RIP California PCPs

[Espressso]

Please refrain from ad hominem attacks about my life or my profession. I will report this post to the moderator.

I get that you are debating going NP or doctor given your dissatisfaction with OT. - AD HOMINEM ATTACK
But I'm out here actually reading charts and getting presentations by nps and pas every week. -- ANECDOTAL
The training isn't good enough for them to be independent. - ANY DATA?
The quality difference is noticeable. They aren't ready. If you really want to be a decision maker, go to med school. - DATA?

You're kidding right?

NPs education is bare bones. 4 years of undergrad followed by 1-3 years of a masters or doctoral of nursing and bam. Is that even close to being comparable to 4 years of undergrad, 4 years of medical school, 3 years of residency? setting aside those who specialize and go into fellowship. This is simply years of training, this doesn't even get into the clinical hours. That is the data.

How can you not think this doesn't translate into a quality difference that is noticeable? They are not ready. They don't have the training.

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[CoastalOT]

Yes. This needs to be re-assessed. That's a giant crux of this entire debate. The entire NP scope of practice needs to be addressed. Which is what these students and physicians are trying to explain. And to be quite honest, these physicians commenting on this thread have made it clear that they work with NPs who help and do great things with their teams. But the issue is of NP independence. I'm confused how you don't seem to understand the motive of administrative cost savings as a rationale to push more NPs into independent practice. Obviously it's a cheaper solution. The physicians are saying, hey wait a minute. They aren't adequately trained to be independent. This is really not a confusing issue. You seem to be making it one.

If you look at the history of NP as a profession. It was designed to be a mid-level provider for nurses who have had 20-30 years of nursing experience, to be able to help the lead physician with the less complex cases. What we're seeing now is not that. Online NP schools pumping out NPs with less than 5 years of nursing experience, then going on to become independent practitioners. This is the problem because it puts patients at risk. How you can argue otherwise is beyond me.

This isn't even taking into account the nursing union that is funding many of these state legislators and pushing for these independent NP laws. Which is a whole separate topic entirely.

Many topics are now becoming conflated. I do think you made many important points; to which I agreed that we should look at the structure of their programs. Why are there even any online degree programs being offered in the first place? If NPs are going to have the independence in practice they desire then they need more rigorous clinical rotations. I'd venture to say that none of us are experts in the structure or content of their programs, but a review of these should be conducted, and this should be part of the discussion.

I am curious to know if data supports your assertions, not just conjecture or anecdotal statements. For instance, how does this vary in primary care compared to psychiatric nps etc etc.

 

[Espressso]

Many topics are now becoming conflated. I do think you made many important points; to which I agreed that we should look at the structure of their programs. Why are there even any online degree programs being offered in the first place? If NPs are going to have the independence in practice they desire then they need more rigorous clinical rotations. I'd venture to say that none of us are experts in the structure or content of their programs, but a review of these should be conducted, and this should be part of the discussion.

Welcome, welcome, stay a while, my friend!

Yes. Obviously, this is an issue. The original post was condemning a state law that expands the scope of practice of NPs that do not have the "rigorous clinical rotations" that they require. Right? I hope you see now what these medical students and physicians are having issue with.

 

[deleted480308]

Please refrain from ad hominem attacks about my life or my profession. I will report this post to the moderator.

I get that you are debating going NP or doctor given your dissatisfaction with OT. - AD HOMINEM ATTACK
But I'm out here actually reading charts and getting presentations by nps and pas every week. -- ANECDOTAL
The training isn't good enough for them to be independent. - ANY DATA?
The quality difference is noticeable. They aren't ready. If you really want to be a decision maker, go to med school. - DATA?

the report button is on the bottom left of every post, feel free. It's not an attack to accurately point out your postings here, you've mentioned that others are medical students multiple times and it's accurate to say that our place in life can impact our perspective. You personally wrote that you didn't think you were a decision maker 4 months ago as an OT and have a whole thread about which profession makes sense for you if you want to be a decision maker. No harm in that. It's a totally legit and valid question to ask. It does however maybe impact your opinion, which again is fair.

