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That does not solve the problem
Meet your undertrained replacements!
Started by physiciansforpatients
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Yes there are multiple malpractice companies that have increased premiums for NPs and PAs. The problem is just starting to amplify.
You should probably provide suggestions then.
A friend of mine is an NP who worked as an ICU nurse for several years before going back to school. More than once she has said, "The only way I would feel comfortable practicing independently is if I had gone through some kind of residency." If only her attitude were more widespread.
There's a lot of training that goes into making a physician ready to practice medicine on his own. Midlevels should not get to skip over that; given that insurers in many states require doctors to be board-certified in order to get paid, an independently-practicing midlevel should have to meet the same standard. I don't think this is the case in states that currently allow independent practice (though I haven't researched it more than cursorily).
Part of the problem is that it takes a long time to train new physicians, and there is a worsening shortage of physicians. Enter mid-levels, who promise to extend the supply of healthcare providers, and also work for cheaper (for now). Hospitals and insurers would much rather pay substantially less to a mid-level for an "equivalent service" than pay even more to physicians as the demand for healthcare increases.
I don't really see an obvious solution to the situation, although I agree that physicians and medical students should not allow their interests to be trampled in the hope of being seen as better team players.
There's a lot of training that goes into making a physician ready to practice medicine on his own. Midlevels should not get to skip over that; given that insurers in many states require doctors to be board-certified in order to get paid, an independently-practicing midlevel should have to meet the same standard. I don't think this is the case in states that currently allow independent practice (though I haven't researched it more than cursorily).
Part of the problem is that it takes a long time to train new physicians, and there is a worsening shortage of physicians. Enter mid-levels, who promise to extend the supply of healthcare providers, and also work for cheaper (for now). Hospitals and insurers would much rather pay substantially less to a mid-level for an "equivalent service" than pay even more to physicians as the demand for healthcare increases.
I don't really see an obvious solution to the situation, although I agree that physicians and medical students should not allow their interests to be trampled in the hope of being seen as better team players.
I’m optimistic that the free market will address much of this issue. The NPs especially are saturating their own market with terrible grads and eventually the truly competent ones are going to tire of lower pay and lost positions to people who did their training online taking unproctored quizzes about nursing theory.
When we’ve posted job positions for new midlevels we’ve received hundreds of applications and that’s in a moderately desireable area. There is massive downward pressure on NP salaries and its only a matter of time before they all push back and start trying to distinguish the good from the bad internally. One can only hope!
I think the jurisprudence surrounding this issue will also be a big player. NPs are actually less prone to malpractice sinply because “standard of care” takes into account one’s background and training, so their missed diagnoses and bad decisions are not compared to an MD but rather to an equally undertrained nurse. No, what’s interesting is how hospitals will fare against wrongful death and injury suits when the plaintiffs allege they were negligent in granting privileges to someone so woefully undertrained. It’s why you can do one year of residency as a doc and then start your own cosmetic surgery practice with just a state medical license, but you won’t get credentialed at any legit hospital without actual surgical training. I think it’s a matter of time before an enterprising young lawyer uses this angle to get a sweet punitive award against a major hospital. If/when that happens, it could be a game changer in how midlevels function.
When we’ve posted job positions for new midlevels we’ve received hundreds of applications and that’s in a moderately desireable area. There is massive downward pressure on NP salaries and its only a matter of time before they all push back and start trying to distinguish the good from the bad internally. One can only hope!
I think the jurisprudence surrounding this issue will also be a big player. NPs are actually less prone to malpractice sinply because “standard of care” takes into account one’s background and training, so their missed diagnoses and bad decisions are not compared to an MD but rather to an equally undertrained nurse. No, what’s interesting is how hospitals will fare against wrongful death and injury suits when the plaintiffs allege they were negligent in granting privileges to someone so woefully undertrained. It’s why you can do one year of residency as a doc and then start your own cosmetic surgery practice with just a state medical license, but you won’t get credentialed at any legit hospital without actual surgical training. I think it’s a matter of time before an enterprising young lawyer uses this angle to get a sweet punitive award against a major hospital. If/when that happens, it could be a game changer in how midlevels function.
