Nurse propaganda

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If it's homophobic or sexist, I'm going to have to call it that. I won't do it if it's not, but I'm going to if it is, because I don't like those things!

And yet again, we need to accept that "homophobia" isn't a literal phobia. The meaning of that word is widely understood to refer to anti-gay discrimination, in the same way that "hate crime" refers to a crime motivated by racism, not just the one literal emotion of hate.

It has been coopted that way as an argumentation tactic because it's easier to attack someone directly as a "homophobe" (ditto racism, sexism, and any -ism) and discredit anything and everything else they might say. You're free to call anyone whatever you want, but at the end of the day no one really cares and you should understand that it's less a moral "score" than it is an attempt to effectively label anyone who disagrees with whatever you think is *-ist and, therefore, a dummy based on whatever arbitrary standard you're using.
 
It has been coopted that way as an argumentation tactic because it's easier to attack someone directly as a "homophobe" (ditto racism, sexism, and any -ism) and discredit anything and everything else they might say. You're free to call anyone whatever you want, but at the end of the day no one really cares and you should understand that it's less a moral "score" than it is an attempt to effectively label anyone who disagrees with whatever you think is *-ist and, therefore, a dummy based on whatever arbitrary standard you're using.
How dare you say something like that! You are such a debate-ist! I can't even.
 
I can't believe I'm bothering to respond to an obvious respawn/troll, but anyways.

If you can't see what's wrong in that video, I just don't know what to say with you.

If a woman attacks you, and you are physically threatened by the possibility of ongoing violence, then yes, self-defense is justified.

If something like this occurs, it is absolutely not justified. You can literally see it on the guy's face. He thinks about it, pauses, then delivers a calculated blow.

Was the woman right to hit him in the first place? Of course not. No one would argue otherwise. But we aren't in Kindergarten anymore. Two wrongs don't make a right.

I believe in equal rights for women....and equal lefts 🙂

If this was a guy slapping another guy then I don't think too many people would berate the 2nd for responding

And while I agree with what the guy did the only time I have done so myself is when I was attacked by a Pscyh patient way back when (in med school)
 
NPs are dangerous unsupervised, and even when supervised they seem to lack very basic knowledge of physiology and rely solely on memorized algorithms. Haven't had a huge amount of interaction with them, though, but in my short time on the wards I've grown even less confident in their training.

The latest was an NP who did a breast exam and missed an enormous melanoma. Thankfully her M.D. found it in time for it to be treated.

I've already told the story about the NP practicing solo who didn't know what the difference between beta blockers and warfarin is (she thought one was a substitute for the other).

1 week ago the NP who works for my attending diagnosed a woman with iron deficiency anemia. I pulled her iron studies (which had been performed 3 days earlier) and her ferritin was 1,000 μg/L.

On neurology this year, a fourth year watched a "Neuro" NP diagnose sciatica in someone with fatigue and ascending symmetrical muscle weakness presenting ~4 weeks after a major GI illness. Yes this was a so-called Neurology Nurse Practitioner.

Of course there was that other story here on SDN which is my favorite. The NP who screamed for "stat kayexalate" for the person with hyperK+ w/ ECG changes.

All anecdotes of course.

And that article is rubbish because there is more than just surgery that NPs can't do. They can't do many procedures in certain states or even write for C-IIs. Which shouldn't change, but will. NPs will be doing surgery soon I'm sure.
 
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Not it's not. You're confusing the social acceptance and the fundamental value of the argument.

Most nowadays accept that women are equal to men, but it wasn't the case before mostly because of religious influence (women being submissive to men in the Christian religion, not being able to become priests etc). Of course you could find some arguments which seemed, in appearance, at least somewhat motivated by "logic", e.g. "women aren't interested in politics" or "women aren't educated enough to vote" but it was only a strawman, really. Not being able to vote was one of the main reasons women couldn't get educated in the first place. The main influence was by far moralistic, based on purely subjective feelings.

