UC Davis midlevels over students?

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[throwaway1939]

get out in the real world. Midlevels are terrible without direction. I see the most insane **** coming from midlevels in all fields of medicine. Just this week, saw a stent thrombosis because an outpatient NP at an ENT clinic stopped a guy's plavix for his fresh stent due to some nosebleeding.

The level of ****ing up is much higher on midlevels than with bad doctors. For example, PO vancomycin for cellulitis. I've seen more than 1 case of this.

As long as these people exist, MDs will have to pick up the garbage they leave behind.

 

[762513]

get out in the real world. Midlevels are terrible without direction. I see the most insane **** coming from midlevels in all fields of medicine. Just this week, saw a stent thrombosis because an outpatient NP at an ENT clinic stopped a guy's plavix for his fresh stent due to some nosebleeding.

The level of ****ing up is much higher on midlevels than with bad doctors. For example, PO vancomycin for cellulitis. I've seen more than 1 case of this.

As long as these people exist, MDs will have to pick up the garbage they leave behind.

The 302,587 instance of the post “midlevels are all trash because I saw a midlevel do this one time” (yawnnnnn)

 

[DO2015CA]

The 302,587 instance of the post “midlevels are all trash because I saw a midlevel do this one time” (yawnnnnn)

302k incidents is quite a bit. How many times until it’s nolonger anecdotal evidence?

 

[762513]

302k incidents is quite a bit. How many times until it’s nolonger anecdotal evidence?

Double blind RTC with a big enough cross country sample. Or your opinions don’t matter. Or so I’m told by literally everyone on this board.

 

[UnoMas]

Double blind RTC with a big enough cross country sample. Or your opinions don’t matter. Or so I’m told by literally everyone on this board.

You also have been told time and time again the burden of proof is on you, physician training is the gold standard, now go get started on that RCT, lots of work to do

 

[VA Hopeful Dr]

get out in the real world. Midlevels are terrible without direction. I see the most insane **** coming from midlevels in all fields of medicine. Just this week, saw a stent thrombosis because an outpatient NP at an ENT clinic stopped a guy's plavix for his fresh stent due to some nosebleeding.

The level of ****ing up is much higher on midlevels than with bad doctors. For example, PO vancomycin for cellulitis. I've seen more than 1 case of this.

As long as these people exist, MDs will have to pick up the garbage they leave behind.

That's called job security.

I love stuff like that. Whenever someone comes to me because they were unhappy with the care they got from a mid-level, that's a win for physician care.

 

[762513]

You also have been told time and time again the burden of proof is on you, physician training is the gold standard, now go get started on that RCT, lots of work to do

Except it’s not, since NP’s are independent in half the country. If you think they shouldn’t be, instead of saying “I saw a dumb midlevel once” I suggest you start looking at IRB’s to contact.

 

[UnoMas]

Except it’s not, since NP’s are independent in half the country. If you think they shouldn’t be, instead of saying “I saw a dumb midlevel once” I suggest you start looking at IRB’s to contact.

and physicians are indepedent since the dawn of time and everywhere on earth
this aint hard, grab a random person on the street and ask them which one is the gold standard, real simple.
alright I don't want to go back and forth with you as most of the time, I feel like arguing with a child

 

[762513]

and physicians are indepedent since the dawn of time and everywhere on earth
this aint hard, grab a random person on the street and ask them which one is the gold standard, real simple.
alright I don't want to go back and forth with you as most of the time, I feel like arguing with a child

So let’s use a sample of random people off the street instead of a well constructed research study... and you’re calling me the child? I challenge you to put your money where your mouth is and start a research study of your own.

