NPs approved for independent practice in Florida

[CidHighwind]

House approves independent practice for advanced nurses

The House passed its number one priority off the floor Friday. The bill allows advanced registered nurse practitioners to practice independently.

www.wjhg.com

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[IMGASMD]

F-Ing sad day.

 

[ace_inhibitor111]

So sad Cary Pigman, an EM physician of all people, pushed this bill for 7 years straight. Ultimate betrayal.

 

[deleted480308]

So sad Cary Pigman, an EM physician of all people, pushed this bill for 7 years straight. Ultimate betrayal.

I believe married to a nurse iirc

 

[Matthew9Thirtyfive]

I believe married to a nurse iirc

No excuse. I’m married to a nurse and I would never support this garbage.

 

[deleted480308]

No excuse. I’m married to a nurse and I would never support this garbage.

Not an excuse, just a potential point of bias

 

[Matthew9Thirtyfive]

Not an excuse, just a potential point of bias

Yeah. My wife never really fell into that whole line of thinking. She has seen NPs and PAs do awesome work in heme/onc but then be completely out of their depth in primary care, so she is more in favor of supervision.

 

[jw3600]

Not an excuse, just a potential point of bias

"potential"

 

[DexterMorganSK]

Sad to see a Physician supporting this.

 

[Rekt]

Sad to see a Physician supporting this.

All comes down to Money. Just like everything. Old EM physicians sold the profession to corporations initially because they got paid a ton. Same thing going on in derm. People want their piece and don't give a damn about the future. As long as they line their pockets.

Florida is already becoming difficult to find a physician job due to HCA starting residencies in nearly every specialty. This is only going to exacerbate the problem

 

[CidHighwind]

No excuse. I’m married to a nurse and I would never support this garbage.

Some men run their household, most don’t.

 

[Tastysalmon]

Y’all need to get off your pedistals tbh. I personally don’t see an issue with NPs doing primary care. No medical students (including myself) plan to go into primary care for many reasons. Let the NPs fill that need while we go into specialty care. As long as the NPs refer when necessary then what’s the issue?

 

[DO2015CA]

Y’all need to get off your pedistals tbh. I personally don’t see an issue with NPs doing primary care. No medical students (including myself) plan to go into primary care for many reasons. Let the NPs fill that need while we go into specialty care. As long as the NPs refer when necessary then what’s the issue?

lol because primary care it too much info to be done correctly without oversight. They are much better utilized in subspecialties where they can be taught a limited set of information and be effective

 

[Link0358]

Y’all need to get off your pedistals tbh. I personally don’t see an issue with NPs doing primary care. No medical students (including myself) plan to go into primary care for many reasons. Let the NPs fill that need while we go into specialty care. As long as the NPs refer when necessary then what’s the issue?

Except family medicine is the second most matched specialty, with internal medicine having the most matches.

Primary care is one of the most difficult fields to do well in because of how broad it is.

 

[Tastysalmon]

It’s better to have an NP do the job then no one... particularly in areas with limited access to healthcare. I’m not saying that NPs have the same level of education and knowledge MDs do, that’d be ridiculous. I’m saying they are better than nothing and should receive some respect. I think we’ve all worked with some NPs that were better than some MDs.. Also tbh NPs learn almost as much clinical medicine as medical students... they just don’t have the first 2 years filled with 75% esoteric stuff lol

 

[iforget2]

Y’all need to get off your pedistals tbh. I personally don’t see an issue with NPs doing primary care. No medical students (including myself) plan to go into primary care for many reasons. Let the NPs fill that need while we go into specialty care. As long as the NPs refer when necessary then what’s the issue?

Plenty of students, including myself, actually WANT to go into primary care.

 

[Tastysalmon]

This is an especially low IQ post. If you think NPs can do primary care well there is no reason they can't do emergency medicine, dermatology, psychiatry, hell even surgery.

Just because I don’t necessarily agree with your point of view doesn’t mean I have a low IQ. That’s a very childish thing to say

 

[Tastysalmon]

Plenty of students, including myself, actually WANT to go into primary care.

