The Rise Of Nurse Practitioners Working Alongside Doctors

[InvestingDoc]

Here in Texas, it seems like almost every nurse I know is taking an online course to be a nurse practitioner. This got me wondering about the numbers of NP's here in Texas.

Looks like numbers have tripled since 2008.

The newest craze in my city seems to be hospitalist who are renting their licenses to these NP's to open up their own family medicine practice and aesthetic practices. There are 4 of them that have opened in the past 2 years in a 10 mile radius of where I live. The doctors appear to almost never be on site since some of these doctors are listed as being in a completely different city who are overseeing the practice. One of them is listed about 400 miles away as having a hosptialist job in another city.

Interestingly, most of the google and yelp reviews are almost all calling their NP---- Dr. John Doe....

I know that competition from midlevels have been a hot topic but it seems that even some our doctor colleagues are willing to sell their license out to midlevels who start up their own practices. Midlevels have a place in medicine but I can't help but get nervous when a brand new graduate from an online NP program opens their own practice, offers botox, weight loss, laser therapies, ADD evaluation and treatment, and typical outpatient primary care treatments.

I have to say that each year I get more and more frustrated by the AMA as our profession is heading towards devaluing our education and profession to this level. All of the midlevels that I've worked with in the past have only had to had 60 hours of in person training per specialty in order go get signed off. That means that thew new online only graduates have only spent 60 hours possibly in primary care before being able to open their own practice after graduation.

Frightening.

I have worked with some brilliant midlevels and in no way mean to bash the whole profession. There can be a well working relationship between physician and midlevel, but I fear we are starting to deviate from what I think that relationship should be. Unsupervised practices with doctors in another city is far from what I imagined.

All data came from Texas Board of Nursing - Nursing Statistics

If you look at the data, the vast majority of midlevels are not going to rural areas but to the main 4 cities in Texas in urban areas.

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[Trogghunter]

Only time will tell, but as far as the midlevels I work with regularly as inpatient (GI, cards, GS, nsgy, Neuro, uro, ER, hospitalist, oncology, ICU, CT surg), I would not trust them more than an intern on the job for 3 months, and this includes the ones that have been working for 20+ years. It's astounding how wrong they usually are when the attending attestation comes in, and even the ones who just do procedures, it's astounding how bad they are despite that it's all they do.

 

[bronx43]

I can confirm that this is also true in my area. The "supervising" physician is a "phone call away" as I was told. Basically, these NPs are practicing on their own, and I would estimate that 1/3rd of patients have no idea that they aren't actual doctors.

In regards to this, the AMA will not take our backs. They are terrified of the nurses's lobby, and we as physicians are too fragmented and weak to combat this.

The only thing that I can see stopping this trend is that they are going to start crowding themselves out. They can pick at the periphery of medicine, but I'm noticing that as more of the cost of care is shifted onto patients, the ones that are able to pay refuse substandard care. If you're paying $30-50 copay every visit, I wouldn't be very happy seeing a NP. This effect is magnified when it comes to sub-specialists. Some of my patients have copays of $80-90.

 

[chessknt]

The AMA is not a physician advocacy organization, they are a tax-exempt pseudo-governmental entity that owns the copyright to CPT codes and their primary purpose is to protect that and only that.

 

[wjs010]

I can confirm that this is also true in my area. The "supervising" physician is a "phone call away" as I was told. Basically, these NPs are practicing on their own, and I would estimate that 1/3rd of patients have no idea that they aren't actual doctors.

In regards to this, the AMA will not take our backs. They are terrified of the nurses's lobby, and we as physicians are too fragmented and weak to combat this.

The only thing that I can see stopping this trend is that they are going to start crowding themselves out. They can pick at the periphery of medicine, but I'm noticing that as more of the cost of care is shifted onto patients, the ones that are able to pay refuse substandard care. If you're paying $30-50 copay every visit, I wouldn't be very happy seeing a NP. This effect is magnified when it comes to sub-specialists. Some of my patients have copays of $80-90.

