NPs can now do dermatology residencies

[motoo]

---

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http://www.msnbc.msn.com/id/36471226/

wow at this lady....I didn't pick rush as my number 1 for residency because I didn't get a good vibe about the dominance of nursing there (e.g. NPs training the residents), and I think I made a good choice.

so basically, NPs are "just like doctors without the pay." except they want to increase their pay to match ours. so ultimately you'll pay both doctors and NPs equally, but one has vastly more education and depth in medical training. who sounds like a better value then?

those of us in medical school or graduating are being served up a raw deal right now.....long training and debt only to be considered the same as someone who took a much easier route

best summed up by a 24 y/o RN I just met....he said he was considering going to do pre-med, but will now just become a CRNA. can't say I blame him really.

 

[JaggerPlate]

However, you cannot use that as the platform for your arguments. You will lose. Nobody, and I mean nobody, is going to shed a single tear for us greedy, overpaid doctors. You're going to need to argue your points from the standpoint of what's best for the public and for patients. It's also what the opposition will do, if they're smart. When they make some of the ridiculous statements that were quoted in the article, it doesn't help their case.

I completely agree, and I never argued otherwise. The only comment I made is that there is nothing wrong with telling the organizations who are supposed to protect doctor's interests (i.e. AMA) - 'protect doctor's interest.' With the general public though, you're right and I don't disagree at all.

I don't know about that. I've seen PA's close up a patient at the end of surgery, and I've seen NPs put in central lines and other quasi surgical procedures. I think it's a mistake to assume the encroachment will stop at primary care and derm. You have people in white coats calling themselves doctors, working cheap, and deciding on their own what they are competent to perform. It's foolish to shrug your shoulders and think you can find some subspecialty to retreat into.

Yup. It's asinine to assume they can't expand into surgery. I've probably heard this argument 10x during this situation. Don't assume.

 

[kdburton]

I don't know about that. I've seen PA's close up a patient at the end of surgery, and I've seen NPs put in central lines and other quasi surgical procedures. I think it's a mistake to assume the encroachment will stop at primary care and derm. You have people in white coats calling themselves doctors, working cheap, and deciding on their own what they are competent to perform. It's foolish to shrug your shoulders and think you can find some subspecialty to retreat into.

Closing up a incision and placing central lines are vastly different from doing a total hip replacement. I had plans to go into orthopaedic surgery prior to hearing anything about these doctor-nurses so I'm not not really retreating anywhere. I don't think its too foolish to assume they won't be encroaching on my [future] territory to any appreciable extent.

 

[kdburton]

BTW there will come a time when these doctor-nurses decide that they are competent to perform at certain levels when they really aren't and and since they are technically independent (unlike PAs) they will eventually run into some circumstances where they will be held responsible for malpractice due to their lack of experience. Insurance companies will stop reimbursing for things that they lack experience in because they don't want to pay out and ultimately they will be faced with the inability to get adequate malpractice insurance or they will have to pay out of their @ss to do so. The laws of supply and demand will kick in and the scope of their practice will ultimately be determined by their training/experience and the competency that resulted from it.

"Back in the day" many medical school graduates would do a 1 year internship, get their license and then open up a medical practice. This is obviously unsafe for patients (although its still technically legal). Fortunately insurance companies realized that they didn't want to make ridiculous settlements and go to court for these doctors who had very limited experience (yet it appears to be more experience than these doctor-nurses will have) and they stopped offering them reasonable coverage. Similarly you'd be hard-pressed to find a practice that would hire you as an independent physician unless you were board certified or board eligible for the same reasons. Thus the only people you realistically see doing these 1 year internships before full-time independent practice these days are the 'flight surgeons' and the like who do flight physicals on pilots all day. And this is more or less simply because the pilots need something signed off on

 

[Slack3r]

Also I wouldn't equate more education with better care. Better care can mean a lot of things to patients: healthy outcomes, the length of the visit, the friendliness of the provider, whether the provider sends a christmas card, and most importantly the costs. But like I said, I don't think DNP's will cost less which is great for the physician community.

Just because a patient THINKS they're getting better care doesn't mean they are. I can talk to my grandma with CHF all damn day, but I doubt many would argue I'm providing better care than a BC cardiologist. Someone said it best earlier in this thread "I'd rather be saved by a competent *****hole than killed by a compassionate fool".

I don't think they can do as well as physicians. I just think they should be given the opportunity to try and prove themselves. If you counter with, "well what about safety?" There is that famous statement from Jefferson about giving up liberties for safety...If I want my grandma to treat my lung cancer than that is my choice of freedom (albeit *****ic). It just seems very un-American (well not today's America) to deny them the chance. I just want the patients to decide. Example, I would never see anyone except a physician in whatever the specialty is. I would want the best of the best. That's just how I think. I have family members who think otherwise, they would have no problem TRYING OUT a NP, DNP, or PA for routine care. Switching later if needed.