Easiest thing to do is to follow Physicians for Patient Protection on fb. The organization is run by attendings/residents from SDN I believe. They update very regularly and let you know about important issues or upcoming BS legislation that the mid-levels trying to pass. You can get involved by writing to your local representatives or simply just be aware of things that are going on around you.
These guys are legit. They actually go to testimony hearings and stuff to oppose independent practice bills. It's awesome to see attending rooting for us and patients.
I am hoping for the group to get big enough to form into an alternative of the AMA cause the AMA is not representing for any medical students, residents or attendings I know
This exact thing happened to me the last few times I’ve gone in for my UC check up. Scary to think that if multiple people on this thread have had this happen, imagine how many people across the nation are, but are unaware because they do not have the education to know better. She also introduces herself as Dr. NP. I am at least able to get in with my GI doc, but for the required check ups, I get scheduled to her every time.
NP=PA same chit just a different name
The politics are different--for now.
As an aside but still related, does anyone think that NPs and PAs will ever full the role of non-MD/DO doctors, like Optometrists, Dentists, Podiatrists, and/or Physical therapists? I think that training in NP or PA gives access to all parts of the body, and in some states with the NP, autonomy.
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pods still do 7 yrs of training. Mids can't do surgery. Hopefully the non-sexiness of feet will keep them away.
One nice thing is Pods secured surgical privileges, which helps, as I doubt a PA or NP will ever be granted surgical privlages.
If PAs or NPs are ever allowed to do independent surgery, then healthcare is basically over.
If PAs or NPs are ever allowed to do independent surgery, then healthcare is basically over.
When you freaks get out into practice, make sure that your contract says you WILL NOT WORK WITH MIDLEVELS OR OVERSEE THEM.
If not, get ready to walk and go where these twits don't wanna go.
Let them hire PAs and NPs and practice crap medicine and endanger people and cost the system more money.
Eff midlevels and what they stand for.
"Heart of a nurse, brain of a physician" MY ASS.
GTFOH.
If not, get ready to walk and go where these twits don't wanna go.
Let them hire PAs and NPs and practice crap medicine and endanger people and cost the system more money.
Eff midlevels and what they stand for.
"Heart of a nurse, brain of a physician" MY ASS.
GTFOH.
Who do we contact to promote OUR insight and OUR stance?
They stupid ass nursing lobbying organization constantly likes to **** on doctors and it's not cool.
I saw we take the fight to them.
These asses wanna go, let's effin' go baby!
They stupid ass nursing lobbying organization constantly likes to **** on doctors and it's not cool.
I saw we take the fight to them.
These asses wanna go, let's effin' go baby!
This lit a fire in me. Im ready for the battle.
cubswin
Full Member
One way would be to attack not only NP/PA's legally, but the hospital system employing them. We all see those advertisements on TV about lawyers seeking people who were harmed by their doctors. We need the same thing but advertisements for people who were harmed by their PA/NP. Get a lot of law suits going after them. But also name the hospital responsible. If you can sue a company because you tripped on there property and claim they didn't do enough to stop the hazard, then you can sue the hospital for not doing enough to stop the hazardous NP/PA. Start in states where they practice independently. Hospitals are employing them for the money, so hit them where it hurts.
What?? If anything they're seeming like LESS of a threat to primary care. They're deep in every non-surgical specialty.
I had a discussion with an FNP friend of mine and her exact words were “Why do I need to send my patients to a specialist? I can do what the doctors do, and the patients don’t have to wait as long. Of course, if it is cancer or surgery I will have to refer out, but I can handle everything else.”
How do you respond to that? Because I sure the heck didn’t know. I would have understood if it was a PCP (maybe), but it astounds me that people think that way.
How do you respond to that? Because I sure the heck didn’t know. I would have understood if it was a PCP (maybe), but it astounds me that people think that way.
