Medicine is taking a nosedive...

Burrell College of Osteopathic Medicine
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Steve_Zissou said:


**** like this is why the younger generation is saying “f*ck midlevels” and have a strong disdain for older physicians who advocate for midlevels. They’re devaluing our education and spreading propaganda that is being bought by politicians and our admin overlords. They’re getting more and more rights, and when they finally have the same rights as a physician, what will be the point of medical school? **** if I can just get my bachelors in nursing, turn around and get my FNP or DNP as soon as I finish my bachelors then I can pretend to be a doctor and make decent money with far less debt and headache.
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DNP is a degree. FNP is a license. Know the words you using. That said, I understand your frustration, the best thing you can do is create some studies that show there is a difference in outcomes.
 
DrNotaDr said:
DNP is a degree. FNP is a license. Know the words you using. That said, I understand your frustration, the best thing you can do is create some studies that show there is a difference in outcomes.
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Bro, I am not going to spend time trying to understand all the acronyms NPs use to bloat their self-importance.

The “studies” they’re talking about are all put out by the AANP and have some pretty creative interpretations to reach NP=MD/DO.

If the AANP would agree to having a NP only hospital (no consulting physicians, only other NPs) and comparing that with a MD/DO only hospital with regards to outcomes we might get good data, but they would claim that is unethical. Why would it be unethical if NPs get better outcomes than physicians? Would this new NP hospital not be the shining light on a dark hill? I
 
Steve_Zissou said:
Bro, I am not going to spend time trying to understand all the acronyms NPs use to bloat their self-importance.

The “studies” they’re talking about are all put out by the AANP and have some pretty creative interpretations to reach NP=MD/DO.

If the AANP would agree to having a NP only hospital (no consulting physicians, only other NPs) and comparing that with a MD/DO only hospital with regards to outcomes we might get good data, but they would claim that is unethical. Why would it be unethical if NPs get better outcomes than physicians? Would this new NP hospital not be the shining light on a dark hill? I
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If you’re not willing to take the time to understand even the basics of the people you plan to fight how exactly do you expect to win?

Right now all you guys are simply agreeing to lose loudly instead of submitting to a IRB to try to prove something that would help your position.
 
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Lem0nz said:
Physician reimbursement is also not going to go up. Like, ever. Its going to go down. Anyone in hospital admin can show you the graphs with the trajectory and the planned CMS cuts and the additional quality cuts that are in the pipe. That is not going to reverse. Perhaps be postponed like it was this year, but not forever.

You don't have to like it but it would do all of us well to accept it because to maintain a salary of 300k+ in many fields of medicine you are going to have to see more volume, become hospital employed, or often some combination of the two of those things while increasing the quality of your care. Someone in this thread posted how they don't want to be a business manager of a bunch of midlevels and see half as many patients who are only complex - that's probably fine for the next 20 years or so, but I personally doubt that will be the future of medicine for MDs past that. That's just not the direction we are headed and I don't see an act of god coming to course correct it. In the era of student loan burdens on graduation being 250-500k for an MD, there is a lot of pressure to try to inflate your salary past that 300 mark to address the lost income potential and tackle the student loans. Fighting and not using midlevels to augment yourself is going to make that harder. I *do* respect and understand all of the docs who don't like it, don't want it, and don't agree with it. But I fear for them because the midlevel issue is a small piece of the much bigger pie and we have very little control over the rest of that pie.

Also doesn't mean you have to use/manage midlevels as the only solution. Its just one of them. Being hospital employed is another great solution. Alternative revenue streams, administrative roles, there's lots of stuff. But for the people who just want to do clinical stuff which I think is probably over half of us, it can be a tough thing to fix.
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Every time @VA Hopeful Dr posts, he refutes the bolded statement above. If I recall correctly, his reimbursements have gone up every single year since he left residency.
 
DrNotaDr said:
If you’re not willing to take the time to understand even the basics of the people you plan to fight how exactly do you expect to win?

Right now all you guys are simply agreeing to lose loudly instead of submitting to a IRB to try to prove something that would help your position.
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Plenty of studies exist and show unequivocally that physicians have better outcomes. Do you seriously not know this?
 
Jack Donaghy said:


Plenty of studies exist and show unequivocally that physicians have better outcomes. Do you seriously not know this?
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I’m in awe of all the studies that state issues requires further study, get more imaging, biopsy more, and prescribe for antibiotics. How about a decent student with a huge population that shows increased morbidity and mortality, because right now you’re linking studies like the NP’s made while complaining about the studies the NP’s made.
 
