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Overpaid nurses
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Reasonably well versed, My moms is heavy into that stuff on a national level as an NP. I have intimate experience on the micro level, which was my point--insight can be gained about the real nature of things from the cockroach's perspective sometimes.
So I understand the rhetoric employed to garner public support and of course nurses will always have the most intimate connection with patients but that's not to say that there isn't a darker side to aggressive politricking, especially with an increasingly small pie of which nursing unions chomp the lion's share.
So I am learning that the CNA is one end of the spectrum while much of the country lies a couple of decades behind. And that's not so good either. Nurse's deserve their due. But society is paying a steep cost for the professionalization of bedside care. A point easily disposed of in brute force when nursing unions like the CNA can squelch any semblance of a dissenting voice.
As the CNA gains more an more power it's veneer of patient advocacy will become stretched thinner and thinner. The public will eventually realize this in the same way that they lost their faith in medicine as it's advocate some decades ago. And that is my not-so-humble viewpoint.
To reiterate from another angle. My mother, whom I adore, was educated by nuns and had to wear a silly white hat. Who knows, maybe she had to put up with archaic doctors making chauvinist come-ons. She'd seen generation after generation of docs wet behind the ears, dependent on nurses looking out for them make their way into lording positions of authority.
So while raising me and my brothers. She went back to school at night while working full-time. She worked her way all the way into being an NP, one of the first generations of nursing clinicians. She's tough. And she's doesn't take any ****. And she's deadly serious about advancing the cause of nursing and nursing clinicians. She is partisan to the bone.
My belabored point is that she is like many of her colleagues and sees things strictly from the view-point of sticking it to the man. Sure, when we talk, or when I hear CNA reps give out their propaganda I hear wonderful things about how nurses only want the public to be safer and all this.
But the energy I sense, and what I see taking place is power grab at all costs. So I am not player-hating so much as calling a spade for what it is.
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rant:
Ya know this is one of the few "buzzword" type phrases that irritate the piss out of me. Yeh senior nurses help out new interns, etc. But man, where are all these experienced nurses coming from. They never had anyone show them the ropes at all? They just somehow knew everything. BS.....I have helped out/supervised just as many nursing students or new nurses with physical exams, procedures, and basic medical knowledge. I just don't find it necessary to tell nursing students: "be nice to the residents because they'll teach you real pathophysiology/pharmacology/genetics/etc"
Have nurses helped me.....uhm yeh. Have I helped nurses.....uhm yeh. Get off the horse, everyone needs a little bit of help at some point, especially when in unfamiliar territory.
The other buzzword phrase that pisses me off is "be nice to the nurses bc they will make your life hell".....uhm no, i'll be nice because i'm a nice person and it's professional to be so. To me, that phrase is extremely degrading to the nursing profession since basically it translates into "be nice to the nurses or else they are immature enough to act like children".....seems pretty insulting to me. I, however, get along great with nurses
anyways, /rant
Maybe your problem is you don't like the idea of nurses having a say in anything. God forbid they have a "voice."
Yes, I am all for safe staffing, and it has nothing to do with wanting to skate through the day with less work. It has everything to do with not having unmanageable workloads. I don't get it. Since when did advocating for patient safety become a bad thing?
I have a feeling your Mom and I were educated around the same time frame. We both went to Catholic nursing programs, for sure, so we both are from the same mind set. I'll bet she has a big nursing cap that looks like a nun's habit, too. Mine's gathering dust on a bookshelf somewhere.
I'm completely with you on that one.... unfortunately a lot of physicians are jerks to nurses, and a lot of nurses try to make their lives a living hell.
If everyone were acting like true professionals, we'd have some mutual respect, and a heck of a team...
Well cheers then you have my respect by association.
But you're off on your assessment of my not wanting some particular group to have a say. Having a say is a long shot from being a bully. I could give scary accounts of my experience with bullying and aggressive herd-like groupthink on behalf of the nurses where I've worked. But who cares.
Clearly I have a limited experience with an Orwellian extreme that does not typify the workplace dynamic everywhere.
To tell you the truth I am perfectly fine and dandy with the idea that nurse's take over and run the hospitals from the floors to the board rooms.
I just cannot stomach grandiose falsities, like the pervasive and widely accepted notion that nursing interests and the public interest are always one and the same. That bill of good has been sold to the public but frankly I know better. I am sorry if that strikes arrogant or out-of-my-place as a nurse's assistant but I am used to it. In fact I've developed cat-like instincts for avoiding the knives between my ribs. I worked hard served you and your patients diligently but I know your dirty laundry intimately and speak my own mind with my own integrity. And I've paid quite a price for doing so. I won't bother you with the details.
But I'll try not to interpret my experience as universal either.
Here's an update:
Note this is a different nurse.
Note this is a different nurse.
