How do we stop nurse practitioners?

[deleted480308]

To practice independently, yes, the only option is in primary care. In specialties, we are extenders.

Try and look us all in the figurative eye and say the NPs don't expect to be independent there too. The crnas also pulled the "extender" line until they thought they could win Independance legislatively.

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[jdav_7]

You don't have to buy it sb247. Just look at the data. NPs have a far larger proportion of them credentialed and practicing in primary care and in the underserved areas.

http://www.ncsl.org/research/health/meeting-the-primary-care-needs-of-rural-america.aspx

This is basically the meat of my research. You all should read social transformation of american medicine by Paul Starr to understand why physicians seem less compelled to serve in underserved regions than their mid-level counterparts.

 

[deleted480308]

You don't have to buy it sb247. Just look at the data. NPs have a far larger proportion of them credentialed and practicing in primary care and in the underserved areas.

http://www.ncsl.org/research/health/meeting-the-primary-care-needs-of-rural-america.aspx

Your link gave the percent of docs practicing in rural areas but I missed the percent of NPs practicing in rural areas.....can you point it out to me?

 

[deleted480308]

I just disagree. Preventive medicine cannot be practiced without a wealth of primary care providers, and our physicians are generally unwilling to establish themselves in underserved areas for a long-term career. I'd be interested to see what effect removing government subsidies for medical education of physicians who go on to practice in over-served areas/specialties... perhaps that would push physicians to seek a service-oriented career over a comfortable career

There is some implication in your statement that the doc in manhatten isn't "service oriented".

 

[FNP_Blix]

I'm hoping so! I wouldn't be shocked to see more 2 and 3 year medical school programs pop up that fast track for primary care (like Texas Tech has). What this will do to quality of care remains to be seen, but certainly looks like it might encourage physicians to enter family Med.

You will be fine as a PCP. If you learn to collaborate with mid-levels and make it a win-win for everyone (Physician, Mid-levels, and most importantly the patients), you will be very successful.

 

[jdav_7]

You will be fine as a PCP. If you learn to collaborate with mid-levels and make it a win-win for everyone (Physician, Mid-levels, and most importantly the patients), you will be very successful.

Agreed!

 

[jdav_7]

There is some implication in your statement that the doc in manhatten isn't "service oriented".

Yes, the implication is that physicians know their services are needed elsewhere and still choose to practice in no-need areas. Not familiar with Manhattan specifically, but if you're seeing a wealth of private insurance patients who are well-to-do, avoiding Medicare and Medicaid patients actively, etc. one cannot pretend to be practicing in a service-oriented manner. This isn't to say you can't act in service in an urban environment because there are many patients who need services there, but a growing number of physicians are going so far as to hire nurse practitioners just to see all the Medicaid patients in Texoma areas. It's gross.

 

[deleted480308]

Yes, the implication is that physicians know their services are needed elsewhere and still choose to practice in no-need areas. Not familiar with Manhattan specifically, but if you're seeing a wealth of private insurance patients who are well-to-do, avoiding Medicare and Medicaid patients actively, etc. one cannot pretend to be practicing in a service-oriented manner. This isn't to say you can't act in service in an urban environment because there are many patients who need services there, but a growing number of physicians are going so far as to hire nurse practitioners just to see all the Medicaid patients in Texoma areas. It's gross.

you seem to be moralizing that good care to poor patients is somehow better than good care to wealthy ones

 

[jdav_7]

you seem to be moralizing that good care to poor patients is somehow better than good care to wealthy ones

Yes, I believe serving the poor despite receiving less compensation is more noble a profession than serving the rich. Obviously not saying the rich don't deserve quality care, but rather that we shouldn't socially perceive physicians whose case volume is dominated by high-compensatory care to be the same as a physician who takes a pay cut to serve the indigent. I personally think we should change our angle and present serving the indigent to be a patriotic service to the country, not unlike serving in the military.

 

[FNP_Blix]

Try and look us all in the figurative eye and say the NPs don't expect to be independent there too. The crnas also pulled the "extender" line until they thought they could win Independance legislatively.