Jack Donaghy said:
Every time @VA Hopeful Dr posts, he refutes the bolded statement above. If I recall correctly, his reimbursements have gone up every single year since he left residency.
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Not necessarily. My pay has gone up. I have no idea what the actual reimbursement figures are showing.
 
DrNotaDr said:
I’m in awe of all the studies that state issues requires further study, get more imaging, biopsy more, and prescribe for antibiotics. How about a decent student with a huge population that shows increased morbidity and mortality, because right now you’re linking studies like the NP’s made while complaining about the studies the NP’s made.
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The mental gymnastics required to come to that conclusion are ..... exactly what I'd expect from a midlevel
 
Honestly at this point, i have a far deeper problem and resentment with the docs that actively promote and defend midlevels while severely mocking and downplaying residents and students than the midlevels themselves
 
Jack Donaghy said:
The mental gymnastics required to come to that conclusion are ..... exactly what I'd expect from a midlevel
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I just clicked on one of your studies that is most damning; Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns - PubMed

It’s a restrospective cross sectional analysis written by physicians. Even the conclusion states that most NP/PA’s prescribe opioids in a similar pattern to physicians. PA’s, who you guys support the most, were significantly worse then NP’s. The population size is solid I wish I could read more than the abstract, but even your most damning and patient safety centered study noted in its conclusion APP prescribing a similar pattern to physicians. Did you read any of these or just link them?
 
Back to the original topic, some hospital have a "provider lounge" to be inclusive. I mean, I guess I wouldnt waste my energy if I worked somewhere that had a lounge that I shared with a NP/PA to eat my lunch. I barely even my use own hospital physician's lounge.

Also, residents sometimes prefer to have their own space away from attendings and other people around the hospital, kinda like a "safe" area. Same for medical students. I will agree that the big sign basically excluding them is kinda tacky.
 
@Steve_Zissou

Couple of thoughts here. Not sure why you felt you needed to quote me but since you did, I guess my rebuttal is fair game.

1) No ones stopping you sunshine. You’d make a fantastic nurse.

2) One person does not reflect an entire, incredibly diverse group of people. Neither does one association. That’s up there with saying the Qanon represents all of Republicans, hence why I invoked that zealotry comparison and will do so again.

3) I still don’t support or agree with independent practice of NPs or PAs. But I think you’re being a child as well as all others who say **** mid levels without taking the time to distinguish all of the APPs who stay in their lane, practice under a physician, and do excellent work for our patients and ourselves. I politely remind you that those people are the majority of APPs. Telling a bunch of people who allow you to deliver more efficient care to your patients to **** off because of their title is immature at best, complete douchebag at worst. And those are the monkeys spamming APP hate on Reddit, and a few here. Basic respect for people who are working in healthcare shouldn’t be so hard to come by.

By all means go to war against APPs independently practicing. Do it better. Don’t be an ass to the ones who are doing their job right and well.
 
Lem0nz said:
@Steve_Zissou

Couple of thoughts here. Not sure why you felt you needed to quote me but since you did, I guess my rebuttal is fair game.

1) No ones stopping you sunshine. You’d make a fantastic nurse.

2) One person does not reflect an entire, incredibly diverse group of people. Neither does one association. That’s up there with saying the Qanon represents all of Republicans, hence why I invoked that zealotry comparison and will do so again.

3) I still don’t support or agree with independent practice of NPs or PAs. But I think you’re being a child as well as all others who say **** mid levels without taking the time to distinguish all of the APPs who stay in their lane, practice under a physician, and do excellent work for our patients and ourselves. I politely remind you that those people are the majority of APPs. Telling a bunch of people who allow you to deliver more efficient care to your patients to **** off because of their title is immature at best, complete douchebag at worst. And those are the monkeys spamming APP hate on Reddit, and a few here. Basic respect for people who are working in healthcare shouldn’t be so hard to come by.

By all means go to war against APPs independently practicing. Do it better. Don’t be an ass to the ones who are doing their job right and well.
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Idk about Steve Zissou but I'm far more interested in fighting a war against physicians who prioritize midlevels over residents/students, which there are tragically way too many.
 
Lem0nz said:
@Steve_Zissou

Couple of thoughts here. Not sure why you felt you needed to quote me but since you did, I guess my rebuttal is fair game.

1) No ones stopping you sunshine. You’d make a fantastic nurse.

2) One person does not reflect an entire, incredibly diverse group of people. Neither does one association. That’s up there with saying the Qanon represents all of Republicans, hence why I invoked that zealotry comparison and will do so again.