Maybe she is extremely smart 😛
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.
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Hand her an EKG. Guarantee this person wouldn't even recognize things a first year med student would. Not remotely joking.
People who talk the most are often laughably incompetent.
It's almost too late. PAs are being trained left and right, and with higher privileges than medical students in some instances. I see this a lot recently.
Problem is, our longer training becomes redundant if we continue to allows PA to train at the same level as residents. They can and will eventually ask for equality, and IMO they will be right for doing so. In fact, residents I work with love PAs because they help with the workload, essentially acting like another resident. Why would they train a medical student that's gonna leave after a few weeks over a PA that will continue to help them for a year or longer?
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At the end of the day...
It's all about the dollar.
If salaries go down and we ONLY make what PAs and NPs make... I've seen figures 150-200K personally for these folks...
Who are they gonna choose?
The resident with more experience of schooling and 3 years of 100+ hours under their belt making decisions... or a midlevel who needs to be overseen.
I'll NEVER let a midlevel student work at my clinic or shadow me or whatever no matter how much their program pays me to do so.
I'll take the student from the brand-new for profit DO program over them.
Eff them.
They are not physicians. They will never be.
Our training matters.
Our residency matters.
Our experience matters.
I will never offer ANY help to them or any midlevel in my life.
I'd quit and go work in some prison or in the middle of nowhere rather than train these twits or give them the chance to hurt somebody in the same vicinity as myself.
This is a really good idea.
I think I will do this in the future.
Who is supposed to represent us? AAMC or something? Who even knows these days.
Tired of taking the high road.
Let's fight these d-bags.
They constantly wanna drag physicians under the dirt like we are greedy and not caring... I"M SORRY MY PATIENT LOAD CANNOT BE ONLY 10 a day.
Ridiculous dude.
You don't. There is nothing you can say that will change that person's outlook. Only screwing up and having a patient hurt as a result can do that. Just move on and remember to never send a patient to that person.
A sobering thought for all the butt hurt crusaders and DramaQueen's😉 out there who think they have time/energy to do battle with any kind of nurse let alone NPs outside of SDN.
The future of medicine is fewer and/or cheaper doctors. Maybe not today, or tomorrow, but eventually. Ultimately that's a good thing for patients.
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deleted610572
If this true then there needs to be increased standards of NP programs before its ultimately a good thing for patients.
This is an awfully dumb comment. This would be true if the patient were to pay 50 bucks to see an NP and 100 to see a doctor.
The reality is the insurance is charged the same way whether you see an MD/DO or an NP. Patients pay doctor price only to see a mid-level. The only party that benefits from mid-level independence is the hospital CEO or the shareholders of the corporation that employs docs and forces them to 'collaborate' to absorb the liability.
Sincerely,
Butthurt crusader/ dramaqueen
I think this will actually work in our favor (assuming we don't get Medicare for all anytime soon).
If you're paying a $50 copay to see someone (or God forbid full price with a high deductible), you're going to get mad if that someone isn't a doctor. This is a trend I've been seeing more and more frequently as time goes on.
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863168
As an outsider, there are certain points that I would like to highlight that have been briefly touched upon in the thread or haven't really been touched upon at all. For physicians to defend exclusivity for practicing within the full scope of their license, it would require them to be be successful or have a strong case for each point as to why a midlevel cannot encroach or do what a physician can within that role. I think that independent practice states for NPs pose a large issue for physicians as it provides a status quo now for the ANA to take a legal stand on the notion that nurse practitioners can render services that are sufficient, they do not need to prove that their practices are necessarily comparative to that of an American trained physician.
The reasons for this can be briefly attributed to the political power of the ANA through lobbyists, sheer member numbers, and the barrier of entry to nursing (much easier to sympathize with the plight of someone who has been working their first job since graduating from a 2 year community nursing program than a doctor who has gotten the privilege of going through 4 years of molecular biology, 4 years of medical school, and a 3 year medical residency). Any politician if it comes to this half or that half would likely go for the demographic that represents the wider majority of their constituents. This will likely always be in favor of nurses.
