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I have to agree with the populace on this one. This is just downright scary. Residencies? Wow, that is just unbelievable.
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NPs can now do dermatology residencies
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deleted307836
Well, that's kind of my point. All I'm saying is that I don't think it's fair to make judgments about a person's intelligence based on his or her profession, just as it's unfair to make judgments about a person's intelligence based on his or her race -- despite statistical differences.
I wouldn't dispute this. If my introductory psych professor was correct, the difference is 119 vs 128, though this was an old statistic.
Agreed...
I have. Perhaps my issue is with semantics ("knowledge base" vs "intelligence"), but just wanted to point it out.
You CAN make conclusions about IQ differences based on intellectual demands of different professions.
You might want to REALLY read through the thread. I've had this argument before repeatedly.
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I feel the need...the need for another anecdote 😀
This was on my Ortho elective- Ortho elective for me= really cool + chance to hang out with the hubby at work.
So we had this 21-yr old red-headed male patient who was returning for the third case of a long bone (femur) fracture in 2 years.
The Ortho resident on call and I take a look at his x-rays and the rather astute resident notes one finding, immediately drops the films, immediately walks back into the patient's room and conducts a...
VISUAL FIELDS EXAM.
This is the difference between a nurse and a physician.
A timely diagnosis or the diagnosis of an otherwise unsuspected condition, as is less likely to be the case with undertrained "professionals", can be the difference between life and death for a patient if his primary caregiver HAS the full knowledge database available at a moment's call (ie physician), and the intellect to connect the dots where no correlation between presenting symptoms/signs seems to exist.
Following the VF test, he conducts a full physical, including examination of the patient's genitalia.
He then orders a- get this- Head CT, while I begin insertion of Steinmann pins at the proximal tibia.
This was on my Ortho elective- Ortho elective for me= really cool + chance to hang out with the hubby at work.
So we had this 21-yr old red-headed male patient who was returning for the third case of a long bone (femur) fracture in 2 years.
The Ortho resident on call and I take a look at his x-rays and the rather astute resident notes one finding, immediately drops the films, immediately walks back into the patient's room and conducts a...
VISUAL FIELDS EXAM.
This is the difference between a nurse and a physician.
A timely diagnosis or the diagnosis of an otherwise unsuspected condition, as is less likely to be the case with undertrained "professionals", can be the difference between life and death for a patient if his primary caregiver HAS the full knowledge database available at a moment's call (ie physician), and the intellect to connect the dots where no correlation between presenting symptoms/signs seems to exist.
Following the VF test, he conducts a full physical, including examination of the patient's genitalia.
He then orders a- get this- Head CT, while I begin insertion of Steinmann pins at the proximal tibia.
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deleted307836
Really, I have -- and if you are referring to the post you made where you listed all of the requirements to become a licensed, board-certified physician, then I guess I would have to agree with whoever gave you the work ethic/humility diatribe.
And I guess I'm basing this on my own experiences -- I don't think I have a particularly high IQ, especially in the subset of the medical field, although I've been able to compensate well through EXTREME effort -- enough effort to be able to learn how to get A's in science and math classes that were once horribly difficult for me and enough to score in the top couple percentiles of college entrance exams after not doing as well as I hoped initially. Even skills such as critical/associative thinking can be developed through hard work and sustained effort, even if these things may come more naturally to those of a higher IQ.
Eta, based on your academic pedigree and past posts, I would conjecture that you are part of the most desirable of medical students and physicians -- those with both a very high IQ and an equally high work ethic. For many, though, an incredible work ethic is enough to compensate for perhaps an initial "deficit" in IQ. And I guess that's why I'm against the labeling of a person's (potential) abilities on the basis of their profession alone.
I will never argue with your experience.
I do respect your willingness to state your arguments logically, even if we differ. And I do respect your unique perspective on this. In many ways, I agree with all your points.
And I certainly agree that critical thinking skills can be honed through "...hard work and sustained effort". Interestingly, this is the premise of a new book by Richard Nisbett, "Intelligence and How to Get It". Funny name but sound arguments. He challenges all the assumptions about innate intelligence that we've been led to believe by reporting on findings that:
i. It has far more (>90%) to do with culture and environment than heritage
ii. People's IQ scores can increase (or decrease) even in adulthood depending on the nature of their work and environment.
iii. Schools and parenting styles account for much, much, much more than genes.