Why should they be given the opportunity to try? They're training is less than 10% of what a physician goes through, why should we even give them this opportunity? Your justification of freedom is a bit hollow. I'd like to play for the Phoenix Suns, is it un-American they don't let me waltz onto the court and try it out?

 

[Law2Doc]

... I don't think its too foolish to assume they won't be encroaching on my [future] territory to any appreciable extent.

Yeah, it actually is. They are not held to the rules you are. If DNPs as a group think they are competent to do orthopedic surgery such as a TKA, THA etc, there's nothing really stopping them from creating another 1000 hour "residency" and letting their practitioners give it a shot. You or I might not attempt it because we see it as something you really should complete 6 years of residency before you feel competent to do, and we have enough training to know the multitude of complications involved. But there's really nothing stopping someone who doesn't have this mind set and feels like the only thing different between them and the MDs is the pay. Now in all fairness, they would probably start with the less complicated procedures first, and work their way up. But I don't see any reason to think you are particularly safe. If your field is lucrative, they will come. Thinking otherwise is foolish.

 

[JaggerPlate]

Yeah, it actually is. They are not held to the rules you are. If DNPs as a group think they are competent to do orthopedic surgery such as a TKA, THA etc, there's nothing really stopping them from creating another 1000 hour "residency" and letting their practitioners give it a shot. You or I might not attempt it because we see it as something you really should complete 6 years of residency before you feel competent to do, and we have enough training to know the multitude of complications involved. But there's really nothing stopping someone who doesn't have this mind set and feels like the only thing different between them and the MDs is the pay. Now in all fairness, they would probably start with the less complicated procedures first, and work their way up. But I don't see any reason to think you are particularly safe. If your field is lucrative, they will come. Thinking otherwise is foolish.

Again, I completely agree.

 

[motoo]

I don't blame the NPs for wanting to increase their scope. I would too if I were an NP, others (e.g. physicians) be damned.

the people to get angry at are the physicians who have in the past trained and continue to train these people. we know RNs can't teach other RNs how to practice medicine....only physicians can teach others how to practice medicine.

they should be considered traitors and shunned.

 

[Law2Doc]

...Fortunately insurance companies realized that they didn't want to make ridiculous settlements and go to court for these doctors who had very limited experience (yet it appears to be more experience than these doctor-nurses will have) and they stopped offering them reasonable coverage. ...

Well the problem with that is that once they go through that door, and they will in this day of projected healthcare rationing, they already will have the beachhead they need. If insurance companies wait until a big lawsuit, they will be functioning at a certain level and you cannot turn back the clock. Patients will see them as equivalent to doctors, they will have already established themselves as "doctors" in terms of the healthcare hierarchy. So at that point if an insurance company wants them to get some additional minimal level of training, or pass a certain test to qualify for a better insurance rate, they will do that. The goal here is really to stop them from getting to that beachhead. Because once they do, sure, they may have some additional hoops to jump through, but they are already on the beach, with their towel covering the spot of sand you had wanted.

 

[filter07]

I agree with Law2Doc. Even surgery is not safe from encroachment. Some might think that there's no way a mid-level can do surgery, and yes, there's no way you can turn a mid-level into a competent surgeon after just 1000 hours of a pseudo-doctorate, but they can go after each procedure and operation one at a time. Will we see Whipples or massive sarcoma resections? Probably not. But how about partial mastectomies, hernias, liposuction? Just a few more steps and you might conceive of a laparoscopic hernia repair, which is not too far from a laparoscopic cholecystectomy. Encroachment is the perfect description really. Since the educational commitment isn't as great, most won't have problems superspecializing in just hernias, or just toe amputations, or just port placements. If you think that is far fetched, just look at the Shouldice Institute, where the hernias are repaired by family practioners.

As an aside, academics seek the "ability" to superspecialize after getting PhDs, MPH, or MS in addition to MD. How's that for irony?

 

[tncekm]

Closing up a incision and placing central lines are vastly different from doing a total hip replacement. I had plans to go into orthopaedic surgery prior to hearing anything about these doctor-nurses so I'm not not really retreating anywhere. I don't think its too foolish to assume they won't be encroaching on my [future] territory to any appreciable extent.

Seriously, you're a *****. Anybody who thinks "it won't happen to me" is a *****, and there is no further explanation needed. You're watching it happen to everyone else, yet you somehow think you're immune. And, why? Well, true to the ortho gunner stereotype, you probably think you're somehow "special". Even more special than the rest of the medical doctors out there. Don't be a fool.

If people can half-ass medicine, they can half-ass surgeries. Monkey see, monkey do. And, if it's cheap, you can guarantee many people (politicians and bureaucrats) will look the other way when people start dying so long as it's an "acceptably small" number.

 

[Zap Rowsdower]

I don't really have anything more to add, so this is my last post on this topic.

No one should be entitled to anything. Life is risk, and medicine should be no different. Patients should have complete choice. They should be responsible for choosing their provider. For the 958574 time, I know we don't have a free market system. But I think physicians would be better off advocating a more free system then asking Big Brother for more regulation to protect their turf. I find this pathetic, asking government/med societies to regulate others based on "safety" concerns, when in reality it is just to maintain status quo for physicians. And if DNP's are more valued by patients in a free market system, then that is NEVER a problem.

