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CHICAGO - A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.
"We're constantly having to prove ourselves," said Chicago nurse practitioner Amanda Cockrell, 32, who tells patients she's just like a doctor "except for the pay."

On top of four years in nursing school, Cockrell spent another three years in a nurse practitioner program, much of it working with patients. Doctors generally spend four years in undergraduate school, four years in medical school and an additional three in primary care residency training.

Medicare, which sets the pace for payments by private insurance, pays nurse practitioners 85 percent of what it pays doctors. An office visit for a Medicare patient in Chicago, for example, pays a doctor about $70 and a nurse practitioner about $60.

The health care overhaul law gave nurse midwives, a type of advanced practice nurse, a Medicare raise to 100 percent of what obstetrician-gynecologists make - and that may be just the beginning.

States regulate nurse practitioners and laws vary on what they are permitted to do:

• In Florida and Alabama, for instance, nurse practitioners are barred from prescribing controlled substances.

• In Washington, nurse practitioners can recommend medical marijuana to their patients when a new law takes effect in June.

• In Montana, nurse practitioners don't need a doctor involved with their practice in any way.

• Many other states put doctors in charge of nurse practitioners or require collaborative agreements signed by a doctor.

• In some states, nurse practitioners with a doctorate in nursing practice can't use the title "Dr." Most states allow it.

The AMA argues the title "Dr." creates confusion. Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?

The feud over "Dr." is no joke. By 2015, most new nurse practitioners will hold doctorates, or a DNP, in nursing practice, according to a goal set by nursing educators. By then, the doctorate will be the standard for all graduating nurse practitioners, said Polly Bednash, executive director of the American Association of Colleges of Nursing.

Many with the title use it with pride.

"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.

What's the evidence on the quality of care given by nurse practitioners?

The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.
"The argument that patients' health is put in jeopardy by nurse practitioners? There's no evidence to support that," said Jack Needleman, a health policy expert at the University of California Los Angeles School of Public Health.

Other studies have shown that nurse practitioners are better at listening to patients, Needleman said. And they make good decisions about when to refer patients to doctors for more specialized care.

The nonpartisan Macy Foundation, a New York-based charity that focuses on the education of health professionals, recently called for nurse practitioners to be among the leaders of primary care teams. The foundation also urged the removal of state and federal barriers preventing nurse practitioners from providing primary care.

The American Medical Association is fighting proposals in about 28 states that are considering steps to expand what nurse practitioners can do.

"A shortage of one type of professional is not a reason to change the standards of medical care," said AMA president-elect Dr. Cecil Wilson. "We need to train more physicians."

In Florida, a bill to allow nurse practitioners to prescribe controlled substances is stalled in committee.

One patient, Karen Reid of Balrico, Fla., said she was left in pain over a holiday weekend because her nurse practitioner couldn't prescribe a powerful enough medication and the doctor couldn't be found. Dying hospice patients have been denied morphine in their final hours because a doctor couldn't be reached in the middle of the night, nurses told The Associated Press.

Massachusetts, the model for the federal health care overhaul, passed its law in 2006 expanding health insurance to nearly all residents and creating long waits for primary care. In 2008, the state passed a law requiring health plans to recognize and reimburse nurse practitioners as primary care providers.
That means insurers now list nurse practitioners along with doctors as primary care choices, said Mary Ann Hart, a nurse and public policy expert at Regis College in Weston, Mass. "That greatly opens up the supply of primary care providers," Hart said.

But it hasn't helped much so far. A study last year by the Massachusetts Medical Society found the percentage of primary care practices closed to new patients was higher than ever. And despite the swelling demand, the medical society still believes nurse practitioners should be under doctor supervision.

The group supports more training and incentives for primary care doctors and a team approach to medicine that includes nurse practitioners and physician assistants, whose training is comparable.

"We do not believe, however, that nurse practitioners have the qualifications to be independent primary care practitioners," said Dr. Mario Motta, president of the state medical society.


