NP Oversaturation?

[pamac]

They let NP/PA in the doctors lounge where you work!

Meh....I’ve yet to see a facility that restricted a provider lounge only to physicians. Maybe those exist. Maybe some docs docs in other places get off on the segregation aspect. Certainly not a country club. It’s where I print things, or use a workstation....be apart from the public to eat and wait for something. Couches I’d rather not sit on. Big screen TVs playing things I’d rather not watch. Food I’d rather not eat, apart from the mere convenience. Nobody is wallowing in the luxury of it. I guess I don’t mind the notion that I can eat 3 plus meals for free every day if I want to from the cafeteria, but I rarely hit the food up even twice in month. If a facility wanted to have a separate place for non-physician providers, I’d be fine with that if it cut down on the traffic. My favorite time in the hospital is when I walk out the door, not chill in the lounge.

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[Splenda88]

Meh....I’ve yet to see a facility that restricted a provider lounge only to physicians. Maybe those exist. Maybe some docs docs in other places get off on the segregation aspect. Certainly not a country club. It’s where I print things, or use a workstation....be apart from the public to eat and wait for something. Couches I’d rather not sit on. Big screen TVs playing things I’d rather not watch. Food I’d rather not eat, apart from the mere convenience. Nobody is wallowing in the luxury of it. I guess I don’t mind the notion that I can eat 3 plus meals for free every day if I want to from the cafeteria, but I rarely hit the food up even twice in month. If a facility wanted to have a separate place for non-physician providers, I’d be fine with that if it cut down on the traffic. My favorite time in the hospital is when I walk out the door, not chill in the lounge.

You are taking things too seriously... I was being tongue-in-cheek.

All clinicians (and some non clinicians) have access to the physicians lounge where I work. The food is actually not that bad.

 

[pamac]

You are taking things too seriously... I was being tongue-in-cheek.

Indeed. I had an inkling I was misinterpreting it. The emoji didn’t even get through to me.

 

[pamac]

All clinicians (and some non clinicians) have access to the physicians lounge where I work. The food is actually not that bad.

The food is indeed great. And it tastes far better when it’s free. Over a decade as a nurse eating the same stuff at a generous discount, and the desire not to put on weight as I age has changed my eating habits a bit. I’m primarily a clinic guy with hospital privileges that grabs a Twix on my way out of a half day on the rare occasion I fill in on a mental health floor. It would be different if I was essentially living there as a medical resident or long shift provider. But I intermittent fast just by accident because that’s how my eating schedule was. Didn’t know I was ahead of my time.

 

[SkepticActivist]

This is purely anecdotal, but there are a lottttt of nurses I know or work with that are going to school to become NP's. It does feel like NP's are becoming oversaturated for sure.

 

[Sleepingdoc]

This is purely anecdotal, but there are a lottttt of nurses I know or work with that are going to school to become NP's. It does feel like NP's are becoming oversaturated for sure.

You are called a doctor without going to medical school and putting a work in it ...

 

[pamac]

This is purely anecdotal, but there are a lottttt of nurses I know or work with that are going to school to become NP's. It does feel like NP's are becoming oversaturated for sure.

True. When I graduated, I counted up how many regulars there were around me at work that were in NP school. Roughly 1 in 5 of my coworkers were studying for their NP. Between quick burnout, and the folks that went into nursing with the NP plan in mind, that makes for a lot of people looking to make the transition. The plus side is that if they can’t land something, they have te RN role to fall back on. I know quite a few folks, especially right now, who are still working bedside with their NP degrees completed. I’d venture to say that 1/3 of the folks I worked with as an RN who are finished with their NP are still working as bedside nurses. A lot of that is COVID related, but I’d expect it to be like 1/4 without the influence of COVID. And most of those folks are the ones you would expect to be sitting things out.... people who frankly are poor performers, or who you could tell really didn’t have a solid grasp of what they were getting into. Mix in a few free spirits who are the type of nurses who jump from RN job to RN job once a year... folks who really didn’t have a plan other than to just go to school and then have a job handed to them. The market is tighter, but places still want to hire sharp NPs, and that will never change. I never was intimidated by the fact that a lot of folks around me were going to be entering the workforce around the same time I was.