The second point I would like to bring up is that although physicians have a collective body of representation, they still willingly participate in a system that separates them along specialties and then furthermore into smaller practices across a wide geographic area. The people who become physicians are usually the type who excel in working within established systems to get what they want (rather than needing to change the system to work for them). An example of this would be attaining the requirements to choose a competitive specialty that is not facing midlevel competition e.g. a surgical specialty. However, this means that many specialties that do see significant push from midlevels and independent midlevels e.g. psychiatry and family medicine will have more stake and more investment therefore causing a potential rift in engagement from physicians as a whole if a push back were to occur (potential strikes, practices losing nurses/physician assistants to other practices). Another issue aside from having differing levels of investment is that fields such as psychiatry and family medicine have very different guidelines on what they would consider safe practice for midlevels, how many hours of training ought to be required, where that training should occur, and what steps should be taken in order to address the issue. If physicians cannot agree on standards of practice amongst individual practices, residencies, and as a physician collective then I don't see them being able to make a successful political defense.
The third point is that I feel like even if physicians are successful in defending their practice from independent midlevels, that it will be a pyrrhic victory. Making a strong case that physicians must perform X, Y, Z procedure for practice and that midlevels are unsafe will put much more strain on residents and even medical school students to take on what may mean to them to be useless scutwork instead of seeing the more analytical/clinical management portion of medicine. Another consequence is that physicians by requesting exclusivity in practice will paint a bigger target on themselves in the case of a malpractice litigation. Lawyers expect that physicians have money to pay them off and the parties they represent which is why they are front and center the most targeted demographic in a malpractice suit.
These were just some broad concepts that I have been considering with the issues that physicians face with taking a stand.
The reasons for this can be briefly attributed to the political power of the ANA through lobbyists, sheer member numbers, and the barrier of entry to nursing (much easier to sympathize with the plight of someone who has been working their first job since graduating from a 2 year community nursing program than a doctor who has gotten the privilege of going through 4 years of molecular biology, 4 years of medical school, and a 3 year medical residency). Any politician if it comes to this half or that half would likely go for the demographic that represents the wider majority of their constituents. This will likely always be in favor of nurses.
The second point I would like to bring up is that although physicians have a collective body of representation, they still willingly participate in a system that separates them along specialties and then furthermore into smaller practices across a wide geographic area. The people who become physicians are usually the type who excel in working within established systems to get what they want (rather than needing to change the system to work for them). An example of this would be attaining the requirements to choose a competitive specialty that is not facing midlevel competition e.g. a surgical specialty. However, this means that many specialties that do see significant push from midlevels and independent midlevels e.g. psychiatry and family medicine will have more stake and more investment therefore causing a potential rift in engagement from physicians as a whole if a push back were to occur (potential strikes, practices losing nurses/physician assistants to other practices). Another issue aside from having differing levels of investment is that fields such as psychiatry and family medicine have very different guidelines on what they would consider safe practice for midlevels, how many hours of training ought to be required, where that training should occur, and what steps should be taken in order to address the issue. If physicians cannot agree on standards of practice amongst individual practices, residencies, and as a physician collective then I don't see them being able to make a successful political defense.
The third point is that I feel like even if physicians are successful in defending their practice from independent midlevels, that it will be a pyrrhic victory. Making a strong case that physicians must perform X, Y, Z procedure for practice and that midlevels are unsafe will put much more strain on residents and even medical school students to take on what may mean to them to be useless scutwork instead of seeing the more analytical/clinical management portion of medicine. Another consequence is that physicians by requesting exclusivity in practice will paint a bigger target on themselves in the case of a malpractice litigation. Lawyers expect that physicians have money to pay them off and the parties they represent which is why they are front and center the most targeted demographic in a malpractice suit.
These were just some broad concepts that I have been considering with the issues that physicians face with taking a stand.