The new U.S. health care law expands the role of nurses with:

• $50 million to nurse-managed health clinics that offer primary care to low-income patients.

• $50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.

• 10 percent bonuses from Medicare from 2011-16 to primary care providers, including nurse practitioners, who work in areas where doctors are scarce.

• A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor's.


The American Nurses Association hopes the 100 percent Medicare parity for nurse midwives will be extended to other nurses with advanced degrees.
"We know we need to get to 100 percent for everybody. This is a crack in the door," said Michelle Artz of ANA. "We're hopeful this sets the tone."

In Chicago, only a few patients balk at seeing a nurse practitioner instead of a doctor, Cockrell said. She gladly sends those patients to her doctor partners.

She believes patients get real advantages by letting her manage their care. Nurse practitioners' uphill battle for respect makes them precise, accurate and careful, she said. She schedules 40 minutes for a physical exam; the doctors in her office book 30 minutes for same appointment.

Joseline Nunez, 26, is a patient of Cockrell's and happy with her care.

"I feel that we get more time with the nurse practitioner," Nunez said. "The doctor always seems to be rushing off somewhere."

http://news.yahoo.com/s/ap/20100413/ap_on_he_me/us_med_dr_nurse;_ylt=AhKTm8tqdAB2LDvxs3REwOsHcggF
 

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Blue Dog

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Practically every article that I've ever read touting the supposed advantages of seeing a mid-level provider over a physician boils down down to the mid-level spending more time with patients.

This is an artificial construct based on the employed status of mid-level providers in physician-supervised practices. If mid-levels were faced with the financial constraints of an independent practice environment, they wouldn't have this luxury.
 

filter07

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Doctors are overtrained, and we learn a bunch of useless crap in order to justify a doctorate degree. America is a nation burdoned with choices. The medical system wastes many years of our lives to prove that being an internist or surgeon or radiologist is what we really want to do. We waste 2 out of 4 years of undergrad trying to decide if medicine is right for us, 1.5 out of 4 years of medical school trying to decide on medicine vs surgery, and a bunch of time during residency trying to decide on which field to specialize in. Being trained like a PA or NP is not glamorous but one thing they have going for them is that they don't waste time talking about JAK-STAT or heat shock proteins.
 

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Nurse practitioners say patients aren't confused by veterinarians calling themselves "Dr." Or chiropractors. Or dentists. So why, they ask, would patients be confused by a nurse using the title?

"I don't think patients are ever confused. People are not stupid," said Linda Roemer, a nurse practitioner in Sedona, Ariz., who uses "Dr. Roemer" as part of her e-mail address.
Does anyone know Dr. Roemer's MENSA ID#? I'd like to congratulate her (or whoever espoused the argument in the first quoted paragraph) on well-thought out and logical remarks. :smack:

The question is, what the hell do we as physicians and medical students do about this? I don't think an online petition is going to do jack, but it's been clear from the whole health care reform debate that physicians are not organized in their lobbying or in dealing with the media.
 

J1515

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Doctors are overtrained,..... Being trained like a PA or NP is not glamorous but one thing they have going for them is that they don't waste time talking about JAK-STAT or heat shock proteins.
Why even bother having a human deliver healthcare then if you are only going to follow algorithms and protocols and not understand the origins of disease? Anyone with afib gets cardizem. Anyone with HTN or myocardial ischemia gets a beta blocker. Damn it's so easy. Why not just type symptoms into a computer and save yourself a car ride and co-pay?

The pathophysiology of disease and why it occurs is extremely important. Making the two assumptions I listed above can potentially worsen or kill a certain subset of patients with afib or HTN. Doctors know what subset of patients I'm talking about, the mechanism, and the alternative treatment without having to google it. PAs, nurses, and computers don't. The answers all go back to the first year of medical school.
 
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Why even bother having a human deliver healthcare then if you are only going to follow algorithms and protocols and not understand the origins of disease? Anyone with afib gets cardizem. Anyone with HTN or myocardial ischemia gets a beta blocker. Damn it's so easy. Why not just type symptoms into a computer and save yourself a car ride and co-pay?

