If nurses want to practice medicine, train them as doctors

[Taurus]

If nurses want to practice medicine, train them as doctors

---

Members don't see this ad.

 

[JaggerPlate]

If nurses want to practice medicine, train them as doctors

Beautiful.

 

[RDlv]

If nurses want to practice medicine, train them as doctors

Timely, as I was browsing through my newly arrived required text for one of my final NP classes.

http://www.amazon.com/gp/product/0763799742/ref=oh_o00_s00_i00_details

The text features "talking points" for responding to physician comments about NPs. Here is an exemplar of a point that is repeated several times in various areas of the text:

"One counterargument to physicians who argue their education is longer is that no data exists to support the necessity of four years of medical school and three years of residency to perform primary care. Physicians set those educational requirements without research to support that level of education. The data showing that NPs are excellent primary care providers support an argument that master's-level preparation is appropriate education for PCPs." (p.446)

I've said it before, before I was exposed to these books, I honestly thought all of you were exaggerating the "NP menace." Alas, basically everything you have said that NPs (at the academic and policy levels, NOT in the clinic) are claiming and advocating for is repeated in our own training materials.

 

[deleted87716]

Haven't you heard...?

 

[RDlv]

Haven't you heard...?

Oh, that just got saved.

I can compare critical care and primary care through my experiences; I find both to be terrifying and fascinating in their own way. I was initially surprised at how much I loved the primary care setting, until I realized that I experience just as much of a sense of my own vast ignorance in PC as I did/do as an RN in a CC setting. Keeps me on my toes, always studying, and humble.

 

[RDlv]

Timely, as I was browsing through my newly arrived required text for one of my final NP classes.

http://www.amazon.com/gp/product/0763799742/ref=oh_o00_s00_i00_details

The text features "talking points" for responding to physician comments about NPs. Here is an exemplar of a point that is repeated several times in various areas of the text:

"One counterargument to physicians who argue their education is longer is that no data exists to support the necessity of four years of medical school and three years of residency to perform primary care. Physicians set those educational requirements without research to support that level of education. The data showing that NPs are excellent primary care providers support an argument that master's-level preparation is appropriate education for PCPs." (p.446)

I've said it before, before I was exposed to these books, I honestly thought all of you were exaggerating the "NP menace." Alas, basically everything you have said that NPs (at the academic and policy levels, NOT in the clinic) are claiming and advocating for is repeated in our own training materials.

Credit where credit is due: the above author also writes pretty harshly about the current state of DNP education, and is critical of the use of "Doctor" by DNPs in the clinical setting. One example:

http://www.medscape.com/viewarticle/743403

She seems to be getting the DNPs on her case, so I've got to give her props for that.

 

[Dirt]

"One counterargument to physicians who argue their education is longer is that no data exists to support the necessity of four years of medical school and three years of residency to perform primary care. Physicians set those educational requirements without research to support that level of education. The data showing that NPs are excellent primary care providers support an argument that master's-level preparation is appropriate education for PCPs." (p.446)

Do people really think that research is good research?

There are so many variables that effect "good primary care provider" that I cannot imagine a quality study that uses that as an end point.

To your first points, how the hell would you get data to support the length of medical training? I guess you could take people from birth and randomize them to one of two medical training arms with different lengths and see who kills more patients or gets sued more.

I love people who take a subject that would be impossible to study adequately and say "there is no data to support it" and imply that makes it wrong is some way. Anecdotes and expert opinion may be at the bottom of the evidence pyramid but they mean a hell of a lot more than nothing.

 

[zenman]

Do people really think that research is good research?

There are so many variables that effect "good primary care provider" that I cannot imagine a quality study that uses that as an end point.

To your first points, how the hell would you get data to support the length of medical training? I guess you could take people from birth and randomize them to one of two medical training arms with different lengths and see who kills more patients or gets sued more.

I love people who take a subject that would be impossible to study adequately and say "there is no data to support it" and imply that makes it wrong is some way. Anecdotes and expert opinion may be at the bottom of the evidence pyramid but they mean a hell of a lot more than nothing.

Good point. Anecdotes mean more to me as they are the patient's stories and I listen to them. Plus our current evidence pyramid is not much higher than a tepee.

