Realistically, will midlevels affect our future?

[jl lin]

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.

And that is also true for most advanced practice nurses. Even those that go for DNP do NOT expect to be on the level of a physician, education + post graduate education and rigors. There are some yahoos. There are always some yahoos somewhere. My thing is, the biggest issue may be lessened use of physicians if a more universal healthcare system takes over....b/c costs WILL have to be controlled severely. Cost controls that are severe will be the only way they can try to make it work in this huge country, and even then, it will be impossible. Quality across the board will go out the window. But let everyone believe whatever they want to believe. You can only do so much with the numbers when you are shooting for a socialized medicine model.

If that doesn't become the case, then again, you will have most midlevels satisfied to put in their hours and go home, with no major dreams and aspirations of usurping medicine. It will all ultimately come down to politics and economics. But most AP Nurses I know could care less about trying to play "God." What does an AP provider have to gain in doing so, except more aggravation and headaches? People who have worked a while in Healthcare, who have some really strong experience see it for what it is. It may be a calling to some, and I think that's awesome, but it's a hell of a calling, which requires endless amounts for more and more tolerance for a lot of non-medical nonsense every day. In fact if I were on an ADCOM, honestly, I would like to hear, though not PC, how it is that someone would pursue the course of medicine, realizing how much of a ginormous pain in the a$$ it is. If they had some substantial clinical, I could totally take them as genuine and think, OK. This person may well deserve a seat in our program. He knows the aggravation and hardships and he his committed to it anyway. Its a serious, life-time commitment, and one that is getting tougher to function in every day. Ask any longstanding, practicing physician. You don't think NPs and other midlevels see that reality? If they have experience and sense, they know. They know.

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