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got this from pre-allo. I want to honestly hear you guys' opinions ..

http://www.latimes.com/health/la-me-...,1509396.story

State lacks doctors to meet demand of national healthcare law
Lawmakers are working on proposals that would enable physician assistants, nurse practitioners, optometrists and pharmacists to diagnose, treat and manage some illnesses.
By Michael J. Mishak, Los Angeles Times
6:03 PM PST, February 9, 2013

SACRAMENTO — As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients.

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

"We're going to be mandating that every single person in this state have insurance," said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. "What good is it if they are going to have a health insurance card but no access to doctors?"

Hernandez's proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

"Patient safety should always trump access concerns," said Dr. Paul Phinney, president of the California Medical Assn.

Such "scope-of-practice" fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states. ...... (more at link)
 

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What will he be allowed to treat under the expanded scope of practice? I assume everything
 
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Anti-immigration sentiment is at an all time high, so we can't get cheap, skilled physician labor from overseas to fulfil the primary care shortage as was the case a decade or two ago. 80% of our medical school students come from affluent families, carry outrageous amounts of debt, and will not settle for anything less than the best spots. DO and Carribean schools are cranking out medical students at an astounding rate, yet residency spots are not increasing in number. What else do you think the government is supposed to do but move primary care to midlevels?
Sure, access to a physician is going to be reduced. Although, there is no real evidence that an experienced NP or PA is worse than a resident in treating community acquired pneumonia or other cookie cutter stuff. As much as I dislike the 'nurses' who have nothing to do with 'nursing' and are really physician-wannabes, the reality is that this is the only practical solution to the problem.
 

Mman

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Although, there is no real evidence that an experienced NP or PA is worse than a resident in treating community acquired pneumonia or other cookie cutter stuff. As much as I dislike the 'nurses' who have nothing to do with 'nursing' and are really physician-wannabes, the reality is that this is the only practical solution to the problem.
residents are supervised by an attending physician. The NPs are looking to remove that requirement. They want to play doctor for real without the training. And once they get that, they'll want equal pay because they are doing the same thing...
 
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wjs010

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residents are supervised by an attending physician. The NPs are looking to remove that requirement. They want to play doctor for real without the training. And once they get that, they'll want equal pay because they are doing the same thing...
this...I want to know how he did not get this..?
 

countingdays

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There will be no increased need for docs.
The newly insured will be healthy young people.
 
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residents are supervised by an attending physician. The NPs are looking to remove that requirement. They want to play doctor for real without the training. And once they get that, they'll want equal pay because they are doing the same thing...
Yes, I know. This issue has been done to death. Move forward with the flow or drown. :)
 

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There is never going to be evidence of the type you demand because those studies are inherently unethical. What could be done is a study looking at referral rates and outcomes in physician vs. midlevel practices, but you can imagine that midlevel participation in such a study would be low.

The inherent problem is that nurses are trained to treat problems and recognize serious ones and call in the troops. They are not trained in the etiology of these problems and the best way to treat it in an acute vs. chronic setting. This logically results in increased referrals and prescriptions for medications that arent needed.

Also what is the modified version of Step 3 that 1/2 pass?
 

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dr doze

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got this from pre-allo. I want to honestly hear you guys' opinions ..
)
Our education, training, skills, sacrifices, licenses, investment, privileges, autonomy, earninng ability are all in the process of being devalued.

See if you can guess what we think.
 
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wjs010

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Our education, training, skills, sacrifices, licenses, investment, privileges, autonomy, earninng ability are all in the process of being devalued.

See if you can guess what we think.
I can only imagine the frustration...if only more docs would get out there and get pissed off enough to vocalize this issue...the nursing lobby does it so well; why not the docs? im curious
 

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Hey guys - according to this chart chiropractors may be the most qualified to fill the primary care shortage - possibly more qualified than medical graduates...:naughty:

 

dr doze

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I can only imagine the frustration...if only more docs would get out there and get pissed off enough to vocalize this issue...the nursing lobby does it so well; why not the docs? im curious
Because money is tight and they offer the perception of an economic incentive. If money wasn't tight, nobody would give them the time of day.
 
