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Nurse2MD2018 said:
What’s up with

Nurses can also share countless stories of the errors we witness at the hand of the physicians. Does that make every physician incompetent? I’m not sure what’s up with SNDers constantly bashing of midlevels.
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Doctors aren't omnipotent, they make mistakes as well. But the difference is in the frequency and content of the mistakes. Forgetting to adjust a medication for someones GFR isn't nearly the same as not knowing what pH is.
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Nurse2MD2018 said:
What’s up with

Nurses can also share countless stories of the errors we witness at the hand of the physicians. Does that make every physician incompetent? I’m not sure what’s up with SNDers constantly bashing of midlevels.
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It's not just SDN or Reddit. There's a rapidly growing group of physicians who are opposing midlevels. The American Emerg med board just came out against them and is not allowing midlevels to join anymore.

Why you ask? Because they want to do 10% of the work and have 100% of the money and prestige with 0% of the liability. Pushing to take over jobs and demanding equal pay to physicians among constant lobbying efforts. You're surprised doctors are fed up?
 
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allantois said:
Sure you can choose to be a prick to other providers, nursing, and ancillary stuff. The only thing you will accomplish is complicating your own job as no one likes to work with a prick
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Far from it, I'm not a prick to any of the nurses, RTs or PTs. I just go out of my way to make midlevels know their place
 
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Spodermin said:
Doctors aren't omnipotent, they make mistakes as well. But the difference is in the frequency and content of the mistakes. Forgetting to adjust a medication for someones GFR isn't nearly the same as not knowing what pH is.
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I've said this so many times actually. The simple difference in the magnitude of the errors is mind blowing. A doctor could miss a subtle finding somewhere on the imaging or EKG. Many midlevels will flat out not even know how to read any of those.
 
Spodermin said:
Far from it, I'm not a prick to any of the nurses, RTs or PTs. I just go out of my way to make midlevels know their place
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You are not in the position to let anyone know their place at your level of training. Unless of course you are counting being a keyboard warrior as letting people know their place
 
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allantois said:
You are not in the position to let anyone know their place at your level of training. Unless of course you are counting being a keyboard warrior as letting people know their place
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Contrary to what you might think, I am.
But here's a nice article for you to go through that explains why you will never understand what we're talking about
Dunning–Kruger effect - Wikipedia
 
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allantois said:
You are not in the position to let anyone know their place at your level of training. Unless of course you are counting being a keyboard warrior as letting people know their place
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I think when midlevels ask me for help on a clinical case, that assures us both on where the level of competency is :)
You simply don't know what you don't know. That's a concrete fact.
 
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MedicineZ0Z said:
I've said this so many times actually. The simple difference in the magnitude of the errors is mind blowing. A doctor could miss a subtle finding somewhere on the imaging or EKG. Many midlevels will flat out not even know how to read any of those.
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Why would they know? They just want to wear a lab coat and scrubs, hang a steth around their neck and pretend to be something they aren't. Faced with the simplest of tasks, they will run to whoever is supervising them for "collaboration"
 
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NPs in primary care function basically same in my work system vs MDs, not all of whom are stellar, but they staff what they’re not sure about with another human which is more than MDs do. The MD may come up with an innovative pathophys based insight where the NP will comprehensively document minutiae, and either might be a breakthrough for me picking up the patient. In specialty care NPs often better than the residents/fellows who just have less experience in the field than the midlevel who’s been doing same role for years vs weeks. And it’s infintely easier to connect with the specialty NP and get them to staff with their staff and recommend to me vs. tracking down the resident who’s probably in the OR during my clinic. As I see it we’re on the same team along with the nurses and techs and etc all trying to do the best for the patient. There’s plenty of room for all of us. Not interested in setting up animosities.
 
