians? ACGME? AAMC? I've no idea. Or does it depend on specialty?
The AANP has time to shell out these dumb reports that have no obvious substance but are still taken serious by the general public and they market the crap out of it.
If we come down to their level... it won't look good and we come off as insecure.
If we still try our own marketing campaign... we look like we are not willing to be apart of the team.
They will be able to play the victim and aggressor at the same damn time. It's ridiculous.
I'm not saying I hate NPs or anything (I have friends that are in it and they are super chill)... but I just don't like their organization tricking the general public to think that a nurse doctor is "better" or "just as good" as a real physician. It gives the militant NPs a false sense of ego and their insecurity really shines through.
It's like a lose-lose for us but we still can't let such a sham organization do that to us.
If they are so mad about physician salaries, tell them to put up their own licenses on the line and stop being babysat by physicians.
Put up or shut up. Simple.
Reimbursement rates for physicians vs the NPs will be forced higher by market forces due to superior quality of care. Otherwise, the insurance companies can kick sand.
That is what this thread is about. They are requesting to have their own licenses and run their own practices without physician supervision.
Each specialist organization has its own lobbyists, almost all physicians belong to their specialty organizations. The AMA also claims to be a lobbyist on behalf of physicians but they're more of lobby on behalf of liberal healthcare ideals than they are for actual physician salaries, a relatively small percentage of physicians belong to the AMA. Finally there are also other lobbyist/advocacy groups that physicians ascribe to.
You're totally right lol.
I just forgot to mention the fact that once they start paying malpractice and realize the possibility of lawsuits.... and that they won't have a real physician to help them... I don't think many of them will go into private practice. Poop will hit the fan real quick. I could be wrong but they will once actually see how much they truly don't know.
All it takes is one wrong diagnosis, one wrong prescription, and one overconfident nurse to screw it up for the rest of them and the AANP will backtrack.
I'm not sure if you guys have heard of this guy, ZDoggMD, but he has an interesting take on things. It is a 20 minute long video, but I figured I would give it a share. Oh! I'm not sure if this violates the TOS, if so, my apologies/take it down.
"Nurse Practitioners are DUMB AND I HATE THEM"
A physician affiliated with FSU made a comment about this very article in doximity and according to faculty, the doc has been getting death threats and now there's even a petition to get him fired from not only his teaching appointment but also his hospital gig. Apparently NPs from all over the country have been emailing FSU admin to complain about his online comment. Granted, he wasn't very "eloquent" in his statement and brought up the IQ of NP's but for a bunch of folks looking to disprove what he said, death threats seem to be a bit of an overreaction.
You're making the assumption that these NPs actually know the proper treatment for those ailments. I can't tell you how many times the NPs on my FM rotation wanted to prescribe steroids or Z-packs for sinus infections, or the number of times they wanted to write only steroids for pneumonia (even after the in-house X-ray showed it was very obviously pneumonia), or really the fact that many of them thought that steroids or Z-packs were literally the answer for anything that walked through the door. Blew my mind that some of these people actually thought they could work independently of physician supervision.
The other scary thing was the number of times they failed to send a severely ill patient to the hospital. "Oh, you're a 70 year old patient who has had 'a cold' for 3 weeks, trouble breathing for a week, and your RR, HR, BP, and temp are all elevated? Nah, that's not pneumonia. Here's a scrip for a Medrol pack, make sure you get lots of rest and drink plenty of water!"
totally agree with everything he said.
There are good and bad on both sides.
SO true. This is a subject that will either get better or worse, and I hope it gets better
The public will NOT come to the rescue. Just look at chiropractic, completely shameful BS but patients go religiously because they get a practitioner that listens and holds their hand. Same for NPs, I've never met a layperson that didn't like an NP if the NP spent exponentially more time with them per visit, even if they are aware of the NP's lack of credentials.
I've made the analogy of tenured PhD professors here before, not the same but worth examining. 60 years ago the professor was a God in academia, much like physicians being the God of medicine, now their position has been completely destroyed by administrators and adjuncts who would be seen previously as having the training and experience of a masters level TA. They hold almost no institutional power comparatively today, despite still being the experts of their field. Where is the public outrage? Not only are there no protests of receiving higher education from under-trained adjunct instructors, the public is paying 10 times the price for it. Meanwhile PhD graduates, after years of sacrifice, are killing each other over a petty few slots, left in indentured servitude of institutional fellowships, or simply forced to find a new career in the private sector.
The fight is not against militant nurse practitioners but against the powers that be that want them in place of physicians for financial or political reasons.
They already do that.
That's because they have created an image of nurses being the team players and doctors being the power hungry money grubbers. The doctor will spend 5 minutes with you and send you on your way with nothing, while the NP will spend an hour with you and always give you something to make you feel better. Only a marketing campaign will change that image.
First, they will actually have LESS malpractice issues to deal with than a comparably bad MD. Crazy? Nope. The legal definition of malpractice takes into account the standard of care delivered by someone with similar background and training. They won’t be judged against a good physician, they will be judged against another nurse. The licensing will be through the boards of nursing so wouldn’t count on them saving the day either.
Personally I think this was inevitable because doctors have delivered a gradually more terrible product overall. At this point, pcps are so inundated with mouse clicking that many are already just practicing script and referral medicine. I think showing any difference between that and NPs is going to be a losing battle. People with means and knowledge will demand MDs only and be willing to pay for it. Others will Be content with quarterly zpacks and a Medrol dose pak. Cest la vie.