I feel very bad for the family, even the future mother knew there was some problems going on. I hope this is the new trend, that the judicial system doesnt have a blind eye for pseudo-physicians asking to be paid as physicians.
Today's News: A nurse may soon be your doctor
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I feel very bad for the family, even the future mother knew there was some problems going on. I hope this is the new trend, that the judicial system doesnt have a blind eye for pseudo-physicians asking to be paid as physicians.
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deleted87716
Probably not. The real issue that we should be focusing on is whether it will hurt patients.
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Or the responsibility. You're exactly right. Mid-levels are quite happy to be viewed and respected as "health care providers" who can "do what doctors do." Just don't ask them to sacrifice any time going to medical school and residency. Just don't have them take call. Just don't make them pay malpractice. Just don't have them answer questions on why they did THIS and didn't do THAT to some thumb-sucking lawyer.
The mid-levels that I know are very satisfied because they earn essentially what a low-paid doctor makes, but don't have any overhead or malpractice. They all have normal lives, most of them coming in to the hospital at 8 AM and leaving around 5 PM or 6 PM and only during the weekdays. None of them are there in the evenings, none of them do holidays. Anything they aren't interested in doing, they just say to a resident, "are you going to take care of that? Because I'm just a PA or an NP. That's for doctors to do."
Hey, if people want to pay less for PAs or NPs, more power to them, but then don't go running to a doctor when things go bad. Stay with your el cheapo PA or NP. This is like when people go overseas to have cheap surgery, come back and have complications. Then all of a sudden they're ecstatic to go to an American hospital where they can sue to their heart's delight if they don't get the most expensive state-of-the-art medical care. And then you get articles about how "it is your ethical duty to take care of these patients." No, it's not. And any so-called ethicist who says so can go to medical school and residency and take care of them or else STFU.
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This is obviously a huge concern.
I think it will hurt patients.
First, it doesnt matter if its a small fringe group of nurses who believe this if they are the ones getting legislation passed. Even if nurses who didnt really care either way had nothing to do with the legislation, they could make more money practicing independently and if they can they will. Clearly they are doing a good job is a nurse midwife can get the same pay and an ob/gyn.
Second, correct me if i am wrong, but the majority of those easy cases help doctors keep their doors open, i.e. they can see alot more of those patients and increase volume to pay for the practice. So if the nurses started cherry picking all these cases and refer out the harder more time consuming cases physicians lose out on volume and thus are forced to close their doors and patients with complex conditions and co morbidities have no where to go.
Thirdly, there may be alot of data out there that proves that mid-levels wont save us, and I agree they probably wont, but the general public doesnt know that. They see articles like the one in the OP, and quotes of studies. They dont know six months isnt enough time to evaluate the effectiveness of such conditions.
What physicians need is an all encompassing lobbying group. Funding small PACs is a good start, but compiling all the money from individual PACs into one bigger foundation would probably get more done. Especially when each specialty only cares about the issue immediately affecting them. Only anesthesiologists were worried, when CRNAs started moving in, now PC is worried, and it looks like derm is next on the list. I also read an article saying nurses wanted to start doing GI procedures independently etc.
Please do not lump all "mid-levels" together, as PAs are largely there to help the practice of their SPs. It amazes me how SOME of you MDs are viewing PAs with contempt when we can help you increase your patient load while still being under your thumb and say so and make sure that you, us, and the patient all benefit.
I realize the concerns with NPs, and I try hard to support the cause of the Physicians. But if Physicians are going to turn against PAs and make us out to be inept, you are just going to find you have one more competition in the long run. There are some PAs who manage to find SPs who are basically hands-off consultants who are SPs in name only and offered 1% of the PAs practice. I don't agree with this in most cases but I feel it necessary for MDs to respect their PAs and work as a team with them for the mutual benefit of everyone. Pulling rank, ego, and the "your not a doctor!" routine will just lead to bitterness and PAs lobbying for expanded rights and curtailing the system.
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I don't have a problem with PAs in that capacity, since that's their stated role. The problem comes when PAs start to re-interpret what constitutes "helping a physician increase their patient load." It is undeniable that PAs are attempting to be allowed to do more and more, especially procedurally, under the broad and nebulous statement of "helping a physician increase their patient load." And the point is, if a PA is going to, for example, start doing surgeries rather than assist in surgeries, then either a) they should go to medical school and become a physician with the attendant requirements and liabilities or b) physicians should not be required to go to medical school and just be allowed to practice similarly. It's one or the other.
