Holy poo! Hate for midlevels.

[fab4fan]

As a nurse in his senior year of medical school - I have been on both sides of this debate. Nurses do organize far to many unnecessary task to keep patients safe. Nurses and doctors both make mistakes no one is perfect.

I have a huge interest in health care informatics and believe (maybe its delusional) that a national heath care record and ID card would prevent unnecessary test, medication errors, and provide a more complete record (conspiracy theory - big brother people do not freak out!) and allow nurses to spend less time checking and arranging for care (which drove me nuts) and more time to...

Deleted. I don't know what I was thinking at the time.

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[mig26x]

if the OP thinks there's hate towards the midlevels because of the DNP discussion going on on this forum, he/she should check allnurses.com and see how nurses in that forum talk about doctors!!! This is little leagues compare to how they express themselves in that forum!!

by the way, i respect nurses. I dont like people like mundinger who wants to push down the nurses throat a "doctorate"= DNP just so nurses can practice like doctors because there's a shortage of Primary care docs, when nurses have their own shortage problem!!!

 

[fab4fan]

if the OP thinks there's hate towards the midlevels because of the DNP discussion going on on this forum, he/she should check allnurses.com and see how nurses in that forum talk about doctors!!! This is little leagues compare to how they express themselves in that forum!!

by the way, i respect nurses. I dont like people like mundinger who wants to push down the nurses throat a "doctorate"= DNP just so nurses can practice like doctors because there's a shortage of Primary care docs, when nurses have their own shortage problem!!!

When dealing with allnurses, it's best to keep this in mind:

The level of hubris in an allnurse's post is inversely proportional to that poster's IQ.

 

[Josh L.Ac.]

Someone is just jealous because they got banned...

 

[fab4fan]

Someone is just jealous because they got banned...

Yeah, that must be it. I'm missing out on all of those "I had a DUI 5 years ago, can I be a nurse?/Jobs where you don't have to clean poo/Am I pretty enough to be a nurse?" threads.

I could always go back to dial-up!

 

[LadyWolverine]

I don't have much of an opinion in this whole MD vs. DNP vs. RN vs. PA vs. Whatever debate. However, I am curious about one thing. If NPs function autonomously from overseeing physicians, wouldn't they have to take out malpractice insurance? Perhaps they already do? If so, is the amount malpractice similar to that of a primary care MD? How long will it take for the medmal legal types to see these practicioners as sitting ducks?

 

[subgel]

I apologize for the crude display. We had a very bad experience with a midwife.

 

[silas2642]

DNP overmedicated my prgnant wife with barbituates. Hospital gave her a urinalysis and the whole ward went apeshizzy. Not to mention she only showed up to half of our scheldualed appointments over the course of 9 months.
I think this DNP's need some serious ethics courses in their program and stringent licensing guildines in terms of morale character..

Why was she prescribing barbiturates? Those things are kind of dangerous, particularly in overdose (this coming from the lowly med student). The only thing you can do is report her to make sure that she can't hurt anyone else-- that is what I'd do.

 

[Oculomotor]

Originally Posted by subgel
DNP overmedicated my prgnant wife with barbituates. Hospital gave her a urinalysis and the whole ward went apeshizzy. Not to mention she only showed up to half of our scheldualed appointments over the course of 9 months.
I think this DNP's need some serious ethics courses in their program and stringent licensing guildines in terms of morale character..


Actually if you do your research (I have) you will find that in 11 states nurse practitioners are autonomous---> they can prescribe drugs independently with no physcian supervision. In 50 states midlevel practitioners such as PA's are "supervised prescribers" as well as 39 states for nurse practitioners respectively. In most states the only "independent" prescribing of drugs is done by Independent Doctorate Level Prescribers (IDLP's)-->Medical Doctors, Podiatrists, Dentists, and Optometrists. In this group MD's/DO/'s are the only ones with unlimited prescribing authority to treat systemic disease whereas the DPM's, OD's, and DDS's are limited to their area of the body/organ system.

Subgel, what state did your circumstance with your wife happen in?


