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WhippleWhileWeWork said:
I think @NickNaylor is working on a Facebook group and/or website. The FB group could be "secret" so only those in the group can see it. However we need some sort of screening process to keep the moles out.
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I hope you'll let this mere nurse participate. I'm on your side on this topic, and would keep mum about it when I'm on allnurses. (I have a different screen name there.)
 
fab4fan said:
I hope you'll let this mere nurse participate. I'm on your side on this topic, and would keep mum about it when I'm on allnurses. (I have a different screen name there.)
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I banish thee....

I banish theeeee from SPACE AND TIME
 
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NeuroSpeed said:
Well...

http://www.thedailybeast.com/articl...ould-be-able-to-practice-without-doctors.html

There are only a handful of comments so far, but I can gaurantee there will be plenty by the end of the day.

Edit: The author, Russell Saunders, is a pseudonym. TDB claims that he's a pediatrician in New England. The guy doesn't have the balls to post that sort of information without using his real name.
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What a piece of ****. What is there to gain by publicly throwing your colleagues under the bus?

I like how he says that NPs aren't Doctors and don't want to be at the end, but the entire article is based on how they are equal.
 
NeuroSpeed said:
Well...

http://www.thedailybeast.com/articl...ould-be-able-to-practice-without-doctors.html

There are only a handful of comments so far, but I can gaurantee there will be plenty by the end of the day.

Edit: The author, Russell Saunders, is a pseudonym. TDB claims that he's a pediatrician in New England. The guy doesn't have the balls to post that sort of information without using his real name.
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I want to bash my own head in, it's as though solving a problem by finding its root cause only exists in the industrial world.

Problem: Shortage of Primary care physicians.
Why? Med students are not choosing primary care.
Why? Ans. (debt to income ratio, overhead, bureaucratic head aches, insurance for employees, etc)
Why? Ans. (spiraling tuition, poorly thought out reimbursement schemes, unnecessary regulations, etc)
Why? Why? = Eventual Root cause/s
Fix THOSE issues.

But instead we're seeing
Why? Med students are not choosing primary care.
Why? Ans. Who cares why they aren't, let's bring in other professions to do the job, and let's talk about making it more attractive for them. Let's spend time, energy, and money to remove barriers for them to go into primary care instead of for the medical students.

I don't get it.
 
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WhippleWhileWeWork said:
I want to bash my own head in, it's as though solving a problem by finding its root cause only exists in the industrial world.

Problem: Shortage of Primary care physicians?
Why? Med students are not choosing primary care.
Why? Ans. (debt to income ratio, overhead, bureaucratic head aches, insurance for employees, etc)
Why? Ans. (spiraling tuition, poorly thought out reimbursement schemes, unnecessary regulations, etc)
Why? Why? = Eventual Root cause/s
Fix THOSE issues.

But instead we're seeing
Why? Med students are not choosing primary care.
Why? Ans. Who cares why they aren't, let's bring in other professions to do the job, and let's talk about making it more attractive for them. Let's spend time, energy, and money to remove barriers for them to go into primary care instead of for the medical students.

I don't get it.
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Because the people making a killing off the backs of dying people and physicians won't allow it. It seems like this is justification to pay physicians less.
 
Yeah, I read the article and looked at the author and it's not even his real name! This person can be anyone.
 
There will be physicians who side with Mid levels like there will be mid levels who side with physicians. It's clear which side is making the bigger splash, public perception seems to be a difficult arena for physicians
 
NeuroSpeed said:
Well...

http://www.thedailybeast.com/articl...ould-be-able-to-practice-without-doctors.html

There are only a handful of comments so far, but I can gaurantee there will be plenty by the end of the day.

Edit: The author, Russell Saunders, is a pseudonym. TDB claims that he's a pediatrician in New England. The guy doesn't have the balls to post that sort of information without using his real name.
Click to expand...

lol or he's just a nurse pretending to be a doctor. Wouldn't be the first time amirite guys?
 
how did I not fin this thread earlier? ehh, some of those resolutions on there... glad I'm going to the meeting. I'll be looking forward to some of the arguing over them. anyway, shooting a pm for the invite.
 
The public is largely not interested in the quality of the outlet it seems
 
NontradCA said:
What a piece of ****. What is there to gain by publicly throwing your colleagues under the bus?

I like how he says that NPs aren't Doctors and don't want to be at the end, but the entire article is based on how they are equal.
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"Further, while the time I spent in the neonatal intensive care unit or on the oncology service was valuable, it has little bearing on the care I deliver as a primary-care physician today."

Yup, bc it's not like the patients you have a PCP will ever be on chemo or that you'll have to do well-baby checks. Yup just compartmentalize and make it someone else's problem. :smack:

"But NPs are not looking to replace physicians" --- actually they are. Ask Mary Mundinger.
 
Please pm me with info as well.
 
NontradCA said:
What a piece of ****. What is there to gain by publicly throwing your colleagues under the bus?

I like how he says that NPs aren't Doctors and don't want to be at the end, but the entire article is based on how they are equal.
Click to expand...

I feel sorry for PCPs, tbh.