3) I still don’t support or agree with independent practice of NPs or PAs. But I think you’re being a child as well as all others who say **** mid levels without taking the time to distinguish all of the APPs who stay in their lane, practice under a physician, and do excellent work for our patients and ourselves. I politely remind you that those people are the majority of APPs. Telling a bunch of people who allow you to deliver more efficient care to your patients to **** off because of their title is immature at best, complete douchebag at worst. And those are the monkeys spamming APP hate on Reddit, and a few here. Basic respect for people who are working in healthcare shouldn’t be so hard to come by.

By all means go to war against APPs independently practicing. Do it better. Don’t be an ass to the ones who are doing their job right and well.
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Dude, the AANP literally represents all NPs, and they only benefit from this BS their society pushes.

As for 1, how can you say “nurse” in such a derogatory term when they have equal, or better, outcomes than you?
 
Jack Donaghy said:


Plenty of studies exist and show unequivocally that physicians have better outcomes. Do you seriously not know this?
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THISSSSS!!!!!!

You wouldn't believe that with all the wailing and gnashing of teeth about midlevels on SDN, that how few people actually come up with the most important info like you did.

This is the argument that has to be made, over and over.

My biggest complaint about the whining (yes, whining) over the subject is that it comes across as "nurses R taking R jobs!" and worse, "How dare those peasants rise above their station! Don't they know that I went to school for twenty years and am better than they are! I can rattle off details of Krebs cycle!"

This is coming from a guy who whose family members have been, well, not well treated by a midlevel. As as been pointed out multiple times in these fora, they really don't know what they don't know, and that's a problem. They're good for shots and sniffles, but for something serious, we ask for doctors now.
 
Goro said:
THISSSSS!!!!!!

You wouldn't believe that with all the wailing and gnashing of teeth about midlevels on SDN, that how few people actually come up with the most important info like you did.

This is the argument that has to be made, over and over.

My biggest complaint about the whining (yes, whining) over the subject is that it comes across as "nurses R taking R jobs!" and worse, "How dare those peasants rise above their station! Don't they know that I went to school for twenty years and am better than they are! I can rattle off details of Krebs cycle!"

This is coming from a guy who whose family members have been, well, not well treated by a midlevel. As as been pointed out multiple times in these fora, they really don't know what they don't know, and that's a problem. They're good for shots and sniffles, but for something serious, we ask for doctors now.
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People have been repeatedly criticizing midlevels because of poor patient outcomes in this thread though. Heck, even my suggestion for midlevel independence so that they'd face full liability and malpractice charges was also met with criticisms about the unnecessary and avoidable patient harm.
 
Lawpy said:
People have been repeatedly criticizing midlevels because of poor patient outcomes in this thread though. Heck, even my suggestion for midlevel independence so that they'd face full liability and malpractice charges was also met with criticisms about the unnecessary and avoidable patient harm.
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Honestly, this is the first time anyone supplied data!
 
Lawpy said:
Agreed there. That's the one rare moment the dumpster fire of a place known as Reddit turned out to be useful!
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It’s interesting to me that people on SDN consider reddit a dumpster fire and that people on Reddit consider SDN a dumpster fire. I like em both, and reddit has some seriously good resources for medical students.
 
Steve_Zissou said:
It’s interesting to me that people on SDN consider reddit a dumpster fire and that people on Reddit consider SDN a dumpster fire. I like em both, and reddit has some seriously good resources for medical students.
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It's the social media reinforcement phemomenon. I think some SDN forums (*cough* SPF *cough*) are a load of crap but as with anything, there's always some very useful and golden stuff anywhere.
 
DrNotaDr said:
Sure, but these aren’t great studies.
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The onus is on the NPs making the claim that they are equivalent to provide good research. They have not done so.

What they have done is raise a generation of “practitioners” who have more training in lobbying than medicine.
 
Jack Donaghy said:
Every time @VA Hopeful Dr posts, he refutes the bolded statement above. If I recall correctly, his reimbursements have gone up every single year since he left residency.
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His reimbursements go up? The money insurance is paying him for a given CPT or ICD diagnosis go up year over year?

I do not believe you. His compensation almost certainly goes up. The hospital may be making more money and some of that may be getting passed on to him. He may be salaried and doing less work for more money and get salary increases because of seniority. He may be churning out more RVUs because he's efficient. But none of that = reimbursement going up.

