NYT Today: "Nurses are Not Doctors"

[NickNaylor]

Here's the thing though and (this is the beautiful kicker)...patients don't care. Like somebody else said, a lot of them actually prefer having "something" done to them rather than telling them the abdominal pain is probably from the day old burrito they ate last night.

In fact, think about it. Why the heck would patients care if the cost difference is made up by NPs ordering more tests? In their world, less money goes into the greedy doctor's pockets and more money goes into "helping them" with all these great tests and bloodwork! Win win! This is a terribly losing argument if we want to convince the general public that we're superior to NPs.

I dunno, they might care when they see their bills...

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[DermViser]

Agree. This ^^^ part is the one I find most fascinating. It is not unlike a cult phenomenon we're dealing with. One that unfortunately has hypnotized the public at large.

It's as baffling as it is sad.

Their propaganda machinery puts me in awe. They're as certain of their rightful claims as fundamentalists. But as sophisticated in mass hypnosis of the public as any mass political movement of the last century. And their social message is pitch perfect with current public imagination.

The situation in Oregon is foretelling. Aging, spoiled, baby boomer hippies who got their educations nearly for free and who received all the benefits of the zenith of american economic boon, selling out anyone and everyone who doesn't cough up what they want...now. They are the perfect public for the Rise of the NP's.

My favorite - petitioning tv shows: http://www.truthaboutnursing.org/letters/

 

[DermViser]

Here's the thing though and (this is the beautiful kicker)...patients don't care. Like somebody else said, a lot of them actually prefer having "something" done to them rather than telling them the abdominal pain is probably from the day old burrito they ate last night.

In fact, think about it. Why the heck would patients care if the cost difference is made up by NPs ordering more tests? In their world, less money goes into the greedy doctor's pockets and more money goes into "helping them" with all these great tests and bloodwork! Win win! This is a terribly losing argument if we want to convince the general public that we're superior to NPs.

Except NPs want to be reimbursed ON PAR with physicians so there is no cost difference.

 

[Psai]

Yes, but the point is based on the person's credentials and training she was supposed to collaborate with the physician on site as defined by Louisiana's scope of practice. She didn't. She had the typical hubris of an NP who thinks she knows it all.

• Duhon did not collaborate with Dr. Bergstedt concerning Taylor’s condition. Instead, she verbally reassured Taylor’s mother and prescribed over thirty medications to treat the child’s multiple complaints and observable symptoms. Additionally, Duhon stated that Taylor only needed to see Dr. Bergstedt in connection with admission to a hospital. After no progress in her condition, Taylor’s mother eventually brought her to Women & Children’s Hospital in Lake Charles, where she was treated for the first time by Dr. Bergstedt. Taylor was diagnosed with neuroblastoma..

Seems like she treated each sx separately, instead of putting it together.

Stuff like neuroblastoma is pounded on our skulls on our shelf exams, and USMLE Step 2 CK, etc. and while we may laugh at it, isn't until it actually pops up and saves someone's life that we actually appreciate having learned it. The ability to come up with an extensive differential diagnosis to rule things in and out, and knowing what warning signs to watch out for can't be replaced by flowcharts and algorithms. For an NP who doesn't even have neuroblastoma on her differential to begin with, there is no way she could have caught it. That's why you have a collaborating physician.

...what the hell 30 medications for symptoms? Jesus christ

 

[Gifted Hands]

A lot of the nursing propaganda and PR machine is because they can unionize and lobby. Does anyone understand why they have that ability but we can't?

 

[Coffee Machine]

The link is awful and should certainly get more publicity. However, physicians still miss things. And because they have been around a whole lot longer, there are many more instances. Even if the prevalence of these kind of errors and oversights was twice or thrice that of physicians, those fighting for NP status will just use the higher absolute count of physicians. And the general public will let their eyes glaze over and just ignore the inconvenient information.

The difference is that this NP missed this because she didn't have the clinical knowledge to spot neuroblastoma. Physicians may miss things too, but it's because they were careless or some combination of extenuating circumstances prevented them from putting things together, not because they fundamentally lack the knowledge necessary to make a diagnosis. Having a bad patient outcome because you're trying to practice beyond your education is malpractice of the worst kind.

