NPs gone wild - another pill mill, now with sex scandals

[Ferrismonk]

Out of curiosity, what do you think the problem was? Inability to distinguish tactile changes and fear of advancing too far?

They both were a little to the right. At multiple levels.

---

Members don't see this ad.

 

[soxman]

I still practice Anesthesiology as a side gig at 1-2 x a month. This place is pretty much run by CRNAs . With that being said the good ones usually work together with the faculty. The dangerous ones do whatever the hell they feel like and have the exact same attitude as this "stopthebs" tool. I had one guy with "35 years of experience" who missed the airway 3 times and when I had to get it , he said I was lucky. Same douche told me that CRNAs are well capable to do pain medicine as he knows some that do a bunch of epidurals............

 

[cowboydoc]

I still practice Anesthesiology as a side gig at 1-2 x a month. This place is pretty much run by CRNAs . With that being said the good ones usually work together with the faculty. The dangerous ones do whatever the hell they feel like and have the exact same attitude as this "stopthebs" tool. I had one guy with "35 years of experience" who missed the airway 3 times and when I had to get it , he said I was lucky. Same douche told me that CRNAs are well capable to do pain medicine as he knows some that do a bunch of epidurals............

Ahh, to be blissfully ignorant. Wasting my youth on medical training has made me jaded.

 

[powermd]

The difference between physicians and non-physicians is the selection process. There's a world of difference between those who clawed their way into medical school and everyone else. I went to a very non-prestigious US medical school, and yet was selected as one of 600 out of 10,000 applicants to be interviewed. And 200 out of that 600 to be accepted. My company in that group included academic stars from Harvard, Caltech, Amherst... etc, and tons of others without the pedigree who worked their balls off to prove they were of equal ability. Competing with these folks in the basic sciences was damn hard! Swimming in that pool forced me to work harder than I ever imagined possible. In the process, I'm 100% sure I transformed into a much smarter person than I was in college. Not just more educated. Smarter. More able. In similar fashion, postgraduate training expanded my ability in other ways. In essence, it made me a "doctor".

Although the outcome in most circumstances is not going to look very different, the value proposition offered by seeing a physician instead of a midlevel is difficult to overstate.

I don't believe for a second that the difference between physicians and non-physicians has anything to do with "education", or "training", or "board exams". Anyone can read a book or game a test, if they work at it. Functioning as a clinician isn't super hard. But physicians bring special value to the table that we shouldn't so readily diminish simply because RTCs don't exist that "prove" the distinction.

 

[paindoc007]

The difference between physicians and non-physicians is the selection process. There's a world of difference between those who clawed their way into medical school and everyone else. I went to a very non-prestigious US medical school, and yet was selected as one of 600 out of 10,000 applicants to be interviewed. And 200 out of that 600 to be accepted. My company in that group included academic stars from Harvard, Caltech, Amherst... etc, and tons of others without the pedigree who worked their balls off to prove they were of equal ability. Competing with these folks in the basic sciences was damn hard! Swimming in that pool forced me to work harder than I ever imagined possible. In the process, I'm 100% sure I transformed into a much smarter person than I was in college. Not just more educated. Smarter. More able. In similar fashion, postgraduate training expanded my ability in other ways. In essence, it made me a "doctor".

Although the outcome in most circumstances is not going to look very different, the value proposition offered by seeing a physician instead of a midlevel is difficult to overstate.

I don't believe for a second that the difference between physicians and non-physicians has anything to do with "education", or "training", or "board exams". Anyone can read a book or game a test, if they work at it. Functioning as a clinician isn't super hard. But physicians bring special value to the table that we shouldn't so readily diminish simply because RTCs don't exist that "prove" the distinction.

I disagree. It’s easy to get into many for profit med schools nowadays. And the more than pop up each year, the less the caliber is of those who go.

 

[cowboydoc]

I disagree. It’s easy to get into many for profit med schools nowadays. And the more than pop up each year, the less the caliber is of those who go.

If you think setting up a for profit med school is easy, look into a "doctoral" NP program.

 

[macman]

tthey don't know what they don't know

Indeed, as an MS4 I thought I knew A LOT

 

[jonnylingo]

Yes, MS4 was where I summited Mt Stupid.

 

[BobBarker]

@EmileeKennedy too funny! Thanks for sharing as always!

 

[oreosandsake]

I have reviewed numerous cases for “over prescribing” for my state medical board.

I have never had to review one for an acgme pain trained physician

it’s always been a PCP

 

[VA Hopeful Dr]

I have reviewed numerous cases for “over prescribing” for my state medical board.

I have never had to review one for an acgme pain trained physician

it’s always been a PCP

My state medical board doesn't have any orders about pain physicians either.

What does happen is the DEA/CMS comes to town and shuts down their practices; then, the doctors involved open up a new office with a different name 3 months later. No clue what's going on there.

