- Joined
- Jul 21, 2017
- Messages
- 475
- Reaction score
- 51
It'll solve the crisis of the underserved. I thought that was your goal? Or is that bull****?
And no it wouldn't. Underserved is not just confined to rural areas genius.
It'll solve the crisis of the underserved. I thought that was your goal? Or is that bull****?
he's got a point...if your arugment is that NPs are needed to fill in where docs arent then all NPs should be required to head out to the country and help in those clinics. That's where its most needed.MadJack, we've debated extensively before and you already know my position, and I already know yours. What do you want?
We never addressed that. I proposed an actual way to help the underserved in a substantial way while fulfilling the NP mission. What is wrong with my proposal if the whole impetus for NP independent practice is increased access to care for those that need it?MadJack, we've debated extensively before and you already know my position, and I already know yours. What do you want?
It was an and statement, meaning rural and underserved. Restrict NPs to federally recognized health care shortage sites. Boom, problem fixed.And no it wouldn't. Underserved is not just confined to rural areas genius.
he's got a point...if your arugment is that NPs are needed to fill in where docs arent then all NPs should be required to head out to the country and help in those clinics. That's where its most needed
We never addressed that. I proposed an actual way to help the underserved in a substantial way while fulfilling the NP mission. What is wrong with my proposal if the whole impetus for NP independent practice is increased access to care for those that need it?
So is your end goal for us to agree that NPs should be fully autonomous everywhere? I mean think about if you had a big legal case...would you want your case handled by a paralegal with hours and hours of experience but nowhere near the education level? Or would you want the guy who went to law school, busted his butt to get through, and knows his stuff?A larger proportion of NPs do practice in rural areas and underserved areas than physicians. Access issues go beyond rural America.
So is your end goal for us to agree that NPs should be fully autonomous everywhere? I mean think about if you had a big legal case...would you want your case handled by a paralegal with hours and hours of experience but nowhere near the education level? Or would you want the guy who went to law school, busted his butt to get through, and knows his stuff?
I have zero problem with primary care situations and rural issues. But the new NPs coming out don't want to go to northern idaho to practice. They want to work in the big city hospitals and 'good' areas to live. That's where I have issues. They view it more as a pay bump and getting to be a 'doctor'. Its the same way with physicians...the shortage is there because there is a maldistribution of available physicians. Its human nature
I feel like all the hard work physicians put in is much more deserving of going where they want to honestly...not being a hypocrite whatsoever. Nurses work hard yes, but the floor is nowhere near as tiring as the training doctors have to do. And a lot of the NP programs aren't exactly super scholasticThis. You are a hypocrite. People in general are looking for a good life, good job, with good pay. A place to rear families and be close to their loved ones. You can't expect NPs to be any different. However, be that as it may, NPs are far more likely to practice in rural areas and as I said before, have a larger proportion of them working for the underserved in both rural and urban areas. And the physician shortage issue is multifactorial. There is a maldistribution issue in addition to their simply not being enough physicians. There will not be enough of you guys to fill the gaps NPs are filling for at least two more decades. So I'm not even worried. Job security either way.
Nurses can go wherever they like...just not with the full autonomy they havent earned. These are peoples lives were talking about one mess up and they can die. I'd trust a doc 10/10 in those situationsThis. You are a hypocrite. People in general are looking for a good life, good job, with good pay. A place to rear families and be close to their loved ones. You can't expect NPs to be any different. However, be that as it may, NPs are far more likely to practice in rural areas and as I said before, have a larger proportion of them working for the underserved in both rural and urban areas. And the physician shortage issue is multifactorial. There is a maldistribution issue in addition to their simply not being enough physicians. There will not be enough of you guys to fill the gaps NPs are filling for at least two more decades. So I'm not even worried. Job security either way.
We already went through that, there is barely a difference at allA larger proportion of NPs do practice in rural areas and underserved areas than physicians. Access issues go beyond rural America.
We already went through that, there is barely a difference at all
Even if I bought the notion that lack of access is an epidemic, which I don't.....you are making a false claim that somehow this disproportionately large fraction of NPs are taking one for the team and working for the "underserved"...11 vs 15 is not at all a large differenceIts a big difference. And Yea 11 vs 15%. NPs having 15-18% of us actively practicing out in rural areas. More than 90% of us are credentialed in some form of primary care. And in our debate we talked about the underserved in rural America. That doesn't include and discredits what NPs in urban areas do too to serve the underserved. You just make it sound black and white like the NPs in rural areas are the only ones doing good. The issue of access is epidemic and is not just restricted to farms and valleys.