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siliso said:
NPs in primary care function basically same in my work system vs MDs, not all of whom are stellar, but they staff what they’re not sure about with another human which is more than MDs do. The MD may come up with an innovative pathophys based insight where the NP will comprehensively document minutiae, and either might be a breakthrough for me picking up the patient. In specialty care NPs often better than the residents/fellows who just have less experience in the field than the midlevel who’s been doing same role for years vs weeks. As I see it we’re on the same team along with the nurses and techs and etc all trying to do the best for the patient. There’s plenty of room for all of us. Not interested in setting up animosities.
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I always wondered why these specialty midlevels weren't familiar with many of the zebras in their field.
 
siliso said:
NPs in primary care function basically same in my work system vs MDs, not all of whom are stellar, but they staff what they’re not sure about with another human which is more than MDs do. The MD may come up with an innovative pathophys based insight where the NP will comprehensively document minutiae, and either might be a breakthrough for me picking up the patient. In specialty care NPs often better than the residents/fellows who just have less experience in the field than the midlevel who’s been doing same role for years vs weeks. As I see it we’re on the same team along with the nurses and techs and etc all trying to do the best for the patient. There’s plenty of room for all of us. Not interested in setting up animosities.
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This is the attitude that got anesthesia to where they are today. There was plenty of room for CRNAs back in the 90s. Now, apparently, there isn't enough room for anesthesiologists
 
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Spodermin said:
This is the attitude that got anesthesia to where they are today. There was plenty of room for CRNAs back in the 90s. Now, apparently, there isn't enough room for anesthesiologists
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Half his pay check comes from midlevels doing his work. He wants to sit around and sell out the profession. Thankfully, the younger generation of attendings residents med students are fiercely opposed to midlevels.
 
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siliso said:
I guess it’s because they don’t have to be - they’re going to staff with their attending and let me know, just like a resident would do.
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So why train any more doctors? Let's just all be "providers" and we can consult none but the oldest of doctors who have seen it all.
 
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IknowImnotadoctor said:
You’ve got a whole lot of growing up to do, kiddo.
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When you can't make an argument, attack the person you're arguing with. Funny, it pays a close resemblance to they way you "provide" care
 
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I see the NPs picking up where there aren’t enough interns and residents to be the pack mules of getting s**t done. It’s not a job I’d want for myself forever, so it’s not what I pursued, but some people are happy enough with it I guess.
 
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Systems without residents need someone to take up the scut and off hours, don’t you think? I don’t know, I’m insulated, I do have residents and students that I enjoy teaching, and high quality RN/LPN staff to help me take care of my non teaching patients. In non teaching systems of care delivery either you’re the pack mule forever or someone else is. If you need to be in the OR or procedure suite it can’t be you all the time. If you’re a PCP in a humane system with admin time like me it can be me, as long as I’m in clinic and not on inpatient service. And when I am in clinic I’m sure glad to be able to contact a specialty/surgical NP to help me coordinate care for my patient even though the resident is in the OR. To offload the surgical/subspecialty residents so they have time to learn their own procedures without interruption in the day is another plus of having a midlevel on board I think, along with the accessibility they can offer to PCPs.
 
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MedicineZ0Z said:
It's not just SDN or Reddit. There's a rapidly growing group of physicians who are opposing midlevels. The American Emerg med board just came out against them and is not allowing midlevels to join anymore.

Why you ask? Because they want to do 10% of the work and have 100% of the money and prestige with 0% of the liability. Pushing to take over jobs and demanding equal pay to physicians among constant lobbying efforts. You're surprised doctors are fed up?
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I can assure you midlevels are not making the same income as physicians.
 
With advances in technology we are doing things in medicine that were unfathomable decades ago. Pt care is only getting more complex and physicians simply cannot manage care alone, regardless of your views on midlevels. Lets take a look at some of the pediatric surgical subspecialties, who would not be able to function at optimal capacity without midlevels. For instance CV. "By 2030, it is projected that it will be about 3,000 cardiothoracic surgeons available to cover about 854,000 cases." General surgery residents usually aren't on these services and if they are, they aren't there long enough to manage the cases in the same capacity of someone whose sole responsibility is to do this everyday. You guys want to complain about working crappy hours, then you complain about people who do the things associated with the least desirable aspects of practicing medicine....
 
