NP propaganda...

[W19]

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How can we even start competing with this kind of propaganda?


I took a class with one of the NP in this piece of propaganda... We had a group project together. Please God help us!

 

[deleted480308]

Seems like a good start would be doing a better job of filling the gaps NPs are claiming to fill. If physicians are not willing to practice primary care and other needed specialties in high-need/low-resource areas, that void will be filled somehow.

It’s a myth that they are disproportionately filling those areas

 

[Psai]

Seems like a good start would be doing a better job of filling the gaps NPs are claiming to fill. If physicians are not willing to practice primary care and other needed specialties in high-need/low-resource areas, that void will be filled somehow.

Every time someone talks about rural areas, you know they're full of ****

 

[NYCdude]

There is most certainly a "provider" shortage (it kills me a little bit inside every time I type out or utter that word) so if NPs are willing to go to these areas and do the dirty work, then there shouldn't be much of an issue. Except the reality is that most of these people end up "specializing" in various fields, not going to these areas anyway and doing nothing to shorten the gap.

 

[Goro]

NPs R taking R jobs!!!!

 

[Chelsea FC]

 

[68PGunner]

I have no problem w/ this promotional video especially when there are plenty of primary care docs out there looking to fill their pockets by hiring NPs, signing their charts, and never seeing the pt for at least 5 mins. Stuff like that is going to piss off a lot of lawmakers and lead to changes that would make PCPs equal whether they’re DO/MD/NP.

 

[Mad Jack]

Does anyone actually know an NP who has gone into underserved primary care? All the ones I know (and there are many) went into ivory tower critical care, derm, ortho, neurosurg, EM, etc etc

I wish we'd just let them practice independently already and let them put their money where their mouth is. I'm sick of signing their charts and taking their risk, just let them do their thing and chips fall where they may. They (or their hospital) can pay their own malpractice and leave me the hell out of it.

I know a few.

 

[AcronymAllergy]

I know a few.

I've worked in a few different underserved areas that filled primary care and psychiatry positions with NPs after the spots were unable to attract physicians for 12+ months. I have no idea as to the generalizability of this to the country as a whole.

 

[Brahnold Bloodaxe]

NPs R taking R jobs!!!!

Da Russianz stolez the electionz! REEEE!!!

 

[Beargryllz]

Hire 3 NPs to do all your work and be the richest **** that ever existed

This thread is amateur hour. Are you all trolling on purpose or on accident?

 

[HopefulSlav]

Does anyone actually know an NP who has gone into underserved primary care? All the ones I know (and there are many) went into ivory tower critical care, derm, ortho, neurosurg, EM, etc etc

Yeah, where I used to live in Missouri. She was the only person for 24 miles (my town didn't have a hospital)...She's the only one like that. I wonder why more don't do that.

 

[IslandStyle808]

Does anyone actually know an NP who has gone into underserved primary care? All the ones I know (and there are many) went into ivory tower critical care, derm, ortho, neurosurg, EM, etc etc

I wish we'd just let them practice independently already and let them put their money where their mouth is. I'm sick of signing their charts and taking their risk, just let them do their thing and chips fall where they may. They (or their hospital) can pay their own malpractice and leave me the hell out of it.

I do since I am currently living such an area. And I fully regret going to one...

 

[857770]

I do since I am currently living such an area. And I fully regret going to one...

If you mean regret going to an NP, I know what you mean. Also, I live in Hawaii too where there are shortages. I have a great PCP that hired an NP and a PA. I had to see the NP before seeing the doctor, and wow, what a waste of time! I wasted 35 minutes with her, and the doctor had a COMPLETELY DIFFERENT diagnosis and treatment plan. While talking to the NP I knew she wasn't right, but I didn't say anything because I knew I was going to see the doctor anyway. Eventually I told the staff that I only want to see the doctor.

 

[Osteoth]

Ok it took me a while but I found something

The first line of the discussion in the paper titled "Practice characteristics of primary care nurse practitioners and physicians." from Nursing Outlook (obvious bias noted) in March of 2015 is that, "PCNPs are more likely than PCMDs to practice in urban and rural areas".

What they don't tell you is that the difference is only 4%...