 

[oldManDO2009]

http://www.yakima-herald.com/storie...-of-pain-troubled-clinic-goes-unchecked/print

 

[Dirt]

http://www.yakima-herald.com/storie...-of-pain-troubled-clinic-goes-unchecked/print

scary stuff

 

[zenman]

Senate Watchdog Targets High-Prescribing Medicaid Docs
by Charles Ornstein and Tracy Weber
ProPublica, Jan. 24, 2012, 2:04 p.m.

An influential U.S. senator is grilling officials in nearly three-dozen states, demanding to know how they are cracking down on physicians who prescribe massive amounts of potentially dangerous prescription drugs.

Iowa Republican Charles Grassley sent letters to 34 states Monday asking what steps they had taken to investigate doctors whose prescribing of antipsychotics, anti-anxiety drugs and painkillers to Medicaid patients far exceeds that of their peers.

The request is a follow-up to a 2010 letter Grassley sent all states that requested statistics on top prescribers of these drugs.

“These types of drugs have addictive properties, and the potential for fraud and abuse by prescribers and patients is extremely high,” Grassley wrote in Monday’s letters. “When these drugs are prescribed to Medicaid patients, it is the American people who pay the price for over-prescription, abuse, and fraud.”

ProPublica reported in November that Florida allowed at least three physicians to keep treating and prescribing drugs to the poor amid clear signs of possible misconduct. One doctor kept prescribing narcotic pain pills to Medicaid patients for more than a year after he was arrested and charged in 2010 with trafficking in them.

A number of the top-prescribing Medicaid doctors around the country are listed in our Dollars for Docs database of payments made by 12 pharmaceutical companies to physicians for speaking and consulting Medicaid, jointly funded by the states and federal government, provides health care coverage to about 60 million low-income enrollees.

Grassley, the senior Republican on the Senate Judiciary Committee, has long argued for greater transparency in health care. The painkillers and mental health drugs Grassley is inquiring about are among the top drivers of Medicaid drug spending.

His letter to Ohio notes that the top prescriber of the anti-psychotic Abilify wrote 13,825 prescriptions in 2009 — about 54 prescriptions per weekday. Ohio paid $6.7 million for that those prescriptions, state officials reported to Grassley.

The biggest prescriber of another anti-psychotic, Seroquel, wrote 18,890 scripts at a cost of $5.7 million. Grassley wrote the tally would amount to nine prescriptions per hour. When Ohio submitted the data to Grassley last year, it did not identify the doctors by name or license number.

“After an extensive review of prescribing habits of the serial prescribers of pain and mental-health drugs in Ohio, I have concerns about the oversight and enforcement of Medicaid abuse in your state,” he wrote. “While I am sensitive to the concerns of misinterpretation of the data you provided, the numbers themselves are quite shocking.”

Grassley’s letter to Maine cites a physician who wrote 1,867 prescriptions for the powerful painkiller OxyContin in 2009, nearly double the second-highest prescriber. The doctor also wrote 1,723 prescriptions for another painkiller, Roxicodone, nearly three times as many as the next highest prescriber.

Calls to officials in Ohio and Maine have not been returned.

In his letters to the 34 states, Grassley asked that officials tell him by Feb. 13 what action, if any, they have taken against top prescribers, whether those doctors are still eligible to bill Medicaid, whether any of the doctors were referred to their state medical boards for investigation, and what systems have been set up to track possibly excessive prescribing, among others.

Grassley is sending letters to 12 other states that never provided him data, as requested, on their top Medicaid prescribers. Four other states will not receive follow-up letters because the senator felt their initial responses to his 2010 letter were adequate.

ProPublica reported in November that since Grassley’s initial letter requesting the data in 2010, Louisiana, Arizona, Oklahoma and New York have kicked some high-prescribing physicians out of Medicaid. California has temporarily suspended or placed restrictions on 15 to 20 doctors in the past two years for prescribing disproportionately high volumes of painkillers and antipsychotics to Medicaid patients.

But Grassley said more needs to be done.

“When a doctor writes more prescriptions than seems humanly possible, it makes sense to ask questions,” he said in a statement to ProPublica. The statement noted that some states never responded to his original letter in 2010.

“If state and federal taxpayers are being cheated because of inappropriate prescriptions,” Grassley said, “the state and federal governments have to get to the bottom of it and stop it.”