Why are they afraid of the nursing lobby? Is it simply money, because if so, where is all the money in the doctor’s lobby? Genuinely curious because I am ignorant in this topic (though not ignorant or blind to the mid level issue).

To OP, I’m also curious to know if you saw a similar setup regarding PAs?

 

[fasteddie911]

Doctors selling out for an easy buck (I'm assuming they get a cut by "renting" their licenses) and confusion by patient on who they are seeing. I think most patients if given the choice will choose the MD. I know plenty of patients who've changed doctors due to NP involvement. However, I'm more disappointed by these doctors who are selling out. Greed. It's all about making the quick buck, doing the least amount of work for the most money. I've seen some doctors for whom doing the right thing, quality patient care, etc. is a low priority over money.

 

[Splenda88]

You have not seen anything yet... Wait when ACGME start advocating for residency to be longer even if NPs are practicing independently with 500 hrs preceptorship in some states... Primary care residency will be 4 years instead of 3.

 

[DoubleBogey]

You have not seen anything yet... Wait when ACGME start advocating for residency to be longer even if NPs are practicing independently with 500 hrs preceptorship in some states... Primary care residency will be 4 years instead of 3.

Really? If anything, I see medical schools and residences trying to stream line the process

 

[bronx43]

Really? If anything, I see medical schools and residences trying to stream line the process

By streamline you mean what exactly?

 

[chessknt]

By streamline you mean what exactly?

Shorten the amount of time you aren't writing notes for academic attendings?

 

[DoubleBogey]

By streamline you mean what exactly?

A better word would be “accelerated” with combining college senior year with medical school year 1 then medical school years 3/4 into residency, specifically for tract oriented individuals.

 

[bronx43]

A better word would be “accelerated” with combining college senior year with medical school year 1 then medical school years 3/4 into residency, specifically for tract oriented individuals.

Lol good luck with that.

 

[DoubleBogey]

Lol good luck with that.

It’s already happening

 

[rokshana]

It’s already happening

Where? The BS/MD programs out there have been around for decades so yeah that decreases by 1-2 years, but where is there a combination of clinical year and residency...not an ACGME program or one on the match.

 

[DoubleBogey]

Where? The BS/MD programs out there have been around for decades so yeah that decreases by 1-2 years, but where is there a combination of clinical year and residency...not an ACGME program or one on the match.

MD Program Family Medicine 3+3 Accelerated Program - Penn State College of Medicine

med.psu.edu

Shaves a year off medical school- residency itself will remain 3 years

 

[bronx43]

MD Program Family Medicine 3+3 Accelerated Program - Penn State College of Medicine

med.psu.edu

Shaves a year off medical school- residency itself will remain 3 years

For every one of these, there are about 100 residents or fellows being tricked into “advanced fellowships” that tacks on additional years of training.

 

[rokshana]

MD Program Family Medicine 3+3 Accelerated Program - Penn State College of Medicine

med.psu.edu

Shaves a year off medical school- residency itself will remain 3 years

The conditional acceptance into the FM is a different thing, but the “shortening “ is a little iffy...there are no breaks between probably comes close to the number of weeks spent in a traditional school...though does let one enter the match a year earlier per say...though you basically suicide match to penn state.

 

[DrMetal]

Here in Texas, it seems like almost every nurse I know is taking an online course to be a nurse practitioner. This got me wondering about the numbers of NP's here in Texas.

Looks like numbers have tripled since 2008.

It's basic economics. When a commodity is scarce and in dire need, society will find a way to circumvent the road blocks in order to obtain said commodity.

If that commodity is food, the scarcity of it is called a famine, and a society will go to war to obtain it.

In our profession, the commodity is medical care delivered by a physician, which is scarce nowadays because of the limited number of medical school graduates and residency spots to train them (the # of residency spots being the major bottleneck). So society has found a way to circumvent the problem...to obtain medical care via the utilization of mid-levels.