And yep, my observations are my own and anecdotal. I've also read all the studies every NP promoter on this site has posted and they are not decent studies. So it is a fair critique that my observations are anecdotal, they are. It's also a fair critique that midlevel training is significantly shorter and less demanding than what we expect physicians to go through to practice independently. So one side is wrong about the necessary training for competent independence. I'm saying that I'm near the end of the harder more thorough path, I've read the notes of those who have completed the midlevel path, of starting physician interns, and attending physicians. It's pretty clear to me (admittedly anecdotally) who is fully trained and who isn't.

 

[Splenda88]

If your assertion were correct and this is a "100% hierarchy" with doctors on top if NP and PA roles are expanding as they are. Nurse practitioners and PAs are independently managing patient care in some states, and in the VA NPs are doing so. It appears that NPs and PAs see view their profession more as co-managers of patient care, and are permitted more and more independence as practitioners. This is the real world, welcome to it.

You are a healthcare provider, and a physician. Please do not let your ego get in the way of a rational discussion, your response seems motivated by emotion and not logic. I suspect that your bristly response is why some nurses who incorrectly form judgments on an entire profession could have the impression that physicians are arrogant? This kind of discourse is counterproductive. I am curious though, and I will be discussing these issues with my NP friends next time I see them.

It's easier to say that we are physicians. Not sure why you have to use the other qualifier.

 

[CoastalOT]

Welcome, welcome, stay a while, my friend!

Yes. Obviously, this is an issue. The original post was condemning a state law that expands the scope of practice of NPs that do not have the "rigorous clinical rotations" that they require. Right? I hope you see now what these medical students and physicians are having issue with.

I am tentatively supportive of their role in primary care settings, and increased independence seems logical in the face of the shortages we have. This is also the case in psychiatry. It seems pointless to lobby against their expanding or independent practice in these fields in the face of rising healthcare costs and the desire of insurers to contain these costs. I would say the best approach is to establish a consultative relationship with the nursing associations to strengthen their program clinical rotation requirements, and definitely ELIMINATE all online programs. If I had to go to school in person for OT school, they definitely should have to attend school as NPs.

 

[CoastalOT]

the report button is on the bottom left of every post, feel free. It's not an attack to accurately point out your postings here, you've mentioned that others are medical students multiple times and it's accurate to say that our place in life can impact our perspective. You personally wrote that you didn't think you were a decision maker 4 months ago as an OT and have a whole thread about which profession makes sense for you if you want to be a decision maker. No harm in that. It's a totally legit and valid question to ask. It does however maybe impact your opinion, which again is fair.

And yep, my observations are my own and anecdotal. I've also read all the studies every NP promoter on this site has posted and they are not decent studies. So it is a fair critique that my observations are anecdotal, they are. It's also a fair critique that midlevel training is significantly shorter and less demanding than what we expect physicians to go through to practice independently. So one side is wrong about the necessary training for competent independence. I'm saying that I'm near the end of the harder more thorough path, I've read the notes of those who have completed the midlevel path, of starting physician interns, and attending physicians. It's pretty clear to me (admittedly anecdotally) who is fully trained and who isn't.

This is correct. I am a pediatric occupational therapist and I considered other professions due to a desire to impact patients directly, by affecting health outcomes. I'd appreciate it if you please not make assumptions about my profession, motivation or satisfaction with it due to this desire; or that you sink to using my statement as an argument tactic in an unrelated thread, it's unbecoming. I am not interested in back and forth or ad hominem attacks. It's demeaning to your profession and to mine. I am leaving it at that. People who work in patient care are expected to display decorum it should stay that way.

 

[CoastalOT]

It's easier to say that we are physicians. Not sure why you have to use the other qualifier.

Sigh. Human ego is a curious animal. Thank you for an interesting discussion.

 

[deleted480308]

This is correct. I am a pediatric occupational therapist and I would like to impact patients directly, by impacting their health outcomes. I'd appreciate it if you please not make assumptions about my profession, motivation or satisfaction with it due to this, or that you sink to using it as an argument tactic in an unrelated thread, it's unbecoming. I am not interested in back and forth or ad hominem attacks. It's demeaning to your profession and to mine. I am leaving it at that.

You're a school OT lecturing doctors about how our daily interactions with hospital and clinic staff work. It's like me trying to tell pilots that I know how they talk in the cockpit. I just plain don't know enough about their universe to comment despite being very good at my personal realm of work. But to be clear, you aren't wrong because of your position. You could be a 20yr attending and I'd tell you that you are wrong because I disagree with the statements and claims you are making. I point out your place as a possible explanation for how you came up with such a wrong opinion as an opportunity for you to step back and re-evaluate some of the assumptions you are making. You aren't a bad guy/girl because you have perspectives impacted by your position. I just think you're wrong about independent practice permission, even if well meaning.