I harped on the PA pathway in another post, but I’ll mention again that there are advantages to becoming an NP, especially due to having the RN to fall back on. There’s a category of NPs I know of who are still bedside because they haven’t quite found the job they want to start in. Some of them are too picky, but others are just patiently waiting for the right fit to come along. I had a brief delay in my credentialing when I graduated, and camped out as an RN for a little while longer while the hiring process rolled on. I quickly got picked up for what is now my secondary job, and didn’t have to work as an RN for long before I was starting in an NP role, but that RN was handy. If I were a PA with $175k of debt waiting for me to pay on vs being an NP with $39k in student loans, life would be more complicated if the job search was going slow. One can be a lot more picky and patient when you are making close to $90k (before overtime) while you look for the right NP job. A lot of PA new grads don’t have that freedom. I read some pretty scary things on PA forums about the job search right now.

 

[pamac]

You are called a doctor without going to medical school and putting a work in it ...

I’m called a nurse practitioner.

 

[scoopdaboop]

the markets going to tank because while the world will always need physicians, the world will be fine without NPs or PAs.

 

[pamac]

the markets going to tank because while the world will always need physicians, the world will be fine without NPs or PAs.

Tell that to your bosses. They are the ones clamoring to hire us. Those are the folks that will move utilization of physician productivity to be as efficient as possible. Physicians are no longer driving their own ship. My primary job opted to retain few physicians and expand the NP workforce rather than hire more docs. If they do hire another one, it will only be when they think the patient pool will also support a couple more NPs to come onboard as well because the NPs are more profitable.

NP and PA schools are driving over saturation, and the professions themselves haven’t reigned things in. Universities like the cash flow, and the nursing profession as a whole, as well as NP groups, feel there is more strength in numbers, especially if socialized medicine takes root someday. If everyone doesn’t get a job as an NP, nobody seems to care but the NPs.

 

[scoopdaboop]

Tell that to your bosses. They are the ones clamoring to hire us. Those are the folks that will move utilization of physician productivity to be as efficient as possible. Physicians are no longer driving their own ship. My primary job opted to retain few physicians and expand the NP workforce rather than hire more docs. If they do hire another one, it will only be when they think the patient pool will also support a couple more NPs to come onboard as well because the NPs are more profitable.

Yeah this is happening in a lot of places. While I agree that there is a role for NPs, that role is being met fast by the NP/PA schools expanding, probably why the NP/PA groups advocate so much for autonomous practice. The need for physicians is being met more slowly, and by other metrics will not be at all due to projected shortages.

 

[pamac]

Projected provider shortage metrics have been the fuel used to feed the NP/PA education industry. For a time, that was reasonable. I agree there are other critical metrics that favor physicians beyond simply accessibility. You can’t have a world without them playing the major role in every realm and specialty, and I’m for anything that brings up their numbers. However, NPs have worked on autonomy since their inception. I don’t think it’s a viable model to have a high stakes career path that is dependent upon another provider. I operate autonomously in my office, with very rare consultation with a physician (and mostly just look for someone... NP or doc... to bounce an idea off of). There’s no reason to have to rope a doc into being perpetually on the hook for liability for what I do all the time. No formal arrangement or compensation necessary for work they aren’t doing. I’ll succeed or fail on my own merits since I’m practicing in an independent state. About half of states allow independent practice for NPs, with health outcomes generally excellent compared to states that don’t allow it.

 

[scoopdaboop]

Projected provider shortage metrics have been the fuel used to feed the NP/PA education industry. For a time, that was reasonable. I agree there are other critical metrics that favor physicians beyond simply accessibility. You can’t have a world without them playing the major role in every realm and specialty, and I’m for anything that brings up their numbers. However, NPs have worked on autonomy since their inception. I don’t think it’s a viable model to have a high stakes career path that is dependent upon another provider. I operate autonomously in my office, with very rare consultation with a physician (and mostly just look for someone... NP or doc... to bounce an idea off of). There’s no reason to have to rope a doc into being perpetually on the hook for liability for what I do all the time. No formal arrangement or compensation necessary for work they aren’t doing. I’ll succeed or fail on my own merits since I’m practicing in an independent state. About half of states allow independent practice for NPs, with health outcomes generally excellent compared to states that don’t allow it.

studies have also shown that there is an increased cost for the patient as well. Which makes sense. NP and PA autonomy will only drive further need for specialists when they will refer everything.