Much of this is our own doing. We're expensive (we demand inflated salaries, we're costly to insure), and we have too many requirements (BC, MOC, CME, etc....most of which we've created and pushed upon ourselves). The anesthesiology community is a great example of this: 30 years ago, a hospital would have to pay an anesthesiologist $400K/year in salary + $120k/year in malpractice + probably another $10K in misc (MOC/CME). For that amount of money, you could hire 5 CRNAs, and that's exactly what they're doing now. Other specialties have followed suit. Mid-level radiologists are coming into play.

If we could make medical education/training a little shorter and more focused, make it a little cheaper (or find other ways to subsidize it, so people don't finish with six figure debts), if we could increase the number of residency spots to allow for more training opportunities (yes, hard to do, I know).....then we stand a chance at alleviating the physician shortage in this country. If not, then you can expect the utilization of mid-levels to increase exponentially. As least in primary care, there's plenty of work to go around.

 

[bronx43]

It's basic economics. When a commodity is scarce and in dire need, society will find a way to circumvent the road blocks in order to obtain said commodity.

If that commodity is food, the scarcity of it is called a famine, and a society will go to war to obtain it.

In our profession, the commodity is medical care delivered by a physician, which is scarce nowadays because of the limited number of medical school graduates and residency spots to train them (the # of residency spots being the major bottleneck). So society has found a way to circumvent the problem...to obtain medical care via the utilization of mid-levels.

Much of this is our own doing. We're expensive (we demand inflated salaries, we're costly to insure), and we have too many requirements (BC, MOC, CME, etc....most of which we've created and pushed upon ourselves). The anesthesiology community is a great example of this: 30 years ago, a hospital would have to pay an anesthesiologist $400K/year in salary + $120k/year in malpractice + probably another $10K in misc (MOC/CME). For that amount of money, you could hire 5 CRNAs, and that's exactly what they're doing now. Other specialties have followed suit. Mid-level radiologists are coming into play.

If we could make medical education/training a little shorter and more focused, make it a little cheaper (or find other ways to subsidize it, so people don't finish with six figure debts), if we could increase the number of residency spots to allow for more training opportunities (yes, hard to do, I know).....then we stand a chance at alleviating the physician shortage in this country. If not, then you can expect the utilization of mid-levels to increase exponentially. As least in primary care, there's plenty of work to go around.

Shortage? I guess only in flyover country. In any market that is considered first, second or even third tier, there is no significant shortage of physicians. You ever try getting a job in NY? Or Boston? Or how about Dallas or even Raleigh/Durham? Unless you're one of the few lucky specialties, it's not particularly easy to find a position in decent cities.

I'm in a "in demand" medical subspecialty and I established practice near a relatively large metro in the South, and I am finding that it's a much more competitive market than I anticipated. What is actually happening is that existing players are hiring midlevels to augment their own bottom line. For instance, if there is increased demand for a particular medical service, the hospital or multispecialty group will hire several midlevels in order to make money off them. Midlevels can bill the same as physicians if they are "supervised," but they make a fraction of a physician's salary. So the difference goes to either the partners of a private group or the hospital.

Now, if a new graduate wants to go into said market, there is no job. And given how hard it is to open up your own shop these days, few would do it to compete with the existing groups.
So the end result is that physicians are being crowded out by mid-levels, who are hired by the market incumbents.

 

[DrMetal]

Shortage? I guess only in flyover country. In any market that is considered first, second or even third tier, there is no significant shortage of physicians. You ever try getting a job in NY? Or Boston? Or how about Dallas or even Raleigh/Durham? Unless you're one of the few lucky specialties, it's not particularly easy to find a position in these cities.

Ok, fair point. I was thinking more nationally, as a whole. And what happens in flyover states is not insignificant. The CRNA model started that way, and eventually perpetuated nationwide.

I'm in a "in demand" medical subspecialty and I established practice near a relatively large metro in the South, and I am finding that it's a much more competitive market than I anticipated. What is actually happening is that existing players are hiring midlevels to augment their own bottom line. For instance, if there is increased demand for a particular medical service, the hospital or multispecialty group will hire several midlevels in order to make money off them.