A nurse at a state prison in Monterey County collected $198,000 in overtime last year - bringing her total pay to more than $310,000.
$198,000
Overtime earned by Lina Manglicmot, a nurse at the state's Correctional Training Facility in Soledad (Monterey County), in addition to her base pay of $108,000 and $4,400 in premium pay and expenses
$198,000
Overtime earned by Lina Manglicmot, a nurse at the state's Correctional Training Facility in Soledad (Monterey County), in addition to her base pay of $108,000 and $4,400 in premium pay and expenses
I actually have no problem with nurses (ie CRNA's as an example) getting payed 6 figures due to the fact it is a function of supply and demand. This is capitalism at work and I second the notion that profit spurs innovation. Case in point, I will be a primary eye doctor (http://www.aoa.org/x5878.xml) in a couple of years when I will have finished my 4 year doctor of optometry degree (4 yr clinical doctorate LOL no online section
) and a one year VA Medical Center residency (additional 2000 patient contacts---- more experience prescribing medications (ocular and systemic) for treating eye diseases). This will be a total of 9 years of my time and hard work (4 yr BS in Biology, 4 yrs of Optometry school, 1 yr of Ocular Residency). I will probably make $130,000 a year after a couple of years in practice. My friend who is planning on getting his CRNA will definitely out earn me be by thousands of dollars! LOL Do I care?-----no. I do not define respect by the amount of money that I am making. My friends who are family practice physicians who have to see "50 patients a day for 8 minutes each" to make $140,000 a year may have more of a problem with high nursing salaries.
My question for you Taurus is why the salary of a Nurse Practitioner (or whatever kind of Allied Health Mid-Level) is such an issue for you?
Online Clinical Doctorate = Degree Puffery = DNP (in its current form)
For the DNP to be legit it needs to be a dedicated 4 yr clinical doctorate after the BSN.
-It should be modeled after the Medicine, Optometry, Podiatry, Dentistry, etc......format
with 4 CONTINUOUS YEARS OF DOCTORATE TRAINING, NO ONLINE CRAP, AND THE
INTENT OF BEING ONLY A PRIMARY CARE PROVIDER WITH A LIMITED SCOPE OF PRACTICE. This
means no surgery, cards, derm, etc........
) and a one year VA Medical Center residency (additional 2000 patient contacts---- more experience prescribing medications (ocular and systemic) for treating eye diseases). This will be a total of 9 years of my time and hard work (4 yr BS in Biology, 4 yrs of Optometry school, 1 yr of Ocular Residency). I will probably make $130,000 a year after a couple of years in practice. My friend who is planning on getting his CRNA will definitely out earn me be by thousands of dollars! LOL Do I care?-----no. I do not define respect by the amount of money that I am making. My friends who are family practice physicians who have to see "50 patients a day for 8 minutes each" to make $140,000 a year may have more of a problem with high nursing salaries.My question for you Taurus is why the salary of a Nurse Practitioner (or whatever kind of Allied Health Mid-Level) is such an issue for you?
Online Clinical Doctorate = Degree Puffery = DNP (in its current form)
For the DNP to be legit it needs to be a dedicated 4 yr clinical doctorate after the BSN.
-It should be modeled after the Medicine, Optometry, Podiatry, Dentistry, etc......format
with 4 CONTINUOUS YEARS OF DOCTORATE TRAINING, NO ONLINE CRAP, AND THE
INTENT OF BEING ONLY A PRIMARY CARE PROVIDER WITH A LIMITED SCOPE OF PRACTICE. This
means no surgery, cards, derm, etc........
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Think about it,
All of these clinical doctorate programs
All of these degrees share ONE thing in common:
-----4 years of FULL-TIME clinical doctorate training.....😎
-----NO online garbage
-----NO "adding" 30+ hours to a Masters degree (ie DNP)
For the DNP to be legit it needs to follow a similar format. If the DNP was modeled after the traditional clinical doctorate programs (MD, DO, OD, DDS, DPM) then a Masters degree NP would have to suck it up and go back school for 4 yrs to get a DNP. Hell my next semester has 27 hours of didactic curricula LOL.....let alone 200+ for the whole 4 year program. 33 hours added on to a masters degree for a DNP?------that is really suspicious and credibility lacking to say the least. Believe me when I say that I am no fan of organized medicine-----not at all (we battle them all the time legislatively)----BUT I have to agree with them on this one. Not only are DNP's making a mockery of the clinical doctorate, they are trying to treat "systemic disease"---something that optometrists, dentists, and podiatrists will not do and only Medical Doctors should do. Mudinger, can you here me?
