The Rise Of Nurse Practitioners Working Alongside Doctors

[GastriqueGraffin]

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

Have anesthesiologists been eliminated? Their fear of CRNAs have been around for at least the last quarter of century but yet people are still going into it and I don’t see MDAs going away. That’s not to say that they haven’t had to redefine their role a bit. 8 years of medical training to push propofol on an ASA 1 patient for a colonoscopy seems like a waste.

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[Splenda88]

Have anesthesiologists been eliminated? Their fear of CRNAs have been around for at least the last quarter of century but yet people are still going into it and I don’t see MDAs going away. That’s not to say that they haven’t had to redefine their role a bit. 8 years of medical training to push propofol on an ASA 1 patient for a colonoscopy seems like a waste.

They are not MDA, they are physicians. Ask any anesthesiologist who is on his/her 50s on how the landscape was 20 years ago. They no longer put it into the ROAD specialties anymore because the average hours they work is no different than IM, and it's very close to some surgical specialties. These people were making banks working 40 hrs/yr and 14-16 wks vacation was the norm.

The mistake that doctors make is that we think some of the things we do are beneath us. The job of a physician is to practice medicine and if what you are doing is practicing medicine, it is not beneath you. It should not be beneath you to round and see your patients after they were operated on.

 

[GastriqueGraffin]

They are not MDA, they are physicians. Ask any anesthesiologist who is on his/her 50s on how the landscape was 20 years ago. They no longer put it into the ROAD specialties anymore because the average hours they work is no different than IM, and it's very close to some surgical specialties. These people were making banks working 40 hrs/yr and 14-16 wks vacation was the norm.

The mistake that doctors make is that we think some of the things we do are beneath us. The job of a physician is to practice medicine and if what you are doing is practicing medicine, it is not beneath you. It should not be beneath you to round and see your patients after they were operated on.

It was a different billing system back then and the change came mostly thanks to how CMS bills. Every part of their procedure from induction, intubation, push some more meds, place IV, recovery, etc was billed. Ask a nephrologist how life was 40 years ago and you’ll get a similar answer before dialysis reimbursement was cut, but anesthesia is still much more lucrative. If anesthesiologists really wanted there to be no CRNAs they would have opened up many more training spots to the point where it’s like family med residency. But they realize this will hurt their bottom line more than this current model. Long winded answer but yes, we need sustainable models where everyone provides something that someone else cannot.

 

[Splenda88]

@GastriqueGraffin

You are probably that GI attending in Wisconsin that one of the GI docs I work with was talking about. Hire 3+ mid-levels to see consults and only scope and rack up over 1 mil per year.


Who gives a damn about future generation of docs if I am making a lof of money now and live my lavish lifestyle?

 

[bronx43]

@GastriqueGraffin

You are probably that GI attending in Wisconsin that one of the GI docs I work with was talking about. Hire 3+ mid-levels to see consults and only scope and rack up over 1 mil per year.


Who gives a damn about future generation of docs if I am making a lof of money now and live my lavish lifestyle?

Don’t hate the player, hate the game.

 

[InvestingDoc]

I can only speak to what I know.

I used to be a hospitalist before starting up my own clinic.

Back then, I used to bust my ass and see up to 32 patients a day. On average, I probably saw about 22 ish patients a day. That was good enough to earn me a living of about $350,000 a year.

The new team health doctors in town are required to be responsible for NP patients and be responsible for 30+ patients a day. Starting salary with TH in my area....$210k a year.

NP's are part of the problem but businesses are happy to have us sign off on their work to put extra money in the owners pocket.

 

[deleted480308]

Have anesthesiologists been eliminated? Their fear of CRNAs have been around for at least the last quarter of century but yet people are still going into it and I don’t see MDAs going away. That’s not to say that they haven’t had to redefine their role a bit. 8 years of medical training to push propofol on an ASA 1 patient for a colonoscopy seems like a waste.

Not MDA, anesthesiologist

 

[bronx43]

I can only speak to what I know.

I used to be a hospitalist before starting up my own clinic.

Back then, I used to bust my ass and see up to 32 patients a day. On average, I probably saw about 22 ish patients a day. That was good enough to earn me a living of about $350,000 a year.

The new team health doctors in town are required to be responsible for NP patients and be responsible for 30+ patients a day. Starting salary with TH in my area....$210k a year.

NP's are part of the problem but businesses are happy to have us sign off on their work to put extra money in the owners pocket.

The problem is the hospitals that employ midlevels, who then take the profit and place medicolegal risk on the physicians.

Whether midlevels should see patients at all is an entirely different argument.

 

[Splenda88]

Not MDA, anesthesiologist

Not sure why physicians start adopting these nursing lobbies lingo...

 

[GastriqueGraffin]

Not sure why physicians start adopting these nursing lobbies lingo...

Because anesthesiologist is 16 letters and there’s no shorthand way of writing it.

 

[deleted480308]

Because anesthesiologist is 16 letters and there’s no shorthand way of writing it.

“Doc” is pretty short

 

[calvnandhobbs68]

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

Yeah right...that's why there's now a "pediatric hospitalist" fellowship in already one of the lowest paying fields in medicine.

I'm not seeing any streamlining whatsoever. All I'm seeing is more organizations trying to use residents as low cost labor for all those shifts the NPs refuse to do. A 2nd year resident is more competent on average than any NP with <5 years of experience (as an NP) any day of the week.