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This might or might not be true but I saw an NP when I was having pleuritic chest pain one time. She ordered an EKG and after I asked her what she thought of it, she said, "it looks pretty similar to the last one you had two years ago so nothing to worry about." Literally her interpretation was based on how similar the lines and waves looked to a previous reading, no actual analysis. Imagine I had a heart block or something and she had no clue. That's why there's no such thing as "routine primary care." You can be sending home something truly dangerous.
Yes, that's why it's important to make the general public aware of mid-level's level of education.
There was a poster made by the ACR a few years back detailing the level of education of a Board Certified Radiologist. I thought that was pretty neat. A side by side comparison of mid-level vs physician and a group/hospital advertising 'We are an all physician group, you will get to see a real doctor' would be pretty cool to see
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863168
@flightnurse2MD has videos on YouTube about the clinical training gap between SRNAs and anesthesiology residents. Super fascinating since he's someone who has lived both lives.
Truth. Probably still better to just accept it.
Ahhh yes poor doctors. If only someone could look out for them. That's no reason to despise mid-levels. Just because your boss takes the profits, companies still have to compete to make things cheaper for patients and insurance alike. And fewer/cheaper doctors isn't just good because there are more mid-levels. Most of the triumphs of modern medicine don't require a doctor because health can be improved without one. This makes healthcare both more accessible and patient driven.
Nobody despises them. They have a role to play in the war to come (GOT FINAL SEASON this SUNDAY WOOT!) aka modern medicine. I oppose mid-levels practicing independently not mid-levels altogether.
The rest of your post is just gibberish. They are not doctors, fewer/cheaper doctors?? Most of the triumphs of modern medicine don't require a doctor???
Edit: I hate the new SDN layout, besides recognizing some old-timer posters on here, I cant tell who I am talking to: a premed, Other Health Professional, troll???
I'd be interested to see some solid studies on the dangers of mid-level ENCROACHMENT. I realize everyone is very proud of their education and infuriated at the arrogance of mid-levels (ironic). But where is the real harm? Or is it all anecdotal? Single horror stories about how someone died in the hands of an NP or PA?
Those studies would be almost impossible to do. This has been discussed ad nauseum before.
That's backward thinking. The burden of proof is on the mid-level. Physician training is the gold-standard like the rest of the world. The mid-level is the group that needs to prove their validity. They need to prove that they are just as competent and safe, not the other way around. Also not with their bogus studies sponsored by their political groups. That's why every new NOAC that comes out always being compared to Warfarin the original gangster. Xarelto can just come out to the market and say 'Yo Coumadin, do studies prove your worth'
They are not as well-trained- that's a fact just counting the numbers
They are not cheaper- that's a fact
????
I mean correct me if I'm wrong, but vaccines, diets, and physicals seem like they're saving a lot more people than surgeries and complex drug therapies.
I guess I don't understand all the emotion then.
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Edward Jenner was an English PHYSICIAN (read- not English NURSE PRACTITIONER) that pioneered the 1st vaccine. Modern medicine wouldn't be where we are today without our predecessors. You clearly don't know what you are talking about.
I think I am talking to a pre-med, someone please correct me so I can stop
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.
I was getting at the fact that regardless of what physicians contributed to medicine 100 years ago, now we don't need a doctor to make vaccines work. In today's world doctors don't do that stuff and nor should we pay them to. I feel like the same could be said of most jobs currently worked by a mid-level or that will be as technology is developed.
You can stop whenever you want. No need to get bent.
It is clear you have no idea, or even concept, of how medicine is practiced or delivered.
Thank you for your thoughts 👍
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deleted87051
Yep. The mid level is there to see clinic patients while the doctor is scoping all day$$$$$. Unless you can change that incentive, midlevels are here to stay.
You should excuse yourself from this conversation as you’ve made it quite evident you have no understanding of the complexities of medicine
I'll take that under advisement.
Troll. Not even a medical student. If you think you can/should be replaced so easily, maybe you should be in a different profession.
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deleted610572
I think they are most likely pre-midlevel because they’re spouting off the same rhetoric that makes no logical sense.
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