 

[UnoMas]

So let’s use a sample of random people off the street instead of a well constructed research study... and you’re calling me the child? I challenge you to put your money where your mouth is and start a research study of your own.

dont need to cause my training is the gold standard (see like arguing with a child, it's a circle)

 

[762513]

dont need to cause my training is the gold standard (see like arguing with a child, it's a circle)

Whether you agree with NP independence or not the NP lobby is and has been winning. So do something to protect your profession like create your own study... unless you think complaining on every SDN post about a dumb midlevel you saw the other day is an effective strategy against the nursing lobby, cuz if so then I have a bridge to sell you too.

 

[DO2015CA]

dont need to cause my training is the gold standard (see like arguing with a child, it's a circle)

Ignore function and move on with life. Lol. There are some people that just like being argumentative

 

[762513]

Ignore function and move on with life. Lol. There are some people that just like being argumentative

I have no plans on ever being independent, but if I did, I would absolutely love the fact many of you guys are all talk and very little action.

 

[Chibucks15]

I have no plans on ever being independent, but if I did, I would absolutely love the fact many of you guys are all talk and very little action.

I would go ahead and assume you are too Mr. internet tough guy. Man I'm astonished you're still on here haha

 

[762513]

I would go ahead and assume you are too Mr. internet tough guy. Man I'm astonished you're still on here haha

I’m trying to develop a thick skin. This is good practice.

 

[Aerus]

Except it’s not, since NP’s are independent in half the country. If you think they shouldn’t be, instead of saying “I saw a dumb midlevel once” I suggest you start looking at IRB’s to contact.

The burden of proof IS on the NP side. It makes sense that with less education, you know less. Now the counterargument against this should be proven. The only studies out there are done with supervised NPs having similar outcomes as physicians. This would not be applicable to independent NP practice and also ignores the fact that NPs see less complex cases, yet the AANP as well as many NPs always say that they are equivalent or better than physicians.

 

[physiciansforpatients]

I'm very clearly mocking you because this thread has gone off the rails in a ridiculous way.

So riddle me this then: why are you worried about pharmacists getting provider status?

Pharmacists, while very well trained and have an immense knowledge of medicines, do not complete a residency, or study the things required to be a medical student. For this reason alone they should not have provider status.

 

[physiciansforpatients]

The burden of proof IS on the NP side. It makes sense that with less education, you know less. Now the counterargument against this should be proven. The only studies out there are done with supervised NPs having similar outcomes as physicians. This would not be applicable to independent NP practice and also ignores the fact that NPs see less complex cases, yet the AANP as well as many NPs always say that they are equivalent or better than physicians.

Sorry for double post, but most of the studies that NPs tout are terribly biased, or have very poor rigor.

 

[762513]

The burden of proof IS on the NP side. It makes sense that with less education, you know less. Now the counterargument against this should be proven. The only studies out there are done with supervised NPs having similar outcomes as physicians. This would not be applicable to independent NP practice and also ignores the fact that NPs see less complex cases, yet the AANP as well as many NPs always say that they are equivalent or better than physicians.

You’re right, that should be how it works, but clearly the NP lobby is winning regardless of the way it *should* work. If you guys want change, start making prospective RCT comparing outcomes in states with NP independence.

 

[nimbus]

Pharmacists, while very well trained and have an immense knowledge of medicines, do not complete a residency, or study the things required to be a medical student. For this reason alone they should not have provider status.

But many pharmacists do complete residencies.

 

[AnatomyGrey12]

Double blind RTC with a big enough cross country sample. Or your opinions don’t matter. Or so I’m told by literally everyone on this board.

Get started then. It's on you to do it.

Except it’s not, since NP’s are independent in half the country.

But it is.

I challenge you to put your money where your mouth is and start a research study of your own.

Cool, and we challenge you to prove your claims. Just because the AANP is good at lobbying doesn't meant that it gets out of proving its claims.

There is a large chunk of the current batch of medical students, including myself, who will never hire an NP. I personally won't ever even interview one, and many of my classmates feel the same. Eventually this growing cohort of medical students will become significantly large enough that lots of NPs will be glossed over as we seek to hire PAs.

 

[DO2015CA]

Get started then. It's on you to do it.