Medicine used to be billed by multiple providers for a given procedure. Then it moved to bundled payments. Then there are quality modifiers (positive and negative) applied to organizations. Then ACOs. Now full capitation. Costs per procedure have gone up as well which confounds the issue but in bundled payments/ACOs/capitation the procedure itself having an increased cost directly leads to less money for the providers and the system.

Something something understanding the business of medicine but the last time I said something along those lines I was told that just makes me a greedy physician and that I hate my patients and don't care about them so what the hell do I know.
 
Lawpy said:
It's the social media reinforcement phemomenon. I think some SDN forums (*cough* SPF *cough*) are a load of crap but as with anything, there's always some very useful and golden stuff anywhere.
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Is this because they called you out for constantly flip flopping between loving trump and hating trump?
 
Steve_Zissou said:
It’s interesting to me that people on SDN consider reddit a dumpster fire and that people on Reddit consider SDN a dumpster fire. I like em both, and reddit has some seriously good resources for medical students.
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Agree 100%. There are communities/users on both sites (really reddit lol) that are extremely outlandish, bizarre, and insane in many respects. That's why I can't broad strokes brush either site. There's an incredible gold mine of information on both sites that you would be extremely foolish to ignore just because there are some off the leash crazies or idiots.

Over the years, I was always puzzled when I would hear people just completely demonize SDN, but I figured that the problem is that they don't know how to differentiate good from bad information, and they choose to swallow the crap that their out of touch administrators spew about the site.
 
slowthai said:
Agree 100%. There are communities/users on both sites (really reddit lol) that are extremely outlandish, bizarre, and insane in many respects. That's why I can't broad strokes brush either site. There's an incredible gold mine of information on both sites that you would be extremely foolish to ignore just because there are some off the leash crazies or idiots.

Over the years, I was always puzzled when I would hear people just completely demonize SDN, but I figured that the problem is that they don't know how to differentiate good from bad information, and they choose to swallow the crap that their out of touch administrators spew about the site.
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The stickies help a lot. I completely recommend regularly using them.
 
slowthai said:
Agree 100%. There are communities/users on both sites (really reddit lol) that are extremely outlandish, bizarre, and insane in many respects. That's why I can't broad strokes brush either site. There's an incredible gold mine of information on both sites that you would be extremely foolish to ignore just because there are some off the leash crazies or idiots.

Over the years, I was always puzzled when I would hear people just completely demonize SDN, but I figured that the problem is that they don't know how to differentiate good from bad information, and they choose to swallow the crap that their out of touch administrators spew about the site.
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Administrators have definitely been the ones pushing that tides at my school. That’s why I never bring up SDN in group settings even if the info I found was on SDN. Lots of classmates gave me eye-rolls the first time I brought it up during first year, so I essentially said “**** it, I’ll keep the good info to myself and pass it on to close friends then.”
 
Steve_Zissou said:
The onus is on the NPs making the claim that they are equivalent to provide good research. They have not done so.

What they have done is raise a generation of “practitioners” who have more training in lobbying than medicine.
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Sure, maybe, I mean it looks like they convinced the people that needed convincing and continue to do so. It’s irony that SDN bashes NP led research and then posts their own research which honestly isn’t much better at all than the NP stuff. Confirmation bias is alive and well.
 
Steve_Zissou said:
Administrators have definitely been the ones pushing that tides at my school. That’s why I never bring up SDN in group settings even if the info I found was on SDN. Lots of classmates gave me eye-rolls the first time I brought it up during first year, so I essentially said “**** it, I’ll keep the good info to myself and pass it on to close friends then.”
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Haha. I've rarely had reason to bring it up, but when I do, I always refer to SDN/reddit as "the forums" for the same reason, lol. I swear, saying the letters "SDN" out loud instantly turns you into a dweeb or something
 
DrNotaDr said:
Sure, maybe, I mean it looks like they convinced the people that needed convincing and continue to do so. It’s irony that SDN bashes NP led research and then posts their own research which honestly isn’t much better at all than the NP stuff. Confirmation bias is alive and well.
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“Sure, maybe”? Is it not the responsibility of the one making the claim to back it up with good data? Anything other than that is being deceitful. They didn’t get to where they are because of good research, they got to where they are because they have a massive union with a **** ton of money and influence, which they used to lobby politicians alongside requiring NP students to send letter to their local representatives about why they deserve independence. This isn’t about good research or doing the right thing, it’s about politics and money. If we’re going to play the same game, we have to put their weak training and mistakes on blast and turn the public against them while simultaneously getting better lobbyists for ourselves. Let’s be honest, politicians and the general population don’t give a **** about the research, and most don’t have the abilities or background to critically analyze the research anyways, which is why the NPs can pump out bogus research and then replay the same “equivalence or better” claims over and over without any real repercussions.
 