The exact same can be said about marriage. It's acceptable still, in 2015, in the USA, to claim that homosexual marriage threatens the "sanctity of marriage" (whatever that means), but it's no less moralistic and rooted in non-sense than claiming that women are inferior to men (notice the attempt to rationalize the belief too: "it's bad for the kids" or "it's unnatural, gay animals don't care for kids"... boy my brain).
Yes clearly it's not possible to have any different views about gay marriage than yourself, unless they're being a bigot. (again coming from someone who supports gay marriage)

You embarass yourself when you refuse to recognize the fact that people can rationally disagree with you. You act like a 12 yr old, where it's your way or they're a dirty bigot/sexist/racist/homophobe
 
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The future for MDs is in consultative and specialty fields. Technology has made it easier than ever to deliver care to those with basic complaints and basic medical problems. It doesn't take 4 years of med school and 3 years of residency to manage diabetes or hypertension in an outpatient setting. Choose your field and build your niche wisely.
Cue the usual people who think you can only do those things with 4 years college, 4 years med school, 3 years residency. I don't blame the govt. for turning to sources that churn out providers faster, when physicians are inefficient.
See, and I'd argue that the explosion in medical knowledge is exactly why midlevels shouldn't be providing primary care independently. A referral is only good if you can spot the condition to refer in the first place, and most of a patient's post-referral follow-up will occur with their PCP.
Have you ever done a clinical rotation? That isn't how referrals from a PCP work in real life. Most specialists aren't going to care what the PCP "thinks" it is on the referral form, they do their own thing. Many times if patients want a specialist andt heir insurance requires a referral, they'll just ask the PCP to write it. It's no skin off their back.
 
Its in a women's magazine. Women worship nurses, a lot of the time because most of them wanted to be one. Medicine has always been the profession of the evil rich privileged white man that everybody seems to hate. Couple that with the fact that everybody nowadays want to seen as a special snowflake and we are in a time where elite education and intellectualism are demonized, and physicians are in a lose-lose situation. Oh but nurses(women) can constantly tug at the heart string of the every day working man and say " See us, we are less arrogant, less educated, and less threatening and better than those evil ole doctors(males)" For people who aren't that smart, they sure came up with one hell of a marketing strategy.


LOL women do not worship nurses. No one worships nurses. Even nurses, who are mostly women, really don't worship other nurses. Sadly nurses can be a catty bunch, in general. As they mature, they usually get better with the catty thing. But it's hilarious what you are suggesting. Now, nurses that are into heavy professional nursing membership roles will go hog wild with promotion. But that is a positive thing I see a lot from women. What I mean by that is with women, in general, I find that when they get behind something, they often give it their all. LOL, at least until they get burned. 😉

If you are open to see reality, you'll find that the majority of levelheaded nurses don't demonize physicians. That would make life at work a living hell and would undermine effective patient treatment.

About the compassion and less arrogance, I firmly believe that will continue to be an individual thing--having nothing to do with the professional role but the individual person.
 
I wish we still had full practice primary care in more of the country. Fifty years ago you could treat some basic complaints, handle a trauma, deliver a baby, and amputate a leg in the same day. The lifestyle was rough, however, and I believe that's the biggest reason we got the specialization system of today- it's less taxing to focus on one thing than be a provider of everything. You can also get better at it, but at the expense of all other skills. It sucks though- I feel like the FPs of old were "real doctors" and we're just a shadow of that care of lifestyle concerns, bureaucracy, and reimbursement issues.

OTOH, I see a greater potential to at least try to positively affect sound wellness practices among patients and their families. Also, I am sure a lot of those traumatic types things didn't have, overall, the positive outcomes they would have today. I just wish a physician wanting her/his own private practice wasn't so much the untenable thing as it is today.

Of course, I feel like although I wasn't a critical care physician, working as a critical care nurse for all these years, I have seen, done, experienced a lot. So, now I am good with primary care.
 
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Cue the usual people who think you can only do those things with 4 years college, 4 years med school, 3 years residency. I don't blame the govt. for turning to sources that churn out providers faster, when physicians are inefficient.

