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[Trollest]

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Man you guys need to calm down

This lit a fire in me. Im ready for the battle.

 

[TheRealCookieMonster]

Troll. Not even a medical student. If you think you can/should be replaced so easily, maybe you should be in a different profession.

That's part of what I don't understand, if you have something to offer then what are you worried about? I feel like a doctors role is changing and the resistance to mid-level autonomy is a misplaced reaction to that. It makes way more sense to have the 2-4 year people screening and scanning at the local clinic while physicians are waiting for more complex and more novel problems. And as procedures and treatments are standardized and given algorithms (By Doctors) those procedures and treatments should be passed to someone who makes less money and has more time to plug and chug.

 

[MedicineZ0Z]

I would seem that there is a market for NP/PA to fill. So if physicians simply can't fill the void something else will. This isn't like a drug working better. Physicians simply aren't meeting demand. Voters and insurance agencies and hospitals all seem to agree they'll hire warm bodies and count on the fact that most healthcare workers don't want to kill someone.

Lol what void? Don't buy the "shortage" myth.

 

[MedicineZ0Z]

That's part of what I don't understand, if you have something to offer then what are you worried about? I feel like a doctors role is changing and the resistance to mid-level autonomy is a misplaced reaction to that. It makes way more sense to have the 2-4 year people screening and scanning at the local clinic while physicians are waiting for more complex and more novel problems. And as procedures and treatments are standardized and given algorithms (By Doctors) those procedures and treatments should be passed to someone who makes less money and has more time to plug and chug.

So doctors should burn out by doing only complex cases? And.. have lower volume as a result and therefore make less money.. but why?? Why can't we have a mix of simple and complex cases. That's what makes actual sense.

 

[TheRealCookieMonster]

Lol what void? Don't buy the "shortage" myth.

The economic one. Enlighten me.

 

[Splenda88]

So doctors should burn out by doing only complex cases? And.. have lower volume as a result and therefore make less money.. but why?? Why can't we have a mix of simple and complex cases. That's what makes actual sense.

I feel like a lot of doctors have bought into that BS... ANA propaganda is great.

 

[TheRealCookieMonster]

So doctors should burn out by doing only complex cases? And.. have lower volume as a result and therefore make less money.. but why?? Why can't we have a mix of simple and complex cases. That's what makes actual sense.

How does it make sense? Nurses don't whipe @$$ when CNAs are around.
Why should a doc lecture about diet and MI risk over something more complex?

 

[MedicineZ0Z]

The economic one. Enlighten me.

There is none. Specialist jobs in good areas are saturated. Primary care does okay in desirable regions but nothing special. Remove a good chunk of those midlevels and you now just created more physician jobs which will get quickly filled.

There are shortages and "voids" in remote undesirable parts of the country. And midlevels are absolutely not going to those places.

 

[MedicineZ0Z]

How does it make sense? Nurses don't whipe @$$ when CNAs are around.

Nursing scut work also isn't tied to their income and proficiency of performing that scut work has a minimal learning curve.

Easy medical cases ARE tied to physician income and poor proficiency in those "easy" cases can be catastrophic to the patient, even though your bogus midlevel studies don't pick up on things that happen years down the road.

 

[Splenda88]

I feel like a lot of doctors have bought into that BS... ANA propaganda is great.

My hospital has a unit for patients that might stay in the hospital for <48 hrs. The unit is being run by PA/NP. However, when the trainwreck come into the ED, let the medicine teams admit them

 

[Trollest]

lol, you are a real cutie monster, arent you?

The economic one. Enlighten me.

 

[Trollest]

That's the new "economic model".

My hospital has a unit for patients that might stay in the hospital for <48 hrs. The unit is being run by PA/NP. However, when the trainwreck come into the ED, let the medicine teams admit them

 

[Splenda88]

That's the new "economic model".

That new economic model is driving up the burnout for docs... When you are managing 9 patients, you want to have 3-4 patients with 1-2 active problems... You don't want to have all 9 of them with 4-5 active problems.

If I am not on call, leaving the hospital at 5-6pm should be reasonable, not 8-9pm managing a bunch of trainwrecks while the mid-level provider is managing easy patients making 100k+/yr working 40 hrs/wk.