The pathophysiology of disease and why it occurs is extremely important. Making the two assumptions I listed above can potentially worsen or kill a certain subset of patients with afib or HTN. Doctors know what subset of patients I'm talking about, the mechanism, and the alternative treatment without having to google it. PAs, nurses, and computers don't. The answers all go back to the first year of medical school.
:thumbup:

Unfortunately, since congress has decided that healthcare is a natural god-given right, there won't be enough of the good stuff to go around. The only way to do it will be to replace our thoughtful diagnoses with the nurses and algorithms to which you're referring. This makes perfect sense and is in line with the progressive opinion that "if everyone can't have quality, then nobody should."

Frankly, it used to bother me that nurses were planning on parading around calling themselves "doctor." But lately I'm finding I couldn't care less. If they want to put in the time to technically qualify for a doctorate (albeit NOT a doctorate in Medicine), just to end up much less competent than an MD and perpetually having to explain what DNP means, then by all means, let them.

If anything, maybe MDs will be thought of as being of higher quality by comparison....thereby letting nurses get crapped on, for once, for the state of primary care.

This may evolve into NPs (or DNPs, or whatever) having to deal with all of the crap MDs have currently deal with (malpractice, etc). I predict they look back on it some day and wish they'd stayed in their sweet little NP niche.
 

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Still bugs me. If paralegals one day decided that they were qualified to give legal advice and have power of attorney, do you think the law profession would just roll over?

Why are physicians as a class so impotent? I know the reputation of medicine as a whole has diminished over the years, but shouldn't we still have some clout? At least over how the practice of medicine is performed in this country??
 

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The user comments are the best:

One of my best doctors was a Nurse Practitioner - she is the one who originally diagnosed me correctly - my so called expert countered her diagnosis and managed to screw me up to the point that I am now disabled! Give me a RNP any day of the week!
Also Np's go through almost as much schooling as doctors do. They must have master degrees and specialty training. Plus they have years of experience in the field getting up to that point.. And working in the er and all over the hospital I can tell you most patients prefer the np's and pa's over the physicians.
.having been a nurse for years...I can tell you that nurses have saved more doctors asses from killing people or being sued because they catch their mistakes and also 9 times outta 10 when I can a doctor about a patient the doctor ask me the nurse what I think the patient needs and if I don't agree with doctor and suggest something else...sense we are the ones spending the time with the patient the docotrs 90% percent of the time take the nurses advise. So for anyone to say that a nurse with years n years of experience does not have the knowledge base to make medical decisons is crazy!!!
I'd rather be seen by a nurse practitioner or physician's assistant anyway. They are more intelligent. Physicians tend to be like car mechanics
 

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I agree there is value to understanding pathophysiology. I disagree that organic chemistry, electromagnetics, heat shock proteins, discharge summaries, or 25 progress notes a day have anything to do with pathophysiology or taking care of patients.
 

smq123

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Moving to Topics in Healthcare.
 

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The clear solution to this is for physicians to refuse to see patients referred to them by nurses. See how simple that was?

A nurse is ostensibly going to see all the patients who don't need to see doctors and refer those who do to doctors. In other words, they will merely see essentially healthy patients. And for this, trust me, they will be paid six-figures. Now, you may make twice as much as the nurse, but it will be for seeing much sicker patients.

If you were told you could get $200K for seeing ICU-level patients OR you could make $100K for seeing patients for annual physicals M-F 9-5, which would you take? It's the law of diminishing returns. Sure, the nurse will say she's "just" making half of what you make, as an example, but she's working about 1/10th as hard as you so she's still winning.

Make patients make a choice. If you want a nurse to be your doctor, then she's going to be your doctor. And if she messes up, sue her.