But it is.



Cool, and we challenge you to prove your claims. Just because the AANP is good at lobbying doesn't meant that it gets out of proving its claims.

There is a large chunk of the current batch of medical students, including myself, who will never hire an NP. I personally won't ever even interview one, and many of my classmates feel the same. Eventually this growing cohort of medical students will become significantly large enough that lots of NPs will be glossed over as we seek to hire PAs.

I wouldn’t want to hire either but if I had to then yes PAs is where I’d go

 

[AnatomyGrey12]

I wouldn’t want to hire either but if I had to then yes PAs is where I’d go

Anecdotally I know far more NPs who are on the "I'm just as good" train than PAs. Most PAs/students I know will straight up tell you they went PA because they didn't want the responsibility and are choosing to work under the doctor because the lifestyle is better and they can still practice medicine but with a huge safety net. This isn't even getting into the fact that their education pathway is very standardized and ran under the medical model.

 

[UnoMas]

Get started then. It's on you to do it.



But it is.



Cool, and we challenge you to prove your claims. Just because the AANP is good at lobbying doesn't meant that it gets out of proving its claims.

There is a large chunk of the current batch of medical students, including myself, who will never hire an NP. I personally won't ever even interview one, and many of my classmates feel the same. Eventually this growing cohort of medical students will become significantly large enough that lots of NPs will be glossed over as we seek to hire PAs.

Yep. The current state of affair was handed over to us from the old timers mostly due to either greed or apathy, I want to believe it’s mostly apathy. The current generation of medical students and younger physicians are very ‘woke.’ Midlevels should expect pushback from the physician side from here on out. Wont train them, prefer not to work with them, PA/AA over NP/CRNA for hiring


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[762513]

Get started then. It's on you to do it.



But it is.



Cool, and we challenge you to prove your claims. Just because the AANP is good at lobbying doesn't meant that it gets out of proving its claims.

There is a large chunk of the current batch of medical students, including myself, who will never hire an NP. I personally won't ever even interview one, and many of my classmates feel the same. Eventually this growing cohort of medical students will become significantly large enough that lots of NPs will be glossed over as we seek to hire PAs.

I never claimed NP=MD in this post or any other that I ever have or will ever post. I have no claim to prove whatsoever. When you guys are actually physicians is when you will choose whether to hire a midlevel or not. I’m sure even the big talkers in here someday will hire one.

 

[DO2015CA]

Anecdotally I know far more NPs who are on the "I'm just as good" train than PAs. Most PAs/students I know will straight up tell you they went PA because they didn't want the responsibility and are choosing to work under the doctor because the lifestyle is better and they can still practice medicine but with a huge safety net. This isn't even getting into the fact that their education pathway is very standardized and ran under the medical model.

For me it has nothing to do with the ego. I have a hard time hiring a mid level to take on their liability. Other physicians have their own licenses therefore if they screw up they get hammered. And if we must employee them in the future then I want the one who is regulated by the same organization as me. Not the nursing leadership.

 

[762513]

For me it has nothing to do with the ego. I have a hard time hiring a mid level to take on their liability. Other physicians have their own licenses therefore if they screw up they get hammered. And if we must employee them in the future then I want the one who is regulated by the same organization as me. Not the nursing leadership.

That’s a very reasonable position.

 

[AnatomyGrey12]

I never claimed NP=MD in this post or any other that I ever have or will ever post. I have no claim to prove whatsoever.

Are you intentionally being obtuse? "you" means the NPs in general. That is pretty obvious.

When you guys are actually physicians is when you will choose whether to hire a midlevel or not. I’m sure even the big talkers in here someday will hire one.

If you genuinely think this then you are hoping for a fantasy... If I ever hire an NP I'll give you every dime of my future salary.

For me it has nothing to do with the ego. I have a hard time hiring a mid level to take on their liability. Other physicians have their own licenses therefore if they screw up they get hammered. And if we must employee them in the future then I want the one who is regulated by the same organization as me. Not the nursing leadership.