 

[CoastalOT]

You're a school OT lecturing doctors about how our daily interactions with hospital and clinic staff work. It's like me trying to tell pilots that I know how they talk in the cockpit. I just plain don't know enough about their universe to comment despite being very good at my personal realm of work. But to be clear, you aren't wrong because of your position. You could be a 20yr attending and I'd tell you that you are wrong because I disagree with the statements and claims you are making. I point out your place as a possible explanation for how you came up with such a wrong opinion as an opportunity for you to step back and re-evaluate some of the assumptions you are making. You aren't a bad guy/girl because you have perspectives impacted by your position. I just think you're wrong about independent practice permission, even if well meaning.

More conjecture and ad hominem attacks. You don't know who I am or what I do. I stated that I am a pediatric OT. I work in school and hospitals, and have a long work history in many settings. I am not a student. Is it the weakness of your arguments that continually makes you resort to these low level tactics? I am not interested in discussing anything further with you; you should discuss issues with the intent to learn, and with an open mind.

 

[Pepe18]

I am tentatively supportive of their role in primary care settings, and increased independence seems logical in the face of the shortages we have. This is also the case in psychiatry. It seems pointless to lobby against their expanding or independent practice in these fields in the face of rising healthcare costs and the desire of insurers to contain these costs. I would say the best approach is to establish a consultative relationship with the nursing associations to strengthen their program clinical rotation requirements, and definitely ELIMINATE all online programs. If I had to go to school in person for OT school, they definitely should have to attend school as NPs.

it is not pointless to lobby against independent practice in the face of insurers wanting to save money! Our job isn’t to protect the interest of insurers. It is to help patients.

There is also no evidence that NPs will save money. In fact, NPs are fighting to bill insurance equally to MDs. They aren’t trying to save money for US healthcare OR the patients. Over treatment, over imaging, over consulting also increases costs. There also isn’t evidence that NPs are electing to remain in primary care and work in areas with physician shortages. Those are manipulative arguments used to chip away at laws that promote collaboration in healthcare in favor of NP independent practice

you keep bringing up the fact that some people here are students in order to undercut their views. When someone says that you are an OT, so you don’t understand the physician-NP view, you claim that is ad hominem. It makes no sense. You presumed people’s backgrounds and experience and used it to discredit their posts. You cannot then get upset if someone points out what you’ve written in past threads

 

[VA Hopeful Dr]

More conjecture and ad hominem attacks. You don't know who I am or what I do. I stated that I am a pediatric OT. I work in school and hospitals, and have a long work history in many settings. I am not a student. Is it the weakness of your arguments that continually makes you resort to these low level tactics? I have no interest in discussing this further with you; I think you are doing your field a disservice with your behavior.

I don't think you actually know what an ad hominem is because nothing he has said is anywhere close to being one.

 

[deleted480308]

More conjecture and ad hominem attacks. You don't know who I am or what I do. I stated that I am a pediatric OT. I work in school and hospitals, and have a long work history in many settings. I am not a student. Is it the weakness of your arguments that continually makes you resort to these low level tactics? I am not interested in discussing anything further with you; you should discuss issues with the intent to learn, and with an open mind.

your words

I am an occupational therapist. I work in pediatrics in a school setting, I like working with kids. I'm growing weary of my job, and I want a change: I have a desire to diagnose and treat patients to positively impact patient wellness. I don't have a family or a partner, and student debt isn't a concern for me.

I have considered going to a direct entry NP program. I am a bright guy with very good grades, and a high aptitude for learning. Should I be happy with my degree, or should I try to be a NP (perhaps an outpatient psychiatric NP), or, even try to get into a DO program?

I don't want to be on my death bed thinking to myself, why didn't I do something I wanted to or could have done and should have done. On the other hand, maybe OT is a great profession. I am positively impacting students lives; I desire to be a diagnostician in a higher level clinical setting. I sometimes think I didn't challenge myself enough. I make a very good salary (no debt, in a union and excellent health care benefits) for my position, I only work 180 days a year, and I have excellent benefits. Should I be happy with my job and just stay put or should I follow a dream and be a NP or doctor to contribute in a different way to fighting disease and contributing to wellness? I sometimes feel like I am confused with a teacher now.