We'll probably never go back to my idealistic views. But that doesn't mean I'll change my perspective or principles on this issue, just because some day I am going to be a physician. Good luck with everything, and talk to everyone on other forums.

 

[tncekm]

Well the problem with that is that once they go through that door, and they will in this day of projected healthcare rationing, they already will have the beachhead they need.

PRECISELY what people should be concerned about. The door was just thrown wide-open for nurses to accelerate their plans.

 

[Kashue]

This is exactly what got us in this mess in the first place - doctors bickering amongst each other. This is a time we need to band together and help each other out. If we were united like the nurses and had a stronger PAC, we wouldn't be talking about this. This is totally ridiculous.

 

[tncekm]

This is exactly what got us in this mess in the first place - doctors bickering amongst each other. This is a time we need to band together and help each other out. If we were united like the nurses and had a stronger PAC, we wouldn't be talking about this. This is totally ridiculous.

It wasn't the bickering, it was the apathy. Like, our future-surgeon friend who apathetically (and naively) states that nurses won't ever make their way to his piece of the pie.

 

[JaggerPlate]

I don't really have anything more to add, so this is my last post on this topic.

No one should be entitled to anything. Life is risk, and medicine should be no different. Patients should have complete choice. They should be responsible for choosing their provider. For the 958574 time, I know we don't have a free market system. But I think physicians would be better off advocating a more free system then asking Big Brother for more regulation to protect their turf. I find this pathetic, asking government/med societies to regulate others based on "safety" concerns, when in reality it is just to maintain status quo for physicians. And if DNP's are more valued by patients in a free market system, then that is NEVER a problem.

We'll probably never go back to my idealistic views. But that doesn't mean I'll change my perspective or principles on this issue, just because some day I am going to be a physician. Good luck with everything, and talk to everyone on other forums.

Eh, I know that you've checked out and I actually agree with a lot of what you say ... but I really don't equate organizations like the AMA, AAD, etc, to asking the government to step in a regulate like our helpful big brother. It's more of a for doctors by doctors sort of a thing, IMO.

 

[Rabbit Hole]

I don't really have anything more to add, so this is my last post on this topic.

Thank god. I was hoping you would shut the f*ck up because my finger started hurting from using the scroll wheel.



Thread: General Residency Issues
NPs can now do dermatology residencies

Thread: Dermatology
DNP Now have Residency in Dermatology



Download:
[Template submitted by JaggerPlate]

Download:
[Short template submitted by JaggerPlate]




Organizations to pol.i.tick

[URL="http://www.aad.org/"]American Academy of Dermatology (AAD)[/URL]
- [URL="http://www.aad.org/site/contact.html"]Contact[/URL]

[URL="http://www.aocd.org/"]American Osteopathic College of Dermatology (AOCD)[/URL]
- [URL="http://www.aocd.org/aboutus/contact.html"]Contact[/URL]

[URL="http://www.ama-assn.org/"]American Medical Association (AMA)[/URL]
- [URL="https://extapps.ama-assn.org/contactus/contactusMain.do"]Contact[/URL]

[URL="http://www.osteopathic.org/"]American Osteopathic Association (AOA)[/URL]
- [URL="http://www.osteopathic.org/index.cfm?PageID=con_consumermain"]Contact[/URL]

[URL="http://www.fmaonline.org/HomePage.aspx"]Florida Medical Association[/URL]
- [URL="http://www.fmaonline.org/Contact%20Home.aspx"]Contact[/URL]

[URL="http://www.doh.state.fl.us/"]Florida Board of Medicine[/URL]
- [URL="http://esetappsdoh.doh.state.fl.us/contactussearch/DOHContacts.aspx"]Contact[/URL][URL="http://www.doh.state.fl.us/mqa/"]
[/URL]


Additional Organizations to pol.i.tick [Email]

[URL="http://www.acmq.org/"]American College of Medical Quality[/URL]
- [URL="http://www.acmq.org/contact/index.cfm"]Contact[/URL]

[URL="http://www.fsdds.org/"]Florida Society of Dermatology & Dermatologic Surgery[/URL]

[URL="http://www.do-online.org/index.cfm"]DO-Online.org[/URL]
- [URL="http://www.do-online.org/index.cfm?PageID=con_main"]Contact[/URL]



Interesting websites related to this issue:

[URL="http://health.usf.edu/nocms/nursing/AdmissionsPrograms/dnp_concentrations_derm.html"]University of South Florida College of Nursing - Doctorate of Nursing Practice[/URL]

[URL="http://www.dnanurse.org/"]Dermatology Nurses' Association (DNA)[/URL]

[URL="http://www.dermatologynursing.net/ceonline/2010/article12437448.pdf"]The Development of a Standardized Dermatology Residency Program for the Clinical Doctorate in Advanced Nursing Practice[/URL] (Dermatology Nursing, Debra Shelby, December 2008) [11pgs]