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wjs010

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Hey guys - according to this chart chiropractors may be the most qualified to fill the primary care shortage - possibly more qualified than medical graduates...:naughty:

lol...and that's a loose definition of "most educated." obviously. I have actually seen threads where DC students have sworn that they learn more neuroanatomy than med students...and have referenced lecturers in DC schools that also swear to have more knowledge in neuro...it's very interesting, and I can't imagine the size of the stones of the person who says that with a straight face.
 

dr doze

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lol...and that's a loose definition of "most educated." obviously. I have actually seen threads where DC students have sworn that they learn more neuroanatomy than med students...and have referenced lecturers in DC schools that also swear to have more knowledge in neuro...it's very interesting, and I can't imagine the size of the stones of the person who says that with a straight face.
Actually it is quite possible if not probable that they get more formal educaton in neurology and neuroanatomy. I would think that they get far less in physiology, histology, micrbiology, embryology, pharmacology, pathology, biochemistry, genetics, microbiology, cardiology, pulmonogy, nephrology, obstetrics, endocrinolgy, oncology...

Not to mention that the people who enter chiropractic are probably on average not sharp as those who go to medical school.
 

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Because money is tight and they offer the perception of an economic incentive. If money wasn't tight, nobody would give them the time of day.
I would be totally OK with the public being offered the opportunity to make an honest, informed decision about getting their care from non-physicians.

If individuals decided to pay less for inferior care from a non-physician, more power to them. It's their money and their health.

Moreover, if the public decided, through their elected representatives, to create a cheaper public health system based on less expensive, less capable midlevel providers, acknowledging and accepting lower quality care in return for the discount, I'd be fine with that too.


But that's not what's happening. The big lie is that equivalent care can be provided at lower cost by non-physicians.

It's not "competition" from midlevels that upsets me. It's this lie that makes me angry and puts misled patients at risk.


Actually it is quite possible if not probable that they get more formal educaton in neurology and neuroanatomy. I would think that they get far less in physiology, histology, micrbiology, embryology, pharmacology, pathology, biochemistry, genetics, microbiology, cardiology, pulmonogy, nephrology, obstetrics, endocrinolgy, oncology...
This also makes me think of ICU nurses turned CRNAs who think that their months or years of "practicing critical care nursing" before they grind through some strip-mall SRNA mill is somehow comparable to what MS3 and MS4 students do. Following a plan made by someone else, after that someone else interviewed the patient, examined the patient, reviewed the record/labs/etc, and was available to modify the plan and handle any changes or complications ... is so far removed from those actual diagnostic and management decisions as to be useless. We know and understand this implicitly. The militant ones just don't get it.

They simply don't understand why their education and training is incomparably inferior to ours. They really think that programming a pump as directed by a critical care physician is akin to choosing the drug and dose in the first place.

They really think education is about hour counting. Nurses - even good ones - will sit at a computer and crank out online credits toward some extra degree, then proudly tack on another letter or two after their names. They actually think that garbage makes them better nurses.

I swear, some of them are so deluded that they ought to be on olanzapine.
 

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Actually it is quite possible if not probable that they get more formal educaton in neurology and neuroanatomy. I would think that they get far less in physiology, histology, micrbiology, embryology, pharmacology, pathology, biochemistry, genetics, microbiology, cardiology, pulmonogy, nephrology, obstetrics, endocrinolgy, oncology...

Not to mention that the people who enter chiropractic are probably on average not sharp as those who go to medical school.
Eh.

I know a guy who's a chiropractor, was successful, but ultimately left it for medicine and is now in anesthesiology as a resident. One could say it's an "n of 1" and not the norm, but I'm not entirely convinced.

Point being, it's hard to make that conclusion because I know lots of sharp folks who opted to go these other routes and NOT into medicine, for various reasons (i.e. time, debt, effort, etc).
 

pgg

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I know lots of sharp folks who opted to go these other routes and NOT into medicine, for various reasons (i.e. time, debt, effort, etc).
The decision to choose an easier path because of reduced time and effort says something about the individual's suitability for medicine.

To be a physician, it's not enough to be smart. The time and effort is a lifelong commitment.

This is not to say that those who make cost/benefit decisions and choose midlevel or allied health careers instead of medical school are bad people, or are making bad decisions. But they are not like us. They have chosen a different path for a reason.
 

Doctor4Life1769

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The decision to choose an easier path because of reduced time and effort says something about the individual's suitability for medicine.

To be a physician, it's not enough to be smart. The time and effort is a lifelong commitment.

This is not to say that those who make cost/benefit decisions and choose midlevel or allied health careers instead of medical school are bad people, or are making bad decisions. But they are not like us. They have chosen a different path for a reason.
Can't argue with that.
 