True. I was looking at it from the perspective of the field I hope to go into. In that field if you don't have a PA working for you then your productivity drops precipitously. Someone to do the grunt/scut work.

 

[DO2015CA]

Are you intentionally being obtuse? "you" means the NPs in general. That is pretty obvious.



If you genuinely think this then you are hoping for a fantasy... If I ever hire an NP I'll give you every dime of my future salary.



True. I was looking at it from the perspective of the field I hope to go into. In that field if you don't have a PA working for you then your productivity drops precipitously. Someone to do the grunt/scut work.

Ya it all depends. From my experience, I thought midlevels were excellently used in ortho. They helped tremendously in the OR and closing. Plus in the clinic they saw post op non-complicated cases to say “yep it’s not infected” or they did some injections.

There are some specialties that they can be utilized effectively. Our problem is that they are seeing the undifferentiated or medically complicated patient without much oversight because of the laziness of our preceding generation.

 

[762513]

Are you intentionally being obtuse? "you" means the NPs in general. That is pretty obvious.



If you genuinely think this then you are hoping for a fantasy... If I ever hire an NP I'll give you every dime of my future salary.



True. I was looking at it from the perspective of the field I hope to go into. In that field if you don't have a PA working for you then your productivity drops precipitously. Someone to do the grunt/scut work.

10 years from now when you realize supervised midlevel are safe and can significantly extend your practice as well as improve your bottom line I’m sure you’ll be complaining about those dumb midlevels all the way to the bank.

 

[Chibucks15]

10 years from now when you realize supervised midlevel are safe and can significantly extend your practice as well as improve you’re bottom line I’m sure you’ll be complaining about those dumb midlevels all the way to the bank.

the NP lobby is explicitly lobbying for the elimination of supervision...

 

[762513]

the NP lobby is explicitly lobbying for the elimination of supervision...

Even if NP care was independent in all 50 states there are many roles that will never be, cards, plum/crit, surgery, internal med, ID, the list goes on. It doesn’t change my argument.

 

[AnatomyGrey12]

10 years from now when you realize supervised midlevel are safe and can significantly extend your practice as well as improve your bottom line I’m sure you’ll be complaining about those dumb midlevels all the way to the bank.

Read moar better. I will most likely hire a mid-level, it just won't ever be an NP.

 

[Chibucks15]

Even if NP care was independent in all 50 states there are many roles that will never be, cards, plum/crit, surgery, internal med, ID, the list goes on. It doesn’t change my argument.

Yes it does? Nobody is talking about supervised work...anyone can be okay if they're supervised. The whole point of this is, like always, that NP independence is a dangerous game with no actual data to back it up. In addition, the education requirements level is much lower than PAs, hence the bias towards them. Honestly the more they push for full independence, the more it will hurt in the long run. Right now the lobby wants NPs to have all the freedom but none of the liability. Therein lies the problem

 

[762513]

Read moar better. I will most likely hire a mid-level, it just won't ever be an NP.

If you don’t hire the best candidate for the position, you’d be foolish.

 

[762513]

Yes it does? Nobody is talking about supervised work...anyone can be okay if they're supervised. The whole point of this is, like always, that NP independence is a dangerous game with no actual data to back it up. In addition, the education requirements level is much lower than PAs, hence the bias towards them. Honestly the more they push for full independence, the more it will hurt in the long run. Right now the lobby wants NPs to have all the freedom but none of the liability. Therein lies the problem

Oh I think people definitely are talking about both supervised and unsupervised NP's. You have an NP like me with no plans on independent practice at any time in their career who has a great relationship with the attending physicians yet some of the current medical students are pledging to never take an NP student for their entire careers? So don't tell me many of you don't have a problem with all NP's. You guys very clearly do.

 

[AnatomyGrey12]

If you don’t hire the best candidate for the position, you’d be foolish.