 

[allantois]

studies have also shown that there is an increased cost for the patient as well. Which makes sense. NP and PA autonomy will only drive further need for specialists when they will refer everything.

this is based on personal anecdotes?

 

[pamac]

studies have also shown that there is an increased cost for the patient as well. Which makes sense. NP and PA autonomy will only drive further need for specialists when they will refer everything.

Again.... talk to your admin overlords and suggest that to them, and bring your evidence. They can be bought if you truly can show them the money. I’ve yet to view compelling research. I guess the answer could be “well of course admin is fine taking money from any patient.” I’m not so sure, though. It’s mostly just doctors that are upset that they feel their power and influence are being upended. None of the medical schools seem to have the time to publish a study that knocks anyone’s socks off, and sends legislatures into fits revoking NPs practice rights. Instead, you see the steady movement each year of states opening up routes for independence. The low hanging fruit of complete independence is probably already picked, so now we see the trend of independence in stages.... like in Virginia, you have NPs qualifying for it after so many hours supervised by a fellow NP or a doc.

NPs refer out too much to docs because they don’t know what they are doing. Or.... NPs are cowboys, and don’t refer out when they should. Or... they are taking docs jobs by costing too little. Or... they don’t deserve to make more money by being independent, because they aren’t worth a higher salary.

Healthcare is changing from mom and pop operations utilizing NPs as physician extenders, and into a workforce of physician employees. It’s natural that the NPs should also all be independently practicing employees as well. A rigid hierarchy is antiquated, which is why you don’t see it in half of all states and the VA (and things work fine) Half of the remaining states it consists of a bare token amount of oversight. In the ones that remain, it’s barely more oversight still, but enough to maintain Complete subservience to the good old boys. It’s telling that the most restrictive states for NPs (tending towards the south and Appalachia) also have among the worst health outcomes. So many of the states that aren’t independent for NPs require supervision consisting of simply having a collaborative agreement, and no real oversight to speak of. That last sentence is what stands out as the best evidence that independence is just fine. It would be one thing if docs were hand holding and keeping NPs in line. Problem is that even among the restrictive states, supervision is such a joke that it means that in most of the country, NPs are essentially practicing independently, but many don’t have any of the benefits of that reality available. So while somehow if I were in Oregon, I’d be qualified to practice without a doc in sight (and by law reimbursed the same for the same treatments), but in Texas I’d need to pay a doc to review a handful of charts each month. In both places. I’d still have a BON that would be investigating all complaints, but that extra doc is needed to make it possible for me to work.

 

[scoopdaboop]

this is based on personal anecdotes?

No I saw a paper linked on reddit that showed exactly what I said.

Again.... talk to your admin overlords and suggest that to them, and bring your evidence. They can be bought if you truly can show them the money. I’ve yet to view compelling research. I guess the answer could be “well of course admin is fine taking money from any patient.” I’m not so sure, though.

but that is the answer. You were right! It’s kind of obvious when during covid hospital execs ask nurses and docs to take pay cuts while giving themselves 200 percent bonuses, that they will no doubt try to cut every corner at the expense of the patient...doctors standing their ground as you mention doesn’t change the fact that studies have shown there is increased cost for the patient.

 

[pamac]

Lol!

Here’s how I use a study like that to kill the thrust of your argument:

If both independent NPs, and dependent NPs ordered tests at the same rate, then that exposes a flaw in the argument that supervision is critical. Think on what the reunifications of that would be....

My guess is that the study authors didn’t parse their data fine enough to nail down that point, and instead kept it nice and broad so as to stick to the agenda. I think I’ve read the study you are referring to. You should post the link. If I recall, the work seems to suggest that NPs and PAs tended to order more tests in general than physicians, but did so at a non considerably higher rate. I could go on for a while about why that might be. Suffice it to say, it didn’t lead to sky high cost overruns, and could be explained by any number of variables.... the years of experience of the nonphysician providers vs the physician providers is probably going to be the big difference, but I can think of many others.