If the physician shortage in underserved areas is the primary reason for becoming an NP, and if NPs are as clinically and academically skilled as physicians, why not just go to medical school and become a primary care physician?
Sent from my iPhone using SDN mobile
Even if I bought the notion that lack of access is an epidemic, which I don't.....you are making a false claim that somehow this disproportionately large fraction of NPs are taking one for the team and working for the "underserved"...11 vs 15 is not at all a large difference
And going back to before....will you admit you were wrong and someone with literally no health care background can now earn an MSN in america in 2 yrs?
From nothing to NP in 4 yrs as I linked earlierwe can do the NP path and be of service in as short as 6 years, from start to finish.
From nothing to NP in 4 yrs as I linked earlier
From nothing to MSN in 2
Even if I bought the notion that lack of access is an epidemic, which I don't.....you are making a false claim that somehow this disproportionately large fraction of NPs are taking one for the team and working for the "underserved"...11 vs 15 is not at all a large difference
And going back to before....will you admit you were wrong and someone with literally no health care background can now earn an MSN in america in 2 yrs?
So you are claiming the one of the highest quality NP programs....the most credible. Makes independent practicing, equal to physicians, nps in 4 yrs from nothing?Okay go get a life for a few hours sb247. Enjoy the sun or something. Im at work now saving lives right now in MSICU.
And you linked Columbia. Like one of the best schools. Their programs are shorter but excellent.
So you are claiming the one of the highest quality NP programs....the most credible. Makes independent practicing, equal to physicians, nps in 4 yrs from nothing?
I'm going to disagree
As someone who lives in rural Vermont which urbanites that come here from Metro NYC/CT/NJ consider the boonies, I am taken aback by the thinking that we somehow are not as deserving of Primary Care MD's to the same extent as urban/suburban folks are. The NP's should be made to come to rural places and all that. Maybe that's not what has been meant but it is what it sounds like. I would throw in the comment I saw that MD's prefer to be in "good" areas (which I took to mean doesn't include rural areas) is part of my interpretation. Personally I think I live in paradise but that's just me. More importantly any Internist MD, NP, or PA that comes here would have as many patients as they can handle and would earn a good living. The quality of life would be quite high, but again maybe that's just me. As it stands there are no Internist MD's within a 1.5+ hour circle from where I live that are taking new patients. The NP's and PA's are almost all maxed out as well.
It seems that if medical schools aren't going to churn out enough primary care MD's that there is no choice but for NP's and PA's to pick up the slack. MD's, NP's, and PA's need to figure out how to co-exist. Our Family and Internal Medicine practices all seem to have some of each.
Actually, some of us have argued that what you deserve -are- MDs, and not substandard care provided by unsupervised midlevels. The solution to a physician shortage is more physicians, not more nurses.
Sent from my iPhone using SDN mobile
As it has been pointed out several times here, the proportion of NPs who practice in underserved areas is similarly low when compared to doctors who serve in underserved areas.
The solution for a shortage of primary care physicians is to produce more primary care physicians. There are new medical schools emerging with a focus on primary care in their states who recruit students with a commitment to primary care or family medicine . Midlevel providers who are not under the supervision of a physician may provide "access to care," but 1) most of them aren't practicing where care is needed the most, and 2) that care is lower quality than what people in well-serviced areas receive. The goal should be that everyone has access to the same thing, not just that everyone has access to something.
Hilarious GomerBlog post went something like, "Obama Appoints NP Surgeon General of the United States"
In all honestly the surgeon general should probably be a dietitian or gym teacher, because America needs to hustle.
This. You are a hypocrite. People in general are looking for a good life, good job, with good pay. A place to rear families and be close to their loved ones. You can't expect NPs to be any different. However, be that as it may, NPs are far more likely to practice in rural areas and as I said before, have a larger proportion of them working for the underserved in both rural and urban areas. And the physician shortage issue is multifactorial. There is a maldistribution issue in addition to their simply not being enough physicians. There will not be enough of you guys to fill the gaps NPs are filling for at least two more decades. So I'm not even worried. Job security either way.