 

[Matthew9Thirtyfive]

That new economic model is driving up the burnout for docs... When you are managing 9 patients, you want to have 3-4 patients with 1-2 active problems... You don't want to have all 9 of them with 4-5 active problems.

If I am not on call, leaving the hospital at 5-6pm should be reasonable, not 8-9pm managing a bunch of trainwrecks while the mid-level provider is managing easy patients making 100k+/yr working 40 hrs/wk.

You’re just working at the top of your license. /s

 

[Splenda88]

You’re just working at the top of your license. /s

That is another ANA catchphrase that drives me crazy. What does that even mean?

 

[Matthew9Thirtyfive]

That is another ANA catch phrase that drives me crazy

Indeed. It’s bogus propaganda.

 

[TheRealCookieMonster]

There is none. Specialist jobs in good areas are saturated. Primary care does okay in desirable regions but nothing special. Remove a good chunk of those midlevels and you now just created more physician jobs which will get quickly filled.

There are shortages and "voids" in remote undesirable parts of the country. And midlevels are absolutely not going to those places.

My point was that the people paying "provider" salaries are willing to pay docs, PAs, and NPs (and even NDs ) for the same jobs. Voter, patient, and everyone except doctors approve. So either not enough people dying to those mid-levels on the record or their care is good enough to not require a doc. Certainly is cheaper to someone.

Nursing scut work also isn't tied to their income and proficiency of performing that scut work has a minimal learning curve.

Easy medical cases ARE tied to physician income and poor proficiency in those "easy" cases can be catastrophic to the patient, even though your bogus midlevel studies don't pick up on things that happen years down the road.

It would seem that everything a nurse does is tied to their income. Which is why when they tell the hospital they want +$ they get it. Leverage is an excellent way to get paid. The learning curve seems less important as treatment is standardized and all you have to do is follow the procedure. I guess if docs need "easy" cases to keep patients from catastrophe I can't argue with the value of fundamentals.

 

[MedicineZ0Z]

My point was that the people paying "provider" salaries are willing to pay docs, PAs, and NPs (and even NDs ) for the same jobs. Voter, patient, and everyone except doctors approve. So either not enough people dying to those mid-levels on the record or their care is good enough to not require a doc. Certainly is cheaper to someone.




It would seem that everything a nurse does is tied to their income. Which is why when they tell the hospital they want +$ they get it. Leverage is an excellent way to get paid. The learning curve seems less important as treatment is standardized and all you have to do is follow the procedure. I guess if docs need "easy" cases to keep patients from catastrophe I can't argue with the value of fundamentals.

And who trained them? And who keeps training them?

 

[TheRealCookieMonster]

My hospital has a unit for patients that might stay in the hospital for <48 hrs. The unit is being run by PA/NP. However, when the trainwreck come into the ED, let the medicine teams admit them

Obviously I'm missing the point. But this makes sense to me. What's the issue here? Is is the lack of more basic cases?

 

[Splenda88]

Obviously I'm missing the point. But this makes sense to me. What's the issue here? Is is the lack of more basic cases?

See post #113

 

[TheRealCookieMonster]

And who trained them? And who keeps training them?

Same point with Vaccines right? And IVs? and Med passes? Wound Care? Doctors taught someone else how to do it. They lost a skill, but now the nurse does it and they do other more complex stuff.

 

[TheRealCookieMonster]

See post #113

So physician burn out is a mid-level encroachment problem? I thought Physician burnout was trending down?

 

[MedicineZ0Z]

Same point with Vaccines right? And IVs? and Med passes? Wound Care? Doctors taught someone else how to do it. They lost a skill, but now the nurse does it and they do other more complex stuff.

Medical management isn't as nuanced as vaccines. And even something as simple as IV placement gets called to the physician when the nurse can't do it.

 

[Splenda88]

And who trained them? And who keeps training them?

We need to stop that... I have worked with nice nurses who are going to NP school and when they ask me to explain to them or teach them a concept, I usually tell them that I will when I have time but never did or change the subject altogether if they re-address it.

They are nice but once they get that NP, their head got big listening to ANA propaganda and suddenly they think "they provide equal or better care than doctors."

I feel bad doing that but they have left me with no choice.

 

[NecFasc92]

We need to stop that... I have worked with nice nurses who are going to NP school and when they ask me to explain to them or teach them a concept, I usually tell them that I will when I have time but never did or change the subject altogether if they re-address it.