Maybe the NPs and PAs weren’t independent, and were ordering tests more liberally as part of an approach to mitigate liability for their overbearing and dismissive supervising physicians. Having my work connected to a physician‘a liability would incentivize me to go the extra mile beyond what was necessary so I didn’t get reamed if something went wrong. Maybe being historically undermined by the physician community makes it harder for NPs and PAs to say no when patients are insisting on more tests because they read an ad from a doctor saying “ask for a doctor”. Maybe physicians are more apt to play fast and loose instead of following protocol. Maybe their positions of power give them the latitude to buck best practice and trust their gut. But the data needs to be really, really good given the vast differences in practice environments for NPs around the country. Think about how much difference you’d see between NPs tightly controlled in protocol driven practices by restrictive supervising physicians vs NPs practicing independently. That factor alone would kill the value of a study if it wasn’t controlled for.

Even if the cost was nominally higher, is it high enough to warrant concern? Would it be more cost effective for physicians to make fewer mistakes because they are less slammed for time, or to have patients get better access to healthcare due to more providers (NPs and PAs)?

I’m not anti-physician in any respect. I am impressed by the work that most of you folks do. Healthcare isn’t healthcare without physicians. I’m not seeing how it’s necessary that there be a feudalistic hierarchy whose most evident virtue is that said hierarchy provides most benefit to physicians. Face it, you guys stand to gain the most from cementing your status as the gatekeepers if provider level patient care. It means you retain more influence, more financial incentives, and more control. I personally don’t think you guys have much at all to worry about vs other changes taking place In medicine that are just a part of the progression of time.

 

[scoopdaboop]

Lol!

Here’s how I use a study like that to kill the thrust of your argument:

If both independent NPs, and dependent NPs ordered tests at the same rate, then that exposes a flaw in the argument that supervision is critical. Think on what the reunifications of that would be....

My guess is that the study authors didn’t parse their data fine enough to nail down that point, and instead kept it nice and broad so as to stick to the agenda. I think I’ve read the study you are referring to. You should post the link. If I recall, the work seems to suggest that NPs and PAs tended to order more tests in general than physicians, but did so at a non considerably higher rate. I could go on for a while about why that might be. Suffice it to say, it didn’t lead to sky high cost overruns, and could be explained by any number of variables.... the years of experience of the nonphysician providers vs the physician providers is probably going to be the big difference, but I can think of many others.

Maybe the NPs and PAs weren’t independent, and were ordering tests more liberally as part of an approach to mitigate liability for their overbearing and dismissive supervising physicians. Having my work connected to a physician‘a liability would incentivize me to go the extra mile beyond what was necessary so I didn’t get reamed if something went wrong. Maybe being historically undermined by the physician community makes it harder for NPs and PAs to say no when patients are insisting on more tests because they read an ad from a doctor saying “ask for a doctor”. Maybe physicians are more apt to play fast and loose instead of following protocol. Maybe their positions of power give them the latitude to buck best practice and trust their gut. But the data needs to be really, really good given the vast differences in practice environments for NPs around the country. Think about how much difference you’d see between NPs tightly controlled in protocol driven practices by restrictive supervising physicians vs NPs practicing independently. That factor alone would kill the value of a study if it wasn’t controlled for.

Even if the cost was nominally higher, is it high enough to warrant concern? Would it be more cost effective for physicians to make fewer mistakes because they are less slammed for time, or to have patients get better access to healthcare due to more providers (NPs and PAs)?

I’m not anti-physician in any respect. I am impressed by the work that most of you folks do. Healthcare isn’t healthcare without physicians. I’m not seeing how it’s necessary that there be a feudalistic hierarchy whose most evident virtue is that said hierarchy provides most benefit to physicians. Face it, you guys stand to gain the most from cementing your status as the gatekeepers if provider level patient care. It means you retain more influence, more financial incentives, and more control. I personally don’t think you guys have much at all to worry about vs other changes taking place In medicine that are just a part of the progression of time.

every study that comes out will have its critics and supporters and it’s obvious what sides are which depending on the data. Still, I think it says a lot when something like this is allowed to happen, relying on a physicians good will to get some people to have sense.