I can look at you in the eye and honestly tell you that NPs are not trying to gain independent practice authority in specialty areas. While NPs do specialize and get extra training to work in specialty areas, there are limitations. And if there is any nurse that should be practicing independently in all 50 states, it is the CRNAs. They represent the oldest advance practice nurse in modern nursing and have the longest safety record and proven efficacy.

 

[FNP_Blix]

Your link gave the percent of docs practicing in rural areas but I missed the percent of NPs practicing in rural areas.....can you point it out to me?

Well thats because you won't find it in that article. You will find the ratios of NPs practicing in rural areas per 100,000 (population) in the article below. This equates to about 18% of practicing ARNPs that go into rural practice after graduation. Not nearly enough and where we need to be (only 10% for physicians practicing in rural areas), but ARNPs are still key to the solution in improving access (not only in rural areas but to the millions of newly insured people as the result of the ACA). The data in the two articles explains why. Now you start providing me with some articles that say any different.

http://www.nursingworld.org/APRNdistributionreport

 

[deleted480308]

I can look at you in the eye and honestly tell you that NPs are not trying to gain independent practice authority in specialty areas. While NPs do specialize and get extra training to work in specialty areas, there are limitations. And if there is any nurse that should be practicing independently in all 50 states, it is the CRNAs. They represent the oldest advance practice nurse in modern nursing and have the longest safety record and proven efficacy.

AANP - Advocacy Center

Yes. They are already pushing for independence in more areas.... They pitch themselves as equally interchangeable and they are not

CRNAs should not be practicing independently

 

[deleted480308]

Well thats because you won't find it in that article. You will find the ratios of NPs practicing in rural areas per 100,000 (population) in the article below. This equates to about 18% of practicing ARNPs that go into rural practice after graduation. Not nearly enough and where we need to be (only 10% for physicians practicing in rural areas), but ARNPs are still key to the solution in improving access (not only in rural areas but to the millions of newly insured people as the result of the ACA). The data in the two articles explains why. Now you start providing me with some articles that say any different.

http://www.nursingworld.org/APRNdistributionreport

page 8....15% of NPs practice rural, with 11% of docs doing the same the notion of opening independent practice to a lesser trained profession isn't justified. Particularly when the nurse advocacy groups don't seem to be interested in restricting their independence to rural primary care. It's something you all hide behind for the ad campaign. And again, kudos on the tactical victory....it's just dishonest

 

[FNP_Blix]

page 8....15% of NPs practice rural, with 11% of docs doing the same the notion of opening independent practice to a lesser trained profession isn't justified. Particularly when the nurse advocacy groups don't seem to be interested in restricting their independence to rural primary care. It's something you all hide behind for the ad campaign. And again, kudos on the tactical victory....it's just dishonest

Of course not. Why would we want restrictions to our practice authority in urban areas when there are access issues there too? There are plenty in urban areas that need healthcare too but can't get it because physicians won't take medicare or medicaid or will not settle for a lower salary. And okay, 15% of NPs work in rural areas. But over 90% of NPs are certified in some area of primary care making for a much larger pool (proportionally) to pull from. That is partly why the data points to NPs as far more likely to practice in underserved areas. And why do you think there is no justification for opening independent practice for NPs in rural areas when all the data says the opposite? Is it because your ego? Elitism? What is it? Because a majority of the data out there shows that NPs and CRNAs and Midwives in these areas (and elsewhere) are doing just fine, not only for themselves (professionally) but for the patient's they care for.

 

[jdav_7]

page 8....15% of NPs practice rural, with 11% of docs doing the same the notion of opening independent practice to a lesser trained profession isn't justified. Particularly when the nurse advocacy groups don't seem to be interested in restricting their independence to rural primary care. It's something you all hide behind for the ad campaign. And again, kudos on the tactical victory....it's just dishonest

How on earth would you be able to know the intentions of thousands of individuals across the country? If you have such a huge problem with the use of mid-levels, go serve in an underserved area as a PCP.

 

[FNP_Blix]

AANP - Advocacy Center

Yes. They are already pushing for independence in more areas.... They pitch themselves as equally interchangeable and they are not

CRNAs should not be practicing independently

Last I checked, I haven't met any NPs functioning as the primary cardiologist for a practice. Have you?

