That last part is a bit of a myth. Most states allow physicians to testify as expert witnesses against midlevels. But the double standard that NPs are not doctors at the time of judgement/decision is real. That's why you see those articles that say "NP cannot be liable because NP is not practicing 'medicine'".
...do you have any solutions or are you just here to drop a bomb and say that we're all hosed? Because we dealt with that like, 4 pages ago.
...do you have any solutions or are you just here to drop a bomb and say that we're all hosed? Because we dealt with that like, 4 pages ago.
Havent people been warning the end is nigh in gas and primary care for like 30 years tho
You guys have to fight. Corporate take over is the death of medicine.
Primary care outpatient is ok so far. But inpatient is dominated by corporate (Envision, team health etc...). Looking for job for the past 5 months has opened my eyes. These corporations are destroying medicine and they are everywhere.
you only need to read the PA forums and PA subreddit to see how brutal their job market is compared to NPs
I have not started my career yet but I could see the writing on the wall. We will not recognize medicine 10 yrs from now.
I think an obtainable goal would be to push for certain certifications to perform certain procedures, like oh I don't know a residency. Make it ILLEGAL for mid levels to perform procedures and problem solved, but this would take some very strong lobbying
You cannot possibly believe it would take a 3+ year residency to learn screening scopes. As mentioned earlier surgeons can get cert after like 50
Clearly not as nurses are doing them, but preventing future creep should be the goal. An example would be to prevent NP/PA from putting tubes in ears etc etc. Its not about the difficulty or the inability to become competent, rather to protect the fields
You're never, ever going to get a legislature in a state with shortage areas to deny FPA on the grounds that we need to protect physician incomes
There are no shortages, just misallocations. The nursing lobbies/PA lie and say "oh we need to be able to do x procedure because there is no one to do it in the rural areas, we can!", said law gets passed and where do they end up doing these procedures? Not in the rural part of the state like they lobbied they would! They're doing those procedures right smack dab in the middle of the city while laughing at physicians
Totally agree we should do more to incentivise distribution to match demand, like PSLF style programs. But you cant blame them for thinking an occasional additional rural NP is better than no care at all, and if NPs trained to screen have the same detection standard we hold MDs to, it's tough to argue against that.
@Lem0nz is right, NPs/PAs aren't going anywhere and we aren't going to convince any lawmaker to prohibit them from doing basic procedures because there are definitely areas with real need for people to do them, even though we all know it's just a lie and they'll set up their screening scope clinic in Manhattan the second they get credentialed.
Colonoscopy is practically GI cash cow. They can do in 15-30 minutes. Even if reimbursement is let's say $500, doing only 4-5/days already pay the bills.
Our profession is doomed.
I had no idea med schools could contractually obligate their students to practice in certain places, that's really interesting. Do they lose their license if they move away? The sticky situation I see happening here is arguments about tiers of care - if NPs are inferior screeners why is it ok for poor or rural areas to get inferior care to wealthier city patients? If they're not inferior, why cant they screen everywhere MDs can? Gets tough to justify without resorting to "MDs deserve first dibs on the cash cows and you can only have them if were unwilling"
No, you have to pay an exorbitant fine.
If they currently have low to no access it’s better to have access to an inferior screener than to nothing at all. Why don’t you ask this question to your faculty at Hopkins since they are so eager to have NPs do screening scopes?
Because the entire nurse lobby campaign for independence has been founded on the idea that NPs will help increase access to care in rural areas. At minimum such a restriction would force them to acknowledge the fact that is a complete lie.
How exactly does this fine work - is it the state government coming to reclaim tuition subsidy they gave under the obligation? Sounds like a promising answer to the distribution issues, not just for midlevel but for the DO and MD state schools funded by taxpayers
Don’t see how that works. How can we say nurses are qualified to do certain things, but only in rural areas. We basically send the message that docs don’t want to deal with the underserved which would backfire hard.
Agreed. Its a fun idea in concept but the real world implications are not at all good.
I don't know how that would work. However, Florida has an ACN (area of critical need) license for physician who are not qualified for unrestricted license. And they have a list of facilities (mostly rural, prisons and migrant clinics) where physicians who hold the ACN license are allowed to practice medicine.
Yeah it would be a thing for like 2 years and then there would be a massive PR campaign about how greedy physicians are keeping their cash cow in desirable areas and that we don’t really care about patients.
There is precedent with ACN licenses as mentioned above. It would definitely depend on how physicians lobbied for it, as it would definitely have to take on the form of “yes we would love the help in getting access to rural and underserved areas, let’s ensure those people get access by allowing adequately trained MLPs to be certified for select
Not the same. Doing the above to nurses will just be seen as bullying. I also just don’t think services by NPs like this are at all appropriate so maybe that’s increasing my bias against the idea. Maybe I’d be more confident in their capabilities to perform an invasive procedure unsupervised if I didn’t see them handing out benzos and stimulants like candy all the while being unable to manage HTN and hyperlipidemia. It’s absolutely ridiculous that we’re giving these people even more opportunity to kill someone.
I agree with you. I had a new NP in a cardiology clinic ask me how I went about reading EKGs because they had never done it before. I’m just not sure how we can put the cat back in the bag.
There are Cardiologist’s training NPs their secrets and NPs love them and work for them and when they retire the NPs start their own thing.
How so? Arent most peoples bread and butter cash cows the repetitive simple procedures that would be exactly what NPs do a fellowship year to scoop up? Skin biopsies, colonoscopies, injections, etc?
Look at any country in the world that has two or more tiers of healthcare and see how much physicians are getting paid in the ‘private, better’ system vs. the ‘public, default’ system.
This is what this Kalloo guy did. Note how the LOR is from a supervising physician.Nurse Practitioner Fellowship Program
The Nurse Practitioner Fellowship combines advanced education with clinical experience so that graduates can provide gastroenterology and hepatology care in any settingwww.hopkinsmedicine.org
Didn’t know this was a thing back when this thread got going.