Opinion | Nursing Boards Failing at NP Oversight?

Change may be necessary to keep patients safe

www.medpagetoday.com

I agree with you that in the states already with full practice, physicians still doing well, and that many nps know their limit and their role. But some of them prance around and put people in danger because they think their on the job experience working alongside physicians makes them qualified enough to, and the article above shows the nursing board isn’t willing to do anything about it because it will make nps look bad. So it’s encumbent on physicians standing up realizing that if healthcare moves towards cheap NP labor, the only people that benefit are greedy execs and not actually patients. Or we have to rely on NPs to have a sense of responsibility, and IMO the NPs that scream “we’re the same!” have the Karen mentality and they are hazardous and can’t be relied on to have that responsibility. I think it’s similar for the Np board as well.

 

[pamac]

You’ll have to find a better article than one produced by that author. She’s a bit of a Karen herself, to say the least. I could do the same thing she did by cherry picking the worst cases of physicians doing bad things, and wrap it up into a movement led by me, just like she is. Buy her book “how to be a rockstar doctor” too, while you are at it.

If you’ve ever seen the nursing board in action, you’d see that it contrasts significantly with the boards of medicine (which are groups that seem to be solely dedicated towards the preservation of physician licenses). Nursing boards are notoriously harsh. Having spoken to folks who have had frivolous patient complaints lodged against them, being investigated by the BON is a life changing event.

Here’s some physician misconduct, as well as some examples of how boards of medicine handle them:

Investigation: Doctors keep licenses despite sex abuse

Even as Hollywood moguls, elite journalists and top politicians have been pushed out of their jobs or resigned amid allegations of sexual misconduct, the world of medicine is more forgiving, according to an Associated Press investigation.

www.spokesman.com

A cynic may say that being supervised by the physicians on boards would be more beneficial for those who want misdeeds overlooked, but obviously docs would treat the underlings like underlings. Meanwhile, their buddies will get a pass because, they know how hard it is to go through medical training, and it’s not something that should be thrown away without significant introspection. And that’s the problem; docs tiptoe around each other because of shared experience, and the desire to maintain a huge threshold for deviance among their ranks before a revocation or even a suspension kicks in. Must be nice. I know NPs who get the third degree over a patient compliant over controlled substances not being provided.

 

[scoopdaboop]

You’ll have to find a better article than one produced by that author. She’s a bit of a Karen herself, to say the least. I could do the same thing she did by cherry picking the worst cases of physicians doing bad things, and wrap it up into a movement led by me, just like she is. Buy her book “how to be a rockstar doctor” too, while you are at it.

Calling her a Karen is a bit of a reach, when she didn't do anything until the NP in question did something he shouldn't have, and then she even tried to go after the supervisory physicians because the nursing board itself wasn't capable of doing anything.

Yes, the doctor in that article you linked is a major a-hole, and shouldn't be able to practice medicine, but your argument seems to hinge on the fact that well the nurse board screwed this one up, but look the medical board screwed this one up too! which then doesn't adress the real problem. Now, your statement on how the medical board is more likely to prance around mal practice to physicians is something that cannot be proven, something that can be proven is that the NP board is supervising way more individuals than a medical board, as is written in the article I had linked.

Also your article and my article highlight 2 different things. Mine is about a NP failing to do their job correctly and not being repramended like they should have, and yours is about sexual harassment which of course isn't to be taken lightly.

 

[pamac]

The Karen physician is the author of the article, who also runs an anti-Np “group” That she founded as her hobby.

I wasn’t talking about your n=1 article.... it’s useless. And yes, there is room for equivocation in this discussion because you are drawing broad conclusions based on an even more precarious article than mine by far. A selected case study....except it’s from one lady that hates NPs being independent so much that she self chartered an organization to promote her disdain. (Oh... and buy her book too. It covers how to be an awesome physician.)