Also, the story said that some nurses are representing themselves as "doctor" because they have a doctorate of nursing. To counteract that, doctors should refer to themselves as "real doctor." So introduce yourself as "Real Doctor Glade" and talk down to nurses who try to use "doctor." It's easy. All you have to do is use actual medical terminology and nurses immediately don't know what you're saying, despite their "equivalent years of training." :laugh:
 

glade

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This thread can either die like a patient being taken care of by a nurse or it can continue to live like a patient being taken care of by a doctor. Sorry, "real doctor."
 

Taurus

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The nursing propaganda machine is in full steam.

We need people to write articles rebutting propaganda like this by pointing out the differences between the training and qualifications of physicians and DNP's. This article, probably written by a nurse, doesn't delve into those details. The public needs to know.
 

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Like I said, all you have to do is make the public decide. And then hold them to it. In other words, if they want to see nurses because nurses can diagnose better than physicians and they're more empathic and spend more time with them, more power to them. Just make them keep seeing nurses when they actually get sick. It'll be comedy gold.
 

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The best U.S. study comparing nurse practitioners and doctors randomly assigned more than 1,300 patients to either a nurse practitioner or a doctor. After six months, overall health, diabetes tests, asthma tests and use of medical services like specialists were essentially the same in the two groups.
:eyebrow: Wow, is this really the best study comparing nurses to doctors? 6 whole months of follow-up...that probably works out to at most 2 visits per patient...lots of time for something to go wrong. I'm sorry, but they'll have to extend these time points out to at least a few years before I buy into the equivalency argument. Especially considering the disastrous long term consequences of poorly managed diabetes, HTN, etc.

Out of curiosity I looked into a recent Cochrane review addressing this issue, and the authors were only able to find one appropriately powered study to assess equivalency (out of over 4000 nurse to doctor comparative studies). Most of these studies claiming nurse and doctor equivalency are just junk.

Doctors and nurses should serve complementary roles in our health system. I don't understand the rationale for nurses to take over the traditional roles that primary care doctors have served, when instead we should be focused on training more primary care docs (and paying them better salaries too) to help meet physician shortages.
 

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How will this help cut down on specialist referrals, I wonder? I thought that was the newest new greatest effort to lower HC expenditures.

I think its just a money grab, personally. The one nurse said she is exactly the same except for the pay. Yeah right. Shows you what her priority is. I find it funny (not really) how nurses often say docs are greedy or just in it for the money while they are the ones that really care, and then turn around and try to push legislation to get themselves more money.

Can any of you attendings report how malpractice and especially audits by medicare, etc. work for these independent NPs? Do they get the same amount of review from the government and insurers?
 
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Like I said, all you have to do is make the public decide. And then hold them to it. In other words, if they want to see nurses because nurses can diagnose better than physicians and they're more empathic and spend more time with them, more power to them. Just make them keep seeing nurses when they actually get sick. It'll be comedy gold.
As a PA, I'm somewhat indifferent to this MD vs NP thing although my loyalty should be to SPs. But this, I'm sorry...it's the type of uncaring and ruthless attitude that makes patients dislike MDs in the first place and prefer NPs and PAs. If you are ONLY concerned about money, you have no place in this field. I don't care how knowledgable you think you are, can you honestly say you would take some kind of pleasure in a patient being sick just because they had the nerve to see an NP? You sound like some kind of antisocial narcissist. Not trying to start a flame war or anything but people are as much concerned about seeing a provider who cares about them as they are how knowledgable someone is.
 

Instatewaiter

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As a PA, I'm somewhat indifferent to this MD vs NP thing although my loyalty should be to SPs. But this, I'm sorry...it's the type of uncaring and ruthless attitude that makes patients dislike MDs in the first place and prefer NPs and PAs. If you are ONLY concerned about money, you have no place in this field. I don't care how knowledgable you think you are, can you honestly say you would take some kind of pleasure in a patient being sick just because they had the nerve to see an NP? You sound like some kind of antisocial narcissist. Not trying to start a flame war or anything but people are as much concerned about seeing a provider who cares about them as they are how knowledgable someone is.
The point glade was making is that people should have to live with their decision and take some personal responsibility. He was obviously saying it for dramatic effect. Stop being so sensitive on an internet message board.