I guarantee you nurses joining the profession of nursing definitely care about their salary. They bring down clinical operations to a halt by going on strike for this, esp. in a liberal haven like Chicago, where unions are powerful.

That's what gets me. None of the people that make that argument have ever spent any time at a nursing school. Nursing is flooded with applicants right now precisely because it offers a good salary and job security. My wife's a nurse and she used to talk all the time about the people in her class that were only in it for the money, many of whom started nursing school with the goal of becoming CRNAs so that they could make >$100k.

 

[DermViser]

...what the hell 30 medications for symptoms? Jesus christ

You would think after the first 10 medications, she would have caught on that maybe this is more complicated than she thought.

 

[Gifted Hands]

I think we'll see their game play out on a grand scale throughout the United States in the next 10-15 years or so. Naturally, physicians are going to migrate from the states that allow independent practice rights to states that don't (kind of like the Ob/Gyn phenomenon with malpractice). As long as the overwhelming majority of states don't grant independent practice rights before this happens, we can see for ourselves what happens when the majority of care is provided by independent NPs. We might get our own natural experiment.

By the time this natural experiment takes place we've already lost - and there's no regaining that ground once it's lost.

Most importantly, the patient loses even more

 

[touchpause13]

A lot of the nursing propaganda and PR machine is because they can unionize and lobby. Does anyone understand why they have that ability but we can't?

Because physicians are too busy fighting among themselves

 

[deleted480308]

I dunno, they might care when they see their bills...

More and more patients don't pay for their own care, that's the luxury your 30+% income tax buys them

 

[Gifted Hands]

Because physicians are too busy fighting among themselves

QFT

 

[DermViser]

Sure, sure but right now they aren't in most states so the patient only gets billed 85% of what they would for a normal office visit (since they only get reimbursed at the 85% rate). In regards to Nick's response, I thought about the big imaging bill too but I think it's a little mitigated by the fact that they're getting something "extra" for their money, especially if they wanted that Xray/CT/ultrasound all along.

Reimbursement difference on an office visit btw an NP or Physician, isn't enough to make up the cost of a CT scan.

 

[PL198]

Here's another thing I don't get. Probably not even half the training, yet equal reimbursement.

Sounds like a recipe for success. Money for all! Hell if you want to just go read through BRS and couple times, we will pay you to '' improve accessibility. ''

 

[calvnandhobbs68]

By the time this natural experiment takes place we've already lost - and there's no regaining that ground once it's lost.

Most importantly, the patient loses even more

But that's the thing right? If "we've lost" because we can't show worse outcomes, then what's the point in the public's eye? Really, what's the point in our eye? Are we just circling the wagons to protect our salaries? I have no problem with that, other professions do it all the time, but then let's be honest with ourselves about what we're doing.

If we do see that outcomes are worse/healthcare gets more expensive, we win. We have the data to go back to legislators and say "Bad idea homie, check out all the people you killed and money you wasted". The moment the study comes out in the NYT that morbidity/mortality rates are higher/healthcare costs more in states with higher numbers of independent NPs, people will be bending over backwards to let the good old doctor be the boss again.

 

[DermViser]

QFT

To be fair, unions are a normal Democratic constituency, period.

 

[NontradCA]

To be fair, unions are a normal Democratic constituency, period.

You know, I'd like to say I'm sorry for the **** I gave you in the other thread. =(

This thread, and especially that AANP Facebook page has me disgusted.

 

[calvnandhobbs68]

Reimbursement difference on an office visit btw an NP or Physician, isn't enough to make up the cost of a CT scan.

Sure, in most cases. But lots of people have the mentality that they're "getting something" for their money with that imaging.

Not to mention, even with these studies, not many people are going to say to themselves "Hmm I bet a doctor wouldn't have wanted to get that CT".

 

[DermViser]

But that's the thing right? If "we've lost" because we can't show worse outcomes, then what's the point in the public's eye? Really, what's the point in our eye? Are we just circling the wagons to protect our salaries? I have no problem with that, other professions do it all the time, but then let's be honest with ourselves about what we're doing.

If we do see that outcomes are worse/healthcare gets more expensive, we win. We have the data to go back to legislators and say "Bad idea homie, check out all the people you killed and money you wasted". The moment the study comes out in the NYT that morbidity/mortality rates are higher/healthcare costs more in states with higher numbers of independent NPs, people will be bending over backwards to let the good old doctor be the boss again.

