Realistically, will midlevels affect our future?

[JB50]

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[Law2Doc]

It's a double edged sword. Physician extenders are a good way to provide less expensive medical care to more people. So the government loves the idea. But let's not kid, the amount of schooling and training a physician gets dwarfs that of any NP or PA. So it's totally an issue of patient care when the NPs create DNP degrees and open up their own shops, not working under the supervision of doctors. I've had a ton of school and training under my belt and I forever worry about the things I might be missing each day -- I shudder to think what life would be like if I had but a fraction of the knowledge base and didn't have the training to know most of the things I should be worried about.

Ignorance can make you bold -- you don't ever really know what you don't know so suddenly hard things may seem easy. You don't worry about certain bad outcomes, reactions, complications if you have no exposure to them. That's a big part of why some midlevels are so bold-- they figure "i will just write scrips for z-packs all day and if someone looks really bad i will just send him to someone else". But that's not medicine, that's a CVS. And patients who think they are seeing a healthcare provider (because patients view everyone who wears a white coat and calls themselves doctor as equivalent) will not get the care they need, often telling themselves "my 'doctor' would have told me if this was something serious".

 

[deleted245139]

Well said ^

 

[jl lin]

It's a double edged sword. Physician extenders are a good way to provide less expensive medical care to more people. So the government loves the idea. But let's not kid, the amount of schooling and training a physician gets dwarfs that of any NP or PA. So it's totally an issue of patient care when the NPs create DNP degrees and open up their own shops, not working under the supervision of doctors. I've had a ton of school and training under my belt and I forever worry about the things I might be missing each day -- I shudder to think what life would be like if I had but a fraction of the knowledge base and didn't have the training to know most of the things I should be worried about.

Ignorance can make you bold -- you don't ever really know what you don't know so suddenly hard things may seem easy. You don't worry about certain bad outcomes, reactions, complications if you have no exposure to them. That's a big part of why some midlevels are so bold-- they figure "i will just write scrips for z-packs all day and if someone looks really bad i will just send him to someone else". But that's not medicine, that's a CVS. And patients who think they are seeing a healthcare provider (because patients view everyone who wears a white coat and calls themselves doctor as equivalent) will not get the care they need, often telling themselves "my 'doctor' would have told me if this was something serious".

Very true Law, but some NPs have more knowledge and clinical experience than others, and they are likely to be more careful or they will refer out.
From a political perspective, I don't see them going anywhere. I mean you can argue that many physicians practice like CVS.

People who are savvy do NOT regard PAs or NPs as having the equivalence of education and extent of supervised clinical experience. In a pinch, however, they will use them.

If someone has more serious health issues, they aren't, however gonna waste their time necessarily w/ a PA or an NP. The concern is for those that don't really see the big picture re: their individual health status, that is, if they do have other issues for which they should be concerned. But depending on how things continue to move, politically speaking, PAs and NPs are going to get those folks that have more serious issues that may be missed. Even if you have an experienced, and excellent physician supervising them, these docs can't be everywhere at once and oversee everything/every patient. This is part of the NP argument for having more autonomy. At some point, however, you'd then think that they would be held legally accountable for their actions or lack of actions--such as not referring patients out to specialists and such. Even many FP physicians are often quick to refer certain patients out; plus all practitioners are being forced to watch what they order and if they can justify what they order with the right codes for reimbursement. Beyond that, they are, after all, protecting their livelihoods too. Personally, as I have said before, if I were an NP or CRNA, I would not work under total autonomy, and I have more critical care clinical experience than many today that apply to NP or CRNA programs. It's not fair to the patients. Of course there is individual practice too. Not every physician practices like others. There are those that are more vigilant and go the extra mile as needed, and others that do not.

 

[badasshairday]

Midlevels armed with machine learning will decrease the need for physicians in many fields.

 

[TaroBubbleTea]

But depending on how things continue to move, politically speaking, PAs and NPs are going to get those folks that have more serious issues that may be missed. Even if you have an experienced, and excellent physician supervising them, these docs can't be everywhere at once and oversee everything/every patient. This is part of the NP argument for having more autonomy.