Awesome! I’m glad you do. I’m just saying in my experience very few do... and that’s backed up by the AMAs own numbers

 

[Link0358]

Awesome! I’m glad you do. I’m just saying in my experience very few do... and that’s backed up by the AMAs own numbers

Except the match data doesn’t show that.

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/03/Advance-Data-Tables-2019_WWW.pdf

 

[Tastysalmon]

Except the match data doesn’t show that.

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/03/Advance-Data-Tables-2019_WWW.pdf

New Findings Confirm Predictions on Physician Shortage

Even with any of this there will still be a HUGE shortage. So what’s all of your remedy? Since we can’t get enough MDs in primary care then these patients should get no primary at all???? We should use these mid level providers for what they know instead of disparaging them

 

[Surgeonvivor]

Also tbh NPs learn almost as much clinical medicine as medical students... they just don’t have the first 2 years filled with 75% esoteric stuff lol

Facepalm.

 

[Tastysalmon]

Except the match data doesn’t show that.

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/03/Advance-Data-Tables-2019_WWW.pdf

And basically everything fills lol I’m saying there aren’t enough spots to fill the need. Even with the IMGs filling the remaining residency spots

 

[DO2015CA]

It’s better to have an NP do the job then no one... particularly in areas with limited access to healthcare. I’m not saying that NPs have the same level of education and knowledge MDs do, that’d be ridiculous. I’m saying they are better than nothing and should receive some respect. I think we’ve all worked with some NPs that were better than some MDs.. Also tbh NPs learn almost as much clinical medicine as medical students... they just don’t have the first 2 years filled with 75% esoteric stuff lol

Your first two years gives you the ability to critically think. All that physiology will not be for not. That combined with residency is what will set you apart. Give it 2 months into intern year and you will realize how far above even 3rd and 4th year medical students are in knowledge base. They have the building blocks, just need to connect the dots together. Midlevels don’t have those blocks.

 

[DO2015CA]

@Tastysalmon how far along are you.

 

[Tastysalmon]

Facepalm.

lol it’s true. If you think med students learn practical medicine in M1-M2 I heavily disagree. We learn mostly minutaie for step 1.

 

[Tastysalmon]

@Tastysalmon how far along are you.

M3. Worked with mid levels and docs extensively before med

 

[DO2015CA]

It’s better to have an NP do the job then no one... particularly in areas with limited access to healthcare. I’m not saying that NPs have the same level of education and knowledge MDs do, that’d be ridiculous. I’m saying they are better than nothing and should receive some respect. I think we’ve all worked with some NPs that were better than some MDs.. Also tbh NPs learn almost as much clinical medicine as medical students... they just don’t have the first 2 years filled with 75% esoteric stuff lol

I would agree with you for the first part. that is why you would require NPs to show need in the county they are trying to practice solo in. The problem is they don’t want to practice there any more than doctors do.

 

[DO2015CA]

M3. Worked with mid levels and docs extensively before med

As did I. I was a scribe. I thought they were geniuses back then. It’s once you go back you’ll see how little they understand

 

[Tastysalmon]

Your first two years gives you the ability to critically think. All that physiology will be for not. That combined with residency is what will set you apart. Give it 2 months into intern year and you will realize how far above even 3rd and 4th year medical students are in knowledge base. They have the building blocks, just need to connect the dots together. Midlevels don’t have those blocks.

I’m not saying there equivalent. I’m saying they’re better than nothing. And also ranting about the complex that med students have a little lol but that’s secondary

 

[Link0358]

New Findings Confirm Predictions on Physician Shortage

Even with any of this there will still be a HUGE shortage. So what’s all of your remedy? Since we can’t get enough MDs in primary care then these patients should get no primary at all???? We should use these mid level providers for what they know instead of disparaging them

Now you are changing your original argument.

If mid-levels were only practicing in rural areas then I would agree with you. But they aren’t. They are using the physician shortage in rural areas as an excuse to get independence, and then they go and open up their own clinic in downtown Miami.

What we should be trying is opening up more residency spots and incentivizing doctors to work in rural areas, not lowering the standard of care.