No amount of studies will work, if you don't have the lobbying and media strength to bring your message to the forefront. Look how impotent the AMA is to where even Congress thinks they're idiots.

http://www.politico.com/news/stories/0710/39586.html

“For the amount of money that AMA spends, it doesn’t seem to get the bang for their buck,” said a senior Republican health staffer who has worked with the group.

“By contrast, the American Hospital Association is much more careful and strategic how it uses its resources and has gotten a lot more done. They’re certainly much more respected and have better access on the Hill.”

“People are beginning to question, from the Hill, what the AMA’s clout is,” said Julius W. Hobson Jr., a senior policy adviser at the law firm Polsinelli Shughart and a former AMA lobbyist. “That’s a problem.”

 

[DocVapor]

Yes, but the point is based on the person's credentials and training she was supposed to collaborate with the physician on site as defined by Louisiana's scope of practice. She didn't. She had the typical hubris of an NP who thinks she knows it all.

The difference is that this NP missed this because she didn't have the clinical knowledge to spot neuroblastoma. Physicians may miss things too, but it's because they were careless or some combination of extenuating circumstances prevented them from putting things together, not because they fundamentally lack the knowledge necessary to make a diagnosis. Having a bad patient outcome because you're trying to practice beyond your education is malpractice of the worst kind.

Yes of course I understood this. My point was that at this point in time, the general public that is pro-NP is either unable to or unwilling to understand the difference. All of us here can moan and complain about it all day long and it won't mean jack unless we start winning those people over, because they'll cite news story after news story about incompetent physicians. Then other well-meaning individuals without the intricate knowledge that we have will see the huge # and become converted themselves. You all can read the comments on the stories here. We COULD fight fire with fire, but it would only end up making us look like greedy bullies.

The NP lobby got this rolling insidiously until it reached a critical mass. If we are going to act, it needs to be a similar approach. How would that be? Beats me, and sadly I have to worry about my boards in the near future so I don't have the time to devote to it right now.

Edit: And hell, most of us have family members that we can't even convince. We have an uphill battle, that's for sure.

 

[DermViser]

You know, I'd like to say I'm sorry for the **** I gave you in the other thread. =(

This thread, and especially that AANP Facebook page has me disgusted.

The fact that I was able to change your mind with evidence presented is enough thanks for me. No need to say sorry.

 

[Gifted Hands]

To be fair, unions are a normal Democratic constituency, period.

True... But lobbying isn't

 

[Gifted Hands]

But that's the thing right? If "we've lost" because we can't show worse outcomes, then what's the point in the public's eye? Really, what's the point in our eye? Are we just circling the wagons to protect our salaries? I have no problem with that, other professions do it all the time, but then let's be honest with ourselves about what we're doing.

If we do see that outcomes are worse/healthcare gets more expensive, we win. We have the data to go back to legislators and say "Bad idea homie, check out all the people you killed and money you wasted". The moment the study comes out in the NYT that morbidity/mortality rates are higher/healthcare costs more in states with higher numbers of independent NPs, people will be bending over backwards to let the good old doctor be the boss again.

I agree with you... But what I meant when I said "we've already lost" is not the outcomes being the same, but that even if we present research showing their presence is having a negative impact, NPs will have already firmly rooted themselves with a death grip as independent providers and they won't give it up because of research studies and hazy outcomes.

 

[DermViser]

I agree with you... But what I meant when I said "we've already lost" is not the outcomes being the same, but that even if we present research showing their presence is having a negative impact, NPs will have already firmly rooted themselves with a death grip as independent providers and they won't give it up because of research studies and hazy outcomes.

Yup, studies tucked away in JAMA won't do it. It doesn't matter how high powered your study is. What matters is the media blitz to publicize that study is.

 

[calvnandhobbs68]

Yup, studies tucked away in JAMA won't do it. It doesn't matter how high powered your study is. What matters is the media blitz to publicize that study is.

That's why I said front page of NYT

 

[postbacpremed87]

By the way, when did other professions hijack the white coat ceremony? I just saw several news articles talking about BSN programs having white coat ceremonies. Waist long white coats like medical students.