I was referring to the study I thought you mentioned that you saw on reddit. If it’s the same one I saw, it was just an acknowledgement that NPs/PAs order more tests than physicians. No surprise. If that’s the case then, since PAs always have a supervising relationship with some doc, then that suggests something fundamentally flawed with direct supervision. I don’t remember if it was just NPs or included PAs, but even if it did, some of the largest states in the US currently tie NPs very closely to physicians as well. So unless they selected out for independent NPs ordering tests more often than physicians, then the water is tainted. But on a forum like this, the deck is always stacked. If a study shows NPs/PAs order fewer tests than docs, then it’s because we are incompetent by comparison. If we order more, then we are incompetent by comparison. If we have better health outcomes, it is because we punt the hard cases. If we have worse outcomes, it’s because we are incompetent by comparison.

And all along, I’ve never said that physicians aren’t great at what they do on the whole. I’ve only said that I don’t want to be tied to them in the model of dependency just like a squire is tied to a knight. As an RN, I didn’t need a physician agreement to work within my scope. We work WITH them, and complete the orders they write for us, but I’m not tied to them in any regulatory fashion. If I were an RN and am hired by a doctors office, then that puts me under their employment, but I can go work somewhere else instead and not have to gain favor of a physician in order to draw a wage or function. Same thing can be had by an NP. My contract for both my jobs say that I have sole say over my decisions for my patients. Nobody can compel me to operate against myself. I can be fired. I can be reported. My license can be yanked. Someone else can plead to me that I’m wrongheaded. But my work is my work. Same as if I was an RN. That’s the same for every NP in my state, at least from a state licensure standpoint. Now for the PAs, the moment their supervising physician dies, gets their license yanked, goes out of business, gets arrested for Medicare/Medicaid fraud, or develops an unfavorable opinion of that PA.... they are F’d. In the case of criminal action, the PA probably better watch their back and check their numbers because they might have had their overlord doing something shady under their name. But ultimately The Pa can then do no work. Complete domination. What other career has that kind of hierarchy?.... surely not one that has as much trust placed in them as the medical industry places with non physician providers. The PA situation is as creepy as can be considering the PAs at one of my jobs do the same thing as me, and consult the physicians there not even a little. But I can leave that job one day and be working the next, and they have to go through a totally different process. Independence is mostly about the circumstances of employment rather than the handful of NPs that go out to run their own operation. Incidentally, it’s at around the same number of PAs that do it, and it’s at less than 5%.

 

[scoopdaboop]

And all along, I’ve never said that physicians aren’t great at what they do on the whole. I’ve only said that I don’t want to be tied to them in the model of dependency just like a squire is tied to a knight. As an RN, I didn’t need a physician agreement to work within my scope. We work WITH them, and complete the orders they write for us, but I’m not tied to them in any regulatory fashion. If I were an RN and am hired by a doctors office, then that puts me under their employment, but I can go work somewhere else instead and not have to gain favor of a physician in order to draw a wage or function. Same thing can be had by an NP. My contract for both my jobs say that I have sole say over my decisions for my patients. Nobody can compel me to operate against myself. I can be fired. I can be reported. My license can be yanked. Someone else can plead to me that I’m wrongheaded. But my work is my work. Same as if I was an RN. That’s the same for every NP in my state, at least from a state licensure standpoint. Now for the PAs, the moment their supervising physician dies, gets their license yanked, goes out of business, gets arrested for Medicare/Medicaid fraud, or develops an unfavorable opinion of that PA.... they are F’d. In the case of criminal action, the PA probably better watch their back and check their numbers because they might have had their overlord doing something shady under their name. But ultimately The Pa can then do no work. Complete domination. What other career has that kind of hierarchy?.... surely not one that has as much trust placed in them as the medical industry places with non physician providers. The PA situation is as creepy as can be considering the PAs at one of my jobs do the same thing as me, and consult the physicians there not even a little. But I can leave that job one day and be working the next, and they have to go through a totally different process. Independence is mostly about the circumstances of employment rather than the handful of NPs that go out to run their own operation. Incidentally, it’s at around the same number of PAs that do it, and it’s at less than 5%.

An RN and a NP have completely different roles. Obviously, NP practices medicine and RN does not. Also, the whole point in me linking that article was to show you that the NP's board should be distinct from a nursing board, because there are just too many things to regulate, and clearly there is evil that falls through the cracks AND the NP board is reluctant to do anything about it unless the DEA got involved. N=1 of course.

except it’s from one lady that hates NPs being independent so much that she self chartered an organization to promote her disdain. (Oh... and buy her book too. It covers how to be an awesome physician.)