The column identifiers are NPs on the left then MDs on the right, this was on the bottom of a table.

 

[IslandStyle808]

If you mean regret going to an NP, I know what you mean. Also, I live in Hawaii too where there are shortages. I have a great PCP that hired an NP and a PA. I had to see the NP before seeing the doctor, and wow, what a waste of time! I wasted 35 minutes with her, and the doctor had a COMPLETELY DIFFERENT diagnosis and treatment plan. While talking to the NP I knew she wasn't right, but I didn't say anything because I knew I was going to see the doctor anyway. Eventually I told the staff that I only want to see the doctor.

Meant to say the state I'm living in where I am attending school (which is on the mainland forgot to mention this). However, yeah, you deal with the same stuff on the outer islands if you can't find a doc. My last visit with the NP where I am currently, I had some bad heart burn and was pretty much told to take over the counter medication and apple cider vinegar. Pretty much what I was doing, well except for the apple cider vinegar, which I have no idea how its suppose to help since its acidic...

 

[Giovanotto]

Meant to say the state I'm living in where I am attending school (which is on the mainland forgot to mention this). However, yeah, you deal with the same stuff on the outer islands if you can't find a doc. My last visit with the NP where I am currently, I had some bad heart burn and was pretty much told to take over the counter medication and apple cider vinegar. Pretty much what I was doing, well except for the apple cider vinegar, which I have no idea how its suppose to help since its acidic...

I believe the thought is that something with such high acidity (~5%) induces a correspondingly great amount of base to be released. I haven't gone over GI yet, but I'm sure SDN will let me know if I'm being cray cray.

 

[IslandStyle808]

I believe the thought is that something with such high acidity (~5%) induces a correspondingly great amount of base to be released. I haven't gone over GI yet, but I'm sure SDN will let me know if I'm being cray cray.

I don't think I learned anything about apple cider vinegar in my pathology GI course. And I am having a hard time finding journal articles strongly supporting it even as a legit over the counter.

 

[kb1900]

I believe the thought is that something with such high acidity (~5%) induces a correspondingly great amount of base to be released. I haven't gone over GI yet, but I'm sure SDN will let me know if I'm being cray cray.

I don't know enough to dispute it...checks out

 

[Psai]

Meant to say the state I'm living in where I am attending school (which is on the mainland forgot to mention this). However, yeah, you deal with the same stuff on the outer islands if you can't find a doc. My last visit with the NP where I am currently, I had some bad heart burn and was pretty much told to take over the counter medication and apple cider vinegar. Pretty much what I was doing, well except for the apple cider vinegar, which I have no idea how its suppose to help since its acidic...

Got a few patients who say it works but thats all anecdotal. I had some bad heart burn and it went away without doing anything

 

[deleted407021]

I believe the thought is that something with such high acidity (~5%) induces a correspondingly great amount of base to be released. I haven't gone over GI yet, but I'm sure SDN will let me know if I'm being cray cray.

Almost definitely comes from the apple cider vinegar as a panacea mentality ... adding acid to GERD is just counterproductive.

 

[operaman]

The apple cider vinegar is just good old fashioned pseudo science, a favorite of chiropractors and naturopaths and the like. To my knowledge, it’s never been subject to any adequate study and the entire concept makes no sense either. That said, arguably the best reflux treatment we often forget about given the ubiquity of PPIs is lifestyle modification, weight loss, treatment of underlying sleep apnea, etc.

As for the NP thing, the further I get into training, the more I see a number of NPs who are a LOT better clinicians than many MDs and who I would much prefer by my side when s—t goes down. I know that’s somewhat anathemous to say, but it’s true. Obviously there are others who are absolutely abysmal. Same goes for MDs of course, but there are far more hurdles to weed out terrible doctors than there are to weed out NPs. My sense is that less desirable places will pull less desirable NPs the same way they get less desirable MDs. If you hit up a minute clinic in some backwater town, your NP experience will be vastly different than in a major center which cherry picked its staff.