 

[DocVapor]

By the way, when did other professions hijack the white coat ceremony? I just saw several news articles talking about BSN programs having white coat ceremonies. Waist long white coats like medical students.

You didn't hear? Everyone's a WINNER these days.

 

[postbacpremed87]

You didn't hear? Everyone's a WINNER these days.

You know that Jr. Basketball league championship that you didn't win when you were 8....YOU DIDN'T DESERVE THAT TROPHY. That mentality of unanimity at all costs sickens me.

I get that everyone wants to feel important, but isn't that why we have appreciation days, weeks, or months....to single them out and appreciate (insert whatever).

 

[Nasrudin]

Here's the thing about studies that makes them flawed from the outset. Physicians and physician training are what drive the competence of the whole clinical enterprise. NP's fight for independence as if they haven't been or aren't trained to competence at full pay by us.

If it was nursey town over there with their schools their hospitals and their systems of training with their barely passing our puppy version of step 3-selves and us over here in Doctorville...THEN....and only then would we have a means of comparison.

The Public will never understand the complexity of this. That their resources in investing in physician education are reclaimed in residency where residents make McDonalds level hourly wages. And that they might actually loose value paying for the completion of NP training at full pay since they have to slow down their doctor to cover the @ss of these green clinicians.

If I didn't subscribe to the thesis put forth by Idiocracy I might be hopeful for us. As it is I think convincing future generations of humans not to water plants with Power Drinks might be accomplishment enough.

Why if you say, *****s get what they deserve, is it so shameful in our profession. As if the burden of *****s commenting against us in the original posted article is both our bane and our responsibility?

 

[Nasrudin]

Has anyone run or seen the numbers run on how much money the public treasury makes on the repayment of medical education loans?

 

[postbacpremed87]

No, but I would be interested in that figure. I don't care what people say - this does beg the question...what specialties are safe? The nurse lady said oncology or surgery, though those are probably on her 25 year plan. Her first goal is to establish a beachhead on the coast of primary care. They have successfully invaded and are moving inward.

 

[PL198]

Has anyone run or seen the numbers run on how much money the public treasury makes on the repayment of medical education loans?

Eh, I'm not a fan of the fed, but aren't private loans from med school pretty difficult to obtain?

 

[KinasePro]

This thread is TLDR, so sorry if this post is redundant.

Primary care has made its bed by devolving into the gatekeeper role far too frequently, and the day is coming when they'll just have to have to lie in it. On top of this, we collectively continue to cannibalize our profession by not playing well with each other in the public policy forum. To me, it comes as no surprise that the "gatekeeper" role is being encroached upon by mid-levels with less training, when there's a large number bad docs who practice like mid-levels anyways. It will continue to happen, and I honestly can't say I disagree with it. Too many PCPs (but obviously not ALL pcps) complain about compensation and mid-levels, when 95% of their day-to-day decision making can be easily substituted by people with less training. Healthy physicals, preventative medicine counseling (i.e. 9-10 of the same conversations repeated ad nauseum to most patients), and simple DM/HTN management don't require 4+3 years of intensive medical training. Sorry, but its the truth. "Here, let me squish your thyroid and abdomen real quick, listen to your heart + lungs for 5 seconds, do a half-assed neuro exam, and stick my finger up your butt for good measure." That's what I saw most of the time on my 8 week primary care rotation.

Sure, outcomes will suffer when mid-levels take over primary care, but not enough to deter the average American from seeing mid-levels instead of real doctors. It's only going to continue in this direction as the primary care need continues to grow. Just another reason to stay away from primary care IMO. If PCP MDs want to protect their role, they need to demonstrate their added value. It's easy for specialists/surgeons to demonstrate their value, because they mostly take care of scary **** that could kill patients if managed poorly.

 

[Psai]

No, but I would be interested in that figure. I don't care what people say - this does beg the question...what specialties are safe? The nurse lady said oncology or surgery, though those are probably on her 25 year plan. Her first goal is to establish a beachhead on the coast of primary care. They have successfully invaded and are moving inward.

I don't see where it begs the question.

 

[postbacpremed87]

Below is a comment (by a nurse) that I found on the NYT article. I have seen this in action where I work.