Great comeback. And more so than IQ, I value a superior work ethic and really believe this is far more indispensable in our profession.
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you keep harping on this, but I feel it represents a logical error.
all physicians have intelligence and a reasonably high IQ - likely true.
but NOT all persons with intelligence and a reasonably high IQ are physicians.
the second statement allows for NPs and other healthcare providers to be just as intelligent as physicians. As medically knowledgeable and experienced, no, but intelligent, yes.
also, we should not hang our hats on less than half the NPs passing a watered down version of step 3. For one thing, it was the first iteration of the test for them and as such they would have less of an idea as to how to best prepare compared to the years of data we have on the actual step exams. First aid was compiled based on test takers telling the authors flatly what was on the test. A resource like that is not available yet for the NP "board exam"
NPs should not be allowed to take step-like exams...given time and the right resources, they can pass them if they want. you don't have to be an intellectual superstar to get a passing 180 on step 1 or 2
Ladies and gentlemen, we appear to have stumbled upon some variation of hemi-neglect.
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deleted307836
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Some of you crack me up -- USMLE, USMLE -- for ****'s sakes, folks, I took Step 3 cold, out of the blue and hungover... Step 2 was very, very similar (OK, it was warm outside). Point is, no prep time for either. Granting such a low bar for qualification is just asking for trouble...
Here's a thought -- for anyone who so desires to hang out the dermatology shingle -- take the derm boards. Then we'll talk -- until then (and I love using this):
STFU and/or GTFO. 😀
Here's a thought -- for anyone who so desires to hang out the dermatology shingle -- take the derm boards. Then we'll talk -- until then (and I love using this):
STFU and/or GTFO. 😀
Unless... nah, that could not be it. Surely this is about what is best for the people, right? Lowered costs and all? Surely this is not in the least bit politically oriented -- where NPs/DNPs/OUD,FIOU,SDFLIJKR,STFU - GTFO - LJELJR:JKRELJKREs are being used as pawns merely to dilute or otherwise diminish a potential adversaries' positioning or power?
http://video.foxnews.com/v/4161870/the-nurse-will-see-you-now
Reporter: "If you see a nurse practitioner do you pay less than when you see the doctor?"
NP: "You don't pay less. You're paying for a service."
awkward silence ensues
Reporter: "OK..."
NP: "I think what you want to know is the cost-effective factor. The cost-effectiveness of NPs is across the board from the ability of the NP to manage the chronic diseases well...BLAH BLAH BLAH BS BS BS"
😡
And here I am naively thinking that a medical bill is determined in part by the level of expertise backing whatever service a patient receives. How does implanting an inadequately trained middle man who charges the same rate and will refer out more frequently (an increased cost in and of itself) help save money? The only people saving money are the NPs themselves; no doubt thanks to their cheaper and shorter training.
Reporter: "If you see a nurse practitioner do you pay less than when you see the doctor?"
NP: "You don't pay less. You're paying for a service."
awkward silence ensues
Reporter: "OK..."
NP: "I think what you want to know is the cost-effective factor. The cost-effectiveness of NPs is across the board from the ability of the NP to manage the chronic diseases well...BLAH BLAH BLAH BS BS BS"
😡
And here I am naively thinking that a medical bill is determined in part by the level of expertise backing whatever service a patient receives. How does implanting an inadequately trained middle man who charges the same rate and will refer out more frequently (an increased cost in and of itself) help save money? The only people saving money are the NPs themselves; no doubt thanks to their cheaper and shorter training.
I do not usually post on here, because it is, after all, a physician's forum. But I just want to mention, that I am glad to see discussions on the scope and practice of NPs. (I am in NP school, and no disrespect to current/future NPs)-- but, how can you be cost effective when you are getting equal reimbursement? I mean, as an RN, I can do all the same tasks as a CNA, yet we don't pay CNAs the same as RNs-- if we did, then why not just have RNs instead of CNAs? NPs can and should work in collaboration with a physician-- say, 2 physicians with 4 NPs in a practice, ect. THAT'S HOW YOU CAN/WOULD SAVE MONEY!!!
Just for the record, I have contacted my BON. I was told that NPs need more specialization because there is a need for primary care. As an anecdote, I live in one of these "rural" areas. There is a practice of two NPs who have a "terrible time keeping supervising physicians on board". So they are pursuing independent practice in my state. Yet, down the street, there are three, 4+ physician family practices (who employ PAs and NPs). (I get that there are probably some areas in the country where there is next to no PCPs. I really am not trying to flame throw, I just do not exactly agree that that can justify independent practice across the board).