I fail to see how granting midlevels more autonomy will magically give them the clinical knowledge they need to take care of more complex patients.

 

[Psai]

I fail to see how granting midlevels more autonomy will magically give them the clinical knowledge they need to take care of more complex patients.

They don't know what they're doing so if you put them in even more complex situations, they will magically know how to handle it. Of course they won't miss things they don't know about as they will have experienced it even if they didn't know to recognize it. Isn't it so obvious?

 

[jl lin]

I fail to see how granting midlevels more autonomy will magically give them the clinical knowledge they need to take care of more complex patients.

I don't disagree w/ you. I am saying, as they are forced eventually into finding themselves w/ more and more patients that are a mixed-bag, so to speak, some will learn and grow, and others won't. There is so much that is dependent upon the particular individual. It's not like it is a total given for everyone, but I believe a "turning of eyes away from the less expert care" in order to meet the demands, is evolving out of our current set of politics and economics. Again, I'd prefer to work in a group w/ experienced, smart physicians to whom I could go and present, etc. Yea. What I don't know, I don't know. A. I'd learn from them as I already have, and B. It just makes sense to get support, back-up, correction, re-direction, whatever. But, some docs will use such NPs, and some won't. That kind of makes it harder for NPs to function in this way, b/c that leaves them with going autonomous in order to work; and the use of them will continue to expand in this way. When you set things up as "us versus them" nobody wins.

 

[Psai]

LOL docs aren't the ones setting up the us versus them mentality. We don't even think about midlevels in general. But in every nursing school, they won't stfu about how nps are just as good or better than doctors and will lead healthcare blah blah blah. It permeates nursing education and leadership. We speak out against it because we're tired of your ****. Patients deserve better than to be misled just so that some nurses can pump up their own ego.

I'm not a fan of "good enough for metrics" nursing practitioner care. Keep that to yourself.

 

[Entadus]

You will have to use some very grossly basic reasoning here. Hopefully you are sitting down because this will shock you.

From medicare.gov

"A doctor can be a Doctor of Medicine (MD), a Doctor of Osteopathic Medicine (DO), or, in some cases, a dentist, optometrist (eye doctor), or chiropractor. Medicare also covers services provided by other health care providers, like physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers, physical and occupational therapists, speech language pathologists, and clinical psychologists."

source: https://www.medicare.gov/coverage/doctor-and-other-health-care-provider-services.html

From wikipedia (weak source, I know but simply a definition. bear with me)

"A health professional or healthcare provider is an individual who provides preventive, curative, promotional or rehabilitative health care services in a systematic way to people, families or communities."

source: https://en.wikipedia.org/wiki/Health_professional

From Cal Berkeley

"Under federal regulations, a "health care provider" is defined as: a doctor of medicine or osteopathy, podiatrist, dentist, chiropractor, clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical social worker who is authorized to practice by the State and performing within the scope of their practice as defined by State law, or a Christian Science practitioner (lolololololololol)"

source: http://hr.berkeley.edu/node/3777




Do you need more @deafdealer or anyone else that is confused about their role as healthcare providers?

For your next assignment, please research the origins of the term "healthcare provider", especially with respect to when the term first appeared, who invented the term, and what their motivations were. Thank you

 

[Rekt]

Midlevels armed with machine learning will decrease the need for physicians in many fields.

Sad this nonsense is coming from a resident. If you truly believe this, then I'm concerned for your intellectual reasoning ability.

 

[Geraltofrivia]

The majority of midlevels I have worked with are perfectly content in their current role: part-time (for medicine, anyhow) scut monkey.

There are a small, but vocal contingency pushing for equal practice rights. Perhaps these groups are what are scaring everybody, and I agree, it seems a bit far fetched in the current training model.

Given the opportunity, I am sure most midlevels would take the ability to be the equivalent of a physician. They would be foolish not to, essentially getting something for nothing.