Have you ever done a clinical rotation? That isn't how referrals from a PCP work in real life. Most specialists aren't going to care what the PCP "thinks" it is on the referral form, they do their own thing. Many times if patients want a specialist andt heir insurance requires a referral, they'll just ask the PCP to write it. It's no skin off their back.
My point want that the PCP is dictating care, it was that a nurse might write something off and not even do a referral, or might be so off base that they order a wildly incorrect referral. I know how referrals work, I just don't trust nurses to actually catch many things that would require referral, our that they would know the appropriate specialist with which to refer, given their very limited knowledge of pathology and pathophysiology.
 
The real problem wasn't when NPs were employed by physician owned practices or partnered up with physicians in practice for supervision. The problem started when they leveraged these positions to market themselves to hospitals as replacements for physicians rather than physician extenders (which was really the whole point of them in the first place). In the hospital system, you're not the employer, the hospital is. If it's cheaper to hire 2 NPs at 100K/yr to "collaborate" with the existing physicians in the department rather than hire another physician at 250K/yr, well you can see where it's heading. Even if the physicians in the department would rather have another one of them on board, they don't make the ultimate hiring decision if their practice is owned by the hospital.
Exactly.
 
My point want that the PCP is dictating care, it was that a nurse might write something off and not even do a referral, or might be so off base that they order a wildly incorrect referral. I know how referrals work, I just don't trust nurses to actually catch many things that would require referral, our that they would know the appropriate specialist with which to refer, given their very limited knowledge of pathology and pathophysiology.

To be fair, I have to tell you. I have seen bonafide physicians do this. I mean I feel what you are saying about education overall and PG training in comparison. But some people that have practiced as a nurse long enough can be pretty darn good in the role. The issue for me is that they let every yahoo, new RN that has <5 years of FT experience, or not so solid clinical experience, into NP grad programs. Then they don't really put them through the rigors clinically, as say compared with PGMed programs.

About the referrals, heck, I know the appropriate specialists and have even had docs call them in for family when they didn't, and I am an RN and not a NP. But I have been in some good places for a lot of years.

Personally, if I were a NP, I would feel safer working with a group of experienced physicians. I don't know why it couldn't be left like that, except as Calvin said. In the hospital, NPs are cheaper than BC physicians. In PCP groups, well, if physicians have any say, the question of using an NP and what his/her role will be should be up to them and the group. But there again, money issues enter into things, so. . .
 
NPs are dangerous unsupervised, and even when supervised they seem to lack very basic knowledge of physiology and rely solely on memorized algorithms. Haven't had a huge amount of interaction with them, though, but in my short time on the wards I've grown even less confident in their training.

The latest was an NP who did a breast exam and missed an enormous melanoma. Thankfully her M.D. found it in time for it to be treated.

I've already told the story about the NP practicing solo who didn't know what the difference between beta blockers and warfarin is (she thought one was a substitute for the other).

1 week ago the NP who works for my attending diagnosed a woman with iron deficiency anemia. I pulled her iron studies (which had been performed 3 days earlier) and her ferritin was 1,000 μg/L.

On neurology this year, a fourth year watched a "Neuro" NP diagnose sciatica in someone with fatigue and ascending symmetrical muscle weakness presenting ~4 weeks after a major GI illness. Yes this was a so-called Neurology Nurse Practitioner.

Of course there was that other story here on SDN which is my favorite. The NP who screamed for "stat kayexalate" for the person with hyperK+ w/ ECG changes.

All anecdotes of course.

And that article is rubbish because there is more than just surgery that NPs can't do. They can't do many procedures in certain states or even write for C-IIs. Which shouldn't change, but will. NPs will be doing surgery soon I'm sure.

You are generalizing. What you have stated is not true for all NPs. Ask reputable physicians that work with reputable NPs. I mean I am supportive of restricting midlevel expansion and takeover; but at the end of the day, I can tell you that your statements are generalizations.

You see good docs. You see not-so-good docs. You see good NPs. You see not-so-good NPs. You see people working through learning curves. You see a lot of things. Don't be so hasty in generalizing is all I am saying.
 
My point want that the PCP is dictating care, it was that a nurse might write something off and not even do a referral, or might be so off base that they order a wildly incorrect referral. I know how referrals work, I just don't trust nurses to actually catch many things that would require referral, our that they would know the appropriate specialist with which to refer, given their very limited knowledge of pathology and pathophysiology.
If anything, NPs are trigger happy in consulting specialists. They have no problem in doing that at all. So PCP is happy that pt. is taken care of, patient is happy they saw the specialist, and specialist is happy.