Quite true. This is a problem as well. So we have to ask ourselves, why is this happening? It used to be that if you owned your own practice, you'd hire more physicians to work for you (maybe entice them with partnership, later on) to beef up your bottom line. But you'll now go for hiring mid-levels, if that's cheaper, and if its allowed. To your point, Consider this: If you have a GI practice, you'd like to hire more GIs to scope and rake in money for your practice. But now NPs are being trained to scope. If you could hire 4 NPs for scopes, for the price of one GI, which option would you prefer?

The real question in my mind is: why the hell are we allowing NPs to scope? why are we allowing them to do procedures in the ICU? The only logical answer to these questions is that there's either not enough doctors to handle the volume, and/or society is unwilling to pay the cost for so many doctors for said volume.

 

[bronx43]

The real question in my mind is: why the hell are we allowing NPs to scope? why are we allowing them to do procedures in the ICU? The only logical answer to these questions is that there's either not enough doctors to handle the volume, and/or society is unwilling to pay the cost for so many doctors for said volume.

It's happening because the incentive structures are in place for it to happen. The problem is that the low hanging fruit in medicine is relatively straight forward and can be done by people with a fraction of the training of a board certified physician. So if you combine this fact with the powerful market players that can dictate whether or not a nurse can do procedures in the ICU, you end up with a system where this can happen.

The overall cost to society is not actually different. If you go to the ICU, and a NP does a procedure on you, it's not like the hospital bills your insurance company any less. They bill the exact same, and you pay the exact same. The only difference is that the hospital is now making a margin on this service at the expense of hiring a physician to do the same.

Perhaps your argument is that we can just keep training physicians until we drive salaries down to match that of a NP, and there would be no incentive for hospitals to hire NPs over MDs. If that is the case, then why would anyone ever spend the time, effort, and opportunity cost of becoming a physician in the first place?

 

[DrMetal]

The only difference is that the hospital is now making a margin on this service at the expense of hiring a physician to do the same.

Ok, good point, but that's quite a margin, and multiply it by several orders of magnitude, and we're talking a lot of money.

there would be no incentive for hospitals to hire NPs over MDs.

There's several things that make a physician expensive, not just her salary. You could keep the salary the same, or maybe slightly reduce it (which I think some physicians would be ok with, if their costs were cut elsewhere....for instance, more loan forgiveness, more subsidies for medical school and residency training). Insurance costs and other administrative things are probably more burdensome to a system than a physician's salary.

If that is the case, then why would anyone ever spend the time, effort, and opportunity cost of becoming a physician in the first place?

Hey it's already happening. An entire generation of pretty smart and hard-working students are opting to go the mid-level route, I know quite a few of them. Most of them cite the 'time' and 'cost' aspect of their decision (not the 'effort', because they're good hard working people, who are capable of the effort if so desired). If we could alleviate these factors to some extent, maybe we'd get more doctors out of the bunch.

 

[MedicineZ0Z]

Only time will tell, but as far as the midlevels I work with regularly as inpatient (GI, cards, GS, nsgy, Neuro, uro, ER, hospitalist, oncology, ICU, CT surg), I would not trust them more than an intern on the job for 3 months, and this includes the ones that have been working for 20+ years. It's astounding how wrong they usually are when the attending attestation comes in, and even the ones who just do procedures, it's astounding how bad they are despite that it's all they do.

I've been saying this nonstop forever and people are always like "uhhgg... cLiNiCaL ExPeRiEnCe"

"Exp" does not replace med school and residency.

 

[MedicineZ0Z]

It's basic economics. When a commodity is scarce and in dire need, society will find a way to circumvent the road blocks in order to obtain said commodity.

If that commodity is food, the scarcity of it is called a famine, and a society will go to war to obtain it.

In our profession, the commodity is medical care delivered by a physician, which is scarce nowadays because of the limited number of medical school graduates and residency spots to train them (the # of residency spots being the major bottleneck). So society has found a way to circumvent the problem...to obtain medical care via the utilization of mid-levels.