"Last year I was admitted to the hospital with chest pain. A nurse practitioner showed up, she was immediately shown the door, and I demanded to be seen by a physician. As a nurse, there is no way I will place my medical decision making in the hands of a peer, even if there is a practitioner designation after the name of our honored profession. The problem is not only the reduced number of clinical hours, but the overall quality of those nurse practitioner programs. They have proliferated like wildfire with little or no control. While there are rigorous programs, the great majority are for profit outfits with no admission standards, will take any nurse, even new graduates, with all the courses online, where there is no control of who actually completes them (many of my colleague nurses pay others to complete their courses), and then those 600 clinical hours are done in a Walgreens or CVS clinic. What a joke. Most of my colleagues at my hospital are enrolled in nurse practitioner programs, and these are people who were barely qualified to be admitted to a community college associate's degree of nursing program just a few years ago. And now after a couple of online courses and an internship at a clinic they want to diagnose and order tests and write prescriptions. Not going to happen to this RN. I really worry about the patients in New York and the 16 other states where nurse practitioners work independently."

I currently work in a pediatric office and many of the nurses barely scrapped by at technical college programs. The level of incompetence is astounding. I have actually heard the following during a catheterization of a female patient:

Nurse 1: "How many holes are down here? Which one is it?"
Nurse 2: "Are there 3 holes down here?!" I am assuming she knows what an anus is and wasn't including that.

The above scenario resulting in much poking and fumbling and a traumatic situation for the patient and parents. Yet one of these nurses has enrolled in an NP program in which many of the classes are online. Incredible.

There is also a newly minted NP in the practice who sees maybe half the patients an MD can in the same amount of time. This is a clinic setting and she seriously strep tests nearly everyone despite symptoms (aside from injuries) because she has zero clinical judgement. She also can't do simple math in order to calculate dosages for drugs. She doesn't understand dimensional analysis and has an app on her phone that she puts in information and it spits out a dosage for her.

A voice of hope drowned in a sea of lunacy....

 

[postbacpremed87]

I don't see where it begs the question.

Uhhh....have you been reading the thread? There is this thing called an assault on medicine. I wasn't referring to the post directly above, but to the overarching theme of the thread.

 

[DermViser]

This thread is TLDR, so sorry if this post is redundant.

Primary care has made its bed by devolving into the gatekeeper role far too frequently, and the day is coming when they'll just have to have to lie in it. On top of this, we collectively continue to cannibalize our profession by not playing well with each other in the public policy forum. To me, it comes as no surprise that the "gatekeeper" role is being encroached upon by mid-levels with less training, when there's a large number bad docs who practice like mid-levels anyways. It will continue to happen, and I honestly can't say I disagree with it. Too many PCPs (but obviously not ALL pcps) complain about compensation and mid-levels, when 95% of their day-to-day decision making can be easily substituted by people with less training. Healthy physicals, preventative medicine counseling (i.e. 9-10 of the same conversations repeated ad nauseum to most patients), and simple DM/HTN management don't require 4+3 years of intensive medical training. Sorry, but its the truth. "Here, let me squish your thyroid and abdomen real quick, listen to your heart + lungs for 5 seconds, do a half-assed neuro exam, and stick my finger up your butt for good measure." That's what I saw most of the time on my 8 week primary care rotation.

Sure, outcomes will suffer when mid-levels take over primary care, but not enough to deter the average American from seeing mid-levels instead of real doctors. It's only going to continue in this direction as the primary care need continues to grow. Just another reason to stay away from primary care IMO. If PCP MDs want to protect their role, they need to demonstrate their added value. It's easy for specialists/surgeons to demonstrate their value, because they mostly take care of scary **** that could kill patients if managed poorly.

Don't forget of course, demonizing specialists. Also, while midlevels TALK about going into and being the primary care workforce, their actions are the exact opposite.

 

[DermViser]

This thread is TLDR, so sorry if this post is redundant.