Thank you in advance for your advice. I appreciate it a lot.

 

[CoastalOT]

it is not pointless to lobby against independent practice in the face of insurers wanting to save money! Our job isn’t to protect the interest of insurers. It is to help patients.

There is also no evidence that NPs will save money. In fact, NPs are fighting to bill insurance equally to MDs. They aren’t trying to save money for US healthcare OR the patients. Over treatment, over imaging, over consulting also increases costs. There also isn’t evidence that NPs are electing to remain in primary care and work in areas with physician shortages. Those are manipulative arguments used to chip away at laws that promote collaboration in healthcare in favor of NP independent practice

- Do you have any data to support any of your assertions that using NPs lead to more costs, or no cost savings? Anything?
- If patients are suffering due to lack of access to providers (sorry, physicians) in primary care, and psychiatry, it kind of is your job to advocate for solutions to increase their access to clinicians. This is kind of why people want NPs working as PCPs and Psychiatric Medication Management, right?
- Is there any evidence that supports your claim that NPs are not staying in primary care? I'm not sure I believe all these anecdotal thoughts.

For the record, I have no desire to be an NP, I'm happy being an OT. I've considered becoming an NP, or a PA, or even taking the arduous path and attempting to get into medical school. That does not mean that I hate my profession; focus on the discussion, I truly have no dog in this hunt beyond learning what physicians think. I largely have learned that. I agree with some of your points, especially as they relate to clinical rotations, others I am not so convinced of.

 

[Splenda88]

I see. He is the OT guy who work in a school and not sure about the path to take since he is unhappy with his career. We know now where you are heading.

 

[TAVR4life]

You're not wrong. A benefit of the specialized training in a high demand field is job security for instance. However, I do not think that precludes total protection from anyone trying to cut in on one's business. Independent NPs should not be able to compete with an already successful MD practice. If the NPs are moving into areas where there is provider scarcity then I cannot really complain? Either docs have chosen not to work in that area, or there are no docs available to work in that area.

The powers that be are under pressure to try to fulfill a need. I am all for having MDs fulfill that role, but if they are not moving to those areas, if they are not going into primary care, if programs/govt are not incentivizing trainees to do the aforementioned, then having NPs practice independently to provide some degree of care seems like a logical conclusion. I don't like it, but it makes sense.

Most of that was not directed specifically to you, just some of my other thoughts.

There are other significant implications beyond this. Most doctors are now hospital employed. Hospital administrators want NPs to be able to bill at same level as a MD for a fraction of the pay. This is where this mid level encroachment is headed. At some point there will be a tipping point and it will ultimately hurt the job market and salary for physicians.

 

[CoastalOT]

your words

Please see my comments about the years I have practiced, the clinical settings I have worked in. Are you able to read? If so, you can understand that just because I worked in area of practice, does not mean I can't have two jobs at the same time? I do not have a job in my summers, I work in a hospital. I also have not always worked in schools.

Just stop. You're rummaging through my motivations to be an occupational therapist in order to make implications that are making you seem as if you are struggling to remain focused on ideas being discussed. Feel free to attempt to throw more mud at me and make assumptions wildly and fill in the gaps based on comments I've made. You should be in politics, it's a great fit.

 

[deleted480308]

- Do you have any data to support any of your assertions that using NPs lead to more costs, or no cost savings? Anything?
- If patients are suffering due to lack of access to providers (sorry, physicians) in primary care, and psychiatry, it kind of is your job to advocate for solutions to increase their access to clinicians. This is kind of why people want NPs working as PCPs and Psychiatric Medication Management, right?
- Is there any evidence that supports your claim that NPs are not staying in primary care? I'm not sure I believe all these anecdotal thoughts.

For the record, I have no desire to be an NP, I'm happy being an OT. I've considered becoming an NP, or a PA, or even taking the arduous path and attempting to get into medical school. That does not mean that I hate my profession; focus on the discussion, I truly have no dog in this hunt beyond learning what physicians think. I largely have learned that. I agree with some of your points, especially as they relate to clinical rotations, others I am not so convinced of.