NPs usually feel they are collaborative in specialist roles, but autonomous in primary care roles. As medical knowledge increases and more intricate treatments come about, that only confirms the need for more specialists, not primary care.

Even in Ortho there is a shortage of Orthopedic surgeons, which will get pretty bad in the next decade.
 
You are generalizing. What you have stated is not true for all NPs. Ask reputable physicians that work with reputable NPs. I mean I am supportive of restricting midlevel expansion and takeover; but at the end of the day, I can tell you that your statements are generalizations.

You see good docs. You see not-so-good docs. You see good NPs. You see not-so-good NPs. You see people working through learning curves. You see a lot of things. Don't be so hasty in generalizing is all I am saying.
For sure i am generalizing, just giving my experience.
 
You are generalizing. What you have stated is not true for all NPs. Ask reputable physicians that work with reputable NPs. I mean I am supportive of restricting midlevel expansion and takeover; but at the end of the day, I can tell you that your statements are generalizations.

You see good docs. You see not-so-good docs. You see good NPs. You see not-so-good NPs. You see people working through learning curves. You see a lot of things. Don't be so hasty in generalizing is all I am saying.

Not so good doc is vastly preferable to a great np. The education and background is just not there for mid levels
 
The cold hard truth about Nurse Practitioners from a R.N.

Yes, the clinical rotations are a joke, I hear this so many times from my co-workers-basically follow someone around for a little while yadda yadda yadda look at a chart yadda yadda yadda that's it, do that for 700 hours and you're done.

Most co-workers in the program are idiots, seriously not being sarcastic, but they are- one told me the other day vaccines still cause autism.

They are not cost effective, they are just referral machines because they lack the ability to comprehend and analyze a patient the way a MD would be able to.

All programs are done online and with zero ability to weed out people who should be in!
 
The cold hard truth about Nurse Practitioners from a R.N.

Yes, the clinical rotations are a joke, I hear this so many times from my co-workers-basically follow someone around for a little while yadda yadda yadda look at a chart yadda yadda yadda that's it, do that for 700 hours and you're done.

Most co-workers in the program are idiots, seriously not being sarcastic, but they are- one told me the other day vaccines still cause autism.

They are not cost effective, they are just referral machines because they lack the ability to comprehend and analyze a patient the way a MD would be able to.

All programs are done online and with zero ability to weed out people who should be in!

Without generalizing -- and this is just my experience -- I have not run into an NP that I would trust with a patient yet -- and the sad part is that they don't know what they don't know -- I've had situations with a family member in the ICU where I was traveling incognito and watched them blow off an SpO2% of 79 and cancel an order by the intensivist for a CXR stating that "I've examined the patient and he doesn't need it" -- I was about to slip out of the room and make a few well placed phone calls when the RT walked in, saw it, and took appropriate action...had another case of being called in for a Hb of 4 which really turned out to be a cluster -- NP sent the patient down for a US to r/o DVT AFTER paging ICU (my team) for an Hb of 4 -- when we got there, the patient was sitting up fat, dumb and happy with bilateral LE edema from a CHF exac -- NP didn't think to repeat labs and treat the patient -- and another one was when an NP student when asked what the fasting CBG value for DM proudly stated "200" -- when f/u questioned about the fasting CBG for pre-diabetes proudly stated "250" and wanted to check microalbumin Qvisit with eye exams Q3 months --- I went into full pimp mode and shark attacked that one -- there were other things in that situation that really pissed me off -- like when they had the balls to tell a colleague that when they graduated from NP school they would be the equivalent of a board certified, FM attending -- in which wet dream was this?