[COLOR=Black][COLOR=DarkRed][I]Articles/documents/literature that were mentioned on this topic have been archived for reference. All material is public access and can otherwise be viewed by clicking on the links posted by members in the original threads. Individual files can be downloaded from this storage folder on the ifile.it website:[/I][/COLOR]

[B][URL="http://ifile.it/_bfmjqig/pol.i.tick.ing%20%5BNPs%20can%20now%20do%20dermatology%20residencies%5D"]pol.i.tick.ing reading material [NPs can now do dermatology residencies][/URL]
[/B][/COLOR][COLOR=DimGray][I]-Note: Non-PDF material not included-[/I][/COLOR]

 

[josephbanks]

Hello All

Please send email to the dermatology chair at USF and tell him what you think about their physicians training these NPs. Problem is these academic attendings who are established in their careers and could care less what they are doing to the rest of the profession.


nfenske @ health . usf . edu

Points to make
1. you think this makes their derm residency a very questionable program, and many other students/residents/faculty think so too.
2. you would never to go a residency that had this program educating NPs
3. you would never refer a patient to their center after hearing about this
4. you think it's inappropriate the NPs are calling it a "residency" and a "board certification."

 

[Arcan57]

Eh, I know that you've checked out and I actually agree with a lot of what you say ... but I really don't equate organizations like the AMA, AAD, etc, to asking the government to step in a regulate like our helpful big brother. It's more of a for doctors by doctors sort of a thing, IMO.

Asking government to step in and crush your enemies is one of the government's most time honored, well-supported functions. Everyone (except true conservatives which are kinda like the Easter Bunny or tooth fairy) can get behind it

 

[Rabbit Hole]

Support your PACs, folks.

👍

OpenSecrets.org - Center for Responsive Politics

OpenSecrets.org - Health Professionals Political Action Committee Contributions

 

[fab4fan]

This is exactly what got us in this mess in the first place - doctors bickering amongst each other. This is a time we need to band together and help each other out. If we were united like the nurses and had a stronger PAC, we wouldn't be talking about this. This is totally ridiculous.

If you think nurses are united, you're foolish. We make you guys look like beginners when it comes to bickering within a profession. We can't even agree on a standard entry-level for practice, for pity's sake.

 

[kdburton]

Seriously, you're a *****. Anybody who thinks "it won't happen to me" is a *****, and there is no further explanation needed. You're watching it happen to everyone else, yet you somehow think you're immune. And, why? Well, true to the ortho gunner stereotype, you probably think you're somehow "special". Even more special than the rest of the medical doctors out there. Don't be a fool.

If people can half-ass medicine, they can half-ass surgeries. Monkey see, monkey do. And, if it's cheap, you can guarantee many people (politicians and bureaucrats) will look the other way when people start dying so long as it's an "acceptably small" number.

Clearly don't have common sense. You think everyone is going to trust a nurse to do a major operation on them? I'm not talking about just orthopaedics. I'm talking about any specialty in which the potential for adverse outcome of a procedure is high or even if an adverse outcome it relatively rare if it were to happen it would be "high impact" as Dr Pestana puts it haha. I'm perfectly comfortable going to my schools' student health clinic and seeing a NURSE to get prescription for antibiotics and I would be comfortable having my blood pressure or diabetes managed by a nurse too if that was a problem I had. However if I needed CABG or an appendectomy I sure as hell wouldn't go to a nurse to have it done. Yeah, sure, there are doctors who can screw that up too, but I'd rather take my chances with a Dr. The thing is that these nurses are going to lobby to be equal (pay, scope of practice, etc) and even if they get what they want the public is still going to be faced with the question of: "Okay I need to have a major surgical operation - should I go have it done by a medical doctor or a nurse?" I will bet my life that when [if ever] these nurses are "equal" to doctors in the scope of their practice there is going to be a lot of information in the media making people aware of it. People already research different surgeons (all medical doctors) to see who has the best outcomes, so you can be damn sure that when they're going to want to know whether its a medical doctor or a nurse operating on them. Its not the fact that they can decide what they want to include in the scope of their practice that is going to allow them to do it, its whether or not they'd be able to have enough patients who are willing to allow someone with 1,000 hours of experience to operate on them. This is just the beginning of this whole doctor-nurse stuff and you're already seeing articles out there making people aware. People will know who is operating on them and if they don't care that its some 23 year old girl who scrubbed in on a few surgeries over the last 6 months then they deserve it haha. So go back to studying your microbiology of whatever FIRST YEAR stuff you're working on at this point.