Malpractice probably won’t be much of an issue for independent NPs. Remember that “standard of care” is based on what other clinicians with similar training background and experience would do. If they miss an occasional tough diagnosis or mismanage a more nuanced condition, I think a plaintiffs attorney would have a hard time showing that most nurses would have done better. This is the same legal standard, for example, that protects many MDs who offer cosmetic surgical procedures despite absolutely no formal training to do so.

Going forward, I think the best thing for patients is advocating that independent advanced practice nurses be required to undergo some sort of basic competency exams akin to the usmle and a minimum number of years in supervised practice either under an MD or a qualified NP. They should also be subject to comparable CME requirements.

 

[Microshaft]

The apple cider vinegar is just good old fashioned pseudo science, a favorite of chiropractors and naturopaths and the like. To my knowledge, it’s never been subject to any adequate study and the entire concept makes no sense either. That said, arguably the best reflux treatment we often forget about given the ubiquity of PPIs is lifestyle modification, weight loss, treatment of underlying sleep apnea, etc.

As for the NP thing, the further I get into training, the more I see a number of NPs who are a LOT better clinicians than many MDs and who I would much prefer by my side when s—t goes down. I know that’s somewhat anathemous to say, but it’s true. Obviously there are others who are absolutely abysmal. Same goes for MDs of course, but there are far more hurdles to weed out terrible doctors than there are to weed out NPs. My sense is that less desirable places will pull less desirable NPs the same way they get less desirable MDs. If you hit up a minute clinic in some backwater town, your NP experience will be vastly different than in a major center which cherry picked its staff.

Malpractice probably won’t be much of an issue for independent NPs. Remember that “standard of care” is based on what other clinicians with similar training background and experience would do. If they miss an occasional tough diagnosis or mismanage a more nuanced condition, I think a plaintiffs attorney would have a hard time showing that most nurses would have done better. This is the same legal standard, for example, that protects many MDs who offer cosmetic surgical procedures despite absolutely no formal training to do so.

Going forward, I think the best thing for patients is advocating that independent advanced practice nurses be required to undergo some sort of basic competency exams akin to the usmle and a minimum number of years in supervised practice either under an MD or a qualified NP. They should also be subject to comparable CME requirements.

just wondering, why do you think these NP make great clinicians? Was is because of the particular school/training program they went through?

 

[operaman]

just wondering, why do you think these NP make great clinicians? Was is because of the particular school/training program they went through?

Nope just from working with them over the past few years. I don’t really know where they trained to be honest.

 

[Chibucks15]

Nope just from working with them over the past few years. I don’t really know where they trained to be honest.

I never see a problem with them being clinicians if they aren't the overzealous type who refuse to refer when they're supposed to because "I'm an independent provider I don't need a docs approval", which unfortunately many are which gives the good ones a bad name. Also, they'll know how to spot the typical presentations of common disorders, but as soon as there's an atypical presentation or rare disorder or something like that is when they'll miss it and people will get hurt. That's my main concern at least.

 

[814965]

Yeah, where I used to live in Missouri. She was the only person for 24 miles (my town didn't have a hospital)...She's the only one like that. I wonder why more don't do that.

I'm curious too. Wouldn't being the sole provider for an area that big mean more money because the insurance companies wouldn't have a choice but to pay whatever you charge?

 

[IslandStyle808]

Got a few patients who say it works but thats all anecdotal. I had some bad heart burn and it went away without doing anything

In my case, I had throat pain for 2 weeks. Otherwise, I normally wait it out.

 

[Ho0v-man]

Docs could just say that since they don’t practice medicine but instead practice “advanced nursing” or whatever that it’s out of our scope of practice to supervise them.

If they’re so amazing, they can prove it. Every other profession has had to put up or shut up so I don’t see why they shouldn’t.

 

[boogaaloo]

Are you upset the 2nd round draw is against Barcelona?

 

[NYCGuy86]

Docs could just say that since they don’t practice medicine but instead practice “advanced nursing” or whatever that it’s out of our scope of practice to supervise them.

Uh...that is basically what NPs say. They'd love it if docs would also say that too.

 

[Chibucks15]

Uh...that is basically what NPs say. They'd love it if docs would also say that too.