IIRC, a group of them were given a watered down Step2 and there was a 50% failure rate and if you do the "hours" to "hours" they're about the equivalent of an MS2/Ms3 -- 40hrs/wk x 46 weeks (1 month off for summer break between ms1-ms2 and 2 weeks off for Christmas during ms1 year) = 1840 hrs so an MS 2, not counting Christmas break during Ms2 has 2.6 times the number of hours AFTER a BS degree (assuming a 700 hour content block)-- at a minimum they're looking at another 2 years for the MD/DO degree plus 3 years of residency ---

So, no, I don't care for NPs and won't hire them -- and yes, there are lousy doctors out there, I get it -- I'm hoping the docs have the moral courage to say/think -- "I don't know this and I'm dealing with people's lives, so I better either get trained or find something else in medicine that I do know and can do" ---

sorry, thread touched a nerve
 
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Justplainbill said it the best. They dont know that they dont know.

It is the exact reason that we dont allow pgy1s to practice independently. You will never in a million years see an article comparing attending outcomes to intern outcomes. You will never see an article lobbying for interns to be unsupervised in an OR.

Society would jump all over that. Because "residents dont have a damn clue what they are doing"

At the same time society will completely accept that an NP is "basically a doctor"
 
Justplainbill said it the best. They dont know that they dont know.

It is the exact reason that we dont allow pgy1s to practice independently. You will never in a million years see an article comparing attending outcomes to intern outcomes. You will never see an article lobbying for interns to be unsupervised in an OR.

Society would jump all over that. Because "residents dont have a damn clue what they are doing"

At the same time society will completely accept that an NP is "basically a doctor"

And I would argue that your first 1-2 years as an attending are tenuous at best in certain situations.
 
And that article is rubbish because there is more than just surgery that NPs can't do. They can't do many procedures in certain states or even write for C-IIs. Which shouldn't change, but will. NPs will be doing surgery soon I'm sure.

So you'r saying I can't go to a NP for my schedule 2 drugs?
 
I've had situations with a family member in the ICU where I was traveling incognito and watched them blow off an SpO2% of 79 and cancel an order by the intensivist for a CXR stating that "I've examined the patient and he doesn't need it" -- I was about to slip out of the room and make a few well placed phone calls when the RT walked in, saw it, and took appropriate action...
How does a nurse practitioner have the authority to cancel the order of a physician? Lol.
 
How does a nurse practitioner have the authority to cancel the order of a physician? Lol.

My question exactly -- basically the intensivist stated he wanted a CXR earlier in the day and the DNP stated when I asked about it in my Joe Schmuck voice that they didn't think the patient needed it as they had examined him themselves and thus never followed through on the order. I later chatted with the intensivist and he struck me as a really weak individual -- and the DNP actually stated that once the intensivists have rounded for the day on weekends, the RNs "who have so much advanced training and are basically doctors" manage the patients and usually don't need to call the intensivists --

I almost spit my coffee through my nose on that one -- I'm still debating on calling the Chief of Pulmonology to let them know of that little issue....
 
lol this is so true. It's also funny when NP's and PA's claim that getting into NP and PA school is more competitive than MD school. Our school has a PA program, so PA students have some lectures with us. Their tests were a joke compared to ours.
Well, in some cases it might be more competitive to get into the PA/NP program than the MD program. My school has 30 spots in their PA program, interview 100, and had 3k people apply this year. That's not to say the population applying is as academically successful as those applying to MD/DO, but strictly by numbers the program may be more difficult to get into.
 
Or we could just save money by having less referrals going out in the first place. I've read a couple of papers that show physicians and NPs are a damn near break even point financially for insurers and the government due to the excess tests and referrals generated by NPs.
Can you send me links for any of these papers? I've always heard about them but have never read them to feel comfortable actually bringing them up in conversation. Thanks!
 
Every good primary care doc I know still has a 3+ month long waitlist and works at least as many hours as they want. I'm concerned but I think its going to be awhile before the apocalypse. I've yet to meet anyone who says they prefer to see nurses over doctors for primary care.

Seriously, I remember shadowing a doctor who employees midlevels and spent some time with the NP. Some dude came with a lump in his throat. 30+ year heavy drinker and heavy smoker. NP had previously given him azithromycin and it didn't clear it up. So this time she gives him azithromycin again and an ENT referral. The type of patients that want this type of care for their whole lives is a type I'm OK passing on.
 