PAs aren't inept. They're just not physicians. I don't try to be a PA, not due to "ineptness" but due to training. Similarly, PAs shouldn't try to be physicians for the same reason. If you consider someone saying a PA should not try to be a physician as saying you're inept, then that's your problem.
That's interesting. I feel it necessary for people to just do their jobs. Everything else is just mumbo-jumbo and B.S.
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So true...main point - Physician does not equal PA and vice versa.
Why is it that you expect NPs to care about the fact that their lobbying is hurting opportunities for doctors and all that but you seem to not give a flip about the concerns of any mid-levels, or anyone else for that matter? I know you are bias because of what field you are in, but in the real world people aren't going to care about your concerns when you don't care about theirs. You can argue until the cows come home about NPs providing, in your opinion, substandard care but if the legislature deems NPs, or in the future even PAs, capable of providing a certain level of care autonomously then all of your arguments are impotent.
Maybe MDs should just "do their jobs" and stop worrying about what NPs are doing. Also, we can stop worrying about what MDs are doing and do our job as determined by the legislature, not the views of people in an online forum.
Actually, this article sheds some light on the real impact of arrogant doctors...
http://www.nytimes.com/2008/12/02/health/02rage.html
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deleted87716
The key is to block the legislation. That's where the PACs come in. Most, if not all, of these battles occur at the state level, which is why it's critical that the state specialty associations and state medical societies throw everything they've got at it. We've been successful thus far in my state, but we need more funding and support.
Can you suggest PACs to join or contribute to-- or what to look for in researching PACs? As a recent grad, all I know is the AMA's AMPAC. Which, I'm gonna bet, isn't going to amount to a hill of beans, considering their recent behavior.
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deleted87716
Look into specialty-specific medical societies in your state. Many of them have formed their own PACs. There are also state medical societies that are part of the AMA. The AMA focuses on lobbying in DC, not the states.
For example, the AAFP has it's own PAC, called FamMedPAC (http://www.aafp.org/online/en/home/policy/fammedpac.html), which funds lobbying at the federal level. My state academy (Virginia), the VAFP, formed the FamDocPAC (http://www.famdocpac.org/) a couple of years ago to focus on lobbying at the state level. Both PACs are underfunded at this time. We also work with the Medial Society of Virginia, which is the state-level AMA. They have their own PAC (http://msvpac.msv.org/). AMPAC, of course, is the AMA's national PAC (http://www.ampaconline.org/).
I don't know of a master list of PACs.*
*Edit: here you go: http://www.opensecrets.org/pacs/industry.php?txt=H01&cycle=2010
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Right. Exactly why while I am concerned about the economics and certain narrow patient care issues. I cannot see physicians recouping any lost ground. They have eroded their own position. With a culture of domination, abuse, and pure self-interest. I will not go to the picket line to undo the what the past has sewn. I am concentrating on seeking the new normal. And doing my best to put something together that will make sense for a middle aged rookie with 300 large in the hole to the man.
These @ssholes out their making their money with their full stable of NP's and PA's in tow. They're just not my concern.
Shoot. I'd make a great team mate to some mid-levels. And maybe we can come up with something that make sense given my larger debt load between us. Transparency and democratic process. Funny. I don't hear a lot of this from the mouths of established physicians.
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And who do you think more insight into what NPs can do... some senator who has absolutely no idea the qualifications of doctors vs NPs except what lobbyist tell him or a doctor with years in the health care industry and intimate knowledge of NPs ad their skillset?
That some idiot senator that knows next to nothing about health care agrees with the nursing lobby doesn't mean an NP should be allowed to be independent.
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deleted87716
The job of the lobbyist is to educate legislators. Lobbyists are funded by PACs. Currently, the nursing lobby is better funded than the physician lobby (I've seen the charts). It should not be so. Money talks.
Thank you. I looked into the PAC for the Medical State Society of New York. They have a very short section on "non-physician providers," lost within a laundry list of items about podiatrists, nurse-anesth, etc.-- essentially, one line in an 58 page document. This document pays the same amount of attention to EMR and offshore medical schools as it does to scope expansion by non-physicians.
I'm wary of donating anything to an affiliate of the AMA. I will look into my specialty's PAC, but as a surgical subspecialty I don't know if they will really care about this until it's too late. I will write to the MSSNYPAC and ask what actions it intends to take before I think about writing them a check.