Most people do not know what a difference there is in MD and NP education- and it is quite significant yet the NP lobby makes it seem like there is no difference. An NPs lack in knowledge is important but not easily understood by the layman.

I for one would much rather have an uncaring ass save me than a compassionate fool hold my hand as her incompetence kills me.
 

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I for one would much rather have an uncaring ass save me than a compassionate fool hold my hand as her incompetence kills me.
Anecdotal story-

One of the first couple of days of 1st year we went to a mandatory personality type class. They had us do a lot of things but toward the end they asked the students if they would rather have a doctor that wasn't that nice but was very competent or someone that was nice but not as competent. About half the students picked either group. I couldn't believe it. Give me the best available doctor. I can deal with the attitude.

But then again, how can the average person know how competent a given doc is? I guess for most, they gamble and just choose the person they like the best.
 

smq123

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But then again, how can the average person know how competent a given doc is? I guess for most, they gamble and just choose the person they like the best.
That's how Press-Ganey surveys work. Which is, often, what websites like HealthGrades are based on, too.
 

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Anecdotal story-

One of the first couple of days of 1st year we went to a mandatory personality type class. They had us do a lot of things but toward the end they asked the students if they would rather have a doctor that wasn't that nice but was very competent or someone that was nice but not as competent. About half the students picked either group. I couldn't believe it. Give me the best available doctor. I can deal with the attitude.

But then again, how can the average person know how competent a given doc is? I guess for most, they gamble and just choose the person they like the best.
My dad did the same thing with regards to my grandfather's health one time. He was in a small, really run-down, care center in a rural area, and the doctors were all very nice, down to earth, etc, but it was all pretty basic and he wasn't getting any better.

Transferred him to a big hospital when he started to take a negative turn, had a team that was very blunt, non-approachable, etc, and my dad really didn't like them, wanted to get him out of there etc. However, they were very, very good docs at a good hospital and surprisingly ... he got better and went home a few weeks later.

Moral of the story ... I agree with you.
 

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That's how Press-Ganey surveys work. Which is, often, what websites like HealthGrades are based on, too.
Yup. Healthgrades, vitals, etc, use 'wait time' as one of their qualifications for a good or bad doc. You can lose a 'star' or whatever else and be ranked lower than another doc simply because your office was busier. Hmmmmm.
 
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The point glade was making is that people should have to live with their decision and take some personal responsibility. He was obviously saying it for dramatic effect. Stop being so sensitive on an internet message board.

Most people do not know what a difference there is in MD and NP education- and it is quite significant yet the NP lobby makes it seem like there is no difference. An NPs lack in knowledge is important but not easily understood by the layman.

I for one would much rather have an uncaring ass save me than a compassionate fool hold my hand as her incompetence kills me.
I think you are missing the point, honestly. The goal isn't to make pts aware that @sshole docs are competent. The goal should be for docs to stop being @ssholes. I don't feel I'm being sensitive either, as this person is planning a career in medicine with an almost Dr. Mengele type of demeanor...creeps me out anyhow.

As far as NP vs MD, I think that you are being overly paranoid about the risk involved. I don't have any data on it but you have yet to present any data on the potential risks of NPs treating routine style pts. I would imagine the quality of care would be similar to a PA, despite the difference in focus at some schools. I know at UCD (where I did my PA program), I believe the NPs did pretty much most, if not all, the same things we did along with their nursing specific classes.

It is a fact that in the whole healthcare field, people tend to be educated more than they actually need. This is a good thing though, don't get me wrong. But people often forget that you seldom, if ever, use everything you are taught. Hell, I think it's funny that it takes MAs 8-12 months of school to prepare for a job that can be learned in a weekend. It also doesnt make since to me why it takes so long for RNs to be trained either but then again, I've never been one.
 