I thought this might help with some of the specifics... (btw, this is from 2007, but it is the most recent document I can find).
http://www.acnpweb.org/files/public/UCSF_Chart_2007.pdf
The cost-effective component would (in theory) come from the savings generated by fewer acute care visits/hospitalizations for people whose chronic diseases are being appropriately managed. So the NPs would compare themselves to having no medical care. And they probably look good compared to not receiving healthcare of any type. The problem of course is that there is a lack of providers in rural areas for a reason, and unless NPs can only practice independently in underserved (ie no available physician) areas, then the same forces that concentrate doctors into suburban/urban areas will have the same effect on independently practicing NPs.
And as multiple prior posters have pointed out, there can be no health savings by paying equivalent rates to someone who is less efficient and charges the same as their available competition.
And as multiple prior posters have pointed out, there can be no health savings by paying equivalent rates to someone who is less efficient and charges the same as their available competition.
that was the best part of the interview, it lets you see that they are not after reducing healthcost but after the name/money etc.
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let's all wake up and smell the coffee....the bottom line is......why don't we increase the number of residency slots and let MD's and DO's fill in the gap as they are supposed to??!!! There are MD's all over the world impatiently waiting to become physicians in the USA who are already done w/ their USMLE's and ECFMG certified, and one of them is me! Medicare funding for another 1.5 billion $ is not going to hurt anyone's finances but by a little less than a dollar per taxpayer as I calculated in a prior thread. (http://forums.studentdoctor.net/showthread.php?t=711429). That way we can maintain standard of care. Sure DNP's NPs PA's and RNs can work with a doc to help them run their practice, but practice alone? they might as well go to med school if they want to do a daunting task like that. With their knowledge not at par as a medical school graduate, they'll just be pawns for making referrals to actual physicians. e.g. NP :"dear anesthesiologist, please evaluate this left foot pain". anesthesiologist "wow that's radiculopathy"... I mean can they fully manage a diabetic? or someone with hypertension? exactly like a physician? or is it of lesser quality with pure referrals to other physicians? What exactly do they do? I don't even know their scope of practice. Maybe it is high time a physician knows their scope of practice so they can be able to know what an NP can and can't handle on their own and when to take over care, etc., since they are already into play at this moment in time.
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Funny, neither do they 🙄
I can't believe it but I joined the AMA tonight.
Not that I agree with the vast majority of their positions, but I am determined to get involved or at least contribute to the scope-of-practice review committees their PAC attorneys are brewing to define and defend the practice of medicine.
With my oodles of free time this should be no problem heh
let's all wake up and smell the coffee....the bottom line is......why don't we increase the number of residency slots and let MD's and DO's fill in the gap as they are supposed to??!!! There are MD's all over the world impatiently waiting to become physicians in the USA who are already done w/ their USMLE's and ECFMG certified, and one of them is me! Medicare funding for another 1.5 billion $ is not going to hurt anyone's finances but by a little less than a dollar per taxpayer as I calculated in a prior thread. (http://forums.studentdoctor.net/showthread.php?t=711429). That way we can maintain standard of care. Sure DNP's NPs PA's and RNs can work with a doc to help them run their practice, but practice alone? they might as well go to med school if they want to do a daunting task like that. With their knowledge not at par as a medical school graduate, they'll just be pawns for making referrals to actual physicians. e.g. NP :"dear anesthesiologist, please evaluate this left foot pain". anesthesiologist "wow that's radiculopathy"... I mean can they fully manage a diabetic? or someone with hypertension? exactly like a physician? or is it of lesser quality with pure referrals to other physicians? What exactly do they do? I don't even know their scope of practice. Maybe it is high time a physician knows their scope of practice so they can be able to know what an NP can and can't handle on their own and when to take over care, etc., since they are already into play at this moment in time.
Opening up residency spots willy-nilly will likely lead to the situation pathologists are currently facing...but in every specialty.
Would you be willing to expand upon that point? I don't know what is up with path right now. Sounds interesting, though.