Much of this is our own doing. We're expensive (we demand inflated salaries, we're costly to insure), and we have too many requirements (BC, MOC, CME, etc....most of which we've created and pushed upon ourselves). The anesthesiology community is a great example of this: 30 years ago, a hospital would have to pay an anesthesiologist $400K/year in salary + $120k/year in malpractice + probably another $10K in misc (MOC/CME). For that amount of money, you could hire 5 CRNAs, and that's exactly what they're doing now. Other specialties have followed suit. Mid-level radiologists are coming into play.

If we could make medical education/training a little shorter and more focused, make it a little cheaper (or find other ways to subsidize it, so people don't finish with six figure debts), if we could increase the number of residency spots to allow for more training opportunities (yes, hard to do, I know).....then we stand a chance at alleviating the physician shortage in this country. If not, then you can expect the utilization of mid-levels to increase exponentially. As least in primary care, there's plenty of work to go around.

What are you talking about? Physician shortages are a myth. And shortages in any profession in 2019 are a huge myth designed to open and recruit students to make $$.
Don't drink the kool aid. If it wasn't for residency which caps the market, our job market would have been wrecked like every other profession. Of course, now they've found an indirect (though thankfully slower) way to do it with midlevels.
The only shortages of doctors are limited to areas where no one else wants to go. Even then these places often have decent access nowadays.

 

[GastriqueGraffin]

Most midlevels especially in subspecialties know and respect their limitations and serve an important function.

 

[xoggyux]

To serve as a devil's advocate I must point out that I believe you are misplacing your frustration. The fact of the matter is none of those nurse practitioners are ultimately responsible for patient care, it is the MD who is. Ultimately it boils down to risk vs benefit. Would you rather have a risky but highly profitable practice or do you rather practice with the highest level of quality you can possibly offer? MDs that "delegate" a large portion of their responsibility to mid-levels, residents or that they practice "rushed" "over the phone", "High-volume, pan-consult", the GI doctor that "cleans, not sterilize the endoscope", the plastic surgeons that do 30 cases in a tiny improvised clinic and half of the patients end up admitted to the nearest ER 24h later due to severe anemia or sepsis, the doctors that make a bucketload of money prescribing painkillers.

 

[rokshana]

To serve as a devil's advocate I must point out that I believe you are misplacing your frustration. The fact of the matter is none of those nurse practitioners are ultimately responsible for patient care, it is the MD who is. Ultimately it boils down to risk vs benefit. Would you rather have a risky but highly profitable practice or do you rather practice with the highest level of quality you can possibly offer? MDs that "delegate" a large portion of their responsibility to mid-levels, residents or that they practice "rushed" "over the phone", "High-volume, pan-consult", the GI doctor that "cleans, not sterilize the endoscope", the plastic surgeons that do 30 cases in a tiny improvised clinic and half of the patients end up admitted to the nearest ER 24h later due to severe anemia or sepsis, the doctors that make a bucketload of money prescribing painkillers.

Uh huh...just wait until
You have been in the real world longer than 2 weeks.

 

[DrMetal]

What are you talking about? Physician shortages are a myth...The only shortages of doctors are limited to areas where no one else wants to go..

So first you state the shortage is a myth, then you admit that there are shortages in some places. Which is it?

Even then these places often have decent access nowadays.

Yeah, b/c of mid-levels! And telemedicine galore.

Okay, if you don't believe that there are shortages, let's just call them shortcomings in certain markets. Then the "local" economy finds a plausible way to circumvent the situation, and the rest of the country takes notice and follows suit, especially if it's a cheaper solution.

Let's try to understand the problem so we can actually fix it.

 

[MedicineZ0Z]

So first you state the shortage is a myth, then you admit that there are shortages in some places. Which is it?



Yeah, b/c of mid-levels! And telemedicine galore.