CRNAs should be practicing independently...we can go back and forth all day

 

[deleted480308]

Of course not. Why would we want restrictions to our practice authority in urban areas when there are access issues there too? There are plenty in urban areas that need healthcare too but can't get it because physicians won't take medicare or medicaid or will not settle for a lower salary. And okay, 15% of NPs work in rural areas. But over 90% of NPs are certified in some area of primary care making for a much larger pool (proportionally) to pull from. That is partly why the data points to NPs as far more likely to practice in underserved areas. And why do you think there is no justification for opening independent practice for NPs in rural areas when all the data says the opposite? Is it because your ego? Elitism? What is it? Because a majority of the data out there shows that NPs and CRNAs and Midwives in these areas (and elsewhere) are doing just fine, not only for themselves (professionally) but for the patient's they care for.

the data does not show they are equivalent....go ahead and post your studies and we'll go through them

 

[jdav_7]

This is a ludicrous conversation at this point. Either empower the ones willing to serve the underserved and get out of the way, or go be part of the solution. Either one is fine.

 

[deleted480308]

How on earth would you be able to know the intentions of thousands of individuals across the country? If you have such a huge problem with the use of mid-levels, go serve in an underserved area as a PCP.

Last I checked, I haven't met any NPs functioning as the primary cardiologist for a practice. Have you?

CRNAs should be practicing independently...we can go back and forth all day

I know what they do......which isn't request restrictions to rural areas.....also evidenced by the other poster in this thread.

The sales pitch is "but the underserved need us in primary care" but there is never a promise to stay to underserved primary care.

The only reason the NPs aren't doing independent cardiology is because they aren't allowed. If they could get it approved, they would take it in a heartbeat

 

[FNP_Blix]

the data does not show they are equivalent....go ahead and post your studies and we'll go through them

I've already had this breakdown of studies discussion on the discussion forum which is attached below. If you want to find where we talked about this, then tag along on the conversation and give your input. The burden of proof is on you my friend. We are already practicing independently and are continuing to move forward. If you want to argue against this, then you provide the articles and the data that disputes my points.

Should physicians let NP/PA take over primary care and anesthesia?

 

[FNP_Blix]

I know what they do......which isn't request restrictions to rural areas.....also evidenced by the other poster in this thread.

The sales pitch is "but the underserved need us in primary care" but there is never a promise to stay to underserved primary care.

The only reason the NPs aren't doing independent cardiology is because they aren't allowed. If they could get it approved, they would take it in a heartbeat

Umm yea, the same is true for physicians. Who can make the promise to stay in rural areas indefinitely? Remember, there are human factors to consider. NPs like physicians are not robots that will just stay and serve their whole lives out in the boons. And if you want to evidence anything, evidence some actual research that supports your arguments as I have done for you.

 

[FNP_Blix]

This is a ludicrous conversation at this point. Either empower the ones willing to serve the underserved and get out of the way, or go be part of the solution. Either one is fine.

Oh its fun here jdav_7! lol don't take it personally. All you can do is present your points and hope something sinks. Check out how crazy this discussion was.

Should physicians let NP/PA take over primary care and anesthesia?

 

[deleted480308]

I've already had this breakdown of studies discussion on the discussion forum which is attached below. If you want to find where we talked about this, then tag along on the conversation and give your input. The burden of proof is on you my friend. We are already practicing independently and are continuing to move forward. If you want to argue against this, then you provide the articles and the data that disputes my points.

Should physicians let NP/PA take over primary care and anesthesia?

I read that discussion when it was happening, I don't think your argument fared well

 

[jdav_7]

Oh its fun here jdav_7! lol don't take it personally. All you can do is present your points and hope something sinks. Check out how crazy this discussion was.

Should physicians let NP/PA take over primary care and anesthesia?

I think as long as the conversation is entered around centralizing power instead of caring for those in need of compassion, we'll get this result.

 

[FNP_Blix]

I think as long as the conversation is entered around centralizing power instead of caring for those in need of compassion, we'll get this result.

What do you mean by centralizing power?

 

[FNP_Blix]

I read that discussion when it was happening, I don't think your argument fared well

Well you have a bias view but sure, you can think whatever you want. Over 50 years of data and over 20 states in the USA would tend to disagree though.