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I may get blasted for this; but, everyone I knew in UG who went into chiro (n=4) had a sub-3.0 GPA. I think it also takes a certain type to buy into a lot of the things that chrio school pushes & to accept the validity of chiro as a healing art. Does not seem congruent with medicine/science.

I agree with PGG that a lot of people self-select themselves out of medicine who may not have found it a good fit. Most people I know who were very 'business-minded', extremely practical, or just didn't want to work "that" hard, went into other health fields like nursing or PA in order to achieve their life goals as well as career goals. Some were very smart; but, if you don't do the time / commitment you don't gain the skills, right?

Eh.

I know a guy who's a chiropractor, was successful, but ultimately left it for medicine and is now in anesthesiology as a resident. One could say it's an "n of 1" and not the norm, but I'm not entirely convinced.

Point being, it's hard to make that conclusion because I know lots of sharp folks who opted to go these other routes and NOT into medicine, for various reasons (i.e. time, debt, effort, etc).
 

jetproppilot

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got this from pre-allo. I want to honestly hear you guys' opinions ..

http://www.latimes.com/health/la-me-...,1509396.story

State lacks doctors to meet demand of national healthcare law
Lawmakers are working on proposals that would enable physician assistants, nurse practitioners, optometrists and pharmacists to diagnose, treat and manage some illnesses.
By Michael J. Mishak, Los Angeles Times
6:03 PM PST, February 9, 2013

SACRAMENTO — As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients.

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

"We're going to be mandating that every single person in this state have insurance," said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. "What good is it if they are going to have a health insurance card but no access to doctors?"

Hernandez's proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

"Patient safety should always trump access concerns," said Dr. Paul Phinney, president of the California Medical Assn.

Such "scope-of-practice" fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states. ...... (more at link)
I'm an MD.
I'll care for you.
I'm not a nurse. I'm a
DOCTOR.


Next question.
 
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In some ways I just don't get this whole issue...

Why make a square peg fit in a round whole? Why not create more residency slots to address shortages? It's odd to me that we're not trying to fill physician positions with physicians.

To be honest - where I work - I have seen some messed up stuff done by PA's & NP. One botched a chest tube and a few hours later the guy through a PE. They died. On top of that they didn't even start them on an anti-coag. It was awful because I could hear the family whaling outside my office. You guys deal with some serious issues as physicians.

Their attending was pretty ticked about the whole thing. Where will this stuff end?
 

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Hey guys - according to this chart chiropractors may be the most qualified to fill the primary care shortage - possibly more qualified than medical graduates...:naughty:

lol...and that's a loose definition of "most educated." obviously. I have actually seen threads where DC students have sworn that they learn more neuroanatomy than med students...and have referenced lecturers in DC schools that also swear to have more knowledge in neuro...it's very interesting, and I can't imagine the size of the stones of the person who says that with a straight face.
They should probably learn that it is Johns Hopkins not John Hopkins especially if they are claiming to be "more educated," and I guess they ignore the thousands of hours of residency?
 

pgg

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Why not create more residency slots to address shortages?
1) Money. Physician GME is heavily subsidized by the government. The talk is of cutting that cost, not expanding it.

2) Where? Creating a new residency program is not a trivial undertaking. There's case diversity and volume to consider. Faculty. Research. You can't just take some podunk community hospital and create an anesthesiology or surgery residency there. For the most part, the hospitals that truly have the capacity to adequately support and train residents already have them.

It's not possible to substantially expand the production pipeline without lowering standards. The CRNA community has done just that - look at the dramatic increase in their production in recent years, and look at the kind of new grads that are coming out these days. They can set up shop in a strip mall, take $60K in tuition from any warm body, and push anyone through a CRNA program.

The military CRNA training programs are excellent. The quality of their applicants tends to be stronger, though I think the last few years they've had trouble filling classes. And last I looked, they had a 40% failure rate. Civilian SRNAs pay tuition; their programs don't drop 40% of their SRNAs. They just graduate them and set them loose.

The crux of the midlevel problem is this: There is a hard limit to how many physicians can be appropriately trained in the US. There is no limit to how many tuition-paying midlevels can have degrees and certifications bestowed upon them.
 