Too many docs are tempted by the forbidden fruit and enabling the continued march of expanded scope of practice for midlevel providers. Namely, if I can pay someone a fraction of my salary to do all of my work, and get paid for it, it makes my life easier and my lifestyle better. Unfortunately, the help eventually figure out the game and start asking why they are doing all of the work and you are reaping the majority of the benefits. Add suits and administrators in to the equation, who simply care about extracting the maximum amount of money from each provider possible and the equation becomes pretty simple.

We have no one else to blame but ourselves for this dilemma.

It's not fair (at least to us students) to say nobody but ourselves. The problem is the current generation of doctors.

 

[Geraltofrivia]

Midlevels armed with machine learning will decrease the need for physicians in many fields.

Honestly this is the realest post in here. Truth being, machine learning will be a reality in 10 years anyway

 

[Chinese13579]

Basically they affect specialties that aren't that difficult or don't require that much intelligence like dermatology and orthopedic surgery.... people say these are competitive specialties but the reality is they're not difficult at all and that's why you'll see PAs replacing dermatologists half the time in the office.... it sucks cus PAs/NPs are not doctors at all and their education is significantly less / inferior to legitimate doctors (MD/DO) but what are you gonna do?

 

[username456789]

Basically they affect specialties that aren't that difficult or don't require that much intelligence like dermatology and orthopedic surgery.... people say these are competitive specialties but the reality is they're not difficult at all and that's why you'll see PAs replacing dermatologists half the time in the office.... it sucks cus PAs/NPs are not doctors at all and their education is significantly less / inferior to legitimate doctors (MD/DO) but what are you gonna do?

0/10 trolling effort.

 

[W19]

@Chinese13579 might be a troll, but the reality is that I have seen a lot of PA/NP doing derm in south FL... Derm might be their next target after they are done pushing physician out of anesthesia...

PA usually assist in surgery. I have not seen PA or NP actually doing surgery. I have no idea what kind of brain power one needs to be a dermatologist or an ortho doc...

 

[jl lin]

LOL docs aren't the ones setting up the us versus them mentality. We don't even think about midlevels in general. But in every nursing school, they won't stfu about how nps are just as good or better than doctors and will lead healthcare blah blah blah. It permeates nursing education and leadership. We speak out against it because we're tired of your ****. Patients deserve better than to be misled just so that some nurses can pump up their own ego.

I'm not a fan of "good enough for metrics" nursing practitioner care. Keep that to yourself.

Dude, it's not my ****. I acknowledge the distinctions and differences. I am just following the politics of it all, and saying how it perpetuates the trends. If physicians would reasonably stand up and utilize these NPs and PA and CRNAs, in the way in which they should be, there wouldn't be so much angst about them. Yes. There is this "us vs. them" mentality, especially among med students and newer physicians. Among the general population of NPs and PAs, they see the turf-war aggression, which doesn't help physicians or healthcare. Forget the extreme touting in the graduate nursing programs. Most nurses just get through the political indoctrination--at some programs and w/ some professors its greater than others. They then worry about testing for their licenses and getting a job. They aren't saying, "Yes. We can't wait to dominate HC and physicians." You listen to those that are extreme and politically outspoken, but they don't represent most advanced nurse practitioners or PAs. In the end, it's all about current healthcare politics and economics. I can't help but believe coalition-building would do more to limit any turf takeover, if physicians stood strong on more precise scopes of practice and were more involved in setting the parameters. Still, the politics and economics will end up having more say in terms of reality.

 

[Psai]

Must be interesting to live in a fantasy world where you get to build your own facts

 

[Mr Roboto]

Must be interesting to live in a fantasy world where you get to build your own facts

Just ask Trump.

 

[jl lin]

Must be interesting to live in a fantasy world where you get to build your own facts

What do you mean? Do you really think most NPs and PAs are marching on D.C. for total equality w/ MDs or DOs? Seriously. Do you not know that a number of these folks are busy living their lives, having children/families, and so, they accepted this as a pathway, knowing the overall limitations. Honestly, people are busy w/ their own lives. The extremers do not represent everyone for God's sake.