 

[Top Gun]

So what? So there are a few unscrupulous physicians who prescribe excessive amounts of narcotics and antipsychotics. That says nothing about the medical profession as a whole. There are a few NP's who would be guilty of the same thing.

 

[bronx43]

So what? So there are a few unscrupulous physicians who prescribe excessive amounts of narcotics and antipsychotics. That says nothing about the medical profession as a whole. There are a few NP's who would be guilty of the same thing.

He's just responding to the post 2 up from him, which is a link to an article about a NP who over-prescribed opiates.

This whole thing has nothing to do with NP vs MD/DO. It's simply a natural byproduct of a defective system.

 

[Top Gun]

He's just responding to the post 2 up from him, which is a link to an article about a NP who over-prescribed opiates.

This whole thing has nothing to do with NP vs MD/DO. It's simply a natural byproduct of a defective system.

I stand corrected, then. I apologize.

 

[BklynRN]

I am a RN and no I don't believe nurses should be practitioners or pseudo PCP's. The correct thing to do is to create more PCP's. I would never voice this opinion at work- nurses are like cops you don't cross the line. Anyways, yes, I work with some people in NP school and they are stupiddddddddddddddddd. I would not want them treating me. I was treated by an NP once who was dead set I had a kidney stone- I had a classic UTI (held my pee too long on a flight). I was actually married to a MD and no the training is completely different- literally night and day. The answer is more PCP's not NP's.

 

[GH253]

Repeal licensing laws. Let consumers decide who does the best job for their money.

 

[DrMason]

NP's and PA's to be the work dogs for the specialists sounds like a good thing. Let the specialists cosign and don't refer a patient to any specialist unless they guarantee an actual physician to see them. NP's are a purely political construct from the side of the nurses union and there is nothing more to it. Just like trial lawyers are the only reason there is no tort reform, so with nurses unions and NP. Our high-minded MD leaders have decided that we should not strike or unionize, so we will not avoid this to worsen. I still remember an NP pulled me out of a room asking me to look at an EKG, because "she was not sure".. What if I was not there? Would she have referred to cardiologist then?

PCP's to direct medicine and boutique practices, along with sports care, high-end niche fields (ED, BHRT, Esthetics, Non-scalpel vasectomies, cash only)...

Every time the government does something you have to find a way out of it. For every action, there is a reaction.

 

[Instatewaiter]

Repeal licensing laws. Let consumers decide who does the best job for their money.

This isn't the answer either. Then you will have a lot of hacks duping the unsuspecting public.

 

[GH253]

This isn't the answer either. Then you will have a lot of hacks duping the unsuspecting public.

There is no such thing as "the public." Most people are smart enough to figure out what criteria make a provider credible. Meanwhile, the ranks of government-licensed health professionals are full of abysmally bad doctors and therapists to which consumers have no alternatives—if this subforum is any indication, hack status is the norm rather than exception. The government isn't a scientific oracle and its licenses are not proof of competence.

 

[Instatewaiter]

There is no such thing as "the public." Most people are smart enough to figure out what criteria make a provider credible. Meanwhile, the ranks of government-licensed health professionals are full of abysmally bad doctors and therapists to which consumers have no alternatives—if this subforum is any indication, hack status is the norm rather than exception. The government isn't a scientific oracle and its licenses are not proof of competence.

First, no the public isnt smart enough. This is why people use chiropractors, naturopaths, homeopaths as their primary care doctors. This is also why people drop their meds and listen to quacks. In the last year I can name more than 10 people who voluntarily stopped their evidence based cardiac meds to go with the local all-natural woo. I recently admitted a STEMI 2 days ago for just that reason. I actually had to bargain with him to "allow" me to start heparin, DAPT, and statins. **** that, buddy. But if you go with the woo, you should have to stick with the woo as well. Don't come whining to me with your chest pain. How's that all-natural therapy work for occluded arteries?

Second, I agree the gov't licensure isn't proof of competence. But I hate to admit it, without it there'd be people without training holding themselves up as reasonable practicioners. I feel it is necessary but not sufficient. Does it need to be through the gov't, no.

What "alternatives" are you talking about. You are starting to sound like one of those woo quacks.