Okay, if you don't believe that there are shortages, let's just call them shortcomings in certain markets. Then the "local" economy finds a plausible way to circumvent the situation, and the rest of the country takes notice and follows suit, especially if it's a cheaper solution.

Let's try to understand the problem so we can actually fix it.

Distribution issues aren't a shortage that you fix by graduating more doctors. And midlevels are just as likely to practice urban medicine.

 

[deleted941485]

Distribution issues aren't a shortage that you fix by graduating more doctors. And midlevels are just as likely to practice urban medicine.

Midlevels were supposed to be part of this troop of providers designed to head out and treat people out in the unreachable rural areas on the cheap.

Turns out they like cities/people and amenities as much as anyone else and want to practice on their own without any input from a physician in areas where there are plenty of them.

These days they are finding use as extenders because literally Medicare and commercial ins stopped paying doctors for their services years ago and the increased patient load is not viable for most practices. So now they see the patient and bill under a supervisor.

 

[DoubleBogey]

I’m seeing some insurances not cover mid levels and the patients then have to see a physician - mostly insurances from the south

 

[Splenda88]

I’m seeing some insurances not cover mid levels and the patients then have to see a physician - mostly insurances from the south

I guess they are starting to realize that they spend more money with MLP ordering a bunch of unnecessary tests and problem not being solved...

 

[deleted941485]

I guess they are starting to realize that they spend more money with MLP ordering a bunch of unnecessary tests and problem not being solved...

I will always remember being on the floor reading an MLP admission HPI. The damn thing read like a bad novel and had nothing to do with why the patient was in the hospital to begin with. They spend at least 2 hours writing the thing and ended up wasting anybodies time that actually read it. It was so bad that I just re wrote a whole new summary. I still haven’t decided what’s more embarrassing writing crap like that or finding some atteding dumb enough to sign off on it.

 

[bronx43]

I’m seeing some insurances not cover mid levels and the patients then have to see a physician - mostly insurances from the south

Even ones supervised by a physician?

 

[DoubleBogey]

Even ones supervised by a physician?

Yes

 

[bronx43]

Yes

Which insurances? I’m in the south and I have never seen that. There would be an uproar here if insurances stopped paying for midlevels.

 

[CCM-MD]

Your nurse cardiologist will see you shortly.

 

[DoubleBogey]

Amerita

Which insurances? I’m in the south and I have never seen that. There would be an uproar here if insurances stopped paying for midlevels.

ameritas health - would have to double check

I’m a northerner- do you feel the south won the war?

 

[GastriqueGraffin]

A lot of fear mongering here. In a time when a generalist medicine doc is afraid to manage most diseases because of potential lawsuits and has become a screen and referral specialist, you really think nurses who did some online course will be comfortable? NPs know their limitations and are fine for following simple algorithms on simple/established disease or reporting back to their supervising doc kind of like a resident. They are a cheaper service and helpful if properly used.

 

[bronx43]

Amerita

ameritas health - would have to double check

I’m a northerner- do you feel the south won the war?

Never seen that insurance plan. All the big players are def still paying for midlevel services. I honestly don’t see that changing.

I live in a fairly diverse city - not that diff from the North.

 

[VA Hopeful Dr]

Never seen that insurance plan. All the big players are def still paying for midlevel services. I honestly don’t see that changing.

I live in a fairly diverse city - not that diff from the North.

I see that one occasionally, no idea if it pays for midlevels or not.

 

[IMreshopeful]

View attachment 272326

Your nurse cardiologist will see you shortly.

Teaching someone to do a procedure isn’t the hard thing. It’s being able to interpret imaging and know what to do/troubleshoot problems. What if they dissect something during the cath? What if they cause an access site complication? What if an arrhythmia occurs during a cath? What if they can’t engage the coronaries with a catheter and need to use more complex technique? What if you shift plaque and cause a STEMI during the case (yes, this can happen)? I highly doubt any nurse is trained enough to do this. This is just absurd

I want to know what physician sellouts are stupid enough to allow nurses and NPs to even attempt to do this. Rest assured this will never get traction though

 

[CCM-MD]

“Rest assured this won’t get traction” is what many anesthesiologists said, look at where that’s gotten them...

