Here we go again!

Discussion in 'Medical Students - MD' started by W19, Oct 11, 2017 at 12:00 AM.

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  2. 68PGunner

    68PGunner 5+ Year Member

    Sep 16, 2012
    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.
    Dermpire, PugsAndHugs and bashwell like this.
  3. cripplepundit

    cripplepundit thicc af 5+ Year Member

    Jul 4, 2011
    Thanks, that's all I needed to know
  4. Matthew9Thirtyfive

    Matthew9Thirtyfive Foxy.

    Jan 10, 2016
    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.
  5. tymont12

    tymont12 But it can't be two illnesses! 5+ Year Member

    Jun 28, 2011
    I like how the author says "NPs can prescribe medicine, so they can do everything a doctor can."
  6. 151 others

    151 others SDN Gold Donor Gold Donor

    Aug 29, 2016
    8 years for a bachelors and a masters degree?
  7. Matthew9Thirtyfive

    Matthew9Thirtyfive Foxy.

    Jan 10, 2016
    Clearly, all primary care physicians are just pill dispensers.
  8. evilbooyaa

    evilbooyaa 5+ Year Member

    Oct 10, 2011
    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?
    VA Hopeful Dr likes this.
  9. Perrotfish

    Perrotfish Has an MD in Horribleness 10+ Year Member

    May 26, 2007
    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.
    Shov, kb1900, PugsAndHugs and 5 others like this.
  10. evilbooyaa

    evilbooyaa 5+ Year Member

    Oct 10, 2011
    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.
  11. atomheart


    May 5, 2016
    I haven't met a PCP who was uncomfortable with the wellness component of nursing scope.

    Sent from my SM-J320V using Tapatalk
  12. Perrotfish

    Perrotfish Has an MD in Horribleness 10+ Year Member

    May 26, 2007
    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.
    WheezyBaby likes this.
  13. ConspecificPlasma


    Sep 20, 2017
    Last edited: Oct 11, 2017 at 9:05 AM
  14. Gorne

    Gorne 2+ Year Member

    Oct 30, 2014
    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.
  15. SurfingDoctor

    SurfingDoctor "Hooray, I'm useful" 10+ Year Member

    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"...
    Last edited: Oct 11, 2017 at 11:04 AM
  16. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

    Jul 28, 2004
    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...
  17. Perrotfish

    Perrotfish Has an MD in Horribleness 10+ Year Member

    May 26, 2007
    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.
    IzumioH20 and VA Hopeful Dr like this.
  18. Staphylococcus Aureus

    Staphylococcus Aureus

    Dec 26, 2016
    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."
  19. Matthew9Thirtyfive

    Matthew9Thirtyfive Foxy.

    Jan 10, 2016
    Meanwhile, there's an ad on instagram for a 19-month online FNP program.
  20. akwho

    akwho 5+ Year Member

    Jan 9, 2012
    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)
  21. NurWollen

    NurWollen Strong with the Force 7+ Year Member

    Dec 27, 2007
    United States
    Not only that, but he doesn't even talk to a physician or a physician professional organization to get a counterpoint.

    Sent from my SM-G930V using SDN mobile
    Matthew9Thirtyfive likes this.
  22. KnuxNole

    KnuxNole Sweets Addict 10+ Year Member

    May 3, 2006
    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.
  23. Lnsean

    Lnsean 7+ Year Member

    May 26, 2009
    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.
  24. Matthew9Thirtyfive

    Matthew9Thirtyfive Foxy.

    Jan 10, 2016
    It's a biased puff piece probably paid for by the AANP.
  25. SunsFun

    SunsFun VICE president 5+ Year Member

    Jun 22, 2011
    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?
    Lnsean likes this.
  26. Staphylococcus Aureus

    Staphylococcus Aureus

    Dec 26, 2016
    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.
  27. DPTinthemaking15


    Oct 21, 2016
    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.
  28. QueenJames

    QueenJames 2+ Year Member

    May 16, 2013
    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.

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