Fine with me...ideally eventually people would realize the knowledge difference and either they would have to do more schooling or be knocked down a peg. Might be the only way to break the propaganda. Also, I feel like as a malpractice insurance agency I'd be charging $$$ for their premiums due to the lack of comparable schooling. Like another poster said...put up or shut up

 

[Chelsea FC]

Are you upset the 2nd round draw is against Barcelona?

Nah we are ready for anyone !!

 

[boogaaloo]

Nah we are ready for anyone !!

Hazard will probably be the only scorer.

PS. NPs. Propaganda. Not good.

 

[operaman]

I never see a problem with them being clinicians if they aren't the overzealous type who refuse to refer when they're supposed to because "I'm an independent provider I don't need a docs approval", which unfortunately many are which gives the good ones a bad name. Also, they'll know how to spot the typical presentations of common disorders, but as soon as there's an atypical presentation or rare disorder or something like that is when they'll miss it and people will get hurt. That's my main concern at least.

I remember thinking this at one point along the way. I've largely let this concern go for a few reasons:

1) 99% of the time, the diagnosis is insanely obvious, sometimes even before you walk in the room. If I'm honest, this has been perhaps the biggest disappointment in medicine as I had come in thinking that diagnosis would pose far more challenge and mystery than it ultimately has (thankfully it has been replaced by the challenges of managing human beings with disease which are infinitely more difficult and challenging). I think if we're honest, the helped:hurt ratio with NPs practicing independently would be largely weighted toward the former. I think the number of truly meaningful missed diagnoses that would have been caught by an MD but are missed by the NP will be incredibly small.

2) PCPs miss a LOT of diagnoses already. This is not a knock against them -- I'm sure I miss plenty too -- but it comes with the territory. Seeing a lot of undifferentiated patients on the front lines of medicine lends itself to occasionally missing things that have yet to evolve to a clinically detectable level. They also see patients without the benefit of the specialty equipment that we have and have to go off the information they have available.

3) Bad things get worse. This is the big one that cemented it for me. Bad things will inevitably get worse. Sometimes you can't make a diagnosis because there is no diagnosis to be made yet, but rest assured that bad diseases will continue to progress along their natural course. With rare exception, these early misses are not usually clinically significant.

4) Specialists exist for a reason. There has been some literature suggesting that NPs refer more than MDs do. I'm unsure exactly how this will impact things over time, probably a combination of both good and worthless referrals coming to specialists' offices. That said, it provides another route by which an NP can get a patient evaluated when they have reached the limit of their own knowledge and experience.

5) Patients already do a lot of self referring. These tend to be pretty worthless referrals overall unless they are self referring for a second opinion after seeing another specialist, but it again provides a way to get care for patients who feel they aren't being cared for appropriately.

6) The rise of online specialty consult services and machine learning products. Online specialty consult services like Rubicon are already offering subscription-based e-consults for PCPs. Machine learning based products are surely on the horizon offering natural language recognition and able to integrate all the available clinical data and suggest diagnoses and guide treatment plans.

 

[Ho0v-man]

Uh...that is basically what NPs say. They'd love it if docs would also say that too.

Yeah. Until they have a question, which happens constantly. Then we just stop taking referrals from NPs. Patients gonna keep going to the “provider” that can’t solve any problems/get you to someone who can just because they “have the heart of a nurse”? If so, they deserve what they get.

Sure, there’s a minority that are working solo primary care. But the vast majority are supervised, primary care or specialty. Take away our ability to sponge up they’re liability and all of a sudden they’re walking a tightrope without a safety net.

 

[deleted393595]

How can we even start competing with this kind of propaganda?

By demonstrating value of care and investing in a strong patient-physician relationship. What turns most patients off from physicians is that "they don't listen" - unsurprising considering the short amount of time per appointment.

This is what direct primary care + concierge can fix. You can sit longer with patients and offer care that's cheaper than what they'd pay for through insurance. Not to mention the 24x7 hour access to a physician and the ability to develop meaningful relationships over time.

 

[Stagg737]

I'm curious too. Wouldn't being the sole provider for an area that big mean more money because the insurance companies wouldn't have a choice but to pay whatever you charge?