Link to American Academy of Nurse Practitioners to find out which states have independent practice (I believe there are 11).

http://www.aanp.org/AANPCMS2/LegislationPractice


Mission behind DNP degree

http://www.aanp.org/NR/rdonlyres/10...OUPLETTER608wcopyrightandattribution61908.pdf

And by the way I wouldn't paint a broad brush stroke over all DNP's for one being incompetant. God knows how many incompetant MD's, Dentists, Podatrists, and Optometrists are out there as well. Even regarding narcotics abuse---> pain management doctors are one of the biggest perpetuators of it. More misprescribing occurs with MD's because there are close to 800,000 of them nationwide! Given time (and supply / demand economics) + vigorous legislation (already happening), DNP's will probably be independent in most states and will be competing with MD's in primary care. As of right now there NO studies that show more negative outcomes for Nurse Practitioners versus MD's doing the same thing in a primary care setting! Given that I would still prefer to go to a board certified doctor of medicine for primary care.

 

[DrJosephKim]

It's a common misconception that NPs are unable to prescribe controlled substances. These rules vary for each state and many NPs are able to work completely independently/autonomously.

 

[fab4fan]

DNP overmedicated my prgnant wife with barbituates. Hospital gave her a urinalysis and the whole ward went apeshizzy. Not to mention she only showed up to half of our scheldualed appointments over the course of 9 months.

I think this DNP's need some serious ethics courses in their program and stringent licensing guildines in terms of morale character..

Did they give the barbiturates to you or your wife? Based on your post, it looks like you were the one who was over-medicated.

 

[badasshairday]

PA's are the best loved midlevel. DNP's are the most hated. NP's are in the middle. Some CRNAs are okay, but a lot of them are hated like DNPs due to their ridiculously militant organization, the AANA.

 

[badasshairday]

I don't have much of an opinion in this whole MD vs. DNP vs. RN vs. PA vs. Whatever debate. However, I am curious about one thing. If NPs function autonomously from overseeing physicians, wouldn't they have to take out malpractice insurance? Perhaps they already do? If so, is the amount malpractice similar to that of a primary care MD? How long will it take for the medmal legal types to see these practicioners as sitting ducks?

They are going to get blasted soon enough. Just give it some time.

 

[bradt9881]

You need malpractice insurance whether or not the physician supervises you. I have it as a PA; it runs around $1700 a year for the occurance based premium.

 

[jabreal00]

I have worked for about 9 months (just finished residency) in the rural midwest. I am starting my GI fellowship this July. I work at a small to medium sized military facility as an internist. I am not there by choice (miltary payback). There are a lot of PAs and NP working here. There's little physician oversight. The midlevels have their own patients. Some do come to me when they know they're in over their heads. I think for the most part they provide adequate care, it's not necessarily standard of care or evidence based but it's adequate. It is more anectdotal. Most of the patients are younger and healthy (40s-50s). The sick or older ones are seen by the internists.

I did my internal medicine residency in a busy medical center. From what I've seen of the civilian doctors (mostly FP) in this rural area, they are no better than the midlevels. I see the same shocking level of boneheaded moves across board; 240 tabs of Percocet/Xanax/Valium (or any highly addictive meds) per month without reevaluating the patient, antibiotics to everyone with a URI, shotgun labs and not following up with the labs, MRI for everyone with back pain, etc.

For the most routine care for a relatively healthy adult in an outpatient setting, a midlevel is no less qualified than an FP or even IM in these rural areas. Internist should be looked at as specialist who manage complext patients (CHF IV, poorly controlled diabetics, the very old and very chronically sick) as an outpatient. Obviously, inpatient should be MD/DO only. If someone has high blood pressure, give them a anti-hypertensive and counsel on lifestyle modification. A midlevel can do a sports physical in a healthy 17 or 18 year old. What's hard about reminding someone to get their flu shot or other vaccines? There's nothing special about that. An NP/PA can do that.

 

[fab4fan]

I have worked for about 9 months (just finished residency) in the rural midwest. I am starting my GI fellowship this July. I work at a small to medium sized military facility as an internist. I am not there by choice (miltary payback). There are a lot of PAs and NP working here. There's little physician oversight. The midlevels have their own patients. Some do come to me when they know they're in over their heads. I think for the most part they provide adequate care, it's not necessarily standard of care or evidence based but it's adequate. It is more anectdotal. Most of the patients are younger and healthy (40s-50s). The sick or older ones are seen by the internists.

I did my internal medicine residency in a busy medical center. From what I've seen of the civilian doctors (mostly FP) in this rural area, they are no better than the midlevels. I see the same shocking level of boneheaded moves across board; 240 tabs of Percocet/Xanax/Valium (or any highly addictive meds) per month without reevaluating the patient, antibiotics to everyone with a URI, shotgun labs and not following up with the labs, MRI for everyone with back pain, etc.