Now, along with the old attorney joke, "First we kill all the lawyers," you want to include advanced practice nurses and PAs as well in that?

Politics and economics and what we do with ACA will have a lot of impact on the use of midlevel providers. It already has. But I am not working with droves of advanced practice nurses or PAs that are out to usurp the hierarchy of medicine. Again, people have lives. Soon as you throw family into the equation, life takes on a whole other dimension, and many of these people want this or have this w/o the hassle of dealing w/ the hoops of getting into MS and all that comes w/ it. Many of those I work w/ in the hospital know their limitations, and if they don't, Oh how fast life teaches them.

 

[Psai]

What do you mean? Do you really think most NPs and PAs are marching on D.C. for total equality w/ MDs or DOs? Seriously. Do you not know that a number of these folks are busy living their lives, having children/families, and so, they accepted this as a pathway, knowing the overall limitations. Honestly, people are busy w/ their own lives. The extremers do not represent everyone for God's sake.

Now, along with the old attorney joke, "First we kill all the lawyers," you want to include advanced practice nurses and PAs as well in that?

Politics and economics and what we do with ACA will have a lot of impact on the use of midlevel providers. It already has. But I am not working with droves of advanced practice nurses or PAs that are out to usurp the hierarchy of medicine. Again, people have lives. Soon as you throw family into the equation, life takes on a whole other dimension, and many of these people want this or have this w/o the hassle of dealing w/ the hoops of getting into MS and all that comes w/ it. Many of those I work w/ in the hospital know their limitations, and if they don't, Oh how fast life teaches them.

Read any comment section for any news article that involves mid levels and you'll see how busy their lives really are.

 

[tatsuchi]

I mean you can argue that many physicians practice like CVS.
[...]
Even many FP physicians are often quick to refer certain patients out.
[...]
Not every physician practices like others. There are those that are more vigilant and go the extra mile as needed, and others that do not.

There are indeed physicians out there who practice "CVS Medicine." These are usually the much older docs in private practices who are one foot out the door anyway.

Here is the thing though: what you try to point out is the lowest denominator for a physician. The rest of us in the field strive to be better than that, to use our clinical acumen in conjunction with our EBM to provide the best care to our patients. And we as well strongly discourage our colleagues from doing any less than the same.

However in your argument, practicing "CVS Medicine" is pretty much the most an NP can strive for. They simply do not have the clinical knowledge, training or skills to diagnose more complex diseases or manage difficult outcomes.

What do you mean? Do you really think most NPs and PAs are marching on D.C. for total equality w/ MDs or DOs? Seriously. Do you not know that a number of these folks are busy living their lives, having children/families, and so, they accepted this as a pathway, knowing the overall limitations.

Why are you even arguing this? It's your field that's making the voice and even if you perceive it as a "vocal minority" it's still something from the top down being instigated by NPs. When they're finally successful with their crusade and things change, that "silent" majority that you mention is just going to move in and shift to their new roles as independent providers. They're not going to suddenly stop and protest "oh wait we didn't actually want this it was just a vocal minority of us all along."

Being silent it is the same as being complicit in the action.

 

[jl lin]

No one says anyone should be silent. Just put things in a balanced perspective. I believe most people w/ any decent direct clinical experience should see it is as beyond foolish to practice on a certain level to which they are not fully prepared. As long as these folks aren't unfairly protected from board sanctions and lawsuits, there should be some clarity shown here in due time
If, however, the political climate unfairly protects them from board sanctions and lawsuits, then yes. Physicians, the general public, and indeed even nurses should be up-in-arms.

IF-- IF they are to function on the same level and scope of practice as board certified physicians, they must be held to the same standards in every way. I KNOW I do not want to be in a situation where I am going to be held fully to such standards if I am not duly prepared to be. It would not be worth it.