 

[jdav_7]

What do you mean by centralizing power?

I mean physicians fighting to maintain power rather than focusing on meeting healthcare needs.

 

[FNP_Blix]

I mean physicians fighting to maintain power rather than focusing on meeting healthcare needs.

Oh yea, that is definitely a component.

 

[deleted480308]

I mean physicians fighting to maintain power rather than focusing on meeting healthcare needs.

What those people "need" for their healthcare is a doctor

 

[psychMDhopefully]

I think the greatest legacy our generation of physicians could leave, would be to expand residency programs and medical schools just enough so that every patients that needs to see a physician can see a physician, thereby completely eliminating the need for "midlevels or "extenders" making them obsolete. Honestly, I don't think there is a shortage of physicians, I grew up in one of the most rural areas of the country and could see one without much trouble, I've yet to feel a shortage.

If there is a supposed shortage or a maldistribution problem, what we could do is increase the number of primary care residency spots, and incentivize (maybe heavily) physicians to practice in rural areas. All of these things are within our control. If there are enough doctors there is no need for midlevels, any patient that has the choice between a fully trained physician, and a half trained pretender would pick the former. Lets make it happen.

 

[FNP_Blix]

What those people "need" for their healthcare is a doctor

I think the greatest legacy our generation of physicians could leave, would be to expand residency programs and medical schools just enough so that every patients that needs to see a physician can see a physician, thereby completely eliminating the need for "midlevels or "extenders" making them obsolete. Honestly, I don't think there is a shortage of physicians, I grew up in one of the most rural areas of the country and could see one without much trouble, I've yet to feel a shortage.

If there is a supposed shortage or a maldistribution problem, what we could do is increase the number of primary care residency spots, and incentivize (maybe heavily) physicians to practice in rural areas. All of these things are within our control. If there are enough doctors there is no need for midlevels, any patient that has the choice between a fully trained physician, and a half trained pretender would pick the former. Lets make it happen.

I agree that we need more physicians. I don't disagree with you guys. However the current situation is that, for whatever reason (physician shortage, maldistribution issues, residency shortage, lack of funding, or whatever), a large number of people are not getting the healthcare they need. NPs have been helping fill that void and quite frankly have stepped up where physicians haven't been able to. This has been the case not just in recent history but since the early 20th century, back when the Frontier Nursing Services served informally as nurse practitioner and midwives in rural areas. We have a long history of delivering health care services in places where physicians have been unable to reach. NPs do not "pretend" to be physicians either. We have been trained in the prevention of diseases and the promotion of better health (and in primary care). Health promotion and disease prevention is currently the goal in health care and NPs are doing a good job with that as well, bringing a unique perspective to medicine. With more people than ever now insured, and a current wave of retiring physicians on the horizon, you shouldn't be so bitter that the nursing profession (the largest profession in healthcare) has stepped up to the plate.

 

[deleted480308]

I agree that we need more physicians. I don't disagree with you guys. However the current situation is that, for whatever reason (physician shortage, maldistribution issues, residency shortage, lack of funding, or whatever), a large number of people are not getting the healthcare they need. NPs have been helping fill that void and quite frankly have stepped up where physicians haven't been able to. This has been the case not just in recent history but since the early 20th century, back when the frontier nursing services served informally as nurse practitioner in rural areas. NPs do not "pretend" to be physicians either. We have been trained in the prevention of diseases and the promotion of better health. That is currently the goal in health care and NPs are doing a good job of that. With more people than ever now insured, and a current wave of retiring physicians on the horizon, you shouldn't be so bitter that the nursing profession (the largest profession in healthcare) has stepped up to the plate.