The path job market sucks. <- understatement
Older pathologists aren't retiring, leaving few jobs for young grads. My friend, who graduated from a top academic program, couldn't find a job for about a year.
we shouldn't do that for specialties like that and only specialties in need such as primary care (FP, IM, etc). it should be planned to make everything better, not worse. If we don't do stuff like that then NP's will take our place, call themselves doctor, and standard of care will decline. Plus the patient population is expected to boom, because the baby boomers are getting older, which will compensate for the increase in doctors. Supposedly there is a shortage, so why not fill it? I think that eventually there will be a need for pathologists too as the number of hospitals may increase to take care of the population boom.
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I just rejoined the AMA about a month ago after a few years, so you're not alone. I also disagree with some of what they are doing such as creating more visas, which creates neglect for US citizen IMG's, but we all deserve to be heard. Maybe we should start up a few 'riots'. I hate my free time..it's so boring...might as well do something productive with it and change the world.
I agree, there IS no end in sight. All of us are too busy doing residencies or taking care of patients to go and put everything on the line - and go march on the capital. This is why pretty much every single other profession has more lobbying power than us - because they ACTUALLY go and lobby rather than writing about it on studentdoctor.net.
I think it'd be hard for a 1000 long white coats to be ignored if they were to descend onto their State Representatives office. Not going to happen though...
The Germans did it. People died because the doctors got so pissed off that they rioted.
I heart Germans. They understand a few things about principle and having a friggin' spine.
Over here, we have WAY TOO MANY pansies in medicine. My med school was flooded with them. Me and a few other- a tiny handful- were castigated as Nazis for not supporting Universal/Socialist healthcare.
Every other lecture we got was by a friggin' liberal wearing a "Support Universal Healthcare" pin and interjecting his political philosophy into his lectures. Its a wonder I graduated without being brain washed.
Over here, we have WAY TOO MANY pansies in medicine. My med school was flooded with them. Me and a few other- a tiny handful- were castigated as Nazis for not supporting Universal/Socialist healthcare.
Every other lecture we got was by a friggin' liberal wearing a "Support Universal Healthcare" pin and interjecting his political philosophy into his lectures. Its a wonder I graduated without being brain washed.
Ze Germanz? ... wait for it ...
HAHA, I know.
^ oh geez, I got so scared, I forgot how to count
I don't get it. 🙁
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If Godwin's law is right, and by golly it usually is, there is a deluge of Nazi references and comparisons coming from the left. Especially since the German physicians' riot has been brought up as an example of adherence to principle.
Eww, that's gross. I guess those guys are pretty isolated in academic medicine though.
Disclaimer: I am an MS-1, not a resident, but I just wanted to point out that this video is linked directly on the AANP home page. THEY EITHER DON'T NOTICE OR DON'T CARE ABOUT THE IRONY IN THIS VIDEO.
www.aanp.org
Also, check out their position paper on the term "mid-level provider" here.
http://www.aanp.org/AANPCMS2/Publications/PositionStatementsPapers/
They do not want to be lumped in with less-trained health professionals, but don't mind at all being equated with more-trained doctors, via the term "primary care provider", or "independently licensed professional."
Please do something, you who are going to be professionals soon, or already are. I am planning to see if our AMA-MSS can introduce anything via our delegate, we are only the MSS.
You're right, it's gone. I wonder why..i guess usf took down the video. lol, i think some of u are to thank for that
Here is the transcript of the video for those who missed out:
Out of curiosity, I know the Derm program director at USF was emailed by a bunch of people from here. Did he/she ever respond? I would be super interested to see what they have to say about all of this.
I believe academic medicine (and all of academia, for that matter) falls pretty far left on the political spectrum.
Eta said:
I thought we were referencing Snatch. 🙁
http://www.youtube.com/watch?v=ru2uixqA7Fk
A little bit of hope in the Anesthesiology forum:
I hope all attendings/residents will use this as a template for how to respond to some of these "incidences" in their hospitals of nurses using the term doctor in the clinical setting
http://forums.studentdoctor.net/showthread.php?t=722781
I hope all attendings/residents will use this as a template for how to respond to some of these "incidences" in their hospitals of nurses using the term doctor in the clinical setting
http://forums.studentdoctor.net/showthread.php?t=722781
Hello, I'm visiting from the pharm boards here. My interest is health policy, and have been following this issue for some time. I've read the whole thread. I understand the concern, but I think some people are missing the point.