But another part of me says, let the nurses have what they want. If independent NPs can provide care just as effectively as us, then it's clear that the current system of medical education is a failing one, and all the extra time we spend learning the TCA and other assorted arcana is pointless.

But if the NP experiment fails and collapses due to poor patient outcomes and burgeoning malpractice insurance rates, then we have won. The overentitled American public won't stand for substandard care.
 
Arkangeloid said:
I feel sorry for PCPs, tbh.

But another part of me says, let the nurses have what they want. If independent NPs can provide care just as effectively as us, then it's clear that the current system of medical education is a failing one, and all the extra time we spend learning the TCA and other assorted arcana is pointless.

But if the NP experiment fails and collapses due to poor patient outcomes and burgeoning malpractice insurance rates, then we have won. The overentitled American public won't stand for substandard care.
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The problem is that the latter will be difficult to prove. Physicians will be the safety net for all the NP train wrecks.
 
qwerty89 said:
The problem is that the latter will be difficult to prove. Physicians will be the safety net for all the NP train wrecks.
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That's where some people are saying "let them practice independently". Without a MD safety net, will they continue to show equivalent outcomes? That's the question that will decide which way this debate goes. If they continue to show equivalent outcomes (at VALID follow up times, like 10+ years, not the 6 month garbage with random markers of health that are >75% due to patient compliance like the Mary Mundinger study), then we've 100% lost the primary care battle. Sure, zebras will go undiagnosed and patients will die (or be maimed) by NPs who don't refer out out of ego (like Susan Dohan http://www.louisianapersonalinjurylawyerblog.com/2011/02/increased_awards_for_victims_o.html ), but the number of lawsuits as a result of that will not be statistically significant compared to all of the reasons people go to their PCP. The rest of the patients with zebras will all get consulted out by responsible NPs (along with consults for non-zebras by those same NPs). That will cost the healthcare system more, but the government probably won't be able to stop it at that point.

One of our chances for salvation (besides what NickNaylor is doing [btw Nick, I PM'd you]) is to give NPs full independent practice rights, then either have media reports about individual royal F ups that these now-independent NPs make. Or, we could do chart reviews on patients in states who already have full independent practice rights. I think an IRB would approve a chart review comparing outcomes of independent practice NPs vs MDs (although I don't think a prospective trial would be approved without MD oversight of the NP).
 
evilbooyaa said:
That's where some people are saying "let them practice independently". Without a MD safety net, will they continue to show equivalent outcomes? That's the question that will decide which way this debate goes. If they continue to show equivalent outcomes (at VALID follow up times, like 10+ years, not the 6 month garbage with random markers of health that are >75% due to patient compliance like the Mary Mundinger study), then we've 100% lost the primary care battle. Sure, zebras will go undiagnosed and patients will die (or be maimed) by NPs who don't refer out out of ego (like Susan Dohan http://www.louisianapersonalinjurylawyerblog.com/2011/02/increased_awards_for_victims_o.html ), but the number of lawsuits as a result of that will not be statistically significant compared to all of the reasons people go to their PCP. The rest of the patients with zebras will all get consulted out by responsible NPs (along with consults for non-zebras by those same NPs). That will cost the healthcare system more, but the government probably won't be able to stop it at that point.

One of our chances for salvation (besides what NickNaylor is doing [btw Nick, I PM'd you]) is to give NPs full independent practice rights, then either have media reports about individual royal F ups that these now-independent NPs make. Or, we could do chart reviews on patients in states who already have full independent practice rights. I think an IRB would approve a chart review comparing outcomes of independent practice NPs vs MDs (although I don't think a prospective trial would be approved without MD oversight of the NP).
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Even if NPs can demonstrate something close to equivalency, PCPs will survive as concierge care providers for the upper and middle classes.
 
Sent a PM, I'm in as well!
 
Could I get a FB invite link from whoever is in charge of that situation? I think this has lots of potential to be an important step for physicians in the future!
 
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I'm surprised that the Family Medicine (or Peds) forums aren't blowing up about this.
 
Arkangeloid said:
I'm surprised that the Family Medicine (or Peds) forums aren't blowing up about this.
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Well that's the rub isn't it. The rhetoric is all about increasing primary care access. But once they graduate with the FNP in autonomous states and do a couple wankadoodle months of this or that they go into whatever they fancy. Which is no surprise...cleaner more specialized fields.
 
Anastomoses said:
Are we sure FM isn't making all the money they want? I mean...I'm starting to wonder...for those who have no real interest in actual medicine...FM seems a good deal. Why don't they just up their prices if they are so scarce? I hear they make a killing in the mid-west.
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Well, I'm not sure what you mean by no interest in real medicine. But the market is very controlled and squeezed by the bureaucratic realities of medical practice in general. Boutique or direct to consumer practice models exist and from what I've heard our colleagues are extremely happy with those.

But running a regular practice is increasingly difficult. And jobs in larger organizations seem likely to be filled by the lowest bidder and not the highest going forward. If we cannot control independent practice rights then our expensive and labor intensive overhead is going to be crippling.

Upping prices is not a simple thing. And if you want more creative freedom then you'll have to be crafty to achieve those.
 
Is this thing working? Anybody get invites to the fb group yet?
 
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