Let's not hide behind claims of a shortage, if the number of docs quadrupled tomorrow, it's not like the nurses would relinquish independent practice.....it's a power grab that leaves patients with a lesser trained person managing their care

 

[FNP_Blix]

Let's not hide behind claims of a shortage, if the number of docs quadrupled tomorrow, it's not like the nurses would relinquish independent practice.....it's a power grab that leaves patients with a lesser trained person managing their care

Okay, so it is about power then? Physicians are more worried about losing their foot hold in primary care, rather than providing optimal care for their patients and focusing their efforts on training more doctors and opening up residencies. Rather than whining about what nurses are doing, how about you make a contribution worthwhile for your profession. You want this "problem" to go away, then do something. Go fund a med student or become politically involved. Better yet, how about you go practice in rural America and make a real difference...If you understood anything about the history of the nursing profession, you would see that your allegations are completely unfounded. How about you get your own house (medical profession) in order before you start scrutinizing mine (nursing profession)...And you know what? So far you haven't been able to really present a sound argument or provide a sliver of data or evidence that says we are not doing a good job..

 

[jdav_7]

What those people "need" for their healthcare is a doctor

Alright, doctor. Go be their doctor.

 

[deleted480308]

Okay, so it is about power then? Physicians are more worried about losing their foot hold in primary care, rather than providing optimal care for their patients and focusing their efforts on training more doctors and opening up residencies. Rather than whining about what nurses are doing, how about you make a contribution worthwhile for your profession. You want this "problem" to go away, then do something. Go fund a med student or become politically involved. Better yet, how about you go practice in rural America and make a real difference...If you understood anything about the history of the nursing profession, you would see that your allegations are completely unfounded. How about you get your own house (medical profession) in order before you start scrutinizing mine (nursing profession)...And you know what? So far you haven't been able to really present a sound argument or provide a sliver of data or evidence that says we are not doing a good job..

optimal care is a doctor. I support increasing residencies and oppose midlevel independent practice......it's not a mutually exclusive proposition

Alright, doctor. Go be their doctor.

I do intend to practice in a rural area.

 

[FNP_Blix]

optimal care is a doctor. I support increasing residencies and oppose midlevel independent practice......it's not a mutually exclusive proposition

I do intend to practice in a rural area.

Optimal care is any qualified medical professional (i.e., MD/DO, APN/PA) that's willing to go out there and offer a lending hand. APNs (i.e., NPs, CRNA, CNM) do just as good a job as physicians in primary care, midwifery, and anesthesia. And let me tell you something: you will not be successful (or just be a bitter physician) if you do not learn to work and collaborate with mid-levels. You will be around a lot of them. Also, independence is SO necessary and there are many layers as to why its important, that I'm not sure you fully understand. For example, in some states, there are silly restrictions on mid-levels that are practicing in underserved areas, that stipulate that they cannot make referrals to physical therapy or a dietitian with out a physician order. It is restrictions like this that restrict access at the micro level. It's not just about how many providers there are for x amount of the population... And are you even a practicing physician? If not, then why are you waisting my time? What would you know about serving the underserved? I thought I would be debating with someone that actually knew what they were talking about. If you are a practicing physician, then you are a hypocrite. Stop complaining and be a part of the solution.

 

[deleted480308]

Optimal care is any qualified medical professional (i.e., MD/DO, APN/PA) that's willing to go out there and offer a lending hand. APNs (i.e., NPs, CRNA, CNM) do just as good a job as physicians in primary care, midwifery, and anesthesia. And let me tell you something: you will not be successful (or just be a bitter physician) if you do not learn to work and collaborate with mid-levels. You will be around a lot of them. Also, independence is SO necessary and there are many layers as to why its important, that I'm not sure you fully understand. For example, in some states, there are silly restrictions on mid-levels that are practicing in underserved areas, that stipulate that they cannot make referrals to physical therapy or a dietitian with out a physician order. It is restrictions like this that restrict access at the micro level. It's not just about how many providers there are for x amount of the population... And are you even a practicing physician? If not, then why are you waisting my time? What would you know about serving the underserved? I thought I would be debating with someone that actually knew what they were talking about. If you are a practicing physician, then you are a hypocrite. Stop complaining and be a part of the solution.

A midlevel is not qualified for independent practice, their training is not sufficient. No legislative permission will change that and no, they haven't been shown to "do just as good a job as physicians".

 

[jdav_7]

optimal care is a doctor. I support increasing residencies and oppose midlevel independent practice......it's not a mutually exclusive proposition

I do intend to practice in a rural area.