It's not about what YOU think, it's about what OTHER people think -- and about what their motivations are. (Other people, as in not other doctors or even nurses. As in legislators, who have the ultimate power here).
In a nutshell, here's what is going on. You guys are getting bad press. As in really, really bad press. Articles in major newspapers about how surgeons postpone Medicare patients surgery until the end of the day, so they are first in line to be bumped kind of bad press. Dermatological surgeon who only agreed to work at a hospital in MT because they offered him $1M/year kind of bad press. Class warfare kind of bad press. Not good for you guys at all, because quite a few people "below" you economically resent you for your success. You are perceived to make a lot of money, be arrogant, and be willingly creating a medical school and residency shortage in order to pad your salaries. (Maybe it's reality, maybe it's not - but it's perception, and that is all that matters).
There are now 10s of millions of people in this country who have been told they have a right to healthcare in 2014. There are not very many of you, however - meaning a bottleneck - and you charge a lot of money for your services, which are already in short supply. Politicians are the decision-makers here, and this presents them with a huge problem. People under this legislation will have a hard time finding care because of both the cost problem and the bottleneck in services. This is why it is easy for legislators to look to allied health professionals to offload the extra work. If nurses, PAs, etc can treat the "horses" and keep them happy, then legislators are happy because pressure is off them. And people LIKE nurses and PAs - they don't have the same PR problem due to class envy that you do. They don't have the reputation of making a lot of money, so people think nurses/PAs are going into medicine for "the right reasons" -- that plays well to John Q Public.
This is your central problem, and it is why "they" are winning and you are losing - it's all about PR.
It's not about what YOU think, it's about what OTHER people think -- and about what their motivations are. (Other people, as in not other doctors or even nurses. As in legislators, who have the ultimate power here).
In a nutshell, here's what is going on. You guys are getting bad press. As in really, really bad press. Articles in major newspapers about how surgeons postpone Medicare patients surgery until the end of the day, so they are first in line to be bumped kind of bad press. Dermatological surgeon who only agreed to work at a hospital in MT because they offered him $1M/year kind of bad press. Class warfare kind of bad press. Not good for you guys at all, because quite a few people "below" you economically resent you for your success. You are perceived to make a lot of money, be arrogant, and be willingly creating a medical school and residency shortage in order to pad your salaries. (Maybe it's reality, maybe it's not - but it's perception, and that is all that matters).
There are now 10s of millions of people in this country who have been told they have a right to healthcare in 2014. There are not very many of you, however - meaning a bottleneck - and you charge a lot of money for your services, which are already in short supply. Politicians are the decision-makers here, and this presents them with a huge problem. People under this legislation will have a hard time finding care because of both the cost problem and the bottleneck in services. This is why it is easy for legislators to look to allied health professionals to offload the extra work. If nurses, PAs, etc can treat the "horses" and keep them happy, then legislators are happy because pressure is off them. And people LIKE nurses and PAs - they don't have the same PR problem due to class envy that you do. They don't have the reputation of making a lot of money, so people think nurses/PAs are going into medicine for "the right reasons" -- that plays well to John Q Public.
This is your central problem, and it is why "they" are winning and you are losing - it's all about PR.
Although I don't completely agree with this, I think Jet makes a valid point. Although physicians are highly respected and valued by society, we are also resented for our high salaries and our arrogance. This is the reason physician strikes are seen as so unethical by the public in comparison to nursing strikes. Unfortunately, I don't really think there's a way to change this perception of physicians.
However, I don't think the public perception is necessarily what's important for preventing midlevels from expanding their scope of practice. I also don't think that public perception of physicians will prevent us from getting the legislators on our side. What we need is to do a better job lobbying for ourselves in political circles. Look at lawyers- they are one of the most negatively perceived groups in the country, but their powerful political lobbying keeps politicians on their side.
However, I don't think the public perception is necessarily what's important for preventing midlevels from expanding their scope of practice. I also don't think that public perception of physicians will prevent us from getting the legislators on our side. What we need is to do a better job lobbying for ourselves in political circles. Look at lawyers- they are one of the most negatively perceived groups in the country, but their powerful political lobbying keeps politicians on their side.
Wow. I wonder if all of our lobbying is making a difference....
True - but aren't the vast majority of legislators lawyers themselves? They've got a bit of an inside advantage there that other professions lack.