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Can you send me links for any of these papers? I've always heard about them but have never read them to feel comfortable actually bringing them up in conversation. Thanks!
http://www.medscape.com/viewarticle/810692

This paper has sources linked for almost every major paper I know of on the topic. Just look in the sources. Here's an excerpt of this meta-analysis of the evidence, which points out the weaknesses in all of these papers:

"Methodological Issues
Although all the reviewers were nurses, the investigator team included 2 experts in the evaluation of heath care quality and effectiveness and a physician with extensive experience conducting systematic reviews. Articles included in the review were published in peer-reviewed medical (n = 12),[33,37,39,45,48,51,52,56,57,59,61,64] interprofessional (n = 10)[34,36,38,43,46,47,49,53,55,60] and nursing (n = 15) journals.[35,40–42,44,50,54,58,62,63,65–69] A draft of the report was reviewed by 2 independent panels of technical experts: 1 panel comprised a consumer, a statistician, and a physician leader; the other included highly respected NPs. Written comments and recommendations from these reviewers were addressed by the authors.

Limitations in the body of research reviewed should be considered when interpreting the results of this systematic review. Heterogeneity of study designs and measures, multiple time points for measuring outcomes, limited number of randomized designs, and inadequate statistical data for meta-analysis were among the methodological limitations encountered. Diffusion of treatment because of inclusion of MDs in both experimental and usual care groups was also a potential problem in some studies.[33,34,58,60,66] In addition, the failure to fully describe the nature of the NP roles and responsibilities and the relationships of team members, including frequency and qualities of collaboration with MDs, limits the ability to replicate the models of care employed."

Basically, NPs have been shown to work as well as a physician when they are working with a physician. That's pretty useless evidence of their abilities to me, as the physician is likely often picking up the slack in the relationship.
 
http://www.medscape.com/viewarticle/810692

This paper has sources linked for almost every major paper I know of on the topic. Just look in the sources. Here's an excerpt of this meta-analysis of the evidence, which points out the weaknesses in all of these papers:

"Methodological Issues
Although all the reviewers were nurses, the investigator team included 2 experts in the evaluation of heath care quality and effectiveness and a physician with extensive experience conducting systematic reviews. Articles included in the review were published in peer-reviewed medical (n = 12),[33,37,39,45,48,51,52,56,57,59,61,64] interprofessional (n = 10)[34,36,38,43,46,47,49,53,55,60] and nursing (n = 15) journals.[35,40–42,44,50,54,58,62,63,65–69] A draft of the report was reviewed by 2 independent panels of technical experts: 1 panel comprised a consumer, a statistician, and a physician leader; the other included highly respected NPs. Written comments and recommendations from these reviewers were addressed by the authors.

Limitations in the body of research reviewed should be considered when interpreting the results of this systematic review. Heterogeneity of study designs and measures, multiple time points for measuring outcomes, limited number of randomized designs, and inadequate statistical data for meta-analysis were among the methodological limitations encountered. Diffusion of treatment because of inclusion of MDs in both experimental and usual care groups was also a potential problem in some studies.[33,34,58,60,66] In addition, the failure to fully describe the nature of the NP roles and responsibilities and the relationships of team members, including frequency and qualities of collaboration with MDs, limits the ability to replicate the models of care employed."

Basically, NPs have been shown to work as well as a physician when they are working with a physician. That's pretty useless evidence of their abilities to me, as the physician is likely often picking up the slack in the relationship.
Thanks for taking the time to reply
 
I went into full pimp mode and shark attacked that one -- there were other things in that situation that really pissed me off -- like when they had the balls to tell a colleague that when they graduated from NP school they would be the equivalent of a board certified, FM attending -- in which wet dream was this?

IIRC, a group of them were given a watered down Step2 and there was a 50% failure rate

Squash them like the bug that they are.

It was Step 3 BTW, which makes it all the more pathetic as most interns don't even study at all for step 3. Unless you count the 15 min computer tutorial as studying.
 
Bruh. NPs can claim whatever they want. There will always be patients who demand physicians.

One thing's for sure, no matter how much they lobby, they will never command the salary of an MD/DO. Cheap healthcare is their selling point.
 
Bruh. NPs can claim whatever they want. There will always be patients who demand physicians.