I'm so glad you intend to do so. With your current attitude, it would be incredibly hypocritical to do anything less than recruit your entire graduating medical class into poverty medicine so that people don't suffer from the effects of legislation that mirrors your thoughts. Good luck to you and wish you well.

 

[psychMDhopefully]

. I don't disagree with you guys. However the current situation is that, for whatever reason (physician shortage, maldistribution issues, residency shortage, lack of funding, or whatever), a large number of people are not getting the healthcare they need. NPs have been helping fill that void and quite frankly have stepped up where physicians haven't been able to.

I agree, which is why I posted a solution that could solve the problem of midlevels in medicine in under a couple of decades. Currently the process of getting into med school and getting a residency is just to damn difficult, the gates to medicine could be opened a bit without a drop in the quality of physicians, opening up more residencies especially in primary care is something we can do and should work towards. I don't mean to be disrespectful, but as medical student that previously attended nursing school, there is a HUGE difference in brain power between the 2 professions, of course there are outliers but people who choose to go to med school are generally a lot brighter. If I had a choice between a NP, and a person from a Caribbean med school who got 195 on Step 1 and matched FM because we expanded residencies ( that person wouldn't match in today's climate) I'd choose the MD because I know that any residency trained MD would be superior to an NP.

 

[deleted480308]

I'm so glad you intend to do so. With your current attitude, it would be incredibly hypocritical to do anything less than recruit your entire graduating medical class into poverty medicine so that people don't suffer from the effects of legislation that mirrors your thoughts. Good luck to you and wish you well.

I'm proposing policy that would bring doctors and you want to have people settle for less....you don't get to claim moral high ground here

 

[FNP_Blix]

I agree, which is why I posted a solution that could solve the problem of midlevels in medicine in under a couple of decades. Currently the process of getting into med school and getting a residency is just to damn difficult, the gates to medicine could be opened a bit without a drop in the quality of physicians, opening up more residencies especially in primary care is something we can do and should work towards. I don't mean to be disrespectful, but as medical student that previously attended nursing school, there is a HUGE difference in brain power between the 2 professions, of course there are outliers but people who choose to go to med school are generally a lot brighter. If I had a choice between a NP, and a person from a Caribbean med school who got 195 on Step 1 and matched FM because we expanded residencies ( that person wouldn't match in today's climate) I'd choose the MD because I know that any residency trained MD would be superior to an NP.

Wow. You know I've done a preceptorship with a physician that wen't to med school in Mexico and then did residency here in the states...scary to say the least. He was good sometimes but a diagnosis of "snoring" is not something I learned in my differentials. Also, I hear so many physicians say "I've been to nursing school", but they rarely have ever actually practiced as nurses (where enormous amounts of hands on learning takes place) or been to ARNP school. Note that on average, NPs have 10-11 years of experience before going into practice. And whether you want to admit it or not, advanced practice nurses (i.e., ARNPs, CRNAs, & CNMs) have been doing at least just as good a job as physicians, if not better in some outcomes of measure.

 

[FNP_Blix]

A midlevel is not qualified for independent practice, their training is not sufficient. No legislative permission will change that and no, they haven't been shown to "do just as good a job as physicians".

Unless you can give specific examples, provide data, or at the very least address some of my other points in my previous replies to support your arguments, I will not waist my time talking to you anymore. You are all talk but with no substance (e.g., research articles) or real life experience to share.

 

[FNP_Blix]

I'm proposing policy that would bring doctors and you want to have people settle for less....you don't get to claim moral high ground here

It's not about people settling for less. It's about the current reality that there are discrepancies in access to healthcare, which the nursing profession has done well at mitigating. The current system would not function without NPs. Physicians (and the patients we care for) are now (and for the indefinite future) dependent on the NPs, CRNAs, and CNMs which is why almost everyday I'm getting emails about locum tenens and practices that need a provider. Take that away tomorrow, and the healthcare system would be crippled. Whether you like it or not, we are here to stay for the long hall.

 

[psychMDhopefully]

It's not about people settling for less. It's about the current reality that there are discrepancies in access to healthcare. The current system would not function without NPs and you know it. Physicians (and the patients we care for) are now dependent on the NPs, CRNAs, and CNMs which is why almost everyday I'm getting emails about locum tenens and practices that need a provider. Take that away tomorrow, and the healthcare system would be crippled. Whether you like it or not, we are here to stay for the long hall.

