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I was doing a barium enema on a patient today who had an incomplete colonoscopy (couldn't get to the cecum). The initial test this patient had for screening was a flex sig. I was shocked to see the note in the computer signed by a Nurse Practioner, who had performed the examination. Is this a new development?
 

bustbones26

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I was told that nurse practicioers can do flex sigs, but the entire procedure is videotaped and the videotape has to be reviewed by an MD/DO to be official. If you ask me, for all the trouble, the doc should just do it anyways!
 

MacGyver

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I told you guys over and over, but everybody in this forum said "NPs will NEVER do X procedure" or "you're exaggerating"

Am I exaggerating? Apparently not. IF they are doing flex sigs now, how many more years before they are doing everything else in GI? How long before they expand in other areas?

NPs will slowly expand their scope. Only a fool thinks they are just going to sit idly by.

The MDs need to do a better job protecting the turf, or NPs and PAs will continue to encroach on it.
 
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MacGyver

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Originally posted by bustbones26
I was told that nurse practicioers can do flex sigs, but the entire procedure is videotaped and the videotape has to be reviewed by an MD/DO to be official. If you ask me, for all the trouble, the doc should just do it anyways!

Yeah, and how many months/years go by before management says "well we dont need to videotape anymore, they can work on their own"

Inch by inch, step by step.
 

june015b

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NP or PA can do a flex sigmoidoscopy UNDER a licensed medical doctor (MD)'s supervision. If they mess up, guess who is in trouble (who pays for malpractice?).

By the way, flex sig has been replaced by colonoscopy gradually. Now, medicare and major HMO rather wants to pay for colonoscopy which can be diagnostic and therapeutic (find and treat/polypectomy at the same time). At my medical school's university hospital, they replaced all flex sig by colonoscopy. NP and PA will never be able to perform a full colonoscopy even under MD's supervision (you think HMO or medicare will reimburse for that?).
 

MacGyver

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Originally posted by june015b
NP or PA can do a flex sigmoidoscopy UNDER a licensed medical doctor (MD)'s supervision. If they mess up, guess who is in trouble (who pays for malpractice?).

Thats not accurate. Its true that PAs are required to be supervised, but in MOST states, NPs are absolutely NOT required to be supervised. They are considered independent primary care physicians in many states, the same status as MDs.

NP scope of practice is controlled by the state nursing boards, not the state medical boards that control PAs. Therefore, the nursing boards can do whatever they want and the MDs cant do a damn thing about it.

Besides, even for PAs, "supervision" means many things. IN some hospitals, it means an MD signing off on every chart within 5 hours after the PA sees the patient.

In other areas, it means that the MD is never on-site, and that he only has to sign charts 1 day a week over the internet, while NEVER seeing the patient. Hell, some states even say that the MD only has to sign 30 or 50% of the charts.

The term physician "supervision" is meaningless. In many states, "supervision" encompasses no more than a rubber stamp from the MD who looks at teh chart many days after the PA has already done the complete workup and discharged with treatment plan.
 

avendesora

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Originally posted by bustbones26
I was told that nurse practicioers can do flex sigs, but the entire procedure is videotaped and the videotape has to be reviewed by an MD/DO to be official. If you ask me, for all the trouble, the doc should just do it anyways!

That sounds like a money machine for the GI doc, actually. I mean, it's like a cardiac ECHO -- you get paid for reading, not the actual procedure, right?

Personally, if I ever see an NP coming at me with some invasive device, I will be running away very fast!! :laugh:
 

rad_one

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The question is why do physicians keep agreeing to sign off on anything these midlevel "practitioners" do? We younger physicians need put a stop to these advances onto our territory.
 

MacGyver

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Originally posted by rad_one
The question is why do physicians keep agreeing to sign off on anything these midlevel "practitioners" do? We younger physicians need put a stop to these advances onto our territory.

No doubt. The answer to your question is that many doctors are looking to make as much money as quickly as possible and then cash out. They simply have no long term interest in the profession.

Take for example the MGH fools who are outsourcing radiology. It was the head radiologist's CHOICE to do this--this was NOT something that came down from hospital management. He doesnt give a damn about the long term viability of the profession, he is only interested in making quick $$$.

Same deal with teh MDs who rubber stamp PA procedures. The PAs give them a cut of the revenue, and the MDs can supervise dozens of PAs simultaneously and make some serious $$$.

Sounds good right? Well it is good at FIRST, but eventually the PAs/NPs wise up and go to the state legislatures. They say "hey look our supervising docs are letting us do procedures X, Y, and Z and they are just signing charts over the internet and never following up with our patients! therefore, we deserve more autonomy"

the state legislatures take a look at that and say "yep, obviously teh docs dont have a problem with it because they allow such loose supervision. Consider it done"

This takes a few years to happen, and the original supervising docs who gave rise to all this madness have already made their $$$ and retired. They dont give a rats ass about what the rest of us have to deal with 20 years later as a result of their foolish transgressions.

Midlevel providers would not be where they are today without doctors GREED. Too many doctors looking to make money quick and cash out before the changes come along that allow midlevels to cut into more of our turf. Once that happens, the money train for doctors dries up. But the original docs dont care; they are already retired and living large by then.
 

Emedpa

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sorry to break it to you guys, but the largest hmo in the country(kaiser) already has g.i. pa's doing colonoscopies unsupervised after a short training period with a gi doc. they have been doing them for years.....also many fp pa's/np's do sigs....also for many years.....THE SKY IS FALLING!!!!!!!!
 

MacGyver

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Originally posted by emedpa
sorry to break it to you guys, but the largest hmo in the country(kaiser) already has g.i. pa's doing colonoscopies unsupervised after a short training period with a gi doc. they have been doing them for years.....also many fp pa's/np's do sigs....also for many years.....THE SKY IS FALLING!!!!!!!!

thats funny... you always say that I'm blowing things out of proportion and exagerrating, but every post you make supports my point exactly.

We're not buying your "everything is OK" mantra. You're the same fool who said that PAs should be totally autonomous to do anything they want to, with no MD oversight AT ALL.

Your motives arent exactly honorable here.
 

Emedpa

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I have never said that pa's should be totally autonomous. you are misquoting me.I have given examples of where pa's practice with an advanced scope but none of these folks does so without some type of oversight.the guys who do colonoscopies(and I personally know several) have a gi doc down the hall they can review stuff with as needed. also they have to have the same qa that the gi docs do( they review a certain % of each others studies for consistency in dx).
every post of yours brings up some info about pa's and np's just started doing xyz and it is stuff we have been doing for years. it is never new info. just because you are 10+ years out of date doesn't mean that the whole practice of medicine is coming to a grinding halt.
 

papilloma

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Emedpa, do you understand the point?

We doctors will be sitting on our gluteuses watching tv while PAs are sweating sucking stinking s4i+ how of people. At the end of the day, the doc has earned at least twice as much as the PA for doing absolutely nothing. Life is so grand for us docs.

Now go on to your work boy....go on...do your hard work to make money for your doc in hawaii.
 

ID4me

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the thing about medicine is that the lawyers will always chase the money. CRNPs may expand their scope and expand their autonomy, but eventually malpractice and over-regulation will catch up to them just like with us. it's just like with anything new in medicine - it seems like a great deal until the lawyers get their hands on it. just a matter of time
 
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