Overall, I don't think you have as much to worry about with AP Nurses and PAs w/o the pull of the politico-economic insensitive to facilitate and drive them in the manner in which you fear. If we move ahead to a total, universal health program, single-payer system, yes. You should most definitely worry as physicians.

 

[JB50]

It's a double edged sword.

What actually happens when a NP/PA screws up?

 

[mimelim]

What actually happens when a NP/PA screws up?

About as much as when a doctor screws up.

 

[JB50]

About as much as when a doctor screws up.

Maybe I need to be more specific. If a PA that's working with a doctor effs up, does the result of that eff up ultimately fall on the physician or does the NP/PA's license get put on the chopping block as well.

 

[mimelim]

Good one. Maybe I need to be more specific. If a PA that's working with a doctor effs up, does the result of that eff up ultimately fall on the physician or does the NP/PA's license get put on the chopping block as well.

For starters, physician's licenses hardly ever "get put on the chopping block" for "screwing up". The vast majority of lost medical license are because of professionalism or non-medical issues. The reality is that when an MD or a PA screws up, whether it be an error in judgement, technical mistake, etc, the vast majority of the time, nothing happens. If they are in an academic center, maybe it gets brought up in M&M. Otherwise, everyone moves on. Hopefully, they learn from it and take ownership of their mistake, but frankly, there aren't exactly great systems in place to force anything.

 

[JB50]

For starters, physician's licenses hardly ever "get put on the chopping block" for "screwing up". The vast majority of lost medical license are because of professionalism or non-medical issues. The reality is that when an MD or a PA screws up, whether it be an error in judgement, technical mistake, etc, the vast majority of the time, nothing happens. If they are in an academic center, maybe it gets brought up in M&M. Otherwise, everyone moves on. Hopefully, they learn from it and take ownership of their mistake, but frankly, there aren't exactly great systems in place to force anything.

Interesting. Thanks!

 

[chipwhitley]

The question really should be - "realistically, will midlevels hurt patients?" and the answer to that is, "yes if we continue to allow them more independence". We're really the only group of people who know enough to realize how dangerous they are, so the moral responsibility is on us to do something. Otherwise, they will harm patients and we will have those patients' blood on our hands.

 

[tennischamp822]

...

 

[chipwhitley]

True but gov + big business don't care about the plight of poor patients.

There are doctors in highly influential positions at insurance companies, in hospital administrations, and in politics too. Businesspeople and politicians have an excuse, they know little about medical professional qualifications apart from what midlevel organizations tell them. But doctors should know better. They deserve a lot more of the blame, and they should be ashamed to let this happen. These docs in high places are selling out their own profession and throwing patients under the bus so they can make money and gain power.

 

[tennischamp822]

...

 

[Psai]

Doctors also act as businessmen and hire midlevels to essentially do their jobs in many fields (especially family practice, psych and even derm). A dermatologist told me that each of his PAs make him an additional 75k per year, and he has 3 PAs at his office. Would you refuse 225k per year? I probably wouldn't tbh.

But, the real issue is that there would be a massive shortage of doctors without any PAs/NPs present at all. There is a small doctor shortage now, but it would be massive without midlevels. Hence, I don't blame anybody for throwing patients under the bus because it is a structural issue that is too late to reverse now.

There is no shortage. We just treat way too many people when they have irreversible disease or caused their own medical problems.

 

[Stagg737]

For starters, physician's licenses hardly ever "get put on the chopping block" for "screwing up". The vast majority of lost medical license are because of professionalism or non-medical issues. The reality is that when an MD or a PA screws up, whether it be an error in judgement, technical mistake, etc, the vast majority of the time, nothing happens. If they are in an academic center, maybe it gets brought up in M&M. Otherwise, everyone moves on. Hopefully, they learn from it and take ownership of their mistake, but frankly, there aren't exactly great systems in place to force anything.