 

[J1515]

Clearly don't have common sense. You think everyone is going to trust a nurse to do a major operation on them? I'm not talking about just orthopaedics. I'm talking about any specialty in which the potential for adverse outcome of a procedure is high or even if an adverse outcome it relatively rare if it were to happen it would be "high impact" as Dr Pestana puts it haha. I'm perfectly comfortable going to my schools' student health clinic and seeing a NURSE to get prescription for antibiotics and I would be comfortable having my blood pressure or diabetes managed by a nurse too if that was a problem I had. However if I needed CABG or an appendectomy I sure as hell wouldn't go to a nurse to have it done. Yeah, sure, there are doctors who can screw that up too, but I'd rather take my chances with a Dr. The thing is that these nurses are going to lobby to be equal (pay, scope of practice, etc) and even if they get what they want the public is still going to be faced with the question of: "Okay I need to have a major surgical operation - should I go have it done by a medical doctor or a nurse?" I will bet my life that when [if ever] these nurses are "equal" to doctors in the scope of their practice there is going to be a lot of information in the media making people aware of it. People already research different surgeons (all medical doctors) to see who has the best outcomes, so you can be damn sure that when they're going to want to know whether its a medical doctor or a nurse operating on them. This is just the beginning of this whole doctor-nurse stuff and you're already seeing articles out there making people aware. So go back to studying your microbiology of whatever FIRST YEAR stuff you're working on at this point.

You obviously haven't been paying attention. These nurses are going to call themselves "Dr. __________". They will call themselves board certified (by the nursing board of course). The general public won't know the difference.

People already research different surgeons (all medical doctors) to see who has the best outcomes,

No they don't. The majority does not.

 

[Rabbit Hole]

Clearly don't have common sense. You think everyone is going to trust a nurse to do a major operation on them? I'm not talking about just orthopaedics. I'm talking about any specialty in which the potential for adverse outcome of a procedure is high or even if an adverse outcome it relatively rare if it were to happen it would be "high impact" as Dr Pestana puts it haha. I'm perfectly comfortable going to my schools' student health clinic and seeing a NURSE to get prescription for antibiotics and I would be comfortable having my blood pressure or diabetes managed by a nurse too if that was a problem I had. However if I needed CABG or an appendectomy I sure as hell wouldn't go to a nurse to have it done. Yeah, sure, there are doctors who can screw that up too, but I'd rather take my chances with a Dr. The thing is that these nurses are going to lobby to be equal (pay, scope of practice, etc) and even if they get what they want the public is still going to be faced with the question of: "Okay I need to have a major surgical operation - should I go have it done by a medical doctor or a nurse?" I will bet my life that when [if ever] these nurses are "equal" to doctors in the scope of their practice there is going to be a lot of information in the media making people aware of it. People already research different surgeons (all medical doctors) to see who has the best outcomes, so you can be damn sure that when they're going to want to know whether its a medical doctor or a nurse operating on them. This is just the beginning of this whole doctor-nurse stuff and you're already seeing articles out there making people aware. So go back to studying your microbiology of whatever FIRST YEAR stuff you're working on at this point.

Are you okay with a nurse putting you under anesthesia as Dr. Surgeon works on you?

 

[dilated]

Clearly don't have common sense. You think everyone is going to trust a nurse to do a major operation on them? I'm not talking about just orthopaedics.

You are an idiot. I tried giving you the benefit of the doubt before, but your entire screed is so blindly wrong in the face of a half dozen people pointing it out to you that there's no other conclusion.

Nurse practitioners already do endoscopy in the UK. If you think it's a huge impossible step from sticking a scope in the colon and taking pictures to sticking a scope in a joint and taking pictures, I don't know what to tell you.

No, they're not going to come after forequarter amputations because they don't WANT forequarter amputations. They don't want things that could get them sued and will regularly expose their lack of training. They want the things that are easy and pay well so that all YOU have left is forequarter amputations. What is so hard to understand about this?

 

[mig26x]

well I sent a short email to the program director of the PHYSICIAN run dermatology residency program. I encourgae everyone to do the same. It only takes 5 minutes.

thanks

 

[FlowRate]

You are an idiot. I tried giving you the benefit of the doubt before, but your entire screed is so blindly wrong in the face of a half dozen people pointing it out to you that there's no other conclusion.

Nurse practitioners already do endoscopy in the UK. If you think it's a huge impossible step from sticking a scope in the colon and taking pictures to sticking a scope in a joint and taking pictures, I don't know what to tell you.

No, they're not going to come after forequarter amputations because they don't WANT forequarter amputations. They don't want things that could get them sued and will regularly expose their lack of training. They want the things that are easy and pay well so that all YOU have left is forequarter amputations. What is so hard to understand about this?

I've been wanting a chance to use this...

kdburton = forest griffith (The white guy)

 

[kdburton]

You obviously haven't been paying attention. These nurses are going to call themselves "Dr. __________". They will call themselves board certified (by the nursing board of course). The general public won't know the difference.



No they don't. The majority does not.

The point of my last post is that the general public will find this is something they need to look into out when "Doctors of Nursing who are board certified in yadda yadda" start biting off more than they can chew and then trying to chew it. You can't use less high-impact diseases that have been managed by midlevel providers as your measuring stick when we're talking about doctor-nurses doing surgery on people. Most people are probably like me in that they wouldn't care too much if an NP prescribed them some medications because given the scope of their current practice its pretty well known that they're not making acute life or death decisions. When thats starts to happen its going to be something the general public will become aware of

 

[kdburton]

Are you okay with a nurse putting you under anesthesia as Dr. Surgeon works on you?