 

[calvnandhobbs68]

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.

Yes, there's some problems with this...
1) When you've relied on other people to followup on certain aspects of patient care since residency in these surgical/procedural specialities, you'll never really be comfortable managing those aspects of patient care and will be relying on others (so likely an NP/PA) to manage a lot of post-op stuff essentially forever. I get some of the scutwork but there's definitely also aspects of clinical care that are lost.
2) As we've already been seeing, there's more and more gradual responsibility creep...not necessarily because NPs are proving that they can actually manage these things but because the doctors in charge would just prefer not to manage them. NPs will argue that they're being allowed more and more responsibility because they can handle it. I'd argue that just letting someone do something doesn't mean they should be doing it.

I don't necessarily have a problem with new people coming into the market and making the argument for more streamlined, faster education. If they're arguing they can learn everything they need to practice in whatever speciality in the amount of time they spend in NP school, okay. But they should have to pass the minimum requirements that have been deemed necessary to practice medicine (not nursing) which is what they're doing. If an NP can pay for and pass step 1, step 2 and step 3 and the board exam for whatever speciality they want to work in, fine, we've deemed that testing the minimum testing qualifications to practice medicine in that speciality. But they don't.

If I'm the taxi driver having to buy this overpriced medallion to drive people around...why didn't I just go work for Lyft?

 

[jdh71]

I work with mid levels in the ICU. They mostly help with orders, answering pages, and procedures. It’s true I’ve forgotten my sliding scale insulin but I really don’t care and could figure it out again pretty fast no? Same for bowel regimen. Idk. Maybe other specialties see a lot more mission creep but I really like working with them in the icu.

 

[VA Hopeful Dr]

“Doc” is pretty short

Kinda vague when writing.

Not really sure why anyone cares. I get called a GP all the time. Doesn't bother me in the slightest.

 

[deleted480308]

Kinda vague when writing.

Not really sure why anyone cares. I get called a GP all the time. Doesn't bother me in the slightest.

That one matters because the shared “A” in crna/mda is meant to imply they are interchangeable

 

[Splenda88]

Now they are no longer nurse anesthetist... Now they are 'nurse anesthesiologist.'

 

[VA Hopeful Dr]

That one matters because the shared “A” in crna/mda is meant to imply they are interchangeable

I'm fairly certain that's not always true.

In fact, let's find out. @GastriqueGraffin did you mean to imply that CRNAs and anesthesiologists are interchangeable?

 

[GastriqueGraffin]

That one matters because the shared “A” in crna/mda is meant to imply they are interchangeable

Kinda vague when writing.

Not really sure why anyone cares. I get called a GP all the time. Doesn't bother me in the slightest.

You mean the GP/NP

I'm fairly certain that's not always true.

In fact, let's find out. @GastriqueGraffin did you mean to imply that CRNAs and anesthesiologists are interchangeable?

No and I think that’s a very insecure way of feeling. That’s like saying PCP/GP and NP are interchangeable because they share “P” and often work in the same setting.

 

[deleted480308]

You mean the GP/NP

No and I think that’s a very insecure way of feeling. That’s like saying PCP/GP and NP are interchangeable because they share “P” and often work in the same setting.

Except the “p” wasn’t assigned to docs by midlevels who are actively trying to assume interchangeable status

 

[IMreshopeful]

Except the “p” wasn’t assigned to docs by midlevels who are actively trying to assume interchangeable status

This

We are NOT providers. We are doctors. This provider BS is a way midlevels are trying to obfuscate the difference between physicians and non physicians who act as extenders

Terminology matters. We should be precise. I had a DNP refer to herself as “Dr. So and so”.... while technically correct, she’s not an MD

 

[rokshana]

This

We are NOT providers. We are doctors. This provider BS is a way midlevels are trying to obfuscate the difference between physicians and non physicians who act as extenders

Terminology matters. We should be precise. I had a DNP refer to herself as “Dr. So and so”.... while technically correct, she’s not an MD

Did you asked where she go get medical degree...I would...in front of the patient.

 

[VA Hopeful Dr]

This

We are NOT providers. We are doctors. This provider BS is a way midlevels are trying to obfuscate the difference between physicians and non physicians who act as extenders

Terminology matters. We should be precise. I had a DNP refer to herself as “Dr. So and so”.... while technically correct, she’s not an MD

Except the argument isn't about being called providers...

 

[GastriqueGraffin]

I think this argument has devolved. Dentists, optometrists, heck even chiropractors call themselves doctor. I roll my eyes but don’t really care. As long as everyone knows their limitations (which in my experience is almost always the case) call yourself whatever you want. My point is NP/PAs have a useful role in our system.

 

[calvnandhobbs68]

 

[DoubleBogey]

View attachment 273437

The proof will be in the pudding with these programs, and unfortunately at the expense of the patient

 

[FiremedicMike]

I've not found an online direct entry program. I've found several RN to NP online programs, but all require an RN first..

 

[InvestingDoc]

All of the NP's that have applied to work for me so far have gone to school to be an RN then did an online NP program. I have no seen a direct pathway yet but then again I have not really spent a lot of time researching it either.

 

[FiremedicMike]

My local state college has a direct entry program, with an accelerated BSN followed by NP, but you can only do it for a few specialties, and they facilitate clinicals through their hospital.

You CANNOT do it online and it does have a good reputation in the area..