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I think you are missing the point, honestly. The goal isn't to make pts aware that @sshole docs are competent. The goal should be for docs to stop being @ssholes.
We should start by giving their jobs away to people with half the training or debt. I know that always puts a smile on my face.

Until we master personality transplants, or allow doctors to practice on drugs ... let's just allow the smart ones who make it through to project themselves the way they do and continue doing their jobs???

Just a thought ...
 

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DNPs say they're more "cost effective" than physicians but they want equal pay. I say let them have it.

When they are no longer cost effective because they cost the same as physicians to employ, they cease to be useful.

Let them burn themselves out on this one. This is funny. Getting my popcorn. :laugh:
 

badasshairday

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DNPs say they're more "cost effective" than physicians but they want equal pay. I say let them have it.

When they are no longer cost effective because they cost the same as physicians to employ, they cease to be useful.

Let them burn themselves out on this one. This is funny. Getting my popcorn. :laugh:
:thumbup:
 

badasshairday

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Isn't this all just going to create bad blood between DNPs and Physicians? I mean, even my classmates who are all shielded from the news because they are too busy studying pharm will probably be annoyed once they start seeing DNPs everywhere. Should be interesting.

Note to everyone: Support PA's as your choice mid level provider. Apparently D/NP's can do everything and are better than you, except for the $ (for now), so let them do it on there own.

Isn't it really sad since patients judge good or "better and more knowledgeable" provider is the provider spends more time and talks to them about useless banter for 10 more minutes? What happen to education as the measure. Whatever. Let them have it.
 

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Note to everyone: Support PA's as your choice mid level provider. Apparently D/NP's can do everything and are better than you, except for the $ (for now), so let them do it on their own.
It's funny you mention this, because this is a joke that one of the PA's and I share - he says, "I know you're not an NP, just an MD, but you might know enough to know the answer to this."
 

glade

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The argument used when mid-levels try to gain more responsibility is always "we're not saying we're equal to doctors, but we can do 70% of what they do and we're willing to do that for 70% of the pay." Fine, how about taking 70% of the responsibility? That's my ultimate point. Because that's not what happens. Like I said, what happens is that mid-levels cherry-pick all the patients where they come in to an office with no medical history at age 20 and say "I have a cough" and they take care of it. But anything like a sixty-year-old guy who says "I have some chest pain" immediately becomes some doctor's responsibility. I mean, come on, realistically they should get like 10% of the pay for that and I'd be fine with that. As an intern I had to take care of some guy's hypertension as an outpatient. Every time I saw him, I'd just increase or decrease his medication that he had already been on when I inherited him and if I ran into trouble I'd call the attending. That's basically what a mid-level does. You know, if that's all I had to do, I'd probably have no way to argue that I deserved more than an intern's salary of some $40,000/year. But I know lots of mid-levels who do that and make six figures and sleep quite well at night and on weekends and holidays because they do what interns do but without the intern lifestyle or schedule. Really, that's insulting, especially when the same people who advocate this set-up are many of the people who will use guilt-tripping to try to shame doctors into working harder for less money as "greedy SOBs." Hey, fine, then give me $150K and I'll just see people at well-checks 9-5 on M-Th and anything that I don't want to see I'll kick over to you and you can say "thank you, doctor, I appreciate the opportunity to take care of this interesting patient, please call me at any time day or night with questions or concerns." See how long it takes you to become bitter.
 

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P.S. Every so often there is someone who asks "what can I do if I don't complete residency?" And one of the replies will invariably be something like "become a PA at some doctor's office." And all the PAs immediately say, "no, you're completely unqualified to be a PA." Now, get that. A PA can do a doctor's job and nobody is allowed to complain, but if you dare suggest that a person who graduated medical school and did some residency time try to do what a PA can do, it's game over. And guess what, I agree with the PAs that an intern would make a lousy PA (or a lousy nurse). But they can't be as impartial in the reverse.
 