One thing's for sure, no matter how much they lobby, they will never command the salary of an MD/DO. Cheap healthcare is their selling point.

Do you really think that many patients know the difference? I mean everything besides physicians is trying to tell them that NP= MD/DO. I'd bet way more people don't understand difference than people who do.
 
Do you really think that many patients know the difference? I mean everything besides physicians is trying to tell them that NP= MD/DO. I'd bet way more people don't understand difference than people who do.

I agree, a lot of people don't know the difference.

It's ridiculous in many ways. Medical schools push this Patient-Center Medical Home model, urging students to enter primary care. At the same time, NPs are flooding the market. Inevitably, most physicians will specialize. Even family doctors will increasingly complete fellowships to make themselves more competitive in the job market in desirable areas.
 
they should just make the NP curriculum like medical school
then at least i know they actually studied medicine
 
Every good primary care doc I know still has a 3+ month long waitlist and works at least as many hours as they want. I'm concerned but I think its going to be awhile before the apocalypse. I've yet to meet anyone who says they prefer to see nurses over doctors for primary care.

Seriously, I remember shadowing a doctor who employees midlevels and spent some time with the NP. Some dude came with a lump in his throat. 30+ year heavy drinker and heavy smoker. NP had previously given him azithromycin and it didn't clear it up. So this time she gives him azithromycin again and an ENT referral. The type of patients that want this type of care for their whole lives is a type I'm OK passing on.

Got one of those the other day. 80-pack year history with dysphonia, dysphagia, and otalgia. Had been getting different antibiotics from her NP for a solid year, with worsening dysphonia, choking, and weight loss. Finally referred to ENT for "chronic laryngitis". Diagnosis: T2N2cM0 supraglottic squamous cell carcinoma. Yeah, NP missed the bulky bilateral lymphadenopathy too.
 
Wow. I heard a good one recently while shadowing at work as well.
 
Got one of those the other day. 80-pack year history with dysphonia, dysphagia, and otalgia. Had been getting different antibiotics from her NP for a solid year, with worsening dysphonia, choking, and weight loss. Finally referred to ENT for "chronic laryngitis". Diagnosis: T2N2cM0 supraglottic squamous cell carcinoma. Yeah, NP missed the bulky bilateral lymphadenopathy too.

I don't even need medical education to know something's not right in that PT. That's the sad part 😕
 
You are right on target. With the explosion of medical knowledge, there's absolutely no way that primary care physicians can know it all and do everything like the general docs of 50 years ago, much like general surgeons don't operate on nearly every organ system in the body like they did 50 years ago; maybe unless primary care residency programs want to lengthen the duration of residency. I'm in a surgical subspecialty in which there are talks of extending the residency to 6 years (rather than 5) because the amount of information keeps growing so rapidly, and with duty hours restrictions there's less time to see and do everything.

From my experience in multiple academic and private clinic settings, this is the direction that healthcare is going: the PCP's will generally try treating diseases like sinusitis, sleep apnea, otitis media, etc. with the first line treatments, and if they aren't seeing results then they'll refer them to us. Reading the NP notes, they generally have a laundry list of problems in the note because they spent an hour listening to the patient's every complaint, then each complaint gets referred out to a specialist instead of actually trying to be treated. Got sinus problems? ENT consult. Aching back? Neurosurgery consult. Headaches? Neurology consult. Trouble urinating? Off to urology. Etc. etc. As a result of this, patients are now going to primary care docs and pretty much demanding to be referred to subspecialists for problems that don't need subspecialty care, because that's what they expect. The end results is that a lot of specialty clinics (including mine) are being overrun with patients who absolutely do not need to be seen by a specialist and can easily be managed by a well-trained primary care doc. Not only is that driving up the cost of healthcare, but it is also taking time away from patients in clinic who have legitimate surgically manageable diseases. This is what scares me the most about the rise of mid-level providers seeing patients unsupervised, because while our clinics are being flooded with unnecessary patients, I cannot tell you the number of delayed cancer diagnoses I have made (often in the ED) that have been completely missed by NP's, who are treating all sore throats and lymphadenopathy with antibiotics. Is that being published? No, because I don't have the time to try to bash NP care in the public forum; I have better things to do in my time.