For the most routine care for a relatively healthy adult in an outpatient setting, a midlevel is no less qualified than an FP or even IM in these rural areas. Internist should be looked at as specialist who manage complext patients (CHF IV, poorly controlled diabetics, the very old and very chronically sick) as an outpatient. Obviously, inpatient should be MD/DO only. If someone has high blood pressure, give them a anti-hypertensive and counsel on lifestyle modification. A midlevel can do a sports physical in a healthy 17 or 18 year old. What's hard about reminding someone to get their flu shot or other vaccines? There's nothing special about that. An NP/PA can do that.

Wow..."Paging Dr. Candyman!" That's a lot of pain medication.

 

[melanoleuca]

You need malpractice insurance whether or not the physician supervises you. I have it as a PA; it runs around $1700 a year for the occurance based premium.

Dude. My malpractice insurance will be $130,000 per year as a new Emergency Medicine attending when I start working in July.

$1700 per year? I paid more for professional liability as a Civil Engineer.

 

[bradt9881]

Dude. My malpractice insurance will be $130,000 per year as a new Emergency Medicine attending when I start working in July.

$1700 per year? I paid more for professional liability as a Civil Engineer.

I feel your pain. Thats the cost for the 1 mil/3mil standard policy in Internal Med paid for by my practice. If I quit, I will have to pay double the premium for the tail coverage. The premiums for ED or surgical assisting would have been higher, but nothing like 130K. Sounds like a good time to have your premiums paid for by your practice group instead of going as an independent contractor, or working for the government as a GS-13 (no malpractice insurance needed, the government pays the claims).

 

[zenman]

I have worked for about 9 months (just finished residency) in the rural midwest. I am starting my GI fellowship this July. I work at a small to medium sized military facility as an internist. I am not there by choice (miltary payback). There are a lot of PAs and NP working here. There's little physician oversight. The midlevels have their own patients. Some do come to me when they know they're in over their heads. I think for the most part they provide adequate care, it's not necessarily standard of care or evidence based but it's adequate. It is more anectdotal. Most of the patients are younger and healthy (40s-50s). The sick or older ones are seen by the internists.

I did my internal medicine residency in a busy medical center. From what I've seen of the civilian doctors (mostly FP) in this rural area, they are no better than the midlevels. I see the same shocking level of boneheaded moves across board; 240 tabs of Percocet/Xanax/Valium (or any highly addictive meds) per month without reevaluating the patient, antibiotics to everyone with a URI, shotgun labs and not following up with the labs, MRI for everyone with back pain, etc.

For the most routine care for a relatively healthy adult in an outpatient setting, a midlevel is no less qualified than an FP or even IM in these rural areas. Internist should be looked at as specialist who manage complext patients (CHF IV, poorly controlled diabetics, the very old and very chronically sick) as an outpatient. Obviously, inpatient should be MD/DO only. If someone has high blood pressure, give them a anti-hypertensive and counsel on lifestyle modification. A midlevel can do a sports physical in a healthy 17 or 18 year old. What's hard about reminding someone to get their flu shot or other vaccines? There's nothing special about that. An NP/PA can do that.

It's so refreshing to read the "truth."

 

[Faebinder]

I have worked for about 9 months (just finished residency) in the rural midwest. I am starting my GI fellowship this July. I work at a small to medium sized military facility as an internist. I am not there by choice (miltary payback). There are a lot of PAs and NP working here. There's little physician oversight. The midlevels have their own patients. Some do come to me when they know they're in over their heads. I think for the most part they provide adequate care, it's not necessarily standard of care or evidence based but it's adequate. It is more anectdotal. Most of the patients are younger and healthy (40s-50s). The sick or older ones are seen by the internists.

I did my internal medicine residency in a busy medical center. From what I've seen of the civilian doctors (mostly FP) in this rural area, they are no better than the midlevels. I see the same shocking level of boneheaded moves across board; 240 tabs of Percocet/Xanax/Valium (or any highly addictive meds) per month without reevaluating the patient, antibiotics to everyone with a URI, shotgun labs and not following up with the labs, MRI for everyone with back pain, etc.

For the most routine care for a relatively healthy adult in an outpatient setting, a midlevel is no less qualified than an FP or even IM in these rural areas. Internist should be looked at as specialist who manage complext patients (CHF IV, poorly controlled diabetics, the very old and very chronically sick) as an outpatient. Obviously, inpatient should be MD/DO only. If someone has high blood pressure, give them a anti-hypertensive and counsel on lifestyle modification. A midlevel can do a sports physical in a healthy 17 or 18 year old. What's hard about reminding someone to get their flu shot or other vaccines? There's nothing special about that. An NP/PA can do that.