Slack3r

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Maybe if they let DNPs have equal Medicare reimbursement rates, the ANA with actually lobby for better payment. Because we know the AMA is pretty much useless in Washington, but the ANA seems to get whatever it wants.
 

IDBasco

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Maybe if they let DNPs have equal Medicare reimbursement rates, the ANA with actually lobby for better payment. Because we know the AMA is pretty much useless in Washington, but the ANA seems to get whatever it wants.
This would probably lead to NPs getting paid more than docs for the same codes/procedures. I'm not entirely kidding.
 

Slack3r

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This would probably lead to NPs getting paid more than docs for the same codes/procedures. I'm not entirely kidding.
Well they deserve it. They are more compassionate than those greedy doctors anyway.
 

sideways

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This would probably lead to NPs getting paid more than docs for the same codes/procedures. I'm not entirely kidding.
Well they're doctors AND nurses, so they can bill for doctoring AND nursing.
 

clueless1

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Yet another comically short-sighted "solution" to a problem...the minute NP's get the same reimbursement as primary care docs, every single medical student in the country ceases to consider primary care as a career option. The analysis is stunningly simple: I'm going to go through more years of training and incur orders of magnitude more debt, just so I can do the same job for the same pay as someone who did half as much training (at 1/10th the cost) as me? No thanks.

In other words, you think there's a shortage of med students going into primary care now? Just wait 'til you devalue it another notch...it will exacerbate the problem to an extreme.
 

JaggerPlate

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Yet another comically short-sighted "solution" to a problem...the minute NP's get the same reimbursement as primary care docs, every single medical student in the country ceases to consider primary care as a career option. The analysis is stunningly simple: I'm going to go through more years of training and incur orders of magnitude more debt, just so I can do the same job for the same pay as someone who did half as much training (at 1/10th the cost) as me? No thanks.

In other words, you think there's a shortage of med students going into primary care now? Just wait 'til you devalue it another notch...it will exacerbate the problem to an extreme.
Yup ... just 100% confirmed that no med students will touch PC fields, especially FM, with a 10 ft pole.
 

Blue Dog

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Yup ... just 100% confirmed that no med students will touch PC fields, especially FM, with a 10 ft pole.
The mere fact that a handful of radical nurses think they can do our jobs doesn't mean they actually can. Their motives are utterly transparent, and - let's be honest - we're dealing with a lunatic fringe here. Most NPs don't want independent practice, and don't even support the DNP. The only leg they have to stand on is the argument that they're cheaper, and by seeking parity in Medicare payments, they're negating even that.

Support your PACs. The only thing we have to fear is fear itself. ;)
 

badasshairday

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The mere fact that a handful of radical nurses think they can do our jobs doesn't mean they actually can. Their motives are utterly transparent, and - let's be honest - we're dealing with a lunatic fringe here. Most NPs don't want independent practice, and don't even support the DNP. The only leg they have to stand on is the argument that they're cheaper, and by seeking parity in Medicare payments, they're negating even that.

Support your PACs. The only thing we have to fear is fear itself. ;)
Blue Dog, I am very glad to see an optimist. As a second year med student about to get into the thick of studying for boards, this forum and news about medicine in general has been depressing. I think I need to stay away from this site for a while. It is killing motivation. But seeing your posts makes me feel a little better. :)
 

ChiDO

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Once things like this start happening; all those midlevel providers wish they would have stayed midlevel providers..

http://www.chicagobreakingnews.com/2010/04/95m-settlement-in-case-of-boy-born-with-cerebal-palsy.html

An Elgin hospital, a nurse midwife and the nurse's employer have agreed to pay $9.5 million to settle a lawsuit filed by an Algonquin family who alleged that the hospital was responsible for causing their son to be born with cerebral palsy, a mediator said today.