If I might add a thought on how to get more physicians into rural areas, it is perhaps to ease the ability for students from those areas to go to medical school. These are people more apt to "go home" and practice after residency but the barriers to entry can be insurmountable no matter how smart they may be. Those who come from families with means or who have friends or relatives that are physicians have certain advantages over those who do not. Large urban/suburban high schools give ambitious kids advantages towards getting into the right programs and schools that kids in many rural high schools just don't have. If your graduating class is 25 kids and there are no AP or honors courses and only very limited math and science offerings, it is just harder to compete when applying no matter how smart you may be.
I didn't pursue medical school but by way of example to make my point, growing up I did not know a single person in my extended family or in my neighborhood that had gone to college. Few had graduated from high school. I didn't know anybody I could talk to about what my options were let alone how to achieve them. The day after turning 15 I took a job scrubbing pots in a cafeteria after school and on non-school days to start saving money to go to college. That precluded any after-school extracurriculars or volunteer work that might have made me look well rounded, and when the time came to pay for my college applications even that expense was entirely on me which tells you where I was coming from financially. Visiting schools I applied to was an impossible luxury in travel expense and time off from work. Fortunately where I went didn't require an interview. The 1st time I saw the college I went to was when I moved into the dorm. Hard work and much sacrifice paid off handsomely and I am quite well off now but rest assured there are very smart kids out in the rural areas who might like to become a physician but just can't see how to overcome the barriers to entry for people like them and from where they are. Many would go home again to practice if somehow they could find the path to medical school.
So the problem is that physician specialties are so specific that actual services are spread thin, requiring that expensive and complicated tertiary care services be centered in large hospital institutions or areas with high catchment. That is the maldistribution issue that has allowed midlevel growth. There are definitely plenty of physicians graduating with new schools being opened all the time, so shortage issues are rapidly disappearing. The maldistribution issue is not.
Though many could live and practice primary care in rural areas, NP and PAs are not trained to practice full scope medicine as an FM graduate theoretically could (many PCPs do not for reasons I mentioned in previous posts). This frequently requires midlevels to refer out for tertiary services (Ob, radiology, ENT, Cardiology, etc). It simply does not make sense for midlevels to practice in rural areas, though it is nice that midlevels are moving there, and I'm sure that many appreciate what they can offer. You are propagating an illusion that full care access is being provided when it is certainly not. It is not that physicians are refusing to answer the call, but that full access to medicine is more complicated than people believe; almost everybody will require tertiary services at some point in their life, and the belief that primary care access alone solves the care issue is just flat out wrong. The trend over the next 50 years will be midlevels going into tertiary care services in larger cities and bulking up "access" there. Private specialized training centers (e.g, CRNA schools) will proliferate for this purpose. It just so happens that the lowest hanging fruit is ambulatory services that do not require intensive training.
Medical services are changing which makes people uneasy, esp when tuition plus other training fees can exceed half a million USD per physician. There will be physician pushback with definite consequences that some midlevels will not appreciate if this trend continues. One thing that certainly needs to happen by physicians (rather than nurses) is operationally defining professional differences in scope of practice and responsibility, which could restrict midlevel income and opportunities. I agree with your sentiment that most people are looking for a good life, but all must pay the tollkeeper to find reward in this crappy US healthcare system. Believe that the crappiness will be distributed equitably by your physician peers.
Your statements are inaccurate on multiple accounts. Thats why you should provide citations to corroborate your claims or do more research on industry... Shortage issues absolutely do exist and are actually getting worse. I invite you to look at the NRMP data to understand how many med students are actually getting placed into primary care residency.
And if anything physicians, patients, and overall, society appreciates the contributions midlevels have made in mitigating the shortage issue. So pushback will not occur as you state at all.
The pay we earn is fair considering how much revenue we produce for a practice and the services we provide.
There's actually no proof that a physician shortage exists. The "proof" is dependent on the model you use. The NRMP data is separate from population demand and doesn't mention shortages. Various partisan organizations instead use this data to declare a physician shortage using their own models.
The rest of your post is opinion based, and similarly has no factual basis. Also, pushback already occurs at state and federal levels for scope of practice, so there's evidence against you there.
What is factual is that there is a shortage.
Also, I would like to see what data you have on "pushback" because as far as I can tell, our scope and practice authority is only increasing by the state.
Then prove it with studies that don't use any modeling. What is factual is that definitions of physician shortage vary. What is factual is that Nursing Practitioners do not ameliorate physician shortages because by definition they are not physicians.