 

[GoBeers]

I know of several in california that have lost license or been reprimanded

 

[SeniorWrangler]

The Supreme Court has ruled that a doctor can’t be charged for overprescribing unless they were knowingly committing a crime, so the bar is set really high for these prosecutions now.

Trading pills for sex is still over the line, I think.

The Supreme Court Decision on Federal Prescribing Rules for Controlled Substances

This Viewpoint explains how a recent Supreme Court decision clarifies rules for prescribing controlled substances so that patients are not denied appropriate care and physicians are not unjustly prosecuted.

jamanetwork.com

A Recent Supreme Court Ruling Will Help People In Pain

By ruling in favor of two doctors accused of running pill mills, SCOTUS is clarifying opioid prescription practices

www.scientificamerican.com

 

[lobelsteve]

The Supreme Court has ruled that a doctor can’t be charged for overprescribing unless they were knowingly committing a crime, so the bar is set really high for these prosecutions now.

Trading pills for sex is still over the line, I think.

The Supreme Court Decision on Federal Prescribing Rules for Controlled Substances

This Viewpoint explains how a recent Supreme Court decision clarifies rules for prescribing controlled substances so that patients are not denied appropriate care and physicians are not unjustly prosecuted.

jamanetwork.com

A Recent Supreme Court Ruling Will Help People In Pain

By ruling in favor of two doctors accused of running pill mills, SCOTUS is clarifying opioid prescription practices

www.scientificamerican.com

We can take away their DEA registration.

 

[SeniorWrangler]

Right, I think everybody in pain practice has seen this play out — the local mill gets shut down and there’s a flood of patients looking for somebody to take over their prescribing.

 

[Ferrismonk]

Yep. You may not be criminally liable for overprescribing (unless you were committing a crime obviously), but you can still lose your license, your practice, and your livelihood.

 

[SpineandWine]

Lol, popular this morning.

Let's play with the way things are noted here. Let's exchange the words to see how things look. Say an egregious crime is committed. A suicide bombing, mass shooting, robbery, etc. We document it here and say: _____________ gone wild again. Fill in the blank with your favorite ethnic/racial group, etc. Doesn't look so good and you'd probably be banned.

Question 1. Do you know of any bad anest/pain docs?
Question 2. Do you know of any good crnas?

If your answer to either is Yes then you must agree that it comes down to the individual.

If all of the training MDs receive is far superior, and I'm not necessarily saying it's not, then MD outcomes should clearly be better. If CRNAs replaced all MDs in a hospital then outcomes should worsen. More complications should occur. More dead pts because CRNA training is not adequate to manage the atypical issues. This becomes noted by the higher-ups and by the community. Word spreads and the reputation of the hospital becomes impacted. People choose to have their surgeries elsewhere. Is this happening? If not, why not?

I'm not worried about crnas or other docs creeping in on my catchment area because I'm not worried about the competition. I welcome it. If the pts like me, they'll continue to see me. If not, then the market has spoken. I evolve or I die just like everything else in this world.

You guys can sit in here and bi*ch and moan about reality all you want or you can evolve and adapt to it. If what you offer is a superior product, you have nothing to worry about. If it isn't, maybe things need to be revamped.

Racial stereotype are not same as professional degree stereotype
- no one has ever conducted eugenics based on profession - like eugenics of all optometrist since they’re inferior to opthalmologist


Stop thinking like an NP and start being an MD

 

[Welcome123]

it seems to me that, in general, doctors are more sleazy and financially driven. physician extenders tend to work harder, do better documentation, and are more caring.

Problem is: PAs and NPs never know what to do and routinely make poor decisions. If there is any sort of deviation from a standard algorithm -- which there always seems to be -- then a visit to the PA or NP is a waste of time. You dont want the newbie flying the plane or investing your money or doing your root canal.

Doctors may seem to you more sleazy, and there are definitely situations where they may be, but this is an incorrect assumption.
It is possible that the media loves a good dr death type story and overly sensationalist journalism may be create bias
This may be more about incentives driving behavior combined with the critical and hierarchical culture you were taught
PAs and NPs on a fixed salary vs rvu or collection based doctors
Put the PA and NP on a productivity incentive vs set salary and watch the changes

 

[SpineandWine]

Doctors may seem to you more sleazy, and there are definitely situations where they may be, but this is an incorrect assumption.
It is possible that the media loves a good dr death type story and overly sensationalist journalism may be create bias
This may be more about incentives driving behavior combined with the critical and hierarchical culture you were taught
PAs and NPs on a fixed salary vs rvu or collection based doctors
Put the PA and NP on a productivity incentive vs set salary and watch the changes

PAs and NPs on average have less training and rigors of med school, esp if went to school in states

 

[Welcome123]

PAs and NPs on average have less training and rigors of med school, esp if went to school in states

It is “Not on average.”
PAs and NPs have less training.