Casting her as a NP hater to pretend like the article doesn't have merit. See there in lies another problem with NPs. Any criticism of their role/function in medicine is met with "they hate us!!!, They're evil doctors who hate us cuz they're mad!!!!" And of course, being a NP is so riduclously easy that there's a hoard of them ready to shout that from the mountain tops as soon as they see any criticism. Of course, it's untrue, and the doc was actually just trying to protect future patients.

 

[KeikoTanaka]

This argument made me want to rip my hair out. You two are dancing in circles. At least I can legibly understand what Pamac is saying. I am against NP independence, but Pamac won this forum battle just based on the coherence of his statements. Scoopdaboop, this is a losing battle for us Physicians-to-be. The only thing we can do is regulate ourselves and hope the right people notice our skills. But that means we should maybe adopt some lessons from the NP-lobbying bodies. Nobody Cares How Much You Know Until They Know How Much You Care - This is why NPs are winning because Physicians walk into the room with so much baggage and spite and expect the patient to just "know how much work they did and how smart they are" - No, you need to talk to them, touch them, listen to them, not zip zip zap here I go write a note. No one will care how much you know or how smart you think you are. Physicians need to do a better job marketing and educating and promoting the right people to go into the right fields. especially Primary Care. If we don't want NPs taking over it, then we need to go into it too, not just say "NPs shouldn't practice independently" as they get accepted to go do EM or Psych because they just couldn't be bothered with lack of prestige and salary, leaving Primary Care dying for anyone with a pulse.

 

[scoopdaboop]

This argument made me want to rip my hair out. You two are dancing in circles. At least I can legibly understand what Pamac is saying. I am against NP independence, but Pamac won this forum battle just based on the coherence of his statements. Scoopdaboop, this is a losing battle for us Physicians-to-be. The only thing we can do is regulate ourselves and hope the right people notice our skills. But that means we should maybe adopt some lessons from the NP-lobbying bodies. Nobody Cares How Much You Know Until They Know How Much You Care - This is why NPs are winning because Physicians walk into the room with so much baggage and spite and expect the patient to just "know how much work they did and how smart they are" - No, you need to talk to them, touch them, listen to them, not zip zip zap here I go write a note. No one will care how much you know or how smart you think you are. Physicians need to do a better job marketing and educating and promoting the right people to go into the right fields. especially Primary Care. If we don't want NPs taking over it, then we need to go into it too, not just say "NPs shouldn't practice independently" as they get accepted to go do EM or Psych because they just couldn't be bothered with lack of prestige and salary, leaving Primary Care dying for anyone with a pulse.

I have no clue what you're talking about. My point was made because Pamac's first response was calling the physician a NP hater.

 

[pamac]

Casting her as a NP hater to pretend like the article doesn't have merit. See there in lies another problem with NPs. Any criticism of their role/function in medicine is met with "they hate us!!!, They're evil doctors who hate us cuz they're mad!!!!" And of course, being a NP is so riduclously easy that there's a hoard of them ready to shout that from the mountain tops as soon as they see any criticism. Of course, it's untrue, and the doc was actually just trying to protect future patients.

Now I know you aren’t serious. I didn’t cast her as a biased critic, she did that herself by SETTING UP A FOUNDATION THAT HAS ONE BASIC TENNET: TO OPPOSE NPs.....

That, in and of itself is consistent with someone who is not only a KAREN of the 3rd degree, but at the very least it betrays more bias than your typical physician. A typical physician likely has several humanitarian movements on the mind, and is lucky if they can devote significant energy to a single worthwhile advocacy. But KAREN found a way to establish herself within the realm of her pet project in a way even many worthwhile social movements would love to emulate. She had a lot of options..... literally tens of thousands of causes available to her, and yet she zeroed in on “Anti-nurse practitioner independence”. Let that sink in. Her.... biggest.... concern.... is..... nurse.... practitioners..... having..... expanded.....employment.... opportunities. Indeed, Karen comes across as a single issue hater with a strange fascination with slinging darts at another profession.