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http://www.chicagotribune.com/news/opinion/chi-100418-chapman-md-column,0,424517.column
Another opinion piece about nurses providing care and how it's all good....this **** makes me sick.
Another opinion piece about nurses providing care and how it's all good....this **** makes me sick.
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deleted87716
I love the analogy:
Yet, he fails to follow it to it's conclusion by suggesting that the solution to this hypothetical "airline crisis" would be to relax safety restrictions on air travel.
After all, you're just taking a quick puddle jumper...it's not like you're flying to Europe, or anything.
good luck with that. You think they give a **** about your debt or patient care. Theyre in it for the money too chief. Have fun trying to "work something out" they will just tell you u were an idiot for going to twice the schooling and debt to do the same things as them and that you shouldve gone their route.
theres a holes in every field, not all nurses are saints either.
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I love the analogy:
Yet, he fails to follow it to it's conclusion by suggesting that the solution to this hypothetical "airline crisis" would be to relax safety restrictions on air travel.
After all, you're just taking a quick puddle jumper...it's not like you're flying to Europe, or anything.
Don't worry. I logged my hours on my Microsoft Flight Sim game on my computer. Taxi to runway, give full throttle, some flaps, and then turn on autopilot. Piece of cake!
I understand what you're saying but try to look at this from the prospective of even a well-meaning politician (yeah right huh?) They realize that physicians aren't completely objective either because they have their own interests to look out for. At the political level, no one should just "take someone else's word for it." If you are a senator who knows nothing about healthcare, how are you to know whether you can trust the nurses or doctors? The only thing to rely on is data and I'm not sure there is enough data yet about NP care vs Physician care to make a definitive analysis. Even then, there are many variables to consider.
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Your "concern" is one of complete self-interest. You just clothe it by saying "patient care," which is what nurses and such always do. You're practicing medicine or performing procedures which you aren't qualified to do. And if you are qualified to do that stuff, then put your money where your mouth is and take the liability and responsibility. That's reasonable, isn't it?
The truth is that your lobbying is solely a cash-grab. You want to be viewed with the respect of a doctor and you want to make money on par with a doctor. You just don't want to take care of any sick patients or take call or be sued. Which is great. I'm sure that makes sense to someone who lives in Candyland.
That's why, if mid-levels are successful, then no physician should take care of their complications or accept referrals from them. Simple as that. Just let the mid-levels sit around "being concerned" about patients that they don't know what to do with. Let the hospitals absorb the liability, too, if they want to partner with the mid-levels. The thumb-sucking lawyers will have a field-day with it. Or, alternatively, you could buy into the idiotic "team" philosophy and let hospitals undercut you with mid-levels and take sick patients off their hands and accept the increased liability. That's up to each individual physician.
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Nurses will always be perceived as providing better care than doctors. Know why? It's simple. Nurses can always put things off on doctors, but never vice versa. It is simple for a nurse to portray any problem as a doctor's fault, and they do it. For example, this happens every day in every hospital: say a patient is pressing a call button for pain medications and the nurse doesn't come for an hour. I've actually seen this happen, the nurse will come and go "oh, sorry, there are no pain medications ordered." That's even if the guy does have the order and has been getting it. Then she'll go, "I'm going to get to the bottom of this and I'll straighten things out for you, dear. Meanwhile, can I do anything else for you?" And then she'll go and get the pain medication, come right back, give it to them, and say, "I got right on the phone and got the order, I'm sorry the pain medicine was not ordered. I apologize because it's not right for a patient to be uncomfortable and I'm going to make sure this doesn't happen again."
Meanwhile, the physician never knew what happened. All he knows is that the patient has his pain well-controlled the next day. The patient is thinking "thank God the nurse was keeping tabs on that doctor, the guy who sees me once or twice a day only. What an angel!"
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Not to rain on your parade, but there are times where I've seen a patient, told them I'm giving them something for pain, walk out of the room and start ordering the labs, x-rays/CT's, etc. and completely forget to write for pain meds. Not common, but it has happened more than once. And the nurse looks like a star when she points it out, and I feel like an idiot (and go to the patient's room and apologize).
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That's happened to me, too, but we work in the ED. He's not referring to that, and I did a year of IM to know about which he is talking. He's on target.
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deleted87716
But, you're both talking about bedside nurses (probably RNs) working under supervision. Everybody makes mistakes. That's not really the point. The real question is whether or not our country is ready to "dumb down" the independent practice of medicine by allowing individuals with considerably less training than physicians to practice unsupervised. There's little question that this would, at least in theory, improve access to some extent. But, at what cost?