It's not really that simple unless you're doing cash only fee-for-service. Contracts with insurance companies as to how much will be reimbursed for various codes are worked out and insurance companies will just bail if the charges are too high, especially in areas with low population densities. So while they can charge more than in other areas where there is a greater provider density, they can't just charge whatever they want.

I remember thinking this at one point along the way. I've largely let this concern go for a few reasons:

1) 99% of the time, the diagnosis is insanely obvious, sometimes even before you walk in the room. If I'm honest, this has been perhaps the biggest disappointment in medicine as I had come in thinking that diagnosis would pose far more challenge and mystery than it ultimately has (thankfully it has been replaced by the challenges of managing human beings with disease which are infinitely more difficult and challenging). I think if we're honest, the helped:hurt ratio with NPs practicing independently would be largely weighted toward the former. I think the number of truly meaningful missed diagnoses that would have been caught by an MD but are missed by the NP will be incredibly small.

2) PCPs miss a LOT of diagnoses already. This is not a knock against them -- I'm sure I miss plenty too -- but it comes with the territory. Seeing a lot of undifferentiated patients on the front lines of medicine lends itself to occasionally missing things that have yet to evolve to a clinically detectable level. They also see patients without the benefit of the specialty equipment that we have and have to go off the information they have available.

3) Bad things get worse. This is the big one that cemented it for me. Bad things will inevitably get worse. Sometimes you can't make a diagnosis because there is no diagnosis to be made yet, but rest assured that bad diseases will continue to progress along their natural course. With rare exception, these early misses are not usually clinically significant.

4) Specialists exist for a reason. There has been some literature suggesting that NPs refer more than MDs do. I'm unsure exactly how this will impact things over time, probably a combination of both good and worthless referrals coming to specialists' offices. That said, it provides another route by which an NP can get a patient evaluated when they have reached the limit of their own knowledge and experience.

5) Patients already do a lot of self referring. These tend to be pretty worthless referrals overall unless they are self referring for a second opinion after seeing another specialist, but it again provides a way to get care for patients who feel they aren't being cared for appropriately.

6) The rise of online specialty consult services and machine learning products. Online specialty consult services like Rubicon are already offering subscription-based e-consults for PCPs. Machine learning based products are surely on the horizon offering natural language recognition and able to integrate all the available clinical data and suggest diagnoses and guide treatment plans.

I've actually had different perspectives on points 2 and 3. Yes, PCPs miss things, and yes bad things get worse. But when things are already worse PCPs rarely miss them. I've seen NPs make some pretty huge mistakes that were so obvious they would have potentially killed their patient had a physician not been supervising. I've also seen NPs with a clinical foundation so lacking it boggled my mind even as a 3rd year medical student (having someone ask me "Do you think this is impetigo" on 3 separate patients in one day, then do the same thing the following week). I've encountered quite a few NPs who were great, but also far too many who were completely inadequate to be seeing patients and making decisions with supervision, nevermind working independently. I feel like my experience has also been somewhat ironic in the way that most of the NPs I'd feel comfortable giving more clinical freedom to were the ones who did not want it. While those seeking to practice independently were the last people I'd ever trust to be on their own.

I feel point 6 is also farther off and easier said than done. Especially if those providers on the front line don't know when a case is serious enough to actually refer out to a specialist, which I think is often the case with NPs. Specialists want to handle things in their field, not every basic thing that comes through the door and act as a babysitter.

 

[IslandStyle808]

It's not really that simple unless you're doing cash only fee-for-service. Contracts with insurance companies as to how much will be reimbursed for various codes are worked out and insurance companies will just bail if the charges are too high, especially in areas with low population densities. So while they can charge more than in other areas where there is a greater provider density, they can't just charge whatever they want.

I know a psychiatrist who works in my hometown (rather rural area). She charges cash, but the insurance companies reimburse patients what the insurance company is willing to pay. It was surprising to hear it can work this way also.

 

[Stagg737]

I know a psychiatrist who works in my hometown (rather rural area). She charges cash, but the insurance companies reimburse patients what the insurance company is willing to pay. It was surprising to hear it can work this way also.