Keep in mind that neither she, nor you, nor anyone can point to excellent quality evidence, or even low quality evidence that tight supervision of NPs produces better results for the supervised NPs vs those that are independent. But conversely, nobody would argue that tight supervision of NPs doesn’t enhance the financial leverage of physicians.

Your own words demonstrate a lack of insight into what you are saying when you question the right for NPs to practice independently. This is something that enhances our employment prospects considerably, and is fundamental to my profession’s wellbeing. So it’s no small thing to suggest dismantling it because of weak evidence and n=1 hearsay. To say that we lump all your resistance toward us as being due “evil doctors who hate us because they are “mad”“ (ie insane) is a considerable oversimplification, as well as a disservice to those that are mad/insane. I don’t attribute dogged insistence on this issue to you guys being “mad“.....I attribute most of it to you guys being arrogant and self centered.

How many more rounds that you want to go here?

 

[scoopdaboop]

Now I know you aren’t serious. I didn’t cast her as a biased critic, she did that herself by SETTING UP A FOUNDATION THAT HAS ONE BASIC TENNET: TO OPPOSE NPs.....

That, in and of itself is consistent with someone who is not only a KAREN of the 3rd degree, but at the very least it betrays more bias than your typical physician. A typical physician likely has several humanitarian movements on the mind, and is lucky if they can devote significant energy to a single worthwhile advocacy. But KAREN found a way to establish herself within the realm of her pet project in a way even many worthwhile social movements would love to emulate. She had a lot of options..... literally tens of thousands of causes available to her, and yet she zeroed in on “Anti-nurse practitioner independence”. Let that sink in. Her.... biggest.... concern.... is..... nurse.... practitioners..... having..... expanded.....employment.... opportunities. Indeed, Karen comes across as a single issue hater with a strange fascination with slinging darts at another profession.

Keep in mind that neither she, nor you, nor anyone can point to excellent quality evidence, or even low quality evidence that tight supervision of NPs produces better results for the supervised NPs vs those that are independent. But conversely, nobody would argue that tight supervision of NPs doesn’t enhance the financial leverage of physicians.

Your own words demonstrate a lack of insight into what you are saying when you question the right for NPs to practice independently. This is something that enhances our employment prospects considerably, and is fundamental to my profession’s wellbeing. So it’s no small thing to suggest dismantling it because of weak evidence and n=1 hearsay. To say that we lump all your resistance toward us as being due “evil doctors who hate us because they are “mad”“ (ie insane) is a considerable oversimplification, as well as a disservice to those that are mad/insane. I don’t attribute dogged insistence on this issue to you guys being “mad“.....I attribute most of it to you guys being arrogant and self centered.

How many more rounds that you want to go here?

I'm assuming this foundation you talk about is called Physician for patient protection? Sad that you view this as anti-NP, when I see no anti-NP rhetoric being listed. Rather, it is about informing patients to make the best decision and ask for a physician. Is that so wrong? But it's not surprising you view that the way you do; I mean just looking at how vehemently you believe that you attribute dogged insistence of this issue to being "arrogant and self centered", rather than ever believing the alternative might be true. You have clouded your own judgment by being deluded by the NPs. See, it seems clear to me, their message got to you.

 

[pamac]

I'm assuming this foundation you talk about is called Physician for patient protection? Sad that you view this as anti-NP, when I see no anti-NP rhetoric being listed. Rather, it is about informing patients to make the best decision and ask for a physician. Is that so wrong? But it's not surprising you view that the way you do; I mean just looking at how vehemently you believe that you attribute dogged insistence of this issue to being "arrogant and self centered", rather than ever believing the alternative might be true. You have clouded your own judgment by being deluded by the NPs. See, it seems clear to me, their message got to you.

Lol!

“It’s not Anti-NP......It’s Pro-insisting-that-you-dont-want-to-see-an-NP!”

-Scoopadoop

Yeah dude, I can’t imagine how I would see that “foundation” as being against NPs when it is clearly just pro non-NP. Or pro-physician. Or pro-“best decision”..... lol!

You are cracking me up.

You aren’t exuding arrogance at all.... please keep not exuding arrogance by continuing to enlighten this thread.

 

[Splenda88]

Lol...

 

[pamac]

That’s for folks that already have a masters degree in nursing.