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deleted6669
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deleted87716
The expanded reliance on advanced-practice professionals to provide around-the-clock care at Akron Children's is necessary, in large part, because of new restrictions on the number of hours doctors-in-training can work.
Sounds like unintended consequences to me.
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deleted6669
Sounds like unintended consequences to me.
unintended but predictable. we have known this would increase demand for pa's and np's for years. residents are the cheapest labor pool. after them it's us.
another nice commentary written by a physician supportive of pa/np practice in primary care:
http://www.kevinmd.com/blog/2011/11/primary-care-changed.html
and another in surgical oncology:
http://www.mdanderson.org/publications/annual-report/issues/2009-2010/liver-cancer.html
Last edited by a moderator:
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Here's a comment from someone to the article that emedpa posted above that I think is worth reading
I think as long as academic leaders like Dr Gifford direct the future of primary care it will end up being serviced by " physician extenders" with much less clinically supervised training than physicians. We will have inpatient hospitalists and outpatient extenders because of decisions gentlepersons like him made allowing it to be entirely too easy to enter a subspecialty or procedure related specialty where the economic rewards were far sweeter than in general internal medicine. Primary care has lost longitudinal care and relationships based on decisions made by the likes of the Dr Giffords of the world. Primary care would have been far better served had he gone to Vermont, practiced what he was trained to do and gave patients and young physicians an example of how it is meant to be done correctly. My disagreement with Dr Gifford is not a personal one nor a personal attack. If you read the ACP White Paper from the late 1980's and 1990's and then see the policy they actually followed you will understand how primary care has been sold down the river ( and the patients as well) by academic medicine and the ACP
I think as long as academic leaders like Dr Gifford direct the future of primary care it will end up being serviced by " physician extenders" with much less clinically supervised training than physicians. We will have inpatient hospitalists and outpatient extenders because of decisions gentlepersons like him made allowing it to be entirely too easy to enter a subspecialty or procedure related specialty where the economic rewards were far sweeter than in general internal medicine. Primary care has lost longitudinal care and relationships based on decisions made by the likes of the Dr Giffords of the world. Primary care would have been far better served had he gone to Vermont, practiced what he was trained to do and gave patients and young physicians an example of how it is meant to be done correctly. My disagreement with Dr Gifford is not a personal one nor a personal attack. If you read the ACP White Paper from the late 1980's and 1990's and then see the policy they actually followed you will understand how primary care has been sold down the river ( and the patients as well) by academic medicine and the ACP
Although I agree that NP's and PA's play an important and invaluable role to the team, I would disagree with the article's statement that they are a physician's peer. There is simply no way that the evaluation and recommendations of a mid-level provider could or should carry the same weight as an attending's or even a resident's. I understand that there is a movement where everyone in the team is an "equal member with valuable input," but in reality this simply isn't the case, especially when the crap hits the fan.
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deleted6669
Although I agree that NP's and PA's play an important and invaluable role to the team, I would disagree with the article's statement that they are a physician's peer. There is simply no way that the evaluation and recommendations of a mid-level provider could or should carry the same weight as an attending's or even a resident's. I understand that there is a movement where everyone in the team is an "equal member with valuable input," but in reality this simply isn't the case, especially when the crap hits the fan.
I agree to an extent. a neurosurgeon or neurosurgical resident certainly trumps a pa on the neurosurgery service but it is likely that a seasoned neurosurg pa would have a knowledge base of the subject greater than a resident rotating from another service such as em or medicine. specialty pa's over time can master a large portion of the knowledge base in any specialty such that only physician specialists in that field know more about it.
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deleted6669
another similar article:
http://www.standard.net/stories/2011/11/27/physician-assistants-nurse-practitioners-take-bigger-role
http://www.standard.net/stories/2011/11/27/physician-assistants-nurse-practitioners-take-bigger-role
I agree to an extent. a neurosurgeon or neurosurgical resident certainly trumps a pa on the neurosurgery service but it is likely that a seasoned neurosurg pa would have a knowledge base of the subject greater than a resident rotating from another service such as em or medicine. specialty pa's over time can master a large portion of the knowledge base in any specialty such that only physician specialists in that field know more about it.
With this line of thinking, then a seasoned nursing assistant with 30 years of experience should have a greater knowledge base than a new PA or NP graduate
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deleted6669
a "seasoned nursing asst." hasn't actually been doing the workups, attending cme, talking to consultants, etc for years. they have been doing nursing asst. work so it's not equivalent to pa's doing much of the same work as their physician colleagues. a pa who runs an icu solo at night learns A LOT about icu medicine. a nursing assistant who works the icu at night doesn't learn the intricacies of the different vasopressors, vent settings, etc because they are not responsible for knowing them....when you enter rotations and see what pa's and np's actually do in day to day practice you will have a better idea about what I am talking about.With this line of thinking, then a seasoned nursing assistant with 30 years of experience should have a greater knowledge base than a new PA or NP graduate
Most of these NP/PA patient mills that have one MD at the head are committing billing fraud. They bill for NP/PA services which require chart review or direct interaction with the patient when in fact they provide neither.
Its time to set up some sting operations and then audit their records. Then these MDs that are committing fraud will lose their Medicare/Medicaid billing privileges.
Its time to set up some sting operations and then audit their records. Then these MDs that are committing fraud will lose their Medicare/Medicaid billing privileges.
Another good one, more up your alley emed
http://www.annemergmed.com/article/S0196-0644(11)00129-6/fulltext
http://www.annemergmed.com/article/S0196-0644(11)00129-6/fulltext
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deleted6669
Another good one, more up your alley emed
http://www.annemergmed.com/article/S0196-0644(11)00129-6/fulltext
excellent article thanks!
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deleted6669
I'll continue posting similar articles here for those interested.