No

 

[deleted87716]

Most people are probably like me in that they wouldn't care too much if an NP prescribed them some medications because given the scope of their current practice its pretty well known that they're not making acute life or death decisions.

Oh, really? Do you have any idea of the increased cardiovascular risk associated with a diagnosis of hypertension or diabetes?

Do you know what the number one killer of men and women in this country is? More than all cancer deaths combined?

And you're OK trusting your life to a nurse?

Good luck with that.

 

[Rabbit Hole]

No

What if she introduced herself to you as Dr. _______


(Because that is what they are doing... you haven't been paying attention man.)

 

[kdburton]

You are an idiot. I tried giving you the benefit of the doubt before, but your entire screed is so blindly wrong in the face of a half dozen people pointing it out to you that there's no other conclusion.

Nurse practitioners already do endoscopy in the UK. If you think it's a huge impossible step from sticking a scope in the colon and taking pictures to sticking a scope in a joint and taking pictures, I don't know what to tell you.

No, they're not going to come after forequarter amputations because they don't WANT forequarter amputations. They don't want things that could get them sued and will regularly expose their lack of training. They want the things that are easy and pay well so that all YOU have left is forequarter amputations. What is so hard to understand about this?

First of all there is a big difference between doing a colonoscopy and an appendectomy. If you don't agree with that then I feel sorry for you. And furthermore you just completely validated my previous post that doctors of nursing (with significantly less training) aren't going to go after a significant amount of surgical practice. I'm not so worried about the nurse who wants to cover the ED overnights and put casts on people, I'd be worried about the nurse who somehow manages to build a practice doing total joints or [insert some other area i may be interested in]. Thats not going to happen because that is the type of procedure that would regularly expose their lack of training and get them sued (if they could even get insurance at this point).

 

[kdburton]

Oh, really? Do you have any idea of the increased cardiovascular risk associated with a diagnosis of hypertension or diabetes?

Do you know what the number one killer of men and women in this country is? More than all cancer deaths combined?

And you're OK trusting your life to a nurse?

Good luck with that.

I said acute life or death decisions. Re-read my post.

 

[keeping-it-real]

Here is why this is going to be an uphill battle:

Consider NP knowledge as "X" amt of knowledge. Consider PCP knowledge as "X + Y" amount of knowledge. Then consider the subspecialist with "X + Y + Z" knowledge. The reality in modern medicine is that if available, people now receive "Z"-type care. The NPs argument is that even though PCPs have more knowledge, that neither group has "Z" knowledge and that they are both equally capable of treating the easy cases and referring out the more difficult ones. They are not completely correct, but you can see how the point does somewhat make sense.

For the most part, the general public already thinks doctors make too much money. The general public also thinks that they know exactly what they need when they visit the doctor. So for those people with chronic sinusitis who just want an Rx for the same symptoms they've been treated for 100 times before, they'll just see an NP. For those people with chronic pain who just want a Lortab fill, they'll just see an NP. For those people with flu symptoms who just want some Abx and a few days off of work/school, they'll just go see an NP. That soccer player who just wants an MRI, they'll just see an NP. Trying to argue to any of these people that they need a doctor's care is essentially like talking to the wall; these groups of people would love to be cared for by an NP since it's quick and cheap. For the more complicated or acute patients, very likely they'll be referred to a specialist or out to a hospital for definitive care. Essentially the argument comes down to whether or not that "Y" piece of knowledge has a meaningful contribution beyond just "X" knowledge, especially in a specialized modern medical system with ever improving diagnostics and ever deepening subspecialization.

At the other end of the spectrum, though, is specialization to the point where general medical knowledge is not required and focused, limited education may be sufficient. In this regard I think Dermatology is a great example. We literally have our best and brightest medical students go into a field where 80% of their medical knowledge is wasted and where a fair deal of complaints could be handled by a medical student. We of course need BC Derms for the more complicated medical issues, but for uncomplicated acne, injecting keloids, freezing warts, biopsying lesions to send to dermpath, even botox, etc... very few of these require BC Derm knowledge. Most Derms even acknowledge this since they have PAs/NPs working in their own offices. The argument then becomes, does it matter if they're working in the same office or just down the road?

The reality is that 1) General medicine has been replaced by specialized care and 2) Specialization requires less general medical knowledge. Unless the medical field and medical education are willing to adapt and change with the tide of technology and resources, this is going to be a losing battle. I don't know that learning amino acid structure beyond the undergrad level is necessary to become a great psychiatrist. I also don't think that memorizing antibiotic structures is necessary to become a great dermatologist. I'd also be hard pressed to believe that histology is required to become an orthopedic surgeon.

The medical community is very dogmatic though. Unless we consider the possibility that perhaps the historical model of medical education is not the most effective model for current medical practices, we're going to be surpassed by those who have developed more efficient models of training.