They already passed in Oregon that it’s illegal for insurance to reimburse less if a treatment code is billed by an NP. They are not interested in working for less, once independent the sales pitch changes to “we do the same thing, pay us the same”

 

[deleted480308]

Please see my comments about the years I have practiced, the clinical settings I have worked in. Are you able to read? If so, you can understand that just because I worked in area of practice, does not mean I can't have two jobs at the same time? I do not have a job in my summers, I work in a hospital. I also have not always worked in schools.

Just stop. You're rummaging through my motivations to be an occupational therapist in order to make implications that are making you seem as if you are struggling to remain focused on ideas being discussed. Feel free to attempt to throw more mud at me and make assumptions wildly and fill in the gaps based on comments I've made. You should be in politics, it's a great fit.

Your career isn’t an insult

 

[CoastalOT]

I see. He is the OT guy who work in a school and not sure about the path to take since he is unhappy with his career. We know now where you are heading.

Human ego is a curious animal. I do work in a school. Did you go to school, your grammar could use some work.
You:
1- Are using conjecture
2- Are engaging in ad hominem attacks
3- "Who work in a school" is not correct use of the English language. Works. If you are going to insult me please take time to check your grammar.

 

[CoastalOT]

Your career isn’t an insult

I never said it was. I am happy to be an OT, please see my comments about my decision to be an OT. I have also questioned this decision, and I am public about that! Otherwise I wouldn't be here discussing these topics! This all strikes of weakness of an argument.

 

[deleted480308]

I never said it was. I am happy to be an OT, please see my comments about my decision to be an OT. I have also questioned this decision, and I am public about that! Otherwise I wouldn't be here discussing these topics! This all strikes of weakness of an argument.

You said I was throwing mud at you, again your words. I have not insulted you

 

[CoastalOT]

Thank you for your childish antics.

I will not engage with you further. All of my words I stated are 100% accurate, and if they were relevant in any way to this discussion it would have made sense for you to post them. Go ahead and talk to me about my motivation to be an OT, my questions about my job satisfaction *which professionals often do* and my consideration of going down other roads? Does this have ANY bearing on this discussion at all?

This is unbelievable that you are going to be a physician and you're behaving like you're 6 years old. Unreal.

 

[Splenda88]

Human ego is a curious animal. I do work in a school. Did you go to school, your grammar could use some work.
You:
1- Are using conjecture
2- Are engaging in ad hominem attacks
3- "Who work in a school" is not correct use of the English language. Works. If you are going to insult me please take time to check your grammar.

I must admit that English is not my strong suit since I started speaking/writing it in my 20s... I guess I know my limitations.

 

[deleted480308]

Thank you for your childish antics.

I will not engage with you further. All of my words I stated are 100% accurate, and if they were relevant in any way to this discussion it would have made sense for you to post them. Go ahead and talk to me about my motivation to be an OT, my questions about my job satisfaction *which professionals often do* and my consideration of going down other roads? Does this have ANY bearing on this discussion at all?

This is unbelievable that you are going to be a physician and you're behaving like you're 6 years old. Unreal.

I am a doctor, not going to be

 

[Splenda88]

Thank you for your childish antics.

I will not engage with you further. All of my words I stated are 100% accurate, and if they were relevant in any way to this discussion it would have made sense for you to post them. Go ahead and talk to me about my motivation to be an OT, my questions about my job satisfaction *which professionals often do* and my consideration of going down other roads? Does this have ANY bearing on this discussion at all?

This is unbelievable that you are going to be a physician and you're behaving like you're 6 years old. Unreal.

You clearly are not happy with your career. There is nothing wrong with that.

 

[CoastalOT]

I must admit that English is not my strong suit since I started speaking/writing it in my 20s... I guess I know my limitations.

Sharpen up, especially if you will be using the English language to patronize, and insult others. This is a new America in which values have been placed to the side, all objectionable hateful speech is fair game, and rhetoric need not be supported by facts. Anything goes, so welcome to our country, and Godspeed if you have an accent. End of my political commentary.

 

[CoastalOT]

I am a doctor, not going to be

I will refrain from attacking ad hominem. You are a physician who used incorrect grammar while personally attacking someone. I'm just throwing that out there, facts, use it as you wish.

 

[Splenda88]

Sharpen up, especially if you will be using the English language patronize, and insult others. This is a new America in which values have been placed to the side, and all objections hateful speech, and rhetoric need not be supported by facts. Anything goes, so welcome to our country, and Godspeed if you have an accent. End of my political commentary.