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i like your style

LOLOLOLOLOLOL, Jet? Have style? :/ That post was only two font sizes, one if his weaker showings if you ask me :D
 
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There is never going to be evidence of the type you demand because those studies are inherently unethical. What could be done is a study looking at referral rates and outcomes in physician vs. midlevel practices, but you can imagine that midlevel participation in such a study would be low.

The inherent problem is that nurses are trained to treat problems and recognize serious ones and call in the troops. They are not trained in the etiology of these problems and the best way to treat it in an acute vs. chronic setting. This logically results in increased referrals and prescriptions for medications that arent needed.

Also what is the modified version of Step 3 that 1/2 pass?
Modified Step 3 for DNP? Here you go:
http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm
Here is the only available proof. On the contrary, your 'logic' is based on assumptions. You don't need engineers to tighten lug nuts on assembly lines. You also don't need an MD to treat every case of community acquired pneumonia. The only people who fuss about the issue are trainees and private practitioners because NPs take away their present (and future) bread and butter, cash-cow patients. Get used to it people. Be innovators, not operators. Work harder, acquire new skills, and roll with the punches.
/End of my contribution to this never ending debate. :cool::cool::cool:
 

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Modified Step 3 for DNP? Here you go:
http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm
Here is the only available proof. On the contrary, your 'logic' is based on assumptions. You don't need engineers to tighten lug nuts on assembly lines. You also don't need an MD to treat every case of community acquired pneumonia. The only people who fuss about the issue are trainees and private practitioners because NPs take away their present (and future) bread and butter, cash-cow patients. Get used to it people. Be innovators, not operators. Work harder, acquire new skills, and roll with the punches.
/End of my contribution to this never ending debate. :cool::cool::cool:
You realize step 3 is something that doctors don't even study for right? I think the saying was for Step 1 it's 2 weeks, Step 2 is 2 days, and Step 3 is a #2 pencil. But I guess it is computerized now so the pencil doesn't help anymore.

Also not sure why you say an MD isn't needed to treat every case of CAP. Maybe not, but it is required to diagnose it. I'd hate for NPs to be missing more serious illnesses by just putting everyone on a Z-pak. Or more commonly overdoing the antibiotics when none are needed. Physicians are guilty enough on that one, but NPs would be orders of magnitude worse. They are all about keeping patients happy and giving them what they want.
 

chessknt87

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Modified Step 3 for DNP? Here you go:
http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm
Here is the only available proof. On the contrary, your 'logic' is based on assumptions. You don't need engineers to tighten lug nuts on assembly lines. You also don't need an MD to treat every case of community acquired pneumonia. The only people who fuss about the issue are trainees and private practitioners because NPs take away their present (and future) bread and butter, cash-cow patients. Get used to it people. Be innovators, not operators. Work harder, acquire new skills, and roll with the punches.
/End of my contribution to this never ending debate. :cool::cool::cool:
Forgive me, but the proof you are referencing to is what? The CACC claims it is equal, ergo it is? It sounds like the CACC set performance standards, so that is like having a teacher give everyone an SAT from 10 years ago, then announce everyones score based on a scheme he invented. Sure 1/2 of his class may have good scores, but we have no idea how that compares to the real administration of the test.

I'd also be cautious of walking into a room of a pt assuming they have CAP. We are trained to think critically and make sure we don't miss more serious problems--falling in to a habit of assuming common things are common and leaving it at that is not a good viewpoint to take in to the start of your career.
 
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You realize step 3 is something that doctors don't even study for right? I think the saying was for Step 1 it's 2 weeks, Step 2 is 2 days, and Step 3 is a #2 pencil. But I guess it is computerized now so the pencil doesn't help anymore.

Also not sure why you say an MD isn't needed to treat every case of CAP. Maybe not, but it is required to diagnose it. I'd hate for NPs to be missing more serious illnesses by just putting everyone on a Z-pak. Or more commonly overdoing the antibiotics when none are needed. Physicians are guilty enough on that one, but NPs would be orders of magnitude worse. They are all about keeping patients happy and giving them what they want.
Whoa, I definitely studied more than 2 weeks for step. I think it may be 2 months, 2 weeks, and then #2 pencil?
 

periopdoc

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What do I think about this? Who is John Gault?

I studied for 6 years for step 1. 2 minutes for step two. Wait, did I take step 3? :laugh:

- pod
 
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Please excuse my friend, for he is a classmate of William Halsted. Back then Step 1 took much less time, even though the test thoroughly tested key concepts in contemporary physic such as the role of black bile and unbalanced humors in causation of cancer of the male bosom.
 