 

[kdburton]

What if she introduced herself to you as Dr. _______


(Because that is what they are doing... you haven't been paying attention man.)

I'm paying attention. You're the one who is selectively reading here. When someone starts doing surgery as a Doctor of Nursing the public will become aware of this (even if they introduced themself as "doctor")

 

[bungo]

Clearly don't have common sense. You think everyone is going to trust a nurse to do a major operation on them? I'm not talking about just orthopaedics. I'm talking about any specialty in which the potential for adverse outcome of a procedure is high or even if an adverse outcome it relatively rare if it were to happen it would be "high impact" as Dr Pestana puts it haha.

Hey,

Wake up.

Look at what optometrists have persuaded state legislators to give them. They weren't even allowed to dilate eyes forty years ago. Now they are practicing medicine under their own medical board and pretty damn close to slicing open eyes and doing whatever their newly formed surgical board lets them.

If nurses want their own surgical board, they will get it. And I promise you it wont take them forty years.

 

[deleted87716]

I said acute life or death decisions. Re-read my post.

I know what you said. Your mistake is in assuming that most people in this country die of acute illness, and that sudden death is the only thing that matters.

 

[kdburton]

I know what you said. Your mistake is in assuming that most people in this country die of acute illness, and that sudden death is the only thing that matters.

I'm not assuming that at all and nothing in my post suggests that. I've made my point and been consistent with my posts here. I dont understand why you're trying to poke holes in what I've said

 

[deleted87716]

I'm not assuming that at all and nothing in my post suggests that. I've made my point and been consistent with my posts here. I dont understand why you're trying to poke holes in what I've said

The point is, it's not just surgery that's "life and death." ALL OF MEDICINE IS LIFE AND DEATH.

 

[Rabbit Hole]

I'm paying attention. You're the one who is selectively reading here. When someone starts doing surgery as a Doctor of Nursing the public will become aware of this (even if they introduced themself as "doctor")

Honk honk... you must be the type that would allow your colleagues to get run over by a bus as long as it doesn't affect you.

Surgery is not safe from encroachment by mid-levels playing doctor. If you want to wait and find out about that.. be my guest.

 

[Maybeknot]

OpenSecrets.org - Center for Responsive Politics

OpenSecrets.org - Health Professionals Political Action Committee Contributions

Those are fascinating links. Looking at the 2nd link (PAC contributions to 2010 federal candidates): From a quick look at the math, of the 111 health professional PACs, it looks like 62 of them appear to represent physicians. While the 111 health PACs favor Democratic candidates to Republicans 64% to 36%, the 62 physician PACs favor Democratic candidates by nearly as much, 60% to 40%.

Of those, the following gave 100% of their contributions to Democratic candidates:
California Assocation of Physician Groups, Renal Leadership Council, American College of Radiation Oncology, American Society for Clinical Lab Science, Joint Council of Allergy and Immunology, Society of Diagnostic Medical Sonography, American Association of Physician Specialists, New Mexico Medical Association, Holston Medical Group, and Physicians for a Democratic Majority.

Conversely, the following gave 100% of their contributions to Republican candidates:
Dupage Medical Group, Kansas Medical Assn, Outpatient Ophthalmic Surgery Assn, Pennsylvania Medical Assn, Triangle Orthopaedic Assoc, Collier County Medical Society, Missouri Medical Assn, Ohio Medical Assn.

Cherrypicking a few PACs that gave the vast majority of their contributions to Democrats:
Gastrointestinal PAC (93%), California Medical Assn (81%), American Academy of Family Physicians (75%), American Academy of Dermatology Assn (74%), American Assn for Vascular Surgery (74%), American College of Rheumatology (71%)

And so on, and so forth.

Does this not compute to anyone else?

 

[filter07]

I don't know about you guys, but as a junior surgery resident I was less comfortable with doing a colonoscopy on my own than doing an appendectomy, precisely because a colonoscopy was less acute. If you have an inexperienced person doing a colonoscopy, I would be more worried about a missed polyp that might end up being cancer later on. With an appendectomy, yes there is greater upfront risk, but you are more likely to detect complications. It is much easier to find out whether or not you did a crappy job with the appendectomy than a colonoscopy.

With a colonoscopy you could conceivably get away with making the patient drowsy and not doing the scope part at all. No one will notice until years down the road when they find out they have colon cancer. That's the part that really scares me, that it's extremely hard to tell if you did a good job or a terrible job. You can look at 5 year outcomes and they will probably be exactly the same depending on how you design your study.

Becoming mediocre at colonoscopy is much easier than at an appendectomy. But becoming thorough and safe in colonoscopy is a lot harder than appendectomy. Just my opinion.

 

[tncekm]

You obviously haven't been paying attention. These nurses are going to call themselves "Dr. __________". They will call themselves board certified (by the nursing board of course). The general public won't know the difference.



No they don't. The majority does not.

Are you okay with a nurse putting you under anesthesia as Dr. Surgeon works on you?