 

[Tastysalmon]

As did I. I was a scribe. I thought they were geniuses back then. It’s once you go back you’ll see how little they understand

I would agree with you for the first part. that is why you would require NPs to show need in the county they are trying to practice solo in. The problem is they don’t want to practice there any more than doctors do.

Fair point. And I see what you’re saying. We should just figured out a way to spread out resources to best help patients.

Ranting on a message board about how docs are >>>> NPs and attacking those who disagree isn’t the way to do it. (This last statement isn’t directed at you )

 

[Tastysalmon]

Now you are changing your original argument.

If mid-levels were only practicing in rural areas then I would agree with you. But they aren’t. They are using the physician shortage in rural areas as an excuse to get independence, and then they go and open up their own clinic in downtown Miami.

What we should be trying is opening up more residency spots and incentivizing doctors to work in rural areas, not lowering the standard of care.

Allowing mid levels expanded access is a bandaid. What you’re saying is the solution, I agree. It would just take too long. These patients don’t have 10 or 15years to wait for new programs to open. And I also agree on your second point, this should be addressed as well.

Once training programs get around to training enough PCPs then this need won’t exist and mid levels won’t have a case? But as of now I see their case to an extent

 

[ace_inhibitor111]

Just because I don’t necessarily agree with your point of view doesn’t mean I have a low IQ. That’s a very childish thing to say

I'm not saying you're low IQ but your post definitely is, because you obviously didn't do a lot of thinking to get to it.

New Findings Confirm Predictions on Physician Shortage

Even with any of this there will still be a HUGE shortage. So what’s all of your remedy? Since we can’t get enough MDs in primary care then these patients should get no primary at all???? We should use these mid level providers for what they know instead of disparaging them

Have you bothered to look at the data the AAMC published and critically evaluate it? The estimated current "shortage" of physicians is 20,000 across the whole US including every rural area that barely has a hospital within 100 miles. There are currently 900,000 physicians in America. The purported shortage makes up less than 2% of the total of supply of physicians. Their estimates of "50,000 physician shortage OMG" assumes increased managed care. Do you understand what managed care is and how that will change demand for specialists?

Look at how many midlevels are graduating every year, especially low-quality ones. The government expects a surplus of 42,500 by 2025. Combine that with the fact that there is a >30% increase in the number of medical students in the past decade, with the majority going into primary care specialties. You are throwing your own colleagues and patients under the bus by allowing hospital administrators to essentially replace them with cheap labor and reduced quality of care.

 

[Splenda88]

It’s better to have an NP do the job then no one... particularly in areas with limited access to healthcare. I’m not saying that NPs have the same level of education and knowledge MDs do, that’d be ridiculous. I’m saying they are better than nothing and should receive some respect. I think we’ve all worked with some NPs that were better than some MDs.. Also tbh NPs learn almost as much clinical medicine as medical students... they just don’t have the first 2 years filled with 75% esoteric stuff lol

What?

 

[67552931811]

It’s better to have an NP do the job then no one... particularly in areas with limited access to healthcare. I’m not saying that NPs have the same level of education and knowledge MDs do, that’d be ridiculous. I’m saying they are better than nothing and should receive some respect. I think we’ve all worked with some NPs that were better than some MDs.. Also tbh NPs learn almost as much clinical medicine as medical students... they just don’t have the first 2 years filled with 75% esoteric stuff lol

I’ve literally never worked with a np that is even in the same stratosphere as the worst physician I have (and that is going back years of work before med school as well). I’d let any MS4 in this country see and treat me over a np

 

[PikminOC]

I would agree with you for the first part. that is why you would require NPs to show need in the county they are trying to practice solo in. The problem is they don’t want to practice there any more than doctors do.

Correct. If midlevels really want to work in underserved areas for "access to care" these bills should tie their practices to those areas.

 

[deleted480308]

I’m not saying there equivalent. I’m saying they’re better than nothing. And also ranting about the complex that med students have a little lol but that’s secondary

A supervised midlevel is better than nothing, independent is not

 

[libertyyne]

Awesome! I’m glad you do. I’m just saying in my experience very few do... and that’s backed up by the AMAs own numbers

Do you think that people would not want to go into to do a job where someone with a quarter of their training can claim equivalency?
There are many things that drive people away from fields this kind of stuff does not help, only makes it worse.