They are nice but once they get that NP, their head got big listening to ANA propaganda and suddenly they think "they provide equal or better care than doctors."

I feel bad doing that but they have left me with no choice.

Why do you feel bad? They are trying to sap your skills from you-- they are quite literally stealing your education and knowledge. You owe them nothing. They aren't a part of your fraternity/ sorority, the brotherhood/sisterhood that is medicine. If anything you should be offended that they are trying to steal work and pay from you, all so they can gain increase wages under the guise of self professed "patient advocacy." It's actually quite disgusting if you think about it.

 

[Splenda88]

Why do you feel bad? They are trying to sap your skills from you-- they are quite literally stealing your education and knowledge. You owe them nothing. They aren't a part of your fraternity/ sorority, the brotherhood/sisterhood that is medicine. If anything you should be offended that they are trying to steal work and pay from you, all so they can gain increase wages under the guise of self professed "patient advocacy." It's actually quite disgusting if you think about it.

I have been conflicted about that, to be honest... They are people I work with and most of them are really good people.

 

[deleted610572]

My point was that the people paying "provider" salaries are willing to pay docs, PAs, and NPs (and even NDs ) for the same jobs. Voter, patient, and everyone except doctors approve. So either not enough people dying to those mid-levels on the record or their care is good enough to not require a doc. Certainly is cheaper to someone.




It would seem that everything a nurse does is tied to their income. Which is why when they tell the hospital they want +$ they get it. Leverage is an excellent way to get paid. The learning curve seems less important as treatment is standardized and all you have to do is follow the procedure. I guess if docs need "easy" cases to keep patients from catastrophe I can't argue with the value of fundamentals.

At face value they are cheaper but hidden costs exist with more imaging, testing, and specialty referrals... not to mention misdiagnoses. The true burden of midlevels is unknown; especially with physicians backing them up and knowing the answers. If doctors let midlevels eat what they kill then ANA would claim we are putting patients endanger to protect our territory. They would then use propaganda terms like "healthcare team". Please enjoy the lawsuit as a healthcare team.

 

[863168]

Medical management isn't as nuanced as vaccines. And even something as simple as IV placement gets called to the physician when the nurse can't do it.

To add on to this when there is a complex line placement especially a central line in a patient with a host of vascular access issues then the doc can almost always expect to be consulted by even someone on an IV/PICC team. Not to mention if there is a complexity with a thoracic abscess that needs administrative tPa to breakdown a potential clot then you can bet that is something completely in the realm of IR even though once successful outcomes are achieved the contribution by the doctor often goes understated and underwritten.

A lot of patients have stabilized outcomes precisely due to the contribution of a physician who is able to identify and excise the etiology of a zebra symptom and act accordingly.

 

[863168]

I have been conflicted about that, to be honest... They are people I work with and most of them are really good people.

Thank you. I appreciate you.

 

[Splenda88]

Thank you. I appreciate you.

?

 

[863168]

?

As a nurse.

 

[Splenda88]

As a nurse.

Are you a nurse trying to get into med school?

 

[deleted610572]

As a nurse.

The vast majority of physicians love their nurses.. what they don’t love is the nurse turned NP student

 

[762513]

I think you guys just need to work and/or hire the right midlevel. The humble, cautious, experienced nurse who has seen the !@#$ go down at the bedside and doesn't want to do harm. As a new grad NP working under supervision I can tell you I don't feel comfortable prescribing anything beyond electrolyte supplementation and tesslon pearls at this point. I wanna know the QTC before I even think about an antibiotic. I am behaving this way because I've been around years of train wrecks and codes in the ICU. Before you guys lose your mind, just remember that there are safe and unsafe NP/PA's just like there are safe and unsafe physicians. Pick your midlevels carefully when you become an attending and you all should be fine.

 

[TheRealCookieMonster]

Why do you feel bad? They are trying to sap your skills from you-- they are quite literally stealing your education and knowledge. You owe them nothing. They aren't a part of your fraternity/ sorority, the brotherhood/sisterhood that is medicine. If anything you should be offended that they are trying to steal work and pay from you, all so they can gain increase wages under the guise of self professed "patient advocacy." It's actually quite disgusting if you think about it.