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I realize the point he was trying to make.
DNP's who claim to spend more time with patients and cost less than physicians will be no different than physicians when the DNP's are no longer supervised. Things will change when they are liable for patients and pay malpractice premiums (currently paid by their sponsors now, they will charge higher rates when they have their own policies instead of riders beneath their sponsors), need to argue with HMO's for pre-approvals and reimbursements, and get more complicated cases than just the snifflers.
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deleted87716
Ideally, we need to work towards preventing it from getting to that point.
Support your PACs.
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I have a hard time reasoning how anyone thinks this is a good idea except the nurses. The nurse practitioners want to remove nurses when there is already a nursing shortage, just to make up for a physician shortage (if only their intentions were that altruistic).
I guess techs will lobby to use their online pharmacy education to administer meds to fill the nursing shortage. Paralegals will lobby to have their own practices. Parapros can be teachers. Pharmacy techs can fill meds, so why have pharmacist oversight?
I guess techs will lobby to use their online pharmacy education to administer meds to fill the nursing shortage. Paralegals will lobby to have their own practices. Parapros can be teachers. Pharmacy techs can fill meds, so why have pharmacist oversight?
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deleted87716
Fire and brimstone coming down from the sky! Rivers and seas boiling! Forty years of darkness! Earthquakes, volcanoes...The dead rising from the grave! Human sacrifice. Dogs and cats living together. Mass hysteria!
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I don't see why anyone would think this would improve access. There are problems in access because nobody wants to accept the low-reimbursing insurance plans or work in rural areas. What makes anyone think independent DNP's would suddenly want to work where physicians already don't want to?
I don't know about NPs, but as a PA, I would jump at the chance to be able to run a practice in a rural area. Very few docs want to but yet I would. Sadly, I can't because, as so many of you state, I'm not "qualified" or "educated enough" to. I doubt people with no healthcare access think that a PA is worse than nothing.
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deleted6669
It's actually pretty easy to land a rural gig as a pa either with on site supervision or with distant supervision. check out the nhsc website. it's full of rural/underserved pa jobs that will also pay off your loans.
I'm working in a rural e.d. as I type this and do so 1 weekend/mo as a per diem gig.
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I think the generally consensus is actually supportive of PA's compared to NP's??
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deleted87716
I agree. Hence, the "at least in theory" qualifier.
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Easy. It's a foot in the door. Nobody is saying that every NP or PA will suddenly want to move to Okiedoke, Montana (I made that place up). But there are some NPs or PAs, just like there are some physicians, who actually prefer rural areas. Again, not a majority, but some. They were planning on going there anyways. Throw in the fact that suddenly they get an expanded contract to practice as a "doctor" without the same liability a doctor faces (that goes on the hospital, probably) and you have eHarmony magic. Then, larger communities will follow suit over time. It's almost inevitable once you get the ball rolling.
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That's right, you aren't qualified or educated enough to run your own independent practice. If that was your career ambition, I guess you should have gone to medical school. We set licensing and supervision standards based on safety and training. The fact that a person in a rural area has poor access to care does not justify relaxing those standards. As others have mentioned, it is possible to get remote supervision, so if your heart is really set on moving to the boonies, I would look into that.
Thank you for your insight, Mr. Doctor Doctor, M.D.
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Good comeback?
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No problem, that's what I'm here for. And that's Dr. Doctor Doctor, MD to you.
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I would think you would need another person to help you carry all that ego.
Yes, the Physician Assistant!
Yes, the Physician Assistant!
Thank you! Someone finally realizes our purpose! hah
Just to shake this thread up a bit, I would like to post a link to a study conducted concerning Advanced Practice Nursing care vs Physician care in the UK. I'm not surprised but I'm sure most of you will make excuses for the results.
http://www.bmj.com/cgi/content/full/324/7341/819
What you call "excuses," the rest of us call "evidence-based medicine." I've been doing a short lit review as part of a website I'm trying to put up regarding the falsehoods propagated by the DNP proponents. All of these studies are short (most are on the order of 6 months), study a very small subset of medical conditions encountered by primary care, and rely heavily on self-reported surveys. There are notable disparities in patient # and time per clinic visit.
And in reference to your BMJ citation, I briefly looked over it and start to wonder; if you put 11 flawed studies together, do you get a valid one?
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