 

[seeinghowitgoes]

M3. Worked with mid levels and docs extensively before med

From shadowing before med school I also couldn’t tell a difference and honestly didn’t really care about this debate. I kind of felt the same way during medical school. As a resident the difference is ABUNDANTLY clear that there is a difference between many PA/NPs and even Interns (let alone attendings). If you don’t know what to look for you won’t be able to tell.

Whether the difference leads to outcomes being affected I don’t know. I’m a sure for Algorithmic, low risk decisions there is no difference in outcomes between provider types, but it’s hard to predict what somebody is going to need before they’re seen.

 

[FMDoge2020]

This is like the worst "Florida man" news since the drive-through alligator toss guy.

Sent from my SM-G965U using SDN mobile

 

[Ganon]

My frustration is that I am taught by the generation of physicians who have sold healthcare down the river for financial benefit.
We are expected to worship the ground the forebears walk on, all while silently acknowledging the fact that they abuse the system (including medical students) and have poisoned the pond.

I've had lecturers go as far as to outright tell the student body who to vote for.

Never have had someone ask me what I think they could be doing better to un**** the healthcare system/rebuild trust between American citizens and physicians. It's all ego and hubris, and lacks any sort of introspection. Everyone knows they destroyed the system, or at the VERY least did nothing while it was being broken, but they still think they deserve hero worship and to be the ones calling the shots. Frustrating.

 

[Mass Effect]

Y’all need to get off your pedistals tbh. I personally don’t see an issue with NPs doing primary care. No medical students (including myself) plan to go into primary care for many reasons. Let the NPs fill that need while we go into specialty care. As long as the NPs refer when necessary then what’s the issue?

Because many of them are totally clueless, that's the issue. You're a medical student, so maybe you haven't seen it but others of us have. When you see a patient on a combination of morphine, Adderall, and Xanax, at doses exceeding the FDA recommendation with ignorance on the part of the prescriber, maybe you'll change your mind.

 

[Epilepsy365]

The best NPs, aka those with 10+ years of exp, may be better than an intern in that selective field. But, the majority of NPs are worse than MS4s, even with the clinical decline from all the boozing and substance abuse.

 

[zero0]

@Tastysalmon how far along are you.

Based on how stupid his comments are, somewhere between high school and nursing school. Then again there are some pretty naive med students out there who fancy the grapey taste of midlevel brand kool-aid. Either way, don't feed.

 

[PikminOC]

A supervised midlevel is better than nothing, independent is not

"Supervision" is a very loose term.

 

[de Ribas]

Allowing NPs become independent will not help solve shortage of doctors in the rural areas. NPs will not go to rural areas anymore than physicians will. I don't see how independent NP will see more patients than if they worked under physician supervision. If NP and physician work in the same clinic, how does NP independence help them see more patients? It doesn't.

And no, NPs with 5, 10 or 20 years of experience will not have more knowledge than fresh graduate. Doing something for more time just makes you better and more confident in it and not necessarily with more knowledge. CNAs can work for 40 years in the hospital, it won't make them know more in terms of medical knowledge. They will know more how to get around the hospital, some in-house details, how to deal with patients and how to do their job properly. But they will be doing their own job repetitively for 40 years. How would they know more? Same thing with NPs. Just because they have 10-year experience doesn't mean they will somehow get that medical knowledge 4th year medical student has. All these 10 years they will be practicing the knowledge they got during their RN/NP education, which is not even close to physician education.

I seen my sister's curriculum when she was working on BSN after she got her RN license and then when she was in NP program. There is nothing in the program that qualifies her to see her own patients independently. Majority is just fluff courses like English, writing, research (more writing), etc. Plus she only had to do 500 clinical hours; again nursing clinical hours, not some physician teaching her.

For those who say that experienced RNs make better NPs. I don't see how this is true. If nurse with 10 years experience spent these 10 years working under direct supervision, training and teaching of a physician then maybe. Otherwise, that RN would only be doing same nursing job duties for 10 years. I don't see how it expands their knowledge to become better PCPs.