All of these clinical doctorate programs
- Doctor of Medicine (MD)
- Doctor of Optometry (OD)
- Doctor of Osteopathic Medicine (DO)
- Doctor of Dental Medicine (DMD)
- Doctor of Podiatric Medicine (DPM)
All of these degrees share ONE thing in common:
-----4 years of FULL-TIME clinical doctorate training.....😎
-----NO online garbage
-----NO "adding" 30+ hours to a Masters degree (ie DNP)
For the DNP to be legit it needs to follow a similar format. If the DNP was modeled after the traditional clinical doctorate programs (MD, DO, OD, DDS, DPM) then a Masters degree NP would have to suck it up and go back school for 4 yrs to get a DNP. Hell my next semester has 27 hours of didactic curricula LOL.....let alone 200+ for the whole 4 year program. 33 hours added on to a masters degree for a DNP?------that is really suspicious and credibility lacking to say the least. Believe me when I say that I am no fan of organized medicine-----not at all (we battle them all the time legislatively)----BUT I have to agree with them on this one. Not only are DNP's making a mockery of the clinical doctorate, they are trying to treat "systemic disease"---something that optometrists, dentists, and podiatrists will not do and only Medical Doctors should do. Mudinger, can you here me?
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Hell freaking yeah! Took the words out of my mouth. I have no problem with people getting advanced degrees if they want them, but calling something a doctorate with 30 credits of work? I just can't believe they're serious!
I heard an MD recently give an argument for why NPs should be used in specialty practice and NOT primary care. He said that if an NP is working in a specialized area, it is easier for them to know that one area well rather than have breadth of knowledge that is required for primary care. Now, you can always argue that a cardiologist did three years of IM first, but that is where I thinky supervision stills plays a role. Also, ideally the NP working in, say cards had years of experience working in cards as an RN first.
I think they should still be supervised in the same way that PAs are (most PAs I know are for practical purposes semi-autonomous, they know when to call for help and confer with their doctor, but most of them have a trusted relationship with the doc and he gives them a lot of leeway. This is how I think NPs should be, BTW).
Either way, I think that supervision is key.
Like I said, I believe in capitalism. If consumers want to go to an NP over an MD, fine. If they want to go to a CNM over an ob-gyn, fine.
However, what I won't tolerate is using misleading statements such as Mundinger's "knowledge of a physician and skills of a nurse", "able to work independently in any clinical setting", etc. to compete in a free market. That's all that the AMA want. They don't want DNP's to mislead the consumer into thinking that when a person walks into a room with a long white coat, introduces themselves as "Dr.", checks your blood pressure, gives you a diagnose, and treats them that they're being seen by a physician. The public expects a certain product when they see a physician. How many consumers realize that their DNP has only 1000 hours of clinical experience vs over 12,000 (not including the 5000 in medical school) for physicians and may have done it completely online? How many would stick with their DNP if they knew?
If DNP's don't think that the public cares, here's a challenge for you.
Put a big posterboard in front of your independent offices. Show in big letters the differences in training and hours between a DNP and physician, whether you did it online or in the classroom, etc. If DNP's are so confident in their degree, then they have nothing to worry about. Am I right?
For the patients who want to still see the DNP, that's fine. It's a free market. What I care more about is that they have been properly informed about the differences.
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I whole-heartedly agree with this. If you focus just on one area of the body, then it's doable to to have clinical doctorates such as dentistry, podiatry, optometry, etc. However, regular medicine, which is what primary care is part of, is huge and it requires a lot of book-learning and clinical training. You can't teach them part-time or online and with such minimal hours and expect to create competent clinicians anywhere close to physicians.
Autonomous NP's now probably think that they are just as good as physicians. What I wonder is, how many cancers have gone undiagosed or delayed diagnosed? How many heart attacks and strokes have been gone undiagosed or delayed diagnosed? How much is it costing healthcare and the suffering of people for these mistakes? Etc, etc. If we can spend millions of dollars on drug research, why can't we fund research that will look into these issues?
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you make it sound like everyone makes misdiagnoses or even misses diagnoses except physicians. that's total BS. just b/c physicians are who they are, does not make one invincible.
i've met and worked with some real winners.
show me the numbers that don't show what physicians cost healthcare for their mistakes.
last i knew, physicians were largely part of the healthcare concerns that cost the system over 8 billion dollars over the course of three years.
i find your arguments getting more ridiculous (and repetitive) every time you say the same thing.
Physicians make mistakes like everyone else does. However, it's one thing to miss something because you're hurried due to current healthcare environment vs not knowing at all because you were not taught it in school. That's what the public has the right to be informed about. That's the risk they take if they go to an independent NP.
Malpractice suits against advanced practice nurses are rising in number and increasing in severity, according to malpractice insurers.
Even though we don't hear much about it, NP's are making mistakes and getting sued. What I want is to document and quantify the differences between NP's and physicians in a well-designed study. Mundinger's study was a joke. I want real, hard-core scientific studies. Why do you have a problem with that? Shouldn't the lawmakers and public be informed before they make healthcare policies and personal life decisions?