You are an idiot. I tried giving you the benefit of the doubt before, but your entire screed is so blindly wrong in the face of a half dozen people pointing it out to you that there's no other conclusion.

Nurse practitioners already do endoscopy in the UK. If you think it's a huge impossible step from sticking a scope in the colon and taking pictures to sticking a scope in a joint and taking pictures, I don't know what to tell you.

No, they're not going to come after forequarter amputations because they don't WANT forequarter amputations. They don't want things that could get them sued and will regularly expose their lack of training. They want the things that are easy and pay well so that all YOU have left is forequarter amputations. What is so hard to understand about this?

👍

 

[dilated]

First of all there is a big difference between doing a colonoscopy and an appendectomy. If you don't agree with that then I feel sorry for you. And furthermore you just completely validated my previous post that doctors of nursing (with significantly less training) aren't going to go after a significant amount of surgical practice.

Uh, I wasn't talking about appendectomy. Maybe you've heard of arthroscopy? It's this thing they've come up with where they put a scope in a joint. It turns out that it makes orthopods a lot of money.

It also turns out that the complication profile is a lot less scary than for a colonoscopy (bowel perfs, missed CA). If NPs can do colonoscopy there is zero reason they shouldn't be doing arthroscopy. They can probably clean up that meniscus while they're in there too, it's not rocket science. Throw in some joint injections, maybe pin a fracture or two.. hey, it's not "major surgery". And as they get experience with that (perhaps in a "comprehensive orthopaedic nursing residency"?), they'll be ready to tackle more challenging procedures! Please take note of how every other person -- including senior residents and attendings -- is telling you that you're completely incorrect and then weigh the value of continuing this argument despite your obvious lack of both experience and knowledge.

 

[michaelrack]

Please take note of how every other person -- including senior residents and attendings -- is telling you that you're completely incorrect and then weigh the value of continuing this argument despite your obvious lack of both experience and knowledge.

I am an attending, and I agree with kdburton

 

[deleted87716]

I am an attending, and I agree with kdburton

You agree with him about what, that sleep medicine, like surgery, couldn't be encroached upon by mid-levels?

Not a whole lotta life-and-death acuity happening there... 😉

 

[kdburton]

Honk honk... you must be the type that would allow your colleagues to get run over by a bus as long as it doesn't affect you.

Surgery is not safe from encroachment by mid-levels playing doctor. If you want to wait and find out about that.. be my guest.

What makes you say that? You think I want midlevels to continue increasing the scope of their practice? All I'm saying is that I don't think it will be quite as easy in for them to be successful in surgery and surgical subspecialties and for some reason everyone is attacking me.

 

[michaelrack]

You agree with him about what, that sleep medicine, like surgery, couldn't be encroached upon by mid-levels?

Not a whole lotta life-and-death acuity happening there... 😉

I agree with him that mid-levels can't encoach on surgery.

Nurse practitioners are moving into sleep medicine, although aren't reading sleep studies yet. I'm sure in about 5 years that will be a big battle.

http://www.sleepschool.com/courses/...nurse-practitioners-and-physician-assistants/

http://www.sleepmedicinenetwork.com/about_people.html

Sleep medicine can be life and death:

http://www.emorywheel.com/detail.php?n=27971

http://reggiewhitemedical.com/

 

[kdburton]

Uh, I wasn't talking about appendectomy. Maybe you've heard of arthroscopy? It's this thing they've come up with where they put a scope in a joint. It turns out that it makes orthopods a lot of money.

It also turns out that the complication profile is a lot less scary than for a colonoscopy (bowel perfs, missed CA). If NPs can do colonoscopy there is zero reason they shouldn't be doing arthroscopy. They can probably clean up that meniscus while they're in there too, it's not rocket science. Throw in some joint injections, maybe pin a fracture or two.. hey, it's not "major surgery". And as they get experience with that (perhaps in a "comprehensive orthopaedic nursing residency"?), they'll be ready to tackle more challenging procedures! Please take note of how every other person -- including senior residents and attendings -- is telling you that you're completely incorrect and then weigh the value of continuing this argument despite your obvious lack of both experience and knowledge.

Listen.. I'm not saying that there aren't any aspects of surgery that a Doctor of Nursing wouldn't be able to learn. I'm just saying that I am under the very strong impression that people in surgery and surgical subspecialties are going to be a lot less threatened than other specialties by mid-levels for all the reasons I've stated above. Arthroscopy is one small component of orthopaedics, and I'm sure we could sit here all day and argue about each operation and how if they added on an extra rotation here and there a Doctor of Nursing could maybe get certified for it. The point is that there are a whole lot of "well if this happened and then that happened then sooner or later Doctors of Nursing will take over the world." I simply don't buy it. I'll apply for orthopaedics next year and hopefully match. And then I'll wait and see how things go as another poster said earlier. I just think I'm right - and I could care less if attendings and senior residents disagree with me.

 

[deleted87716]

I just think I'm right - and I could care less if attendings and senior residents disagree with me.

So sayeth the medical student.

I hope you're right. For your sake.