Data? Here is a random article from 2014 from my state Anesthesiologist society on Pain Clinics:
"At the request of House Speaker David Ralston, the GCMB included language to clarify that CRNAs are not prohibited from working in pain clinics within CRNA scope of practice as defined by Georgia Code. This language was initially crafted by GSA and submitted to the Board in February in response to the Speaker’s request so that the language could be inserted into the proposed rule rather than the legislature re-opening the pain clinic licensure act. GSA successfully fought an attempt by the GA Association of Nurse Anesthetists to amend the definition of “Medical treatment or services” to exclude administration of anesthesia by a CRNA acting within scope of practice as defined in code. The GSA Government Affairs Committee and the American Society of Anesthesiologists determined that the GANA amendment would, were it adopted by the Medical Board, later be used by the GANA to seek expanded CRNA scope through Nursing Board rulemaking."
source: https://gesa.memberclicks.net/assets/gsa scope summer 2014.pdf
In other words, physician societies have long been calling out midlevels on their scope of practice bull****.
It's my understanding that there are more fm residency slots every yearThe only opinion stated so far today was your notion that NPs earn too much money. What is factual is that there is a shortage. No matter what political paradigm you align yourself with, the data outthere is overwhelmingly clear atomheart. And no matter how you want to spin your argument, there is nothing partisan about NRMP data. Its pretty obvious that demand for primary care services will only increase with the aging population and the next wave of retiring physicians on the horizon. Creation of primary care doctors is at the very least plateuing and thats being generous.
Furthermore, you can open up as many FM focused med schools as you want, but if there is a lack of residencys or preceptor, then those med school graduates are rendered basically useless. This is so true to the extent that I've seen 3rd and 4th year medical school students following NPs here where I live.
Also, I would like to see what data you have on "pushback" because as far as I can tell, our scope and practice authority is only increasing by the state.
It's my understanding that there are more fm residency slots every year
More spots every year since 20092016 NRMP data doesnt show that unfortunately
Its impossible to take such massive amounts of data and represent a concept or make sense of it with out modeling. The data out there is the best we have, and rather than trying to spin it in someway that makes you feel all warm and fuzzy inside, accept the writing on the wall. That is, there is a shortage and doctors need our help. And for us to be of service the best we can, there cant be unnecessary restrictions to our ability to practice. That includes doctors too. There are states that limits the number of mid levels they can oversee, and the number of locations they can collaborate with, which is also a ridiculous law and limits their abilities on both ends.
I never claimed that we NPs will ameliorate the physician shortage. I said that we would mitigate it. Big difference. Im the first to tell people that we need more physicians. So I think we can agree on that point. What I don't appreciate is how ungrateful and rude you are about the efforts and contributions we've made.
Also, that article you cited is hardly pushback. CRNAs still have tons of scope in GA and practice authority elsewhere and are independent in several states.
So what I'm reading is you have no factual basis to support a physician shortage. So then that also means any evidence that mid-levels "mitigate" a shortage is questionable. There's also no evidence that mid-levels have made contributions to anything.
You come here stirring up the beehive, then ignore logical arguments that don't support your viewpoint and go on a data crusade. How does it feel chump?
More spots every year since 2009
Family Medicine 2017 National Resident Matching Program (NRMP) Results Analysis
I actually feel pretty good about the arguments Ive made and actually have provided lots of data to support my arguments unlike yourself.
I'm sure you feel good about yourself, but you've also pissed people off, and convinced nobody... including the people who were willing to give you a chance.
I am 64 years old and retired, so no. I made my money being able to manage complex operations and being good at solving problems, not as an author with a polished writing style. I had copywriters and proofreaders for that kind of thing.Is this a medical school admissions personal statement? Cringeworthy. Needs editing.
I may have pissed YOU off but there are thousands like me making the same argument. If you cant argue without getting all emotional then thats your problem, not mine...& who are you to speak for "the people willing to give me a chance"? I already work with many physicians that agree with several of the points ive made
It's really hard to educate dumb people who think they're smart. But to educate the M1/2s here who may not sense what's going on, most physicians in practice don't give a **** about politics, and mostly just want to work in a peaceful setting for 30 years without making waves. It's mid-levels who tend to bitch and make work unpleasant, so physicians are forced to be pleasant to appease them, giving mid-levels delusions of collaboration where none actually exists. There is more to risk to physicians administratively by going toe to toe with mid-levels so why bother? How do I know? Because I work with those docs, and I'm present when the doors are closed. I'm just a student who gets to watch for a few weeks; they have to put up with you for years.