My understanding is that there is little if any evidence to date that suggests NP's have worse clinical outcomes than physicians. I wouldn't think that your suggested study would reveal anything different either. You could make a case based on some ED workflow studies that clinical efficiency is higher with boarded specialists. But that's also common sense.
But when it comes to primary care NP's are well-equipped for successful practice. Independent practice vis-a-vis physicians, we'll have to see in the coming years, most don't practice independently so that's a difficult thing to investigate it would seem.
Really I think it's a consumer issue because we're comparing apples and oranges. If Joe Public decides seeing an NP is more convenient, affordable, and safe enough to receive proper care then I'm sorry but physician clamoring for turf rights is just too little, too late.
Physicians seem to have the wrong business model for bringing their product--their license--to market. Besides it's clear that physicians have fallen on their own sword while trying to act like they're being assaulted by villians.
Physician bodies have notoriously eaten their young with slave labor and exorbitant tuition bills in a deliberate and concerted process to engineer their own scarcity to drive up their salaries. Decades in the making--now cloaked in the distance of history. They were vehemently against medicare now they're sinking by scaled cuts to it.
NP's on the other hand have shepherded their young with meticulous care. They are getting stronger, gaining political will.
Besides if I've got any number of basic illnesses I can afford the NP at the walk-in clinic in the megastore. I am happy with that risk--if that's what physicians would like to claim it is. I call it no health insurance. Cry me a f'n river about your student loans.
There is a lot of anecdotal evidence to suggest otherwise. My personal experience is the same.
For some simple disease states like otitis media, there's probably no differences. How about if someone comes in with chest pain, abdominal pain, or fatigue? Will the NP get it right nearly as many times as a physician? Will the NP diagnose it nearly as quickly when it is in its early stages? Yes, we all know stories of some bad physicians and some great NP's. But the question I am asking is the average physician and NP and looking at large sample sizes from each group to compare results to knock out the outliers. Basically, what is your relative risk of morbidity or mortality by going to an NP? If a drug like Vioxx increases your stroke chances slightly by a few percentage points, the FDA is forced to pull the drugs off the market for public safety concerns. If by going to an NP your risk is higher, what is an acceptable risk level before the govt is forced to mandate supervision for public safety concerns?
That's why we need real studies to find out. Lawmakers need to know to make policies that will protect the unwitting public. The public needs to know to make informed decisions.
Physicians are the most scrutinized group out there. We get scrutinized for our medical decision-making, outcomes, ethics, etc. Why do you think that our education is so long and why we take so many damn tests that measures our knowledge, clinical competency, etc?
If DNP's want to perform the same role as physicians, doesn't it seem reasonable that we start to ask the same questions and do the same level of scrutiny to them that we do to physicians? Doesn't that seem fair and as a way to protect the public? What's more shocking is that we as a society have allowed NP's to have for the most part dodge any real scrutiny. That needs to change.
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Probably because you dont realize it yet as a student. The medicare pie is a limited pie. I.E. your taxes provide XXX amount of dollars. This XXX amount of dollars is split between:
1) Providers
2) Hospitals (The majority of the money goes here!)
3) Nursing Homes
Nurses are part of the hospitals. Optomitrists and Physicians are part of the providers. You reduce the amount that goes to providers to pay hospitals, guess who benefits and who gets upset.
This will all go away as medicare continues to cut reimburisements. You'll see doctors refusing medicare and thus not caring about the distribution of the pie. Many fields are not part of this pie: Plastic Surgery, Dermatology, Fertility in OBGYN... etc etc.
Incase you didnt know, private insurances are also pies similar to medicare cause they base their reimburisement on medicare.
again, show the studies that show NPs are negligent/poor practice/worse outcome providers...
i feel your pain taurus, but i feel this is more personal than reality thinking.
I hear you. By all means outcomes should be investigated as a matter of principle.
But you'll have to excuse me if my faith in medical/scientific evidence is less than total. It seems that wherever there is the money or political will for a particular story there is "scientific" evidence that will prove its validity.
But your point is a good one. Besides I think the moneyed interests would stack up in favor of increasing the number of drug pushers period. So the physician political view will probably be the minority one. But good luck selling the public safety thing--Nurses do the same thing to professions encroaching on their territory as well.
To me its all a spectacle. And matters not in the slightest with regards to how I view my safety as a potential patient.
Question:
If we had a 100% public/socialized health care system, and everyone paid taxes into the system.
If as a paying citizen you could either be seen by a Board Certified physician or a DNP...
(By the way: The amount you spent to see this person was the same either way via taxes)
Who would you rather see? ...Who would you rather see your sick mother or child?
Wouldn't you rather get someone with more education and training?
Hmm.....
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I don't mean to de-rail the conversation, because this is a little off topic. However, Naturopaths have already set precedents in a few US states also allowing them to be considered PCPs and they too wish to act as an independant "Family Medical Doctor".