Let's not forget where the responsibility ultimately lies though. If a patient is given improper treatment that leads to harm or a sentinel event occurs under a team that includes nurses, PAs, and physicians, the nurses and PAs aren't the ones the lawyers are going to go after. If each were practicing independently, then sure, they'd be responsible for their own errors, but in the traditional setting the bulk of the responsibility and liability is going to fall on the physician's shoulders, as it should.

 

[chipwhitley]

Doctors also act as businessmen and hire midlevels to essentially do their jobs in many fields (especially family practice, psych and even derm). A dermatologist told me that each of his PAs make him an additional 75k per year, and he has 3 PAs at his office. Would you refuse 225k per year? I probably wouldn't tbh.

But, the real issue is that there would be a massive shortage of doctors without any PAs/NPs present at all. There is a small doctor shortage now, but it would be massive without midlevels. Hence, I don't blame anybody for throwing patients under the bus because it is a structural issue that is too late to reverse now.

The solution to not having enough doctors is... wait for it... to make more doctors. And why can't we? There are plenty of people domestically who would love to become doctors if we let them train, and even more doctors abroad who would love to move here and train if we gave them the chance. And yeah, I know you're going to say that no one wants to do primary care in the middle of nowhere. Well neither does your average NP, they're human beings just like the rest of us and want the best job at the best location, but they take what they get. If we flooded the market with doctors, we'd be in the same situation, except we'd have doctors everywhere and not NPs/PAs. The only thing is that our artificially high income and job security would probably plummet and we can't have that, even if it means everyone gets to see a real doctor. And no, we do have the money to train a lot more doctors than we do. We've just put it in the wrong place.

 

[VA Hopeful Dr]

The solution to not having enough doctors is... wait for it... to make more doctors. And why can't we? There are plenty of people domestically who would love to become doctors if we let them train, and even more doctors abroad who would love to move here and train if we gave them the chance. And yeah, I know you're going to say that no one wants to do primary care in the middle of nowhere. Well neither does your average NP, they're human beings just like the rest of us and want the best job at the best location, but they take what they get. If we flooded the market with doctors, we'd be in the same situation, except we'd have doctors everywhere and not NPs/PAs. The only thing is that our artificially high income and job security would probably plummet and we can't have that, even if it means everyone gets to see a real doctor. And no, we do have the money to train a lot more doctors than we do. We've just put it in the wrong place.

Even if I agreed with everything here, it would take a minimum of 7 years for any changes we make today to really take affect.

 

[peanutbutternjelly]

So I've noticed that at a lot of offices that use midlevels, the NP or PA will often see only 1/4 to 1/3 of the number of the patients per day as the physician does. I know this has to do with the fact that most midlevels are on a fixed salary that doesn't depend on the number of patients they see, but I'm don't understand how this really is beneficial to the physician they are working for? Why aren't they required to see as many patients per hour or atleast a certain number? It seems like it would be more cost-effective for the doctor to just squeeze in the small number of patients they see into their own schedule rather than hiring a midlevel, especially when a lot of these cases are just simple followups. Can someone explain this?

 

[Stagg737]

So I've noticed that at a lot of offices that use midlevels, the NP or PA will often see only 1/4 to 1/3 of the number of the patients per day as the physician does. I know this has to do with the fact that most midlevels are on a fixed salary that doesn't depend on the number of patients they see, but I'm don't understand how this really is beneficial to the physician they are working for? Why aren't they required to see as many patients per hour or atleast a certain number? It seems like it would be more cost-effective for the doctor to just squeeze in the small number of patients they see into their own schedule rather than hiring a midlevel, especially when a lot of these cases are just simple followups. Can someone explain this?

In that case, instead of hiring mid-levels why not just get paid to take on med students doing rotations? You're going to have to sign off on the treatment plan either way, and as sad as it is I've already worked with more than one or two nurses that the physician had to babysit more than any of the 3rd year med students on rotation.

 

[W19]

In that case, instead of hiring mid-levels why not just get paid to take on med students doing rotations? You're going to have to sign off on the treatment plan either way, and as sad as it is I've already worked with more than one or two nurses that the physician had to babysit more than any of the 3rd year med students on rotation.