Beware the mid-levels and their lies. Speaking of propaganda

If it's so easy to sap those skills then doctor's should be replaced. But it's not is it? Which is why we will always have doctors.

Lol you guys are actually suggesting not sharing information with people you work with? STOP THE LEARNING! (Elysium approves)

All this coming from leaders of the medical community and arguably the best paid profession in the world. And the nurses are the disgusting ones.

 

[Rekt]

I think you guys just need to work and/or hire the right midlevel. The humble, cautious, experienced nurse who has seen the !@#$ go down at the bedside and doesn't want to do harm. As a new grad NP working under supervision I can tell you I don't feel comfortable prescribing anything beyond electrolyte supplementation and tesslon pearls at this point. I wanna know the QTC before I even think about an antibiotic. I am behaving this way because I've been around years of train wrecks and codes in the ICU. Before you guys lose your mind, just remember that there are safe and unsafe NP/PA's just like there are safe and unsafe physicians. Pick your midlevels carefully when you become an attending and you all should be fine.

Right, but there's plenty with your level of training thinking they can run clinics and floors all by themselves. "Just google it or use UpToDate lol" is commonly what I hear from them. I'd argue most aren't like you. Most want as much autonomy (and money) as possible at the expense of patient safety.

 

[Splenda88]

I think you guys just need to work and/or hire the right midlevel. The humble, cautious, experienced nurse who has seen the !@#$ go down at the bedside and doesn't want to do harm. As a new grad NP working under supervision I can tell you I don't feel comfortable prescribing anything beyond electrolyte supplementation and tesslon pearls at this point. I wanna know the QTC before I even think about an antibiotic. I am behaving this way because I've been around years of train wrecks and codes in the ICU. Before you guys lose your mind, just remember that there are safe and unsafe NP/PA's just like there are safe and unsafe physicians. Pick your midlevels carefully when you become an attending and you all should be fine.

That is another catchphrase that drives me up the wall... Proportion matters in everything. (Most of) the physicians that are unsafe is because they are careless--not because of lack of basic knowledge. Residency is standardized in the US. There is a floor. No one knows what is the floor for NP.

 

[TheRealCookieMonster]

Medical management isn't as nuanced as vaccines. And even something as simple as IV placement gets called to the physician when the nurse can't do it.

Seems like that reinforces the idea that physicians have a marketable skill. If mid-levels learn it and can compete in the same job market without risk to the employer then doctors will have to develop other skills, like they've been doing forever. If they're taking cases away from doctors who need them to be proficient then I guess that makes sense. Otherwise this forums reaction to people calling themselves "providers" and saying they're just like doctors is just an overreaction to not having exclusive rights over medical practice. A turf war, which physicians practice better than anyone.

 

[puahate]

Rather higher my colleagues. I'll hire nurses but not NPs. Best thing to do is let NP schools proliferate and self destruct their supply.

 

[brownsfan999]

Before you guys lose your mind, just remember that there are safe and unsafe NP/PA's just like there are safe and unsafe physicians.

By that logic, there are winning and losing basketball teams just like there are winning and loosing Powerball tickets.

 

[TheRealCookieMonster]

Most want as much autonomy (and money) as possible at the expense of patient safety.

It's like all the bad people go into NP and the good guys go MD. Again form the best paid profession you can find. mid-levels have to deal with HR just like docs.

 

[762513]

Right, but there's plenty with your level of training thinking they can run clinics and floors all by themselves. "Just google it or use UpToDate lol" is commonly what I hear from them. I'd argue most aren't like you. Most want as much autonomy (and money) as possible at the expense of patient safety.

I agree, don’t hire those people!

 

[ThetisAntithesis]

Dang!!
If I didn't know what NPs were, judging by this thread I would think they were banshees needing to be banished back to the world of bed pans and IVs.

In all seriousness though, I get it, NPs are not well trained for the work they do (hopefully come next year, I will never have have to renew my NP license) but I don't think the solution is not training them or helping them learn (I guess except the arrogant ones). I don't know what the solution is but its definitely not spilling all this vitriol against mid-levels... Even the post with name-calling and such... Like chill fam!!
I do however discourage my nurse when she says "I think I want to go back to school to get my NP". I'm like "Nope, don't, go be a PA instead... For real..."