They now even have residency programs in "Naturopathic oncology".
Most of these people are simply capitalizing on the "alternative loving" hippie baby boomers who are now dieing of lung cancer because they smoked too much.
If an MD oncologist says you're dieing and there is nothing else they can do.. and some Naturopath in a white coat says he/she has completed a residency in "oncology" and call themselves Dr. and say.. "well, Mrs. Jones.. if you simply come in for 4 treatments of IV vitamins and a golgi berry infusion at $2,000+ per visit... I'll be able to cure you. Oh, by the way.. I only accept cash." 👎
Also, here's the kicker... What if they give the patient something that interacts with their warfarin, etc... and actually shorten the patients life? It is very unlikely they will get sued. They are required to hold almost no malpractice insurance. They also are not required to "prove" that any of their treatments actually work through publishing well designed studies in high value journals.
There maybe "some" relation to the current attractiveness of DNP programs.
(I'm not in anyway insinuating that nurses as a group would take such advantage of dying patients)
Simply, that it seems that ($money$ and to some ..."white coat respect") may also prove to be a very attractive motivator for some nurses who.. through obtaining a DNP may be able to work "independently" in their own medical clinic.
Again.. if the cost to you as a consumer was the same. Who would you choose to be YOUR PCP provider?
A ..DNP, Naturopath, Chiropractor, or someone who actually went to medical school and is a Board certified Physician?
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If you remove the cost question I would see--for primary care purposes mind you--whomever I relate well to and whom my instincts tell me are into their job and doing the best they can for me.
I think the care people get is not as easy to quantify or predict along the lines you are suggesting.
If I need angioplasty well then now you stand on more solid ground with your conjecture.
I think the problem with your concerns is that they represent your interests naturally, and not the consumers. The mental acrobatics that take place in these sparring matches between professions as to who owns the public interest is the pinnacle of conceit. It would be hilarious if it was less consequential.
I love how people contrast an Angry, hurried, (I've got no time for you MD) stereotype with a Caring, "I'll sit here all day and listen to your problems" DNP stereotype.
Hmm.. I'm sure there are a full range of personalities and different types of Board certified Physicians out there. I'm sure there are at least 1 or 2 that I could "get along with".
Well.. If I'm paying the same amount of money for the same amount of time with 2 different PCPs. I'll take the one with more education and experience any day.
But... Hey... sounds like I'm the only one. 🙄 Obviously, I must be crazy.
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"Probably because you dont realize it yet as a student. The medicare pie is a limited pie. I.E. your taxes provide XXX amount of dollars. This XXX amount of dollars is split between:
1) Providers
2) Hospitals (The majority of the money goes here!)
3) Nursing Homes
Nurses are part of the hospitals. Optomitrists and Physicians are part of the providers. You reduce the amount that goes to providers to pay hospitals, guess who benefits and who gets upset.
This will all go away as medicare continues to cut reimburisements. You'll see doctors refusing medicare and thus not caring about the distribution of the pie. Many fields are not part of this pie: Plastic Surgery, Dermatology, Fertility in OBGYN... etc etc.
Incase you didnt know, private insurances are also pies similar to medicare cause they base their reimburisement on medicare."
Faebinder,
You make a compelling point. Personally if sat atop the "Mt Olympus" of salary setting for health care providers, I would pay all "doctors" (physicians, surgeons, optometrists, dentists, podiatrists,etc) at least $200,000 a year because of the level of education, responsibility, and liability they undertake with aplomb on a daily basis. Specialists would make at least $300,000 + I would not pay a supervised mid-level provider (NP's, PA's, etc) more than an (MD, OD, DDS, DPM,.etc..) Capitalism is not perfect but it is still the most preferable economic system! I know you worked your tail off for your MD and I am doing the same for my OD, Your point regarding the distribution of "Medicare Pie" is a good one. Anything else I can learn on here will help me as a future eye care doctor (and as you said a "provider").
1) Providers
2) Hospitals (The majority of the money goes here!)
3) Nursing Homes
Nurses are part of the hospitals. Optomitrists and Physicians are part of the providers. You reduce the amount that goes to providers to pay hospitals, guess who benefits and who gets upset.
This will all go away as medicare continues to cut reimburisements. You'll see doctors refusing medicare and thus not caring about the distribution of the pie. Many fields are not part of this pie: Plastic Surgery, Dermatology, Fertility in OBGYN... etc etc.
Incase you didnt know, private insurances are also pies similar to medicare cause they base their reimburisement on medicare."