What's up with the DNP Dermatology Residency program at USF?
http://health.usf.edu/nocms/nursing/...residency.html
The link for "Clinical Residency Concentrations" has been removed. Therefore, the dermatology residency section is gone (which included a welcome video and a pdf presentation). I don't have the video, but I have their pdf presentation archived. 😉
So what's going on with the program? If any of you can find out please let us know.. either post it here or you can private message me and I will post it on your behalf.
Is it possible that our seemingly insignificant voices were heard (1 email/phone call at a time)? We must follow up. Do not be lulled into apathy my friends, that's what they expect from us.
http://health.usf.edu/nocms/nursing/...residency.html
The link for "Clinical Residency Concentrations" has been removed. Therefore, the dermatology residency section is gone (which included a welcome video and a pdf presentation). I don't have the video, but I have their pdf presentation archived. 😉
So what's going on with the program? If any of you can find out please let us know.. either post it here or you can private message me and I will post it on your behalf.
Is it possible that our seemingly insignificant voices were heard (1 email/phone call at a time)? We must follow up. Do not be lulled into apathy my friends, that's what they expect from us.
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That and their massive campaign contributions.
When I was looking to see what happened to their webpage, I found this.
http://www.dermatologynursing.net/ceonline/2010/article12437448.pdf
http://www.dermatologynursing.net/ceonline/2010/article12437448.pdf
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I wonder why all the info about the derm residency program is gone. There's no way this means it's not happening, right? I bet they're just re-making the video, maybe to make it less misleading after all of the negative responses we've given them.
The correct answer. It's also amazing how powerful the ABA is in comparison to the AMA. It's night and day.
You're right and thanks for your perspective.
We have a lot to do in terms of educating the public. We are dealing with an impressionable, naive and gullible public who are easily swayed by appearances and charisma rather than substance. And you are right that we have failed to fill a deep void in the public's perception of our pivotal role in healthcare.
Case in point, in the video (see link) where a nurse posing as a physician, replete with costume, albeit lacking substance, intelligence or even eloquence (not that the public would notice those shortcomings) appeared on CNN with Ali Velshi touting the nurse practitioner quackery, there was no physician present to correct his distortions of the role of physicians vs the adjunctive and subsidiary role of nursing. NONE. Velshi even made a point of stating the he contacted the AMA to request that they send a representative- and none came!!!
When that sort of balderdash and negligence is allowed to take place, we only have ourselves to blame.
And shame on the AMA
Shame.
Shame.
Here was this nurse incoherently reciting talking points that he could not expound on nor logically discuss- and they was no counter position from a physician. We could have had him for lunch. I mean it would have been beyond easy to demonstrate this guy's idiocy. But where was the AMA? probably on another one night stand rendezvous at the local motel with Maobama and his henchmen.
We actually have to spoon feed the truth to this naive and gullible public- THE BUCK STOPS WITH YOUR MD/DO PHYSICIAN. And we have failed, thanks to the AMA, in this regard.
👎
LINK- ubiquitous on this forum so didn't post full video
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Look at an even smaller group-
Wall Street.
Negative public perception? double check.
Disastrous consequences for the economy on a national and international scale? Double check.
Powerful wall street lobby? Quintuple check
good ol' boys' club of classmates from Harvard in the house, senate and presidency? Hell yeah double check.
And so nothing gets done.
Here's an idea:
Maybe we should petition, but i dont know if it will help to send things to congress. This nurse doctor thing seems to be a state issue. We could find someone that could write it up really nicely and in a convincing manner.
Congress petition:
http://petition2congress.com/2/create/?gclid=CIKppPKYraECFUtX2god7nRoAQ
Generalized petition:
http://www.ipetitions.com/start-petition?q=GoogleSearch
I guess all individual hospitals need to start taking action on this, that may be the most powerful method.
We shouldn't wait for the AMA or any association to take action. Individuals in power can make a difference too.
Maybe we should petition, but i dont know if it will help to send things to congress. This nurse doctor thing seems to be a state issue. We could find someone that could write it up really nicely and in a convincing manner.
Congress petition:
http://petition2congress.com/2/create/?gclid=CIKppPKYraECFUtX2god7nRoAQ
Generalized petition:
http://www.ipetitions.com/start-petition?q=GoogleSearch
I guess all individual hospitals need to start taking action on this, that may be the most powerful method.
We shouldn't wait for the AMA or any association to take action. Individuals in power can make a difference too.
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