Helen O'Came was admitted to Sherman Hospital on Oct. 26, 1996 in labor with son, Patrick, according to a statement from her attorneys Barry Chafetz, Margaret Power and Shawn Kasserman of Corboy & Demetrio.
The nurse failed to get a doctor when O'Came requested one after she began experiencing complications, O'Came's attorneys allege.


Retired Cook County Circuit Court Judge and mediator, Daniel Localla, said that he agreed to the settlement today.


"I thought it was a good settlement for both sides," Localla said. "There was a lot of money at stake but at the same time, the jury could have found the hospital not guilty."
 

JaggerPlate

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The mere fact that a handful of radical nurses think they can do our jobs doesn't mean they actually can. Their motives are utterly transparent, and - let's be honest - we're dealing with a lunatic fringe here. Most NPs don't want independent practice, and don't even support the DNP. The only leg they have to stand on is the argument that they're cheaper, and by seeking parity in Medicare payments, they're negating even that.

Support your PACs. The only thing we have to fear is fear itself. ;)
I'd like to agree with you. I know you are an intelligent, very well respected poster on these boards, and I've asked you for advice on several occasions. However ... I disagree. I think, EVEN if this is just one small pebble in the pond, one little sect of crazies, it's still indicative of the future. I've echoed this sentiment various times throughout this discussion, but it's just become the attitude of 21st century America ... people want things, but don't want to do the work.

I think a LOT of people in the health care industry think they can do what physicians do and want that level of authority, notoriety, etc, and truly believe that their NP, DC, CRNA, etc, level entitles them to such. They aren't about to go back to medical school, but they will bitch and whine and, in some unfortunate cases, use their lobbying power to get it done. My guess is that you'll see more and more of this, and physicians entering into more of a managerial position than that of a clinical practitioner.

Like I said though ... you're the expert here, not me. You could very much be right, I just can't force myself to believe it.
 

JaggerPlate

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Once things like this start happening; all those midlevel providers wish they would have stayed midlevel providers..

http://www.chicagobreakingnews.com/2010/04/95m-settlement-in-case-of-boy-born-with-cerebal-palsy.html

An Elgin hospital, a nurse midwife and the nurse's employer have agreed to pay $9.5 million to settle a lawsuit filed by an Algonquin family who alleged that the hospital was responsible for causing their son to be born with cerebral palsy, a mediator said today.



Helen O'Came was admitted to Sherman Hospital on Oct. 26, 1996 in labor with son, Patrick, according to a statement from her attorneys Barry Chafetz, Margaret Power and Shawn Kasserman of Corboy & Demetrio.
The nurse failed to get a doctor when O'Came requested one after she began experiencing complications, O'Came's attorneys allege.


Retired Cook County Circuit Court Judge and mediator, Daniel Localla, said that he agreed to the settlement today.


"I thought it was a good settlement for both sides," Localla said. "There was a lot of money at stake but at the same time, the jury could have found the hospital not guilty."
Unfortunate, and who knows the whole story ... but I see more and more of these lawsuits happening. Will it halt the DNP movement??? Who knows.
 

Blue Dog

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I'd like to agree with you. I know you are an intelligent, very well respected poster on these boards, and I've asked you for advice on several occasions. However ... I disagree.
Based on what, facts or fantasy?
 

JaggerPlate

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Based on what, facts or fantasy?
I explained above why I disagree. Furthermore, I explained why you're the one with the facts, and I'm the one with a gut feeling. However, I'm having a rough time denying that gut feeling, and I simply can't see this as a little, fringe, don't worry about it issue.
 

Blue Dog

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I'm sorry, but where have your facts been posted?
There's plenty of data out there about NPs and the workforce. Some of it has been posted in other threads at various times. The net effect is to show that further empowerment of mid-levels isn't going to save us. This isn't a new issue.
 

JaggerPlate

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There's plenty of data out there about NPs and the workforce. Some of it has been posted in other threads at various times. The net effect is to show that further empowerment of mid-levels isn't going to save us. This isn't a new issue.
It isn't going to save us ... but won't expanding practice rights in 28 states hurt docs????