Faebinder,
You make a compelling point. Personally if sat atop the "Mt Olympus" of salary setting for health care providers, I would pay all "doctors" (physicians, surgeons, optometrists, dentists, podiatrists,etc) at least $200,000 a year because of the level of education, responsibility, and liability they undertake with aplomb on a daily basis. Specialists would make at least $300,000 + I would not pay a supervised mid-level provider (NP's, PA's, etc) more than an (MD, OD, DDS, DPM,.etc..) Capitalism is not perfect but it is still the most preferable economic system! I know you worked your tail off for your MD and I am doing the same for my OD, Your point regarding the distribution of "Medicare Pie" is a good one. Anything else I can learn on here will help me as a future eye care doctor (and as you said a "provider").
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Dr.Millisevert,
Not all CAM practitioners are quacks. I know some very reputable ND's and DC's! ND's even have prescription rights in some states. That said, something like "Naturopathic Oncology" is a "theater in the absurd" and lacks any evidence based foundation whatsoever. That would constitute quackery.
Not all CAM practitioners are quacks. I know some very reputable ND's and DC's! ND's even have prescription rights in some states. That said, something like "Naturopathic Oncology" is a "theater in the absurd" and lacks any evidence based foundation whatsoever. That would constitute quackery.
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Your perception of what I am saying is through the filter of your own sacrifice. You have know way of knowing what I meant by my own instincts. But you assumed it must be some sort of vague feminized nurse-centric perspective as if I need my hand held for hours while being handed my lab results.
While I appreciate you casting me for a role in your new cowboy doctor TV drama series, I think I would prefer my own life. Good luck with your project though and keep after those pesky Doctor-Nurses will ya--it's good entertainment.
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Your perception of what I am saying is through the filter of your own sacrifice. You have know way of knowing what I meant by my own instincts. But you assumed it must be some sort of vague feminized nurse-centric perspective as if I need my hand held for hours while being handed my lab results.
While I appreciate you casting me for a role in your new cowboy doctor TV drama series, I think I would prefer my own life. Good luck with your project though and keep after those pesky Doctor-Nurses will ya--it's good entertainment.
I didn't say "how you stereotyped".. I said.. "how people..". Just pointing out that it is a common used argument. Simple as that.
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keep after those pesky Doctor-Nurses will ya--it's good entertainment.
If I'm going to spend 200 bucks on a pair of "similar looking" leather dress shoes.. I have a right to know if they are (Shoes: A) hand made in italy by someone with 40 years experience or (Shoes: B) made in indonesia by a 14 year old girl stamping out patterns on a machine. 🙂
I simply agree with Taurus.. if people are going to pay the same amount of money to see someone in a white coat who introduces themselves as "hello, I'm Dr. Smith.. your PCP". They should at least know what their getting.
I think public education as to the actual education of each PCP should be provided.. then let the public decide how best to spend their hard earned money. Its their money... let them make an informed decision.
Fair nuff?
Fair and Square!
I am all for transparency.
All I am trying to say is that I have been a patient to all sorts of providers big and small in reputation and my experience has had zero correlation to the educational criteria being suggested here.
The neurosurgeon that saw me at a nationally renowned hospital gave me horrible care, if you could call it that, it felt more like disdain, so it was excellent disdain then.
So educational attainment may have meant something to him and his colleagues and maybe the Board of Trustees but nothing to me.
I would not assume that a country doctor from Buster Brown State University would give me worse care. Or that DO's or NP's or whathaveyou would give me a lesser level of care than that schmuck. They could not do worse if they tried to peddle me snake oil in a back alley.
And furthermore, believe it or not, the public is qualified to judge in a longer-term general sense what kind of medical care they're getting. If Medicine is contemptuous of this notion it engages in attitudes that erode its own foundation.
I am not certain that length of time spent in malignant systems is conclusive to a better patient-provider relationship. Or that there is one and only one path to clinical knowledge.
Having said that. Nursing non-clinician managers walking around hospitals attending meetings while wearing dubious white coats should be dragged into the street and shot.
Cool!
There are 2 meanings for "quality of care" being flung around on this thread.
I'm sorry that you had a very bad experience with a neurosurgeon.
However, (this is my opinion).. I'd rather have a neurosurgeon who clinically excellent at diagnosing and operating and a prick to me... than one who was my best friend and crap surgeon. 🙂
Also... we are discussing specialty vs primary care.
In reference to primary care.. Of course everyone would prefer someone (DNP or MD/DO) who is nice to them and someone they get along with. However, at the same time. If my child is sick. (again.. this is only my persional opionion and preference) .. but I'd still rather have someone with more clinical experience and knowledge.. (9 times out of 10 that will be the Physician over the DNP) 👍
I understand your point. However there is a nuance to my argument that is lost on you. My point on being a patient is this:
How many of your daily decisions are purely a question of clinical acumen and how many are the result of diligence and a will to serve well?
My experience in the belly of the gray beast is that more often than not it comes down to who is going to really go to bat for you. And that's not a measure of your training hours.
Most of us cannot afford the medical Johnny Cochrans and so we get stuck with these court appointed mf'ers who just got off the golf course with their drug reps or just left the HMO meeting where their told to keep costs down or maybe even just finished ghost writing an industry study.