Random Anesthesiologist

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Whoa, I definitely studied more than 2 weeks for step. I think it may be 2 months, 2 weeks, and then #2 pencil?
That's pretty much it these days. Unless you're a gunner. Then you've started studying for Step 1 on day 1 of medical school.
 

dr doze

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What do I think about this? Who is John Gault?



- pod
As far as health care goes, The response to the Mr. Gaults (the doctors) will be "don't let the door hit you on the ass on the way out. We can get by with a whole lot fewer of you. We are making more of you than ever. They will be slaves to their student loan servicing"
 

periopdoc

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Whenever I make that statement on these threads, folks assume that I mean to encourage going Gault, but it was never John Gault and his ilk who asked that question was it?

I mean it as a statement on the question posited by the OP, not an answer to it.

Characters who asked "Who is John Gault" were individuals who saw themselves as helplessly stuck in a system that they were powerless to change. The people who start these threads and perpetuate them like chickens with their heads cut off are not the Gaults, d'Anconias or Danneskjölds of the world. Some are the Eddie Willers and some are the Jeff Allens, but most are the common man with little recourse left but to ask, "Who is John Gault?"



- pod
 
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dr doze

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Whenever I make that statement on these threads, folks assume that I mean to encourage going Gault, but it was never John Gault and his ilk who asked that question was it?

I mean it as a statement on the question posited by the OP, not an answer to it.

People who asked "Who is John Gault" were individuals who saw themselves as helplessly stuck in a system that they were powerless to change. The people who start these threads and perpetuate them like chickens with their heads cut off are not the Gaults, d'Anconias or Danneskjölds of the world. Some are the Eddie Willers and some are the Jeff Allens, but most are the common man with little recourse left but to ask, "Who is John Gault?"



- pod
They won't know enough to even ask the question.
 

periopdoc

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:thumbup:

-pod
 

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Whenever I make that statement on these threads, folks assume that I mean to encourage going Gault, but it was never John Gault and his ilk who asked that question was it?

I mean it as a statement on the question posited by the OP, not an answer to it.

Characters who asked "Who is John Gault" were individuals who saw themselves as helplessly stuck in a system that they were powerless to change. The people who start these threads and perpetuate them like chickens with their heads cut off are not the Gaults, d'Anconias or Danneskjölds of the world. Some are the Eddie Willers and some are the Jeff Allens, but most are the common man with little recourse left but to ask, "Who is John Gault?"



- pod
Not to be that guy, but isn't it Galt? I thought maybe the first post was a typo but I see you are spelling it that way consistently.
 

W222

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Whenever I make that statement on these threads, folks assume that I mean to encourage going Gault, but it was never John Gault and his ilk who asked that question was it?

I mean it as a statement on the question posited by the OP, not an answer to it.

Characters who asked "Who is John Gault" were individuals who saw themselves as helplessly stuck in a system that they were powerless to change. The people who start these threads and perpetuate them like chickens with their heads cut off are not the Gaults, d'Anconias or Danneskjölds of the world. Some are the Eddie Willers and some are the Jeff Allens, but most are the common man with little recourse left but to ask, "Who is John Gault?"



- pod

I just want to point out that invoking Ayn Rand/objectivism/libertarianism is completely absurd in this argument. If you follow the laissez faire/free market theory, the argument of any one group having a scope of practice would fall apart and my degree wouldn't matter more than a nurses. Instead it would be the outcome of the market and the value of my product which would determine my success vs a nurse. Now, the nurses and other midlevels are merely playing into the libertarian argument of "let all practice medicine because the outcomes are the same or better and the economics cheaper." So please for the love of God drop the Rand stuff.
 

periopdoc

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For the love of Flying Spaghetti Monster read my argument and understand it before you respond.

- pod
 

periopdoc

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Not to be that guy, but isn't it Galt? I thought maybe the first post was a typo but I see you are spelling it that way consistently.
Caught me.

-pod
 

yappy

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Yeah... I don't get the Rand argument for lic laws. Me? I'm an elitist and am for all lic laws. I'm comfortable saying many people are not cut out to practice medicine and patients are not educated enough to make the decision that an RN is the right person to see instead of a physician. It's not a popular stance today; however, I don't go with the flow.

Practically speaking, I find that many people think this way. Though, there are a lot of ideologues out there.

EDIT: Rand was an academic lightweight and her logic was faulty.