That's interesting, I'm assuming the patients have to submit the charges/bill themselves and are basically applying for reimbursement with each visit? If that's what's happening I've heard of that before, but it's really difficult to get the insurance companies to actually reimburse anything. Either way, the insurance company isn't just going to pay whatever price the physician/NP/whoever wants to charge, they reimburse what they would normally pay for whatever codes are being billed for and the patient picks up the difference. Either way, the provider doesn't just set whatever price they want and then they get reimbursed by insurance, insurance still gets the final say.

 

[giantswing]

As for the NP thing, the further I get into training, the more I see a number of NPs who are a LOT better clinicians than many MDs and who I would much prefer by my side when s—t goes down.

Based on the consult I've gotten, I'd say the complete opposite. Some are VERY good in settings they have been in for along time - say working on the floor in one specialty, yes, they will get very good at what they do. But take an NP and put them in a setting where they have to work through clinical reasoning with less medical background - like the ED; they struggle. Totally different.

 

[Psai]

The apple cider vinegar is just good old fashioned pseudo science, a favorite of chiropractors and naturopaths and the like. To my knowledge, it’s never been subject to any adequate study and the entire concept makes no sense either. That said, arguably the best reflux treatment we often forget about given the ubiquity of PPIs is lifestyle modification, weight loss, treatment of underlying sleep apnea, etc.

As for the NP thing, the further I get into training, the more I see a number of NPs who are a LOT better clinicians than many MDs and who I would much prefer by my side when s—t goes down. I know that’s somewhat anathemous to say, but it’s true. Obviously there are others who are absolutely abysmal. Same goes for MDs of course, but there are far more hurdles to weed out terrible doctors than there are to weed out NPs. My sense is that less desirable places will pull less desirable NPs the same way they get less desirable MDs. If you hit up a minute clinic in some backwater town, your NP experience will be vastly different than in a major center which cherry picked its staff.

Malpractice probably won’t be much of an issue for independent NPs. Remember that “standard of care” is based on what other clinicians with similar training background and experience would do. If they miss an occasional tough diagnosis or mismanage a more nuanced condition, I think a plaintiffs attorney would have a hard time showing that most nurses would have done better. This is the same legal standard, for example, that protects many MDs who offer cosmetic surgical procedures despite absolutely no formal training to do so.

Going forward, I think the best thing for patients is advocating that independent advanced practice nurses be required to undergo some sort of basic competency exams akin to the usmle and a minimum number of years in supervised practice either under an MD or a qualified NP. They should also be subject to comparable CME requirements.

Can I get the number of those people because NPs that know what they're doing are in short supply here.

 

[SunsFun]

Nurses to the Rescue! - Freakonomics

Probably the most one-sided episode that I've heard. Some of the more anti-NP posters here beware.

 

[68PGunner]

NPs are fantastic. When I come in for a visit, they actually listen to me and try to holistically help me unlike those pill pusher MDs.

 

[AnatomyGrey12]

NPs are fantastic. When I come in for a visit, they actually listen to me and try to holistically help me unlike those pill pusher MDs.

Bruh, clearly you haven’t seen a bone wizard yet. Talk about monopoly on holistic-ness, it even says it on our pamphlets so you know it’s legit

 

[Man o War]

Can I get the number of those people because NPs that know what they're doing are in short supply here.

Same. My experiences with them have not been good at all.

 

[operaman]

Can I get the number of those people because NPs that know what they're doing are in short supply here.

No way man, I don’t want anyone stealing the good ones away!

There certainly are some bad ones out there and no doubt we’ve all run into them before too.

There was another comment about the inability to drop them into unfamiliar practice settings, that they can only do well that which they have done previously. I have to agree with this wholeheartedly, but also find the same true of physicians. If you dropped me into the ED I would certainly struggle for awhile and make some boneheaded consults as well. I get some occasional bad consults from both NPs and MDs in the ED, but overall those tend to be the exception. If I’m totally honest, the worst have definitely come from fellow MD trainees.

I have certainly come across some NPs who dramatically overestimate their own abilities. Perhaps the most stunning in my work have been RTs who feel way more comfortable with some airways than they should. Or MDs who have never put a knife on a neck talk nonchalantly about maybe having to crike someone. We’ve all seen that famous graph about learning where we all hit this danger period where our confidence far outstrips our actual knowledge (hello October of intern year), and we’ve all been there and encountered others who are currently there.