Nurse2MD2018 said:
With advances in technology we are doing things in medicine that were unfathomable decades ago. Pt care is only getting more complex and physicians simply cannot manage care alone, regardless of your views on midlevels. Lets take a look at some of the pediatric surgical subspecialties, who would not be able to function at optimal capacity without midlevels. For instance CV. "By 2030, it is projected that it will be about 3,000 cardiothoracic surgeons available to cover about 854,000 cases." General surgery residents usually aren't on these services and if they are, they aren't there long enough to manage the cases in the same capacity of someone whose sole responsibility is to do this everyday. You guys want to complain about working crappy hours, then you complain about people who do the things associated with the least desirable aspects of practicing medicine....
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Sure, until you start asking for independent practice rights. Which they did, and got.
 
Nurse2MD2018 said:
I'm not understanding the point you are trying to make.
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The point is, midlevels get their foot in the door by doing the work no one else wants to do. Then they push for independent practice rights so they can practice medicine independently. And, I'll repeat it again... *independent practice* means you have effectively taken over a physician's job. Understand?
 
I didn’t know that being referred to as a provider was such a negative thing. In the military, doctors, PAs, and NPs are referred to as such. It wasn’t until I was being interviewed by a physician and referred to doctors as providers that I learned that it was a big no no. He made sure to counsel me that I’ll never be a provider; I will be a physician.
 
IL1B said:
Why do you feel threatened by professionals who joyfully do jobs “no one else wants to do”?
If “no one wants to do” these jobs then they would be extinct by the time you finish residency.

Suggestion: engage the topic at hand and refrain from the ad hominem.
There is no reason to bludgeon others be they midlevels, janitors, valet parking attendants, et al
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What? The whole point is that midlevels day by day push to replace doctors, literally. For the 4th time, it's called independent practice rights. I have no idea what's so difficult to understand about that.
 
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IL1B said:
Why do you feel threatened by professionals who joyfully do jobs “no one else wants to do”?
If “no one wants to do” these jobs then they would be extinct by the time you finish residency.

Suggestion: engage the topic at hand and refrain from the ad hominem.
There is no reason to bludgeon others be they midlevels, janitors, valet parking attendants, et al
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None of their independent practice proposals contain the language “don’t pay us the same and fire us if a doctor decides they want that job”

They want the same jobs, not the leftover bad ones
 
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sb247 said:
None of their independent practice proposals contain the language “don’t pay us the same and fire us if a doctor decides they want that job”

They want the same jobs, not the leftover bad ones
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Can't believe I had to try and explain this in 5 different ways.
 
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7B1AA394-DA63-4C44-957C-17CE93C1F66A.jpeg


Came across this fun little conversation on Twitter...
 
NicMouse64 said:
half of them graduated at the bottom of their class.....Yeah I am gonna be one of those, can't trust half of all the doctors out there lmao.....these threads really get me sometimes
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I know! In my head I was like well duh that’s a mathematical fact... Btw half of all of your precious EMTs graduated in the bottom of their certificate course.
 
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sunshinefl said:
I know! In my head I was like well duh that’s a mathematical fact... Btw half of all of your precious EMTs graduated in the bottom of their certificate course.
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You know why people become paramedics? Because EMT is too hard to spell. (I am MD, but also a NYS certified paramedic.)
 
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Providers in my hospital include physicians, APPs, RNs, dietitians, social workers, psychologists, pharmacists, PTs, OTs, medical students........
 
In the context of the status quo, "doctor" and "physician" specifically refer to individuals licensed by the governments to practice medicine. "Provider" encompasses potentially anyone in the business of providing medical services. One could use this term in describing a hypothetical scenario in which today's particular trade guilds don't exist.
 
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