Oh well, studies have shown their care is on par or better than physicians'... I guess online classes plus 500-1,000 hrs preceptorship are a heck of lot better than what we are getting for 30k-40k/yr...

 

[chipwhitley]

Even if I agreed with everything here, it would take a minimum of 7 years for any changes we make today to really take affect.

Well it's the best solution we have, so we should probably start now.

 

[Psai]

Oh well, studies have shown their care is on par or better than physicians'... I guess online classes plus 500-1,000 hrs preceptorship are a heck of lot better than what we are getting for 30k-40k/yr...

? Why are you parroting this? It's not even true and if it were it would be irrelevant

 

[W19]

? Why are you parroting this? It's not even true and if it were it would be irrelevant

Not parroting anything; just pointing out how crazy our medical system is...

 

[qwerty89]

Oh well, studies have shown their care is on par or better than physicians'... I guess online classes plus 500-1,000 hrs preceptorship are a heck of lot better than what we are getting for 30k-40k/yr...

What residents are getting paid 30K a year? Nearly every program offers 47k+ that I've seen. Most are 50k+ starting with PGY-1.

 

[Psai]

What residents are getting paid 30K a year? Nearly every program offers 47k+ that I've seen. Most are 50k+ starting with PGY-1.

He is always clueless. I don't know how he manages to be wrong all the time but somehow he does it

 

[Mr Roboto]

What residents are getting paid 30K a year? Nearly every program offers 47k+ that I've seen. Most are 50k+ starting with PGY-1.

I think he's referring to tuition, not resident salary.

 

[niko327]

The question really should be - "realistically, will midlevels hurt patients?" and the answer to that is, "yes if we continue to allow them more independence". We're really the only group of people who know enough to realize how dangerous they are, so the moral responsibility is on us to do something. Otherwise, they will harm patients and we will have those patients' blood on our hands.

Yeah, Ummm....no. So I can't speak about NP's because I am not one. But all of this talk about PA's pushing for more independence rights only happens in the world of SDN. This independence push is not a mainstream thing in the world of PAs. No PA that I ever worked with ever demanded independent practice rights, a larger scope or more responsibility. Often times though we did demand LESS responsibility. You see chipwhitley, when you are being paid X amount of dollars in salary, you want to receive X amount of dollars with as little exposure to liability as possible. Every seasoned PA I ever worked with was acutely aware of this fact. The people I worked with hated nothing more than to have a new responsibility thrust upon them. Especially if that additional responsibility came without further compensation. You want to know who is pushing for more scope of practice and responsibilities for PA's? The doctors who enjoyed the help they got from the PAs. Yup, its true. The more we did, the less they had to do. But you know what else? Nobody ever wanted to pony up the extra dollars that assuming extra responsibility should entail. I can tell you, no one gave a craap about ego stroking that came along with being "the man". Oh you want me to be responsible for anyone who needs a central line and all of the complications that may come? Great, train me and make sure we get a cut of the billing. What's that? No money?
Just professional recognition and prestige for my dept? Oh OK, sure. That's why we get out of bed in the morning, we'll get right on it. Ummmm...no. Honestly, the reality chipwhitley, is the exact OPPOSITE of what you and many others on SDN are describing. But heck, its a lot more fun to regurgitate the same old sensationalist garbage and feign righteous indignation.

 

[Mr Roboto]