Primary care has made its bed by devolving into the gatekeeper role far too frequently, and the day is coming when they'll just have to have to lie in it. On top of this, we collectively continue to cannibalize our profession by not playing well with each other in the public policy forum. To me, it comes as no surprise that the "gatekeeper" role is being encroached upon by mid-levels with less training, when there's a large number bad docs who practice like mid-levels anyways. It will continue to happen, and I honestly can't say I disagree with it. Too many PCPs (but obviously not ALL pcps) complain about compensation and mid-levels, when 95% of their day-to-day decision making can be easily substituted by people with less training. Healthy physicals, preventative medicine counseling (i.e. 9-10 of the same conversations repeated ad nauseum to most patients), and simple DM/HTN management don't require 4+3 years of intensive medical training. Sorry, but its the truth. "Here, let me squish your thyroid and abdomen real quick, listen to your heart + lungs for 5 seconds, do a half-assed neuro exam, and stick my finger up your butt for good measure." That's what I saw most of the time on my 8 week primary care rotation.

Sure, outcomes will suffer when mid-levels take over primary care, but not enough to deter the average American from seeing mid-levels instead of real doctors. It's only going to continue in this direction as the primary care need continues to grow. Just another reason to stay away from primary care IMO. If PCP MDs want to protect their role, they need to demonstrate their added value. It's easy for specialists/surgeons to demonstrate their value, because they mostly take care of scary **** that could kill patients if managed poorly.

If that's the case then ALL doctors should be specialists and no residency positions should be afforded to primary care residencies at all. We could start by taking all those Family Medicine residencies and put them either in specialties or in ones that can specialize right after: IM and Peds.

 

[DrCharlemagne]

Uhhh....have you been reading the thread? There is this thing called an assault on medicine. I wasn't referring to the post directly above, but to the overarching theme of the thread.

Here's a hint, begging the question does not mean raising the question.

 

[synecdoche]

Here's a hint, begging the question does not mean raising the question.

So many people use "begging the question" incorrectly these days that I usually just assume they mean "raising the question", haha.

 

[postbacpremed87]

Here's a hint, begging the question does not mean raising the question.

Modern usage
Many English speakers use "begs the question" to mean "raises the question", "evades the question", or even "ignores the question", and follow that phrase with the question, for example: "I am 120kg and have severely clogged arteries, which begs the question: why have I not started exercising?"
In philosophical, logical, grammatical, and legal contexts, authorities deem such usage to be mistaken or at best unclear.

I am sorry Mr. or Mrs. Authority. I'll concede to you on that point....let's move on to the main point of the thread please.

 

[TheRobin]

Well, this is a bummer.

 

[Arkangeloid]

This thread is TLDR, so sorry if this post is redundant.

Primary care has made its bed by devolving into the gatekeeper role far too frequently, and the day is coming when they'll just have to have to lie in it. On top of this, we collectively continue to cannibalize our profession by not playing well with each other in the public policy forum. To me, it comes as no surprise that the "gatekeeper" role is being encroached upon by mid-levels with less training, when there's a large number bad docs who practice like mid-levels anyways. It will continue to happen, and I honestly can't say I disagree with it. Too many PCPs (but obviously not ALL pcps) complain about compensation and mid-levels, when 95% of their day-to-day decision making can be easily substituted by people with less training. Healthy physicals, preventative medicine counseling (i.e. 9-10 of the same conversations repeated ad nauseum to most patients), and simple DM/HTN management don't require 4+3 years of intensive medical training. Sorry, but its the truth. "Here, let me squish your thyroid and abdomen real quick, listen to your heart + lungs for 5 seconds, do a half-assed neuro exam, and stick my finger up your butt for good measure." That's what I saw most of the time on my 8 week primary care rotation.

Sure, outcomes will suffer when mid-levels take over primary care, but not enough to deter the average American from seeing mid-levels instead of real doctors. It's only going to continue in this direction as the primary care need continues to grow. Just another reason to stay away from primary care IMO. If PCP MDs want to protect their role, they need to demonstrate their added value. It's easy for specialists/surgeons to demonstrate their value, because they mostly take care of scary **** that could kill patients if managed poorly.

We should expand concierge care to the upper middle and middle classes, so we get PCPs, and poor/rural people have to go with NPs.

Well, that's probably going to happen anyways if the NPs have their way.

 

[DermViser]

We should expand concierge care to the upper middle and middle classes, so we get PCPs, and poor/rural people have to go with NPs.

Well, that's probably going to happen anyways if the NPs have their way.