I've got intimate experience having my fate decided by different types of people. And frankly your 9 times out of 10 is baseless. But then that's why your here--to meddle with Doctor Nurses--not to actually make sure you yourself, regardless of your title, are one of those 9 which is realistically more like 3 or 4.
Heh, i hate to defend narcissits especially against folks that make good points but i have to stop you there and point something CRITICAL.
How much did you pay him that day and how much time did he spend with you? A normal board certified GENERAL SURGEON charges around a 1000 for an hour consultation with say... a lawyer or a someone that needs the full attention of the surgeon. A neurosurgeon can easily go to $3000 to $5000 for that hour... it's a valuble hour. He could be saving someone's life in the OR. Do you fairly believe you paid an hour's worth that day? Really? Heck you moonlight as a resident an hour in the ED and that's a $100. A pharmacist working in the weekend can make a $100 per hour. Did you pay more than 10 minutes worth even for a board certified neurosurgeon? Each state in the US graduates 1-2 of those per year.. if they survive the horrible practice conditions of 7 years of bad luck that is.
I just wanted to express the unique look of the usual evil neurosurgeon.
Fair enough.. it sounds like your personal experience with this neurosurgeon has left quite an impression on you.
however, just because someone has a medical degree.. doesn't make them a horrible person.
Correct me if I'm wrong.. but it sounds like you're saying that all DNPs are better primary care providers than MD/DOs because they are on average nicer people.
(if that's your point...) I don't feel like you can make such a generalised statement.
My point ...is that there are all different types of nurses (horrible mean ones.. and the angels).. just like there are all types of physicians out there.
At the end of the day... I'll choose a physician as my PCP because they have more training.
Wow I feel like I a fan who ended up getting in between two angry sumo wrestlers quite by accident.
I am my neurosurgeon's advocate as he is mine. That is, the guy who actually reconstructed the tissue in my spine had minutes on the fly to spend with me in between phone calls to other physician whose patients were a far shot worse off than me....I understand all this. In fact he missed something serious in his procedure on me, admitted it, and had to open me up multiple times. He was worried I would sue him. That thought never entered my mind for a second. Why?... because I knew, in the way that all of your patients will eventually know about you, that on a basic level he was doing the best he could for me. I moved and had complications, he wanted me to see a neurosurgeon. I was treated like piece of **** by an academic nerd of a surgeon in an academically pretentious environment. He and any other Dr out there that spews that kind of contempt can s%ck my MF'n D!ck.
Clear enough.
PS. I am open enough but my finances are none of your business.
Doesn't seem unusual to me, California prisons have been so poorly staffed that the state prison system recently was taken over by the feds. The state prison system now pays new internists and family practice types $250,000+, and nurses are paid around $100,000+. This is about 40-50% higher than other institutions, which is unsurprising given the working conditions (would you like to work with inmates?). San Francisco is a city and county, probably saw the writing on the wall, and has an exceptionally strong nurses union so likely has a similar compensatory scheme.
Typical prison nurses with 20 years+ experience make about $140,000 or roughly $65 per hour in SF. They receive call pay at 30-50% of salary ($19-$33/hour of call). Since he's the most senior nurse, and he sounds like a workaholic and call hog, he probably is on call the other 100 hours of the week he isn't working. That adds another six figures of OT/Call pay to his income.
Nurses receive time-and-a-half if called back in and are paid a minimum of 4 hours for a callback.
So his pay corresponds exactly to how much he's worked. It's not as if he has a salary of $350k, which would be nuts. More like $140k salary for a prison nurse with 20 years of experience, $100k for being on call 24/7 to deal with results prison riots and other wonderful ordeals, $100k for working overtime.
This is a great development for physicians. I hope more nurses soon earn more than primary care docs. How else will physicians argue their case for too low of a compensation and fiscal abuse by managed care? The public thinks physicians are paid more than enough and can take care of themselves. But anyone with half a brain cell will see how grossly undercompensated primary care physicians are if nurses with a 2 year associates degree are making more per hour than PCP's with 4 years bachelor's degree, 4 years medical degree, and 3 years residency.
Note though, if physicians take the stance that nurses are overcompensated rather than primary care physicians being undercompensated, they will surely lose, the public/common man sympathizes far more with the nurse than with the physician. Complaining about how overcompensated nurses are does nothing for physicians, except earn the enmity of nurses, and makes physicians look like arrogant greedy pricks in the eyes of the public.
Physicians need to demand their time be respected or be compensated for it. Instead, the "professional, exempt worker" covenant is being abused to force physicians to work 55-60 hour weeks. How? If NP's can handle FP/IM/ER duties then great, now FP/IM/ER doctors can now strike without patients dying. Unless they can't. In which case they shouldn't claim they can. Right?
