Meet your undertrained replacements!

[762513]

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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?..?

No personal slight to you, but I’m not disclosing.

 

[TheRealCookieMonster]

 

[DPTinthemaking15]

Hand her an EKG. Guarantee this person wouldn't even recognize things a first year med student would. Not remotely joking.

I’m laughing because the last NP misread one of my moms scans. Which resulted in a missed diagnosis and a week stay in the hospital.

Maybe she is extremely smart 😛

Haha don’t make laugh. I had this person convinced that some dog collars come equipped with a “translator,” so that humans can hear dogs thoughts.

Yeah. Let her arrogant ass hurt somebody or overlook something critical and see what happens.

It's always these types of people in medicine that end up mucking up. I hope it doesn't but I hope it humbles her ass.

I feel like it is coming with her attitude and I just feel bad for the patient.

Random side note: My wife believes it will take a senator, high-up lawyer, or a CEO’s wife/daughter/son/husband to be negatively affected by a mid-level before this issue is looked into.

 

[VA Hopeful Dr]

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.

Couple points to unravel here.

As far as cost, the only people benefiting from midlevels over doctors is whoever employs them. Patients/insurance pay the same 90+% of the time.

Outcomes - the areas where midlevels are shooting for independence (primary care and cosmetics) don't often have emergencies or situations where a wrong decision results in immediate harm. If you do a bad job treating someone's diabetes, they aren't going to have an MI next week. But in 5 years when they develop CKD, its hard to prove that it was directly the fault of something their PCP did wrong unless its glaringly obvious. In addition, they have the safety net of specialists to fall back on even if they don't have a supervising physician.

Following procedures is easy... until it isn't. That's where clinical judgement comes into play. Previously most midlevels of both stripes had to have significant experience in medicine before entering in NP/PA school. Most of us have noticed a significant drop in midlevel quality since that requirement has been weakened. The NP that works with me, for example, was an ER nurse for 10 years before NP school. She's not perfect, but she's good at recognizing when someone is actually sick. You can't teach that in school, only through experience which is becoming less valuable in midlevel training.

 

[NicMouse64]

My statement was pure speculation. When you confuse two diseases that have 2 different pathophys with different treatments you can get in trouble. Physicians provide back up to prevent these kinds of mistakes. That’s why we fight for oversight.

There are major malpractice companies that have made big announcements about premium increases for NPs.

 

[Rekt]

Couple points to unravel here.

As far as cost, the only people benefiting from midlevels over doctors is whoever employs them. Patients/insurance pay the same 90+% of the time.

Outcomes - the areas where midlevels are shooting for independence (primary care and cosmetics) don't often have emergencies or situations where a wrong decision results in immediate harm. If you do a bad job treating someone's diabetes, they aren't going to have an MI next week. But in 5 years when they develop CKD, its hard to prove that it was directly the fault of something their PCP did wrong unless its glaringly obvious. In addition, they have the safety net of specialists to fall back on even if they don't have a supervising physician.

Following procedures is easy... until it isn't. That's where clinical judgement comes into play. Previously most midlevels of both stripes had to have significant experience in medicine before entering in NP/PA school. Most of us have noticed a significant drop in midlevel quality since that requirement has been weakened. The NP that works with me, for example, was an ER nurse for 10 years before NP school. She's not perfect, but she's good at recognizing when someone is actually sick. You can't teach that in school, only through experience which is becoming less valuable in midlevel training.

It hasn't been weakened, the barrier for entry into NP school is essentially gone. There's more straight through programs than anyone could even count. Not even a single day working as an RN is needed and you can get admission to some online degree mill. Find a couple docs to take a few grand to let you "shadow" for your 500 clinical hours and boom you're an NP harming patients.

 

[VA Hopeful Dr]

It hasn't been weakened, the barrier for entry into NP school is essentially gone. There's more straight through programs than anyone could even count. Not even a single day working as an RN is needed and you can get admission to some online degree mill. Find a couple docs to take a few grand to let you "shadow" for your 500 clinical hours and boom you're an NP harming patients.

I've never been offered money to have the NP students shadow and I used to get requests every other week or so when I owned my own practice.

I like to think that money wouldn't have changed my mind about accepting any, but the early days were awfully lean...

Interesting, the university affiliated PA program didn't offer either.

 

[MedicineZ0Z]

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..."

Forget poorly trained. We should be defending our market from non-physician attack. And yes I use the word "attack." Go read legislative efforts in every state and "attack" is putting it veryyyy politely compared to how their lobbies come after us.

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


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.

Most NPs outside of the ICU (still can't believe America lets nurses manage the sickest patients lol) don't even know what weening off the vent even is. The fundamental difference in knowledge is astronomical. We're comparing 6th grade math to 12th grade calculus.

 

[MedicineZ0Z]

I've never been offered money to have the NP students shadow and I used to get requests every other week or so when I owned my own practice.

I like to think that money wouldn't have changed my mind about accepting any, but the early days were awfully lean...

Interesting, the university affiliated PA program didn't offer either.

They want you to train your replacements for CME credit? loooool. Insult to injury.

 

[VA Hopeful Dr]

They want you to train your replacements for CME credit? loooool. Insult to injury.

Apparently. Also turns out that teaching medical students helped towards getting that FAAFP after my name but teaching NP/PA students would not have.