Hey, at least the patients will be better off by seeing the specialist vs. the NP would have no idea what to do. Plus, there are patients who want to call the specialist's office upfront, get denied, get upset, so they rush to find a NP with the only chief complaint of "needs referral to XX".
 
I agree, a lot of people don't know the difference.

It's ridiculous in many ways. Medical schools push this Patient-Center Medical Home model, urging students to enter primary care. At the same time, NPs are flooding the market. Inevitably, most physicians will specialize. Even family doctors will increasingly complete fellowships to make themselves more competitive in the job market in desirable areas.

Ugh, I HATE the PCMH model...my eyes can't stop rolling so hard everytime I see that ****.
 
Fun one we had recently:

pt goes to urgent care with chest pain and shortness of breath. NP diagnoses pneumonia clinically and sends out with oral antibiotics.

1 week later presents to ED with ventricular wall rupture as a complication of the MI he had been having a week ago when he saw the NP.

NP didn't get CXR, EKG, or labs.

Good times.
I liked this post but seriously that is a ***HUUUUGEEE*** screw-up.
In the EM forums, they talk a lot about emergency departments that, even if they do employ NPs or PAs, they do NOT allow them to handle cases like this. If you come in with a CC of "chest pain," you are at the very least going to see an intern.

This also sounds like a HUGE lawsuit.

Do you live in a state where the NP will be held liable or will it be his/her "supervising" physician?

Also the patient... I am assuming they died?
That is really just a completely unforgivable screw-up, but of the handful of NPs I have worked with, I don't think any of them could even read an EKG or a chest x-ray. They mostly would rely on computer or radiologist interpretation. Some of them would immediately admit this and go grab the nearest physician, though.
 
Got one of those the other day. 80-pack year history with dysphonia, dysphagia, and otalgia. Had been getting different antibiotics from her NP for a solid year, with worsening dysphonia, choking, and weight loss. Finally referred to ENT for "chronic laryngitis". Diagnosis: T2N2cM0 supraglottic squamous cell carcinoma. Yeah, NP missed the bulky bilateral lymphadenopathy too.
Incredible. The other day my attending told me of his patient who had a huge melanoma on her breast was embarrassed to be examined by a male. So the female NP did her breast exam and completely missed it.

These are the cases where you will see a huge disparity in outcomes if they ever started directly comparing solo practice NPs with attendings, but doing such a study would be considered unethical by many.
 
Fun one we had recently:

pt goes to urgent care with chest pain and shortness of breath. NP diagnoses pneumonia clinically and sends out with oral antibiotics.

1 week later presents to ED with ventricular wall rupture as a complication of the MI he had been having a week ago when he saw the NP.

NP didn't get CXR, EKG, or labs.

Good times.
Oh my sweet lord

You would think that the news of events like this would spread quickly enough that no one would want to see a NP for anything even remotely serious. But you never hear of it. Whereas if a physician misses something like this, it's all over the news.
 
That's a clean kill right there. I hope the family sues them.


The doc is the one who has to pay up in these lawsuits.


When it comes to mistakes, midlevels love being midlevels. its always the physician who should have double checked.
 
The doc is the one who has to pay up in these lawsuits.


When it comes to mistakes, midlevels love being midlevels. its always the physician who should have double checked.

If the NP was practicing independently it would be on them though, as there would be no supervising physician to sue. Obviously that's limited by the state, but still, if NPs want to play doctor, let them do it in court and with insurance instead of just in the clinic.
 
You actually don't have to be a NP to make good money in nursing. If you schedule yourself right you can easily make over a 100,000 a year if not more without burning out. You do not need the debt or extra time in school and responsibility to make good money. The biggest lie ever sold by NP programs.
 
You actually don't have to be a NP to make good money in nursing. If you schedule yourself right you can easily make over a 100,000 a year if not more without burning out. You do not need the debt or extra time in school and responsibility to make good money. The biggest lie ever sold by NP programs.

Money is important but i think what gets nurses is the prestige, the white coat and the extra letters on their name. Also floor nursing sucks, you always have too many patients, too many tasks and too much bs charting
 
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