I do respect that you haven't resorted to name calling and stayed professional thus far. But I strongly disagree that CRNAs and Midwives should practice independently. What if something goes wrong, can a midwife perform surgery? No, then you would have a situation where you are rushing the child to an Ob/Gyn. I've seen attending anesthesiologist swoop in and save CRNAs more times than I can count, but CRNAs conveniently forget these instances.

 

[FNP_Blix]

I do respect that you haven't resorted to name calling and stayed professional thus far. But I strongly disagree that CRNAs and Midwives should practice independently. What if something goes wrong, can a midwife perform surgery? No, then you would have a situation where you are rushing the child to an Ob/Gyn. I've seen attending anesthesiologist swoop in and save CRNAs more times than I can count, but CRNAs conveniently forget these instances.

Honestly, I cannot make the best arguments for CRNAs and CNMs, as I am an FNP. All I can really say is that there is a wealth of data out there that speaks to their efficacy in independent practice. They already are practicing independently in several states (and have been for decades), and to date, I have not heard of any cases that would disqualify them from practicing.

 

[jdav_7]

Last I'll say:
1. It would be amazing if we could give each individual in the United States their own personal physician. This would certainly put an end to health disparities. However, we are limited by both number of physicians and number of physicians WILLING to serve in underserved regions. It's classic iron triangle: cost, quality, and access. When you improve one or two, you decrease one or two of the others.
2. As long as physicians treat mid-levels like second-rate providers, we will not be able to coordinate effectively on a national scale. Should NPs be considered equally capable of handling the most difficult and complex cases as a fully trained physician? On a macro level, of course not. However, I know several kick ass NPs that could embarrass physicians with both their clinical expertise and ability to provide compassionate, patient-centered care. The only people who say ignorant things like "NPs aren't as good as physicians" are medical students who haven't had their ass handed to them by an NP yet.
3. All you have to do is look at any state's medical board bulletin to see the atrocities that dozens of physicians commit on a monthly basis that are equally if not more reprehensible than NP mistakes. Can't tell you how many times I see physicians get labeled a "danger to society" by the medical board. Given, most of these physicians are internationally trained, but that begs the question why we are forcing a false dichotomy between physicians and NPs instead of making the discussion centered around competent care. Once we get to that place, we can then have a conversation about what a viable solution looks like for rural and underserved areas. Hint: unless the government literally stations physicians in underserved areas like they do for the military, it ain't happening with just physicians.

That's all. Goodnight!

 

[FNP_Blix]

Last I'll say:
1. It would be amazing if we could give each individual in the United States their own personal physician. This would certainly put an end to health disparities. However, we are limited by both number of physicians and number of physicians WILLING to serve in underserved regions.
2. As long as physicians treat mid-levels like second-rate providers, we will not be able to coordinate effectively on a national scale. Should NPs be considered equally capable of handling the most difficult and complex cases as a fully trained physician? On a macro level, of course not. However, I know several kick ass NPs that could embarrass physicians with both their clinical expertise and ability to provide compassionate, patient-centered care. The only people who say ignorant things like "NPs aren't as good as physicians" are medical students who haven't had their ass handed to them by an NP yet.
3. All you have to do is look at any state's medical board bulletin to see the atrocities that dozens of physicians commit on a monthly basis that are equally if not more reprehensible than NP mistakes. Can't tell you how many times I see physicians get labeled a "danger to society" by the medical board. Given, most of these physicians are internationally trained, but that begs the question why we are forcing a false dichotomy between physicians and NPs instead of making the discussion centered around competent care. Once we get to that place, we can then have a conversation about what a viable solution looks like for rural and underserved areas. Hint: unless the government literally stations physicians in underserved areas like they do for the military, it ain't happening with just physicians.

That's all. Goodnight!

Well said my friend. Good night and good luck in med school!

 

[deleted480308]

Unless you can give specific examples, provide data, or at the very least address some of my other points in my previous replies to support your arguments, I will not waist my time talking to you anymore. You are all talk but with no substance (e.g., research articles) or real life experience to share.