I do have a French accent and a Spanish one depending on the situation. I am perfectly comfortable with my accents.

 

[67552931811]

Sigh. Human ego is a curious animal. Thank you for an interesting discussion.

It’s not ego, it’s reality. The term has been instituted in order to purposely blur the lines between those who know less (midlevels) and the standard (physicians). To purposely make it appear like we are all interchangeable “providers” but those if us see the palpable diff daily in our work.

You conflate ego with proper use of terms because you’re jealous and instead of becoming a doctor you curve your jealousy by way of asinine alternate routes (like your desire to go straight from an ot to a np lol) not because you care about patients but because you lust after being a charlatan and $$$ and this is the easiest path of resistance.

 

[CoastalOT]

I do have a French accent and a Spanish one depending on the situation. I am perfectly comfortable with my accents.

I hope your patients are. We have a problem with racism in our country these days being openly expressed. We have a problem with everything being openly expressed; see this thread. We have no boundaries as a society. We should be ashamed of the cultural wasteland we are creating imo.

 

[CoastalOT]

It’s not ego, it’s reality. The term has been instituted in order to purposely blur the lines between those who know less (midlevels) than the standard (physicians). You conflate ego with proper use of terms because you’re jealous and instead of become a doctor you curve your jealous by asinine alternate routes (like your desire to go straight from an ot to a np lol) not because you care about patients but because you list after being a charlatan and $$$ and this is the easiest path of resistance.

Reported. No words need be used. You should really be ashamed of yourselves. Wow. Unbelievable due to how untrue this is. Wow. It also shows what your motivation is in becoming a physician: MONEY. I don't want to make more money, I am actually from a relatively wealthy family. Do you want more ammo about my personal life? I don't have any debts, please see my post about becoming an OT and how I don't have debt. Why on earth and how on earth could someone in middle age afford to do a career change as I can?

Would you like to all know more about me, my address where I live my phone number? What other fake dirt do you want? This is repulsive.

 

[Splenda88]

I hope your patients are. We have a problem with racism in our country these days being openly expressed. We have a problem with everything being openly expressed; see this thread. We have no boundaries as a society. We should be ashamed of the cultural wasteland we are creating imo.

My job is to take care of patients to the best of my ability and not worry about what they think of me. They are free to fire me if they don't want a physician who has an accent or two, and I am fine with that. I will just move on to the next patient.

 

[CoastalOT]

It’s not ego, it’s reality. The term has been instituted in order to purposely blur the lines between those who know less (midlevels) and the standard (physicians). To purposely make it appear like we are all interchangeable “providers” but those if us see the palpable diff daily in our work.

You conflate ego with proper use of terms because you’re jealous and instead of becoming a doctor you curve your jealousy by way of asinine alternate routes (like your desire to go straight from an ot to a np lol) not because you care about patients but because you lust after being a charlatan and $$$ and this is the easiest path of resistance.

You have been reported for abuse for that comment to this forum moderator.

 

[CoastalOT]

My job is to take care of patients to the best of my ability and not worry about what they think of me. They are free to fire me if they don't want a physician who has an accent or two, and I am fine with that. I will just move on to the next patient.

The moral of the story is: DO NOT INSULT OTHERS. Treat others as you wish to be treated. No matter what your accent is that should be easy to understand.

 

[deleted480308]

I will refrain from attacking ad hominem. You are a physician who used incorrect grammar while personally attacking someone. I'm just throwing that out there, facts, use it as you wish.

As someone who respects expertise in a given field, I have all my professional writing edited by an English major. Life is easier if one knows their lane.

That wasn’t insulting to me

 

[67552931811]

Reported. No words need be used. You should really be ashamed of yourselves. Wow. Unbelievable due to how untrue this is. Wow. It also shows what your motivation is in becoming a physician: MONEY. I don't want to make more money, I am actually from a relatively wealthy family. Do you want more ammo about my personal life? I don't have any debts, please see my post about becoming an OT and how I don't have debt. Why on earth and how on earth could someone in middle age afford to do a career change as I can?

Would you like to all know more about me, my address where I live my phone number? What other fake dirt do you want? This is repulsive.