It's already set on being a two-tier system, and Obamacare is accelerating that trend.

 

[SurgeDO]

is there no way to boycott referrals from NPs and physician's who hire NPs? Oregon may have already been lost, but other states still have a chance at seeing how physicians view nurses with master degrees.

 

[Burla]

It doesn't appear that this has been brought up yet, but after a cursory search physician salaries account for ~8.5% of total health care costs and 20% if you include practice expenses. How can it even be argued that using NPs to replace PCPs will dramatically reduce costs?

 

[Arkangeloid]

It doesn't appear that this has been brought up yet, but after a cursory search physician salaries account for ~8.5% of total health care costs and 20% if you include practice expenses. How can it even be argued that using NPs to replace PCPs will dramatically reduce costs?

The NPs don't care. They hate us and they are exploiting public anger against "the 1%" to advance their agenda.

 

[mmmcdowe]

Found this gem of a comment... had the most likes (47) of any comment I saw. lol.

"As an Advanced Practice Nursing student at the University of California-San Francisco and future primary care provider, I am disappointed by Sandeep Jauhar’s limited inquiry into advanced practice nursing and his assumption that nurses want to be confused with medical doctors (clarification: many nurses ARE doctors, having attained Doctorates of Nursing Practice or PhDs). Jauhar’s acceptance of APNs as being more “sensitive to patients’ psychological and social concerns” coupled with his rejection of nurses as competent clinicians suggests an outdated understanding of nursing science, one in which nurses only meet the spiritual/emotional needs of patients. A systematic review of APN practice from 1990-2008 concludes APNs have comparable patient outcomes with MDs (Newhouse, 2008). The 15 yo study Jauhar cites does not, as he asserts, prove NPs “compensate for a lack of training” by ordering excessive diagnostic tests. Rather, the researchers “found a trend toward increased utilization… but for most of these [measures] our study lacked sufficient power to show statistical significance” (Hemani, 1999). The anecdote about a MD diagnosing goiter based simply on a patient’s hoarse voice is quite remarkable considering that an actual diagnosis of goiter would require, at minimum, a physical exam and labs confirming abnormal thyroid hormone levels. Perhaps as long as residents believe primary care requires near mystical powers they will choose specialization over family medicine."



Strong awareness of the difference between a PhD and an MD

People are missing the real zinger in this comment, which is that all goiters apparently requires abnormal thyroid hormone levels.

 

[DermViser]

It doesn't appear that this has been brought up yet, but after a cursory search physician salaries account for ~8.5% of total health care costs and 20% if you include practice expenses. How can it even be argued that using NPs to replace PCPs will dramatically reduce costs?

You actually think they're trying to truly address costs?

 

[Frazier]

There is often blame for this placed on physicians by physicians (or future physicians, like many of us on this forum).

"Why don't docs unionize?" "How can we fight back, when we are too busy fighting among ourselves?" "Psychiatry not respected by vascular surgeons" "EM docs are basically glorified triage nurses"....etc

It always brings up the thought for me::: the physician fields within "medicine" are largely not the same profession. Huh? Sounds strange, I imagine.

A neurosurgeon and a family med doc are both physicians, they are both at the pinnacle of their field, and both deserve respect... why doesn't the neurosurgeon rally for the family med doc in the face of NP's taking over primary care?

They aren't the same career.

The radiation oncologist and anesthesiologist are both physicians, they are both highly educated, and both deserve respect... why doesn't the radiation oncologist rally for the anesthesiologist facing replacement by CRNA's?

They aren't the same career.

Human nature is to care most about ourselves, our family, and our personal friends. We give most attention to the threats to our own well-being...not so much to what happens to that other antelope being chased by the lion 100 yards away.

While different specialties all practice under the umbrella of medicine with the title "physician", they are no more similar than NFL player is to NBA player playing under the umbrella of sports entertainment with the title "professional athlete".

Aggregated:

NFL players don't strike for NBA players' reimbursements, turf, interests.

Specialists don't strike for PCPs' reimbursement, turf, interests.

There will never be any "union" formed. Different specialties are not the same career.

No one can be blamed. It is nature.

 

[mmmcdowe]

Whevever this topic pops up I can't help but browse http://www.pandabearmd.com/category/the-future-of-medicine/