And who determines if this is the simple case that can be handled by the midlevel or it needs a physician? You don't know that you don't know what you don't know.... e.g. Do you expect a midlevel to know that a 33 y/o female 2 years post bilateral breast resection on tamoxifen complaining of low mood should not be started on an SSRI for depression? Sounds like a benign case simple case for the truly unexperienced. In real life, no one comes and tells you that this case is truly beyond your limit and you are causing harm (i.e. increasing the chance of recurrence of cancer in this case) with the lack of your true experience.

 

[Febrifuge]

Do you expect a midlevel to know that a 33 y/o female 2 years post bilateral breast resection on tamoxifen complaining of low mood should not be started on an SSRI for depression? Sounds like a benign case simple case for the truly unexperienced.

Yes, well, part of being a good midlevel is taking responsibility for knowing stuff like that. Most of it is having the common sense not to write anything for anyone unless you're sure about potential contraindications. I have yet to graduate, but even now when my preceptors are asking me what I would do (and will do, in a couple more months), I'm looking up interactions and slowly building my data banks.

You actually can develop at least a sense of what you don't know. That's why what we do still counts as practicing medicine, rather than just following a cookbook. But again, the difference isn't always MD vs midlevel; it's overconfident, ignorant clinician vs careful, circumspect clinician.

 

[deleted6669]

Dude. My malpractice insurance will be $130,000 per year as a new Emergency Medicine attending when I start working in July.

that seems excessive unless you are also doing high risk obgyn at the same time....seriously our em docs pay about 1/4 of that....and our pa coverage is 6k/pa/yr

 

[USArmyDoc]

I wish midlevels would stop trying to strive to be doctors. Not because I feel threatened but because of the potential of a backlash from physician. I know over 30 of my classmates will come out and say they would never hire a PA/NP because of these exact reasons. After reading this, I am not sure if I would either. I even signed some petitions for PA's supporting them, but again this thread makes me think again. Furthermore, my interactions with PA students has been horrendous.

 

[njbmd]

I wish midlevels would stop trying to strive to be doctors. Not because I feel threatened but because of the potential of a backlash from physician. I know over 30 of my classmates will come out and say they would never hire a PA/NP because of these exact reasons. After reading this, I am not sure if I would either. I even signed somen petitions for PA's supporting them, but again this thread makes me think again. Furthermore, my interactions with PA students has been horrendous. They jump

Actually, most MDs have no problems hiring PAs as they greatly extend our practicies. I tend to not want an NP (too specialized) and definitely prefer PAs for my surgical practice but most of my colleagues have no problems with midlevels.

 

[mig26x]

I wish midlevels would stop trying to strive to be doctors. Not because I feel threatened but because of the potential of a backlash from physician. I know over 30 of my classmates will come out and say they would never hire a PA/NP because of these exact reasons. After reading this, I am not sure if I would either. I even signed somen petitions for PA's supporting them, but again this thread makes me think again. Furthermore, my interactions with PA students has been horrendous. They jump

I will hire PA's but not NP's

 

[prairiedog]

I will hire PA's but not NP's

I cant believe that I went to medical school just to find out that it was going to be nursing school the one that would REALLY prepare me to be a better physician!!!! damn, how silly of me!!! sarcasm off!!!

Can you turn your english skills on?

 

[mig26x]

I cant believe that I went to medical school just to find out that it was going to be nursing school the one that would REALLY prepare me to be a better physician!!!! damn, how silly of me!!! sarcasm off!!!

Can you turn your english skills on?

I can tell you didn't like my signature!! LOL. what can I do?!!

 

[USArmyDoc]

Actually, most MDs have no problems hiring PAs as they greatly extend our practicies. I tend to not want an NP (too specialized) and definitely prefer PAs for my surgical practice but most of my colleagues have no problems with midlevels.

It is probably just a thing that goes on during school. When I am on rotations, I have seen them attempt to take any situation to show up a medical student. I always take the approach to work together because everyone has something to add. I feel like pride can really hurt your education and should be put on the back seat. Listen to someone regardless of their degree because you will learn something!

 

[beefballs]

I've noticed that too,

 

[prairiedog]

It is probably just a thing that goes on during school. When I am on rotations, I have seen them attempt to take any situation to show up a medical student. I always take the approach to work together because everyone has something to add. I feel like pride can really hurt your education and should be put on the back seat. Listen to someone regardless of their degree because you will learn something!

Who is "them" PA? NP? Midlevel?