 

[762513]

Forget poorly trained. We should be defending our market from non-physician attack. And yes I use the word "attack." Go read legislative efforts in every state and "attack" is putting it veryyyy politely compared to how their lobbies come after us.

Most NPs outside of the ICU (still can't believe America lets nurses manage the sickest patients lol) don't even know what weening off the vent even is. The fundamental difference in knowledge is astronomical. We're comparing 6th grade math to 12th grade calculus.

Speaking about a lack of knowledge, current literature doesn’t recommend weaning off a ventilator at all, which is why it was put in quotes. Either a patient passes their daily SBT or they don’t, and we try again tomorrow. If you’re going to give an opinion while calling into question other people’s knowledge, it might be helpful if you knew what you were talking about.

 

[MedicineZ0Z]

Speaking about a lack of knowledge, current literature doesn’t recommend weaning off a ventilator at all, which is why it was put in quotes. Either a patient passes their daily SBT or they don’t, and we try again tomorrow. If you’re going to give an opinion while calling into question other people’s knowledge, it might be helpful if you knew what you were talking about.

What?? You were talking about the topic and I said the concept as a whole would be entirely unknown to almost all midlevels.
Don't try to pull mental gymnastics on me.

BTW, loved your antibiotics QTc comment earlier. Shows your lack of understanding of how much antibiotics truly prolong QTc. Unless you're using stuff that shouldn't even be used, you're adding maybe 10ms tops with your zpak. And just because X & Y drugs prolong by Z ms does not mean equal torsadogenicity. But hey at least you're familiar with the concept which deserves credit.

 

[762513]

What?? You were talking about the topic and I said the concept as a whole would be entirely unknown to almost all midlevels.
Don't try to pull mental gymnastics on me.

BTW, loved your antibiotics QTc comment earlier. Shows your lack of understanding of how much antibiotics truly prolong QTc. Unless you're using stuff that shouldn't even be used, you're adding maybe 10ms tops with your zpak. And just because X & Y drugs prolong by Z ms does not mean equal torsadogenicity. But hey at least you're familiar with the concept which deserves credit.

Great way to deflect the conversation away from your obvious lack of knowledge in critical care though. Please keep giving opinions about things you have very little knowledge on, I love hearing it.

 

[MedicineZ0Z]

Great way to deflect the conversation away from your obvious lack of knowledge in critical care though. Please keep giving opinions about things you have very little knowledge on, I love hearing it.

Ignorance is bliss. Dunning-Kruger effect on full display on your posts. You don't know what you don't know but you do love to fabricate stuff. I did not once take a position on vent management.

And it wasn't a deflection. I was highlighting the fact that you are clearly missing other meds by fixating on antibiotics. You also look at it from an algorithmic approach because you don't have the slightest clue on the physiology behind it. Feel free to PM me if you would like a lesson on the topic though.

 

[Little Green Mensch]

Circling back around to the actual topic of the thread, if NPs and PAs want to practice medicine independently, they should have to pass the USMLE and complete an accredited internship, just like physicians. The states that have legalized independent practice are experimenting with their citizens' lives for no proven benefit.

As for physicians being painted as meanies for "defending our turf" - medicine, like law and engineering, is a legally-protected profession. States have standards for medical licensing because, if they didn't, people would get fleeced (or seriously hurt) by quacks on a regular basis. If the current standards are eroded into meaninglessness by mid-level encroachment, we will find ourselves in the same situation that prompted the Flexner Report.

 

[TheRealCookieMonster]

Most of us have noticed a significant drop in midlevel quality since that requirement has been weakened. The NP that works with me, for example, was an ER nurse for 10 years before NP school. She's not perfect, but she's good at recognizing when someone is actually sick. You can't teach that in school, only through experience which is becoming less valuable in midlevel training.

Completely agree with this. The "mid-level" became a thing because people in nursing and other positions put time in working with physicians and patients and deserved to be paid for that valuable experience. Most learning is done on the job in any profession anyway. It's good for patients. The lack of standardization that followed when universities students and deans realized they could start pumping out 2 year doctors with no residency and HR could hire them is the real problem.

99% of every other argument against mid-levels is pure speculation and/or is blatantly self serving. It essentially boils down to a turf war. It's kind of pathetic regardless of the circumstances. Physicians make great money, have great jobs, and should be expected to adjust appropriately.

 

[762513]

Ignorance is bliss. Dunning-Kruger effect on full display on your posts. You don't know what you don't know but you do love to fabricate stuff. I did not once take a position on vent management.

And it wasn't a deflection. I was highlighting the fact that you are clearly missing other meds by fixating on antibiotics. You also look at it from an algorithmic approach because you don't have the slightest clue on the physiology behind it. Feel free to PM me if you would like a lesson on the topic though.

lol you don’t know a thing about my psychotic alcoholic patients and their med rec, much less my education and experience. Keep throwing the insults tho it makes you sound super ready to practice medicine

 

[MedicineZ0Z]

lol you don’t know a thing about my psychotic alcoholic patients and their med rec, much less my education and experience. Keep throwing the insults tho it makes you sound super ready to practice medicine

I'm only responding to your insults and pointing out flaws in what you think you may know. And what is "tho" ? This is a medicine forum, not messenger chat.

 

[GoSpursGo]

This thread is closed because it has predictably turned into flame bait.