Reported for speaking the truth and calling you out? Lol ok. That’s some millennial snowflake stuff if I’ve ever seen it.
My motivation is making sure ALL patients be seen by a physician in ALL situations. Not a charlatan who doesn’t have a clue what they are talking about. Because I care about human lives not the bottom line, unlike the np profession and apparently yourself

 

[Splenda88]

The moral of the story is: DO NOT INSULT OTHERS. Treat others as you wish to be treated. No matter what your accent is that should be easy to understand.

Who did I insult here? You can not be serious!

 

[hamstergang]

I do have a French accent and a Spanish one depending on the situation. I am perfectly comfortable with my accents.

Now this is a more interesting topic than the garbage this thread has become. Why the 2 accents, if you don't mind?

 

[67552931811]

You have been reported for abuse for that comment to this forum moderator.

Ya you said that once. But thanks for the second comment. It’s like we can all feel your tachycardia. It’s clear from all who are reading this thread your response when I pulled down the veil (my last comment) and your emotional vomit response (the “reporting”).

Anywhoo, im done wasting my time with this cesspool of a thread

 

[CoastalOT]

Reported for speaking the truth and calling you out? Lol ok. That’s some millennial snowflake stuff if I’ve ever seen it.
My motivation is making sure ALL patients be seen by a physician in ALL situations. Not a charlatan who doesn’t have a clue what they are talking about. Because I care about human lives not the bottom line, unlike the np profession and apparently yourself

Reported for multiple ad hominem insults. So many that they're hard to tabulate. I am not a charlatan, you're casting aspersions: I am open about considering other fields, that's why I am in your forum in the first place! Secondly, this has no bearing on the facts of this discussion, rather it shows some kind of insecurity, and inability to argue based on facts. Lastly do not start a sentence with "because", that is incorrect use of the English language.

 

[RangerBob]

I do have a French accent and a Spanish one depending on the situation. I am perfectly comfortable with my accents.

 

[Splenda88]

Now this is a more interesting topic than the garbage this thread has become. Why the 2 accents, if you don't mind?

I use my French accent when I speak with young hot women. They like it.

 

[Pepe18]

Human ego is a curious animal. I do work in a school. Did you go to school, your grammar could use some work.
You:
1- Are using conjecture
2- Are engaging in ad hominem attacks
3- "Who work in a school" is not correct use of the English language. Works. If you are going to insult me please take time to check your grammar.

This is straight up an ad hominem argument.

I can’t. This is ridiculous

 

[deleted480308]

View attachment 297445

Quality meme timing, respect

 

[CoastalOT]

This is straight up an ad hominem argument.

I can’t. This is ridiculous

Yes I am sorry if when all the mud is slung that when someone insults me that I respond by correcting their grammar.

 

[hamstergang]

Lastly do not start a sentence with "because", that is incorrect use of the English language.

Because I care about the proper use of English, I am going to have to disagree with you here. You can start a proper sentence with "because" even if the other poster did it technically incorrectly.

 

[CoastalOT]

As someone who respects expertise in a given field, I have all my professional writing edited by an English major. Life is easier if one knows their lane.

That wasn’t insulting to me

You should not have confidence to insult others in a language if you cannot use it in a grammatically correct manner. If you graduated from school in an English speaking country and you require all your writing to be professionally edited your schools have failed you. I owe special thanks to the Sisters of the Humility of Mary for my penmanship (a lost art), for my general adherence to correct grammatical usage when writing, and more broadly for instilling within me the value of compassion.

 

[CoastalOT]

Because I care about the proper use of English, I am going to have to disagree with you here. You can start a proper sentence with "because" even if the other poster did it technically incorrectly.

As a general rule, do not start a sentence with a preposition. We had to memorize all of ours, I still know them by heart. The reason you can't usually start a sentence with “because” is because the sentence needs two parts for because to join together. Usually “because” goes in between the two clauses, so if we start a sentence with “because” there is often only one clause in the sentence.

For the record, the other poster did not use "because" correctly.

 

[hamstergang]

As a general rule, do not start a sentence with a preposition. We had to memorize all of ours, I still know them by heart. The reason you can't usually start a sentence with “because” is because the sentence needs two parts for because to join together. Usually “because” goes in between the two clauses, so if we start a sentence with “because” there is often only one clause in the sentence.

For the record, the other poster did not use "because" correctly.

My sentence started with because and is grammatically correct. Therefore, you are wrong to assert that doing so is incorrect. I don't know why you're trying to teach me grammar here instead of just admitting that what you wrote was not correct.