You know, I wonder if part of the issue with NPs stems from the same innate human trait that belies much discrimination, namely our tendency to lump together all people who are unlike us. The classic example is someone who is a different age or age or gender who cuts you off in traffic; our innate reaction tends to be “wow those people are terrible drivers!” If the same comes from someone just like us, it’s more “that dude is a terrible driver!” Perhaps something similar is happening with NPs where we apply the faults of a few to the whole profession while we limit similar criticism of fellow MDs to the individuals.

 

[Psai]

No way man, I don’t want anyone stealing the good ones away!

There certainly are some bad ones out there and no doubt we’ve all run into them before too.

There was another comment about the inability to drop them into unfamiliar practice settings, that they can only do well that which they have done previously. I have to agree with this wholeheartedly, but also find the same true of physicians. If you dropped me into the ED I would certainly struggle for awhile and make some boneheaded consults as well. I get some occasional bad consults from both NPs and MDs in the ED, but overall those tend to be the exception. If I’m totally honest, the worst have definitely come from fellow MD trainees.

I have certainly come across some NPs who dramatically overestimate their own abilities. Perhaps the most stunning in my work have been RTs who feel way more comfortable with some airways than they should. Or MDs who have never put a knife on a neck talk nonchalantly about maybe having to crike someone. We’ve all seen that famous graph about learning where we all hit this danger period where our confidence far outstrips our actual knowledge (hello October of intern year), and we’ve all been there and encountered others who are currently there.

You know, I wonder if part of the issue with NPs stems from the same innate human trait that belies much discrimination, namely our tendency to lump together all people who are unlike us. The classic example is someone who is a different age or age or gender who cuts you off in traffic; our innate reaction tends to be “wow those people are terrible drivers!” If the same comes from someone just like us, it’s more “that dude is a terrible driver!” Perhaps something similar is happening with NPs where we apply the faults of a few to the whole profession while we limit similar criticism of fellow MDs to the individuals.

Doubt it because i love the pas i work with. Haven't had much issue with any of them. They introduce themselves as "pa" last name, never put in airs, don't try to steal good patients, very patient and helpful. Some of them are annoying as students but never had any major issues with them. There's just not much inferiority complex like there is for so many nps.

 

[begoood95]

Doubt it because i love the pas i work with. Haven't had much issue with any of them. They introduce themselves as "pa" last name, never put in airs, don't try to steal good patients, very patient and helpful. Some of them are annoying as students but never had any major issues with them. There's just not much inferiority complex like there is for so many nps.

I'm still pre-med so take this with a grain of salt, but from my experience, all of my friends who decided to eschew the MD route and go PA seem to know what they're getting into, and go into it with an explicit purpose which is served by becoming a PA. (i.e., lifestyle, flexibility, etc.)

I've had less experience with NPs, but a couple of my high-school/college friends went that route, and their personalities are just...different. Perhaps much more prone to that inferiority complex than are PAs. Less humility. PAs might also be in a sweet spot of autonomy, whereas nurses (in popular opinion, usually) are simply "doctors' aids" with little real working medical knowledge; funny, though, because PA is literally physician's assistant.

Of course, these are sweeping generalizations, but just my two cents.

 

[jhamaican]

They want it both ways:

autonomy and the money that comes with it.

But when something goes bad, where is the doctor!?!, I am not a doctor!

 

[operaman]

Doubt it because i love the pas i work with. Haven't had much issue with any of them. They introduce themselves as "pa" last name, never put in airs, don't try to steal good patients, very patient and helpful. Some of them are annoying as students but never had any major issues with them. There's just not much inferiority complex like there is for so many nps.

Hmm you raise an interesting point here. The big underlying difference I see is that PAs enter the healthcare field in their given role while NPs typically do a stint as bedside RNs first. I wonder if the interaction with MDs in their role as bedside nurses colors their perceptions and interactions later. It's changing now, but there remain a number of physicians who cop quite a 'tude with nurses. I could see enough of these bad interactions creating some baggage that would get carried into an advanced practice position.