Typical prison nurses with 20 years+ experience make about $140,000 or roughly $65 per hour in SF. They receive call pay at 30-50% of salary ($19-$33/hour of call). Since he's the most senior nurse, and he sounds like a workaholic and call hog, he probably is on call the other 100 hours of the week he isn't working. That adds another six figures of OT/Call pay to his income.
Nurses receive time-and-a-half if called back in and are paid a minimum of 4 hours for a callback.
So his pay corresponds exactly to how much he's worked. It's not as if he has a salary of $350k, which would be nuts. More like $140k salary for a prison nurse with 20 years of experience, $100k for being on call 24/7 to deal with results prison riots and other wonderful ordeals, $100k for working overtime.
This is a great development for physicians. I hope more nurses soon earn more than primary care docs. How else will physicians argue their case for too low of a compensation and fiscal abuse by managed care? The public thinks physicians are paid more than enough and can take care of themselves. But anyone with half a brain cell will see how grossly undercompensated primary care physicians are if nurses with a 2 year associates degree are making more per hour than PCP's with 4 years bachelor's degree, 4 years medical degree, and 3 years residency.
Note though, if physicians take the stance that nurses are overcompensated rather than primary care physicians being undercompensated, they will surely lose, the public/common man sympathizes far more with the nurse than with the physician. Complaining about how overcompensated nurses are does nothing for physicians, except earn the enmity of nurses, and makes physicians look like arrogant greedy pricks in the eyes of the public.
Physicians need to demand their time be respected or be compensated for it. Instead, the "professional, exempt worker" covenant is being abused to force physicians to work 55-60 hour weeks. How? If NP's can handle FP/IM/ER duties then great, now FP/IM/ER doctors can now strike without patients dying. Unless they can't. In which case they shouldn't claim they can. Right?
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I still have no idea how CA state maintains such a large budget surplus year to year.. they really have there fiscal duckies in a row....
There are two separate issues going on here....
1. People taking advantage of a loop hole, which is ultimately abusing tax dollars. There was a tollbooth guy who did this in NJ awhile back, making into the 6-figures for working a ton of OT.
2. Shrinking reimbursements, rising insurance costs, and out of control lobbyist groups.
1. People taking advantage of a loop hole, which is ultimately abusing tax dollars. There was a tollbooth guy who did this in NJ awhile back, making into the 6-figures for working a ton of OT.
2. Shrinking reimbursements, rising insurance costs, and out of control lobbyist groups.
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Never a more false statement.
This is total and utter BS....Nurses along with teachers have the most potent and aggressive union representation in the entire country.
The nursing union is a well organized ruthless political machine willing to flood propaganda at the slightest insinuation of a challenge or questioning. Their lobbying efforts are notoriously corrupt.
Overall, I doubt the common man has anymore nursing sympathy than do sympathy for big oil, aerospace/defence or automotive industries which likewise lobby government for job security and increased profits.
In fact I KNOW they dont have sympathy for nursing, Im not merely floating conjecture here.
The idea there is some underswell of sympathy would be akin to saying residents of Chicago in the roaring 20s had sympathy for the Mafia because they dared not openly confront Capone.
They are right up there with the UAW (United Auto Workers), who were the pioneers of union "tactics". Sadly the lobbyists and special interest groups are the ones who dictate legislation, and the legislators are just there to carry it out.
Right now there are a minority that are taking advantage of the system, but I'd be curious if this current shortage will turn into larger longer term issues (over-extension of scope, a greater variance in training to meet the need, and eventual over-supply). Look no farther than the IT world post-2003.
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Here's something that will really boggle your mind from 2004:
We see how well that worked out ...
This guy has been one of the SF's top paid since 2004. What has the city done? They nearly doubled his base pay and now allow him to work even more overtime!
Some nurses undoubtedly get paid too much, and others not enough. I think the outrage here isn't that nurses make that much, it's that our government has failed us on many levels. They steal money from our pockets and treat us like indentured servants. The concept of government serving us has long ago died, we exist solely to fund their whims and bloated payrolls. San Francisco is the worst example of municipal government ever--well, maybe Vallejo is a bit worse, google their situation if you really want to see run-away payrolls.
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I would hope that the HR or immediate level management is getting their arse handed to them for that type of personal management.. but probably not... they are probably applauded for ensuring that adequate staff to patient was maintained.
I would not be able to do that in good conscience as a 'public servant' despite the loophole and it's opportunity to get $$. I would have to report this lack of management directly to the governator.
I would not be able to do that in good conscience as a 'public servant' despite the loophole and it's opportunity to get $$. I would have to report this lack of management directly to the governator.
I don't see how working overtime is "abusing the system." You can't work overtime if there is adequate staffing and there are no shifts to be filled. Seems to me the real problem is understaffing, not the nurse filling those shifts.
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