Pain Mgmt NP

[mariajane]

I’m an outpatient pain mgmt NP. Here’s my experience followed by my unsolicited opinion. I’m sorry for intruding on your MD forum but thought it could be a useful perspective. Please kindly disregard if it isn’t.

I graduated from high school with 4.0. Wanted to go to medical school since forever but also wanted a normal lifestyle, to be a mostly-stay-at-home mom, etc. So I went to nursing school...again 4.0. Then straight into a fairly prestigious university for my NP...4.0...I was shocked to discover that I had to study more for an undergrad degree than for the master’s. Worked in beside nursing for 3 yrs after graduation to get hospital experience.Then hired by hospitalist group at same hospital (large teaching hospital). As a perfectionist I knew I was unprepared for the job at hand....I was wholly unprepared. I worked alongside numerous midlevels not understanding how they could have job satisfaction knowing they, too, didn’t have/know 25-50% of what it takes to do the complex work of hospitalist medicine effectively and independently. The MDs knew it, I knew it, yet they didn’t shut down the program. My realization was that 1) I regretted getting this education. 2). I need to utilize it better. I have since moved to an outpatient subspecialty... pain mgmt. Truthfully, I am a smart person and was just as intelligent as previous acquaintances who went on to pursue medicine as MDs. Because of this, I am keenly aware of what I do and do not know. I honestly do really strong work in my current setting, seeing follow ups and new consults. I study continually and take great pleasure in the diagnostic aspect of my job - I enjoy learning about zebras to keep them in the back of my mind - even if 90% of it is straightforward LBP... understanding that a solid diagnosis allows the pain interventionist I work with to then treat the patient (which, yes translates into profit $$$) and the patient to go from point A to point B. I don’t get excited about doing injections and things because I feel I’m trying to play doctor when I’m not one...I do trigger point inj a fair amount to spare the docs that are bored by them.

My opinion: NP school sucks. (PA school definitely superior.). There should be a level of rigor in it to weed out dummies in the first year. It should also be three years in total and include at least triple the clinical hours.

I definitely believe there is a role for midlevels, supervised only. A great doctor can train his/her own midlevel in such a way to greatly benefit his practice, lifestyle, and profit margins. I do not believe, as things currently stand, NP’s are equipped to manage primary care; and I personally see only an MD (unless I already know what’s wrong). But subspecialty work can be a great niche...and I would like to believe that holds true for pain too. (Cue the dissent in 3....2....1.). .

(P.S. I enjoy reading your posts and take away tidbits, btw. My current practice does not check thoracic MRI’s prior to SCS placement.... pondering that recently. Truth be told, the greatest difficulty in pain, having been in it for several years now, is seeing the lack of efficacy in interventions, interventions based on minimal data, cost barriers. The patients are miserable, yes, but a little mental/emotional dissociation goes a long way. Observing greed take over otherwise solid physicians is also sad to watch.)

---

Members don't see this ad.

 

[callmeanesthesia]

I think you’re preaching to the choir on a lot of those points. Are you happy with your current job? Do the satisfying elements more than balance out the dissatisfying for you?

 

[mariajane]

My job satisfaction is irrelevant. The argument isn’t whether midlevels are satisfied... who cares, quite frankly. My overarching point was they have surpassed their scope and are undertrained; but, limitations aside, perhaps they have a legitimate role in specific, well-delineated situations.

 

[Laryngospasm]

The cat is out of the bag. There is a relentless drive for “cheaper” healthcare while companies continue to make billions. Requiring more school is not part of the equation. This will only get worse.

 

[callmeanesthesia]

My job satisfaction is irrelevant. The argument isn’t whether midlevels are satisfied... who cares, quite frankly. My overarching point was they have surpassed their scope and are undertrained; but, limitations aside, perhaps they have a legitimate role in specific, well-delineated situations.

No arguments on this end. Wasn’t sure whether your post was about your misgivings about your fellow NPs or about your role in the system as a whole and churning through patients to generate procedures. I chose a PA to work with me largely because of wanting to avoid the “Heart of a nurse, brain of a doctor” types that the NP programs seem to attract.
I do think Mid levels do have a role to play in sub specialty care. My PA sees primarily follow ups where I’ve already outlined a treatment plan, and selected new patients that sound straightforward (I review all incoming referrals). A 75yo with a few years of aching axial low back pain and a benign MRI with facet arthropathy isn’t rocket science.