You already presented your data in the other thread and it wasn't the indefensible proof you claim it to be

 

[FNP_Blix]

You already presented your data in the other thread and it wasn't the indefensible proof you claim it to be

I never claimed it to be "indefensible proof" nor am I saying the studies are perfect (though better than what you have been able to provide to refute my position). But listen, if you want to debate with me, and be taken seriously, offer more than your infinite wisdom...Until you do that, then we are done here. I have nothing more to say to you.

 

[atomheart]

Yes, I believe serving the poor despite receiving less compensation is more noble a profession than serving the rich. Obviously not saying the rich don't deserve quality care, but rather that we shouldn't socially perceive physicians whose case volume is dominated by high-compensatory care to be the same as a physician who takes a pay cut to serve the indigent. I personally think we should change our angle and present serving the indigent to be a patriotic service to the country, not unlike serving in the military.

That is very bright eyed of you to have that perspective. Here is part of the reality I saw during my FM rotation:

1. There is a massive and complex cost issue that isn't solved with number or type of provider. More MD or NP will not solve the problem alone. FM physicians can typically provide more extensive knowledge and services due to their training to justify a higher income. NPs provide some overlapping services but are rarely full-scope (what most people would call "quality care" from an FM point of view)...it is simply impossible for either MD or NP to practice full-scope medicine without relying on specialist services at some point, and those services are costly to everyone, including the physician. It always costs more for FM providers to accept the liability of providing these extra services, and nobody will thank you or feel sorry for you for accepting that responsibility. It may be more cost-effective to simply not provide those services (ex: FM-OB).

2. The government is reluctant or completely unwilling to take on the costs. Where available, medicare and medicaid usually want providers to fight a never ending paper battle. The paper battle involves spending twice as long with patients to receive below average compensation--you could bankrupt yourself. It is a path of high resistance, and many, including NPs, are unwilling that fight against that resistance. That path of less resistance involves moderate-high income patients with insurance or a concierge model if your community is interested. Speaking practically, the government would appreciate it if you would see more rich patients that can pay for their medical services so that they could go on ignoring a large indigent population.

3. The indigent population is typically uneducated, nonadherent, have more healthcare needs on average due to their situation, and are completely unwilling to accept any costs. This could mean spending extra time talking to a wall, and usually involves spending extra resources and money on patients that simply wont get better. It is an equity battle, which the government understands and is also why they triage payment. It usually comes out of the pocket of the physician or nurse who is more willing than the patient to create and foster health.

When you put in the 30 years of dealing with this constantly, people will respect that talk. I do think that FM is "noble", but I also understand the 30 year FM who discourages students from going in. It is like volunteering to serve in the infantry during the Vietnam war because "Communism". Literally nobody wants you there, except the government. The reality is that your ideal transcends the political and economic landscape insofar as it is not what anybody wants of healthcare right now. Ironically, you might be able to do more "good" than you think by specializing and taking indigent patients...in that sense, military medicine is perfect for you. But I don't see the addition of NPs significantly impacting the issues above, and may actually serve as an impediment in all three cases (increasing costs by providing subpar or inefficient services).

Honestly, I cannot make the best arguments for CRNAs and CNMs, as I am an FNP. All I can really say is that there is a wealth of data out there that speaks to their efficacy in independent practice. They already are practicing independently in several states (and have been for decades), and to date, I have not heard of any cases that would disqualify them from practicing.

No. There is a wealth of data that show that CRNAs take on less sick patients and less complex cases to the same outcome as an anesthesiologist. I do not know if any CRNAs are taking on complex cases at a university level without anesthesiologist oversight. The hospitals and states that these independent practitioners serve typically run uncomplicated cases. You cannot be a cherry picker and accept responsibility to provide the full scope of services that a highly focused consultant specialty says it provides. CRNAs are interested in taking the easy bread and butter cases that all anesthetic providers must live and earn off of ; in their own words, they "do not want to be physicians or anesthesiologists." In the case of the very proficient CRNAs, there is the same problem that NPs have which is there is no consistency from one CRNA to the next. While that may be acceptable for NPs, that is unacceptable for licensure in providing all anesthetic services that would justify independent practice.