Yeah, Ummm....no. So I can't speak about NP's because I am not one. But all of this talk about PA's pushing for more independence rights only happens in the world of SDN. This independence push is not a mainstream thing in the world of PAs. No PA that I ever worked with ever demanded independent practice rights, a larger scope or more responsibility. Often times though we did demand LESS responsibility. You see chipwhitley, when you are being paid X amount of dollars in salary, you want to receive X amount of dollars with as little exposure to liability as possible. Every seasoned PA I ever worked with was acutely aware of this fact. The people I worked with hated nothing more than to have a new responsibility thrust upon them. Especially if that additional responsibility came without further compensation. You want to know who is pushing for more scope of practice and responsibilities for PA's? The doctors who enjoyed the help they got from the PAs. Yup, its true. The more we did, the less they had to do. But you know what else? Nobody ever wanted to pony up the extra dollars that assuming extra responsibility should entail. I can tell you, no one gave a craap about ego stroking that came along with being "the man". Oh you want me to be responsible for anyone who needs a central line and all of the complications that may come? Great, train me and make sure we get a cut of the billing. What's that? No money?
Just professional recognition and prestige for my dept? Oh OK, sure. That's why we get out of bed in the morning, we'll get right on it. Ummmm...no. Honestly, the reality chipwhitley, is the exact OPPOSITE of what you and many others on SDN are describing. But heck, its a lot more fun to regurgitate the same old sensationalist garbage and feign righteous indignation.

So you want more responsibility as long as you're getting paid for it.

 

[KnuxNole]

Midlevels won't take our jobs, honestly. Yes, a good chunk of them work independently. There are NPs who see ED patients without any mandatory supervision(only optional curbside from a MD/DO), and in the hospital during rounds/admits without an attending signing off on them, and as PCPs taking care of primary care without anyone watching them. However, them doing all of these doesn't stop us from having job prospects, at all. IMO, I can't think of a speciality which should be shaking in their boots due to NP/PA grads popping up left and right...

 

[chipwhitley]

Yeah, Ummm....no. So I can't speak about NP's because I am not one. But all of this talk about PA's pushing for more independence rights only happens in the world of SDN. This independence push is not a mainstream thing in the world of PAs. No PA that I ever worked with ever demanded independent practice rights, a larger scope or more responsibility. Often times though we did demand LESS responsibility. You see chipwhitley, when you are being paid X amount of dollars in salary, you want to receive X amount of dollars with as little exposure to liability as possible. Every seasoned PA I ever worked with was acutely aware of this fact. The people I worked with hated nothing more than to have a new responsibility thrust upon them. Especially if that additional responsibility came without further compensation. You want to know who is pushing for more scope of practice and responsibilities for PA's? The doctors who enjoyed the help they got from the PAs. Yup, its true. The more we did, the less they had to do. But you know what else? Nobody ever wanted to pony up the extra dollars that assuming extra responsibility should entail. I can tell you, no one gave a craap about ego stroking that came along with being "the man". Oh you want me to be responsible for anyone who needs a central line and all of the complications that may come? Great, train me and make sure we get a cut of the billing. What's that? No money?
Just professional recognition and prestige for my dept? Oh OK, sure. That's why we get out of bed in the morning, we'll get right on it. Ummmm...no. Honestly, the reality chipwhitley, is the exact OPPOSITE of what you and many others on SDN are describing. But heck, its a lot more fun to regurgitate the same old sensationalist garbage and feign righteous indignation.

I am talking about NPs, CRNAs, etc. You just need to do a few google searches to know that quite a few of them and their leadership in general has been pushing for independence and has been successful in obtaining it in over half of the United States.

 

[niko327]

So you want more responsibility as long as you're getting paid for it.

No. Most of the PA's I worked with didn't want anymore responsibility. More responsibility means more training, more credentialing, more liability and of course more work. But if it were being forced on us, we would have liked to see the compensation that should go along with it at the very least. That almost never happened.


Look, nobody I ever worked with as a PA wanted to be the man in charge with their PA credential. We knew what we could safely do by virtue of our training and what we couldn't. That last thing anyone ever wanted was to hurt a patient because we got in over our head on something. PAs for the most part understand this and do what is safe.


The stuff I hear on this website about PAs thinking they're hot shyt is fantasy. PAs like myself who were interested in doing more and learning more, usually go on to med school.

I am talking about NPs, CRNAs, etc. You just need to do a few google searches to know that quite a few of them and their leadership in general has been pushing for independence and has been successful in obtaining it in over half of the United States.

I understand. But you did say "mid-levels" so I assumed you also meant PAs.