 

[TheRealCookieMonster]

Listen, I know you think you're cute and all, being your 25 y/o pre-med keyboard warrior self, but the amount of proverbial stupidity you spew is unreal. Your lack of intellect and insight is beyond naive, it borders on downright IDD. Next time, before you start to type your utter stupidity and expose yourself for any lack of real world life experience/ job understanding/ and/or healthcare literacy remind yourself of this saying: "Better to remain silent and be thought a fool, than to speak and remove all doubt."

Hey man I’m just preaching the truth here.
Golden rule.
I like to get ahead in life because I have something to offer. Not because I prevent others from doing what I do.

 

[762513]

Listen, I know you think you're cute and all, being your 25 y/o pre-med keyboard warrior self, but the amount of proverbial stupidity you spew is unreal. Your lack of intellect and insight is beyond naive, it borders on downright IDD. Next time, before you start to type your utter stupidity and expose yourself for any lack of real world life experience/ job understanding/ and/or healthcare literacy remind yourself of this saying: "Better to remain silent and be thought a fool, than to speak and remove all doubt."

When you get challenged you get very combative. As a experienced hospital administrator (when you were in your early 20’s... hard to believe but ok) you know that the number of nurses in administration is high, and the hearts and minds you are trying to win here have already been bought and paid for. It’s likely that refusing to work with midlevels is going to end up with you suffering consequences, not the other way around.

 

[TheRealCookieMonster]

Residency is standardized in the US. There is a floor. No one knows what is the floor for NP.

This is the best argument on this topic I’ve seen. It’s the correct one. Standardization is a fundamental important difference between “providers” and Doctors.

 

[NecFasc92]

When you get challenged you get very combative. As a experienced hospital administrator (when you were in your early 20’s... hard to believe but ok) you know that the number of nurses in administration is high, and the hearts and minds you are trying to win here have already been bought and paid for. It’s likely that refusing to work with midlevels is going to end up with you suffering consequences, not the other way around.

You don't know my body language, tone, verbal expressions, etc. Therefore, your conclusion about being "combative" isn't possible. Should I use emojis constantly to change this perception. How's this 🙂. And when did I say I was a hospital admin in my early 20s? 😕

The only downside will be the midlevels who won't be working with me. Literally everything else will have an upside: me, the patient, their family, and their health. These are what matter. O, I guess the other downside will be the suits who can't profit off the midlevels (which is the only reason they hire/use them, for $$$$$$).

 

[762513]

By that logic, there are winning and losing basketball teams just like there are winning and loosing Powerball tickets.

Are there more unsafe midlevels than unsafe physicians, absolutely. Do both still exist and are both still a problem? Yup.

That is another catchphrase that drives me up the wall... Proportion matters in everything. (Most of) the physicians that are unsafe is because they are careless--not because of lack of basic knowledge. Residency is standardized in the US. There is a floor. No one knows what is the floor for NP.

I agree for sure there’s no good floor for NP’s. You’re right on that. However, I’ve seen covering attendings in the ICU “ween” ventilated patients using out of date protocols that haven’t been used for a decade. Some docs may have the basic knowledge but simply haven’t kept themselves current, and so are no longer safe.

 

[762513]

You don't know my body language, tone, verbal expressions, etc. Therefore, your conclusion about being "combative" isn't possible. Should I use emojis constantly to change this perception. How's this 🙂. And when did I say I was a hospital admin in my early 20s? 😕

The only downside will be the midlevels who won't be working with me. Literally everything else will have an upside: me, the patient, their family, and their health. These are what matter. O, I guess the other downside will be the suits who can't profit off the midlevels (which is the only reason they hire/use them, for $$$$$$).

You were an admin. You know if the suits can’t profit off of you then you aren’t in a good place in a large hospital system. Sounds like you want to hang your own plank, if so I wish you all the best.

 

[NecFasc92]

You were an admin. You know if the suits can’t profit off of you then you aren’t in a good place in a large hospital system. Sounds like you want to hang your own plank, if so I wish you all the best.

That is fair 🙂. What I'm pursuing sadly conflicts with what you stated as I won't be able to start up shop. Regardless, who knows what healthcare will look like in 8-10 years. Prognosticators have been correct...well...never...

Mind if I ask what area you are a NP in, sir/?ma'am?..?