We are on the same side. I don’t believe midlevels should be performing cardiac cath... among other things. Somehow there are physicians who think this is a good idea.

Though the above paper is from the UK, there was also a study about PAs doing cath a while back. And according to someone I know who just recently trained at Sinai, this continues to occur there.

The invasive nurse angiographers are actively promoting their agenda. Quote from the BJC paper “minimum of 100 procedures a year must be performed. In setting up and developing this nurse angiographer role we have achieved and exceeded these recommendations.” So each one is doing >100/year according to the paper.

 

[rokshana]

“Rest assured this won’t get traction” is what many anesthesiologists said, look at where that’s gotten them...

We are on the same side. I don’t believe midlevels should be performing cardiac cath... among other things. Somehow there are physicians who think this is a good idea.

Though the above paper is from the UK, there was also a study about PAs doing cath a while back. And according to someone I know who just recently trained at Sinai, this continues to occur there.

The invasive nurse angiographers are actively promoting their agenda. Quote from the BJC paper “minimum of 100 procedures a year must be performed. In setting up and developing this nurse angiographer role we have achieved and exceeded these recommendations.” So each one is doing >100/year according to the paper.

That’s approx 1 every 3 days...most fellows are doing 3 caths in 1 day!

 

[CCM-MD]

That’s approx 1 every 3 days...most fellows are doing 3 caths in 1 day!

Minimum is the key word.

And I know cardiologists that are doing 2 a week...

 

[IMreshopeful]

Minimum is the key word.

And I know cardiologists that are doing 2 a week...

I do two to three pci per day and around 5-6 diagnostics as an interventional fellow. In practice it varies but > 100 PCI per year is considered good

Again, most interventional cardiologists aren’t stupid and won’t allow this to gain traction. I firmly believe this

And as for the Sinai thing, that cath lab and fellowship is immensely abusive and they are not a good representation of your average lab or fellowship

 

[dragqueen]

A lot of fear mongering here. In a time when a generalist medicine doc is afraid to manage most diseases because of potential lawsuits and has become a screen and referral specialist, you really think nurses who did some online course will be comfortable? NPs know their limitations and are fine for following simple algorithms on simple/established disease or reporting back to their supervising doc kind of like a resident. They are a cheaper service and helpful if properly used.

Quote from a CT surgeon I worked with as a med student, talking to a resident: "I appreciate that you did X, but that's what we have the PA for. We have them here to do non educational things so that you can do educational things."

This was in a large rural health system.

 

[GastriqueGraffin]

Quote from a CT surgeon I worked with as a med student, talking to a resident: "I appreciate that you did X, but that's what we have the PA for. We have them here to do non educational things so that you can do educational things."

This was in a large rural health system.

That’s my point. Do you expect the CT surgeon to answer pages about the patient’s constipation or pain or even routine labs? Sure, you can say that’s what the intern is there for or sometimes even an attending medicine hospitalist in some situations but is that really a better use of resources than a mid level? And besides, that’s not always available. There are countless examples of this in all specialties, inpatient and outpatient.

 

[dragqueen]

That’s my point. Do you expect the CT surgeon to answer pages about the patient’s constipation or pain or even routine labs? Sure, you can say that’s what the intern is there for or sometimes even an attending medicine hospitalist in some situations but is that really a better use of resources than a mid level? And besides, that’s not always available. There are countless examples of this in all specialties, inpatient and outpatient.

Oh yeah my intention was in fact to illustrate your point, sorry I didn't say that explicitly

 

[Splenda88]

We should ask our colleagues in anesthesia how is that working for them after they gave CRNA an inch...


If you visit some popular nursing blogs, you will see discussion about an unfair system that will not allow them doing minor surgeries (like lap chole) if there is 1-2 year surgery 'residency' for NP?

It won't take Vandy many years to have such programs at the pace they are opening 'non-traditional' residencies for NP