Steve_Zissou said:
“Sure, maybe”? Is it not the responsibility of the one making the claim to back it up with good data? Anything other than that is being deceitful. They didn’t get to where they are because of good research, they got to where they are because they have a massive union with a **** ton of money and influence, which they used to lobby politicians alongside requiring NP students to send letter to their local representatives about why they deserve independence. This isn’t about good research or doing the right thing, it’s about politics and money. If we’re going to play the same game, we have to put their weak training and mistakes on blast and turn the public against them while simultaneously getting better lobbyists for ourselves. Let’s be honest, politicians and the general population don’t give a **** about the research, and most don’t have the abilities or background to critically analyze the research anyways, which is why the NPs can pump out bogus research and then replay the same “equivalence or better” claims over and over without any real repercussions.
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They made their case strong enough to get what they wanted. It doesn’t help that the studies posted here are no better than the studies the NP’s themselves push. Students sending letters to legislators? I must have missed that assignment in school, good on you for making stuff up now. You lost. You’ll continue to lose, and when you’re an attending, you’ll be working with these folks.
 
DrNotaDr said:
They made their case strong enough to get what they wanted. It doesn’t help that the studies posted here are no better than the studies the NP’s themselves push. Students sending letters to legislators? I must have missed that assignment in school, good on you for making stuff up now. You lost. You’ll continue to lose, and when you’re an attending, you’ll be working with these folks.
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I’m not going to go digging through programs to find the ones that require advocacy as part of their “nursing theory” BS curriculum. **** pops up all the time on reddit.

The war is not over. The PPP and AMA have been stepping up their advocacy, and the younger generation of physicians are fired up about it. The pushback is still in its infancy.

Good luck with the not doctoring, this conversation is at an impasse and has become pointless
 
DrNotaDr said:
Don’t be mad bro. You know as well as I do the ship has sailed. The only question to ask yourself is if you’re going to keep tilting at windmills. Good luck if you I mean, trolling the MD student forums kinda gives away your position. And BTW, doesn't make those skeptical of midlevels more likely to respect them or play nice in the future.
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Is it that you're mad at the AANP for pumping out degree mills and driving your compensation to <100k? Is it that you feel so inferior via lack of training and knowledge that you need to "flex" anonymously online to make yourself feel better? We may never know. But it is true that there's no good in conversing with you as you seem uninterested in having a real conversation.

As for your assertion that those studies are "just like the NP ones" - pretty laughable and not worthy a real reply as it is clear you're either trolling or your schooling didn't equip you well to read scientific literature. Either way, I'm afraid I can't help you. Good luck out there in the real world and PLEASE for the sake of good patient care let your hubris be an online persona and know when to give up and seek help when treating real patients.
 
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Jack Donaghy said:
You come off as being pretty pathetic. I don't know you IRL so I hope that's not reality. I mean, trolling the MD student forums kinda gives away your position. And BTW, doesn't make those skeptical of midlevels more likely to respect them or play nice in the future.

Is it that you're mad at the AANP for pumping out degree mills and driving your compensation to <100k? Is it that you feel so inferior via lack of training and knowledge that you need to "flex" anonymously online to make yourself feel better? We may never know. But it is true that there's no good in conversing with you as you seem uninterested in having a real conversation.

As for your assertion that those studies are "just like the NP ones" - pretty laughable and not worthy a real reply as it is clear you're either trolling or your schooling didn't equip you well to read scientific literature. Either way, I'm afraid I can't help you. Good luck out there in the real world and PLEASE for the sake of good patient care let your hubris be an online persona and know when to give up and seek help when treating real patients.
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Don’t be mad bro. I read each abstract. Two studies are repeated in the list. One study is on PA’s only. The other studies group PA/NP into one category; hard to differentiate. One study had a data set from as long as 26 years ago. These do not answer the question on NP’s and independence to any substantial degree because of the limitations of their designs, (NP/PA in same category, independent vs non independent, level of supervision; chart review vs in person collaboration, etc etc) their retrospective natures, and the age of their sample size. The final
Blog? isn’t even about NP ‘s at all. These aren’t great studies. I would hope a someone who claims to know so much would see that.
 
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That's right, tear that sign down!!! Eat your heart out GW!! Lol

Screenshot_20210216-193629~2.png
 
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