Agreed, and I will never view an NP as the best candidate. Same concept as a PD at MGH not ever viewing me as the best candidate simply by me being a DO.

yet some of the current medical students are pledging to never take an NP student for their entire careers? So don't tell me many of you don't have a problem with all NP's. You guys very clearly do.

Fix the educational model. Make the education standardized, stop allowing people to get a degree with 500 hours of clinical shadowing, and stop your leadership group from attempting to take a metaphorical crap on physicians in public every chance they get. Until then, nope, I won't ever hire an NP.

 

[Chibucks15]

Oh I think people definitely are talking about both supervised and unsupervised NP's. You have an NP like me with no plans on independent practice at any time in their career who has a great relationship with the attending physicians yet some of the current medical students are pledging to never take an NP student for their entire careers? So don't tell me many of you don't have a problem with all NP's. You guys very clearly do.

I've said nothing about taking or not taking an NP. I've brought up valid concerns about the education rigor and the issues associated with full independence. I have done so calmly and never attacked. You have yet to actually refute literally any of my issues I have brought up. This is what you do every time.

There are great NPs who know their roles and add value, never denied that and people have brought that up. There are many vocal, militant ones (like the lobby) who throw tantrums wanting full independence without the responsibility or education. The curriculum are mostly a joke, especially compared to PAs, much less to actual doctors. They are literally just trying to find an easy way to be a doctor.

 

[762513]

I've said nothing about taking or not taking an NP. I've brought up valid concerns about the education rigor and the issues associated with full independence. I have done so calmly and never attacked. You have yet to actually refute literally any of my issues I have brought up. This is what you do every time.

There are great NPs who know their roles and add value, never denied that and people have brought that up. There are many vocal, militant ones (like the lobby) who throw tantrums wanting full independence without the responsibility or education. The curriculum are mostly a joke, especially compared to PAs, much less to actual doctors. They are literally just trying to find an easy way to be a doctor.

I've never argued with you because I don't need to. I've stated my opinion that NP education needs standardization and increased rigor and clinical hours about 2 dozen times on these forums. However I'll do it again just so you can remember; NP education needs standardization, increased rigor, and more clinical hours. Why would I need to debate you on something I agree with you on?

I also wasn't replying to you in particular, more to the dozen or so medical students who state they will never hire an NP or train one. They will most likely do both, once they realize that many NP's are superior to their PA peers, and you evaluate candidates one at a time, not based on where they received their training and the initials following their names.

 

[AnatomyGrey12]

They will most likely do both, once they realize that many NP's are superior to their PA peers, and you evaluate candidates one at a time, not based on where they received their training and the initials following their names.

You are seriously delusional.

NP education needs standardization, increased rigor, and more clinical hours.

Good. Until that happens no I will never hire or train one, and there are more and more medical students who feel the same.

 

[762513]

You are seriously delusional.



Good. Until that happens no I will never hire or train one, and there are more and more medical students who feel the same.

Ok, I guess the thousands of physicians who employ NP's are all fools and you have it all figured out in med school, Good on ya, mate. 😉

 

[AnatomyGrey12]

Ok, I guess the thousands of physicians who employ NP's are all fools and you have it all figured out in med school, Good on ya, mate. 😉

You can throw as many tantrums as you want. Still not going to hire one lol

 

[762513]

Agreed, and I will never view an NP as the best candidate. Same concept as a PD at MGH not ever viewing me as the best candidate simply by me being a DO.



Fix the educational model. Make the education standardized, stop allowing people to get a degree with 500 hours of clinical shadowing, and stop your leadership group from attempting to take a metaphorical crap on physicians in public every chance they get. Until then, nope, I won't ever hire an NP.

Sometimes an NP is absolutely the best candidate, usually for a hundred reasons or more. You'll realize that as you get out into practice.

 

[762513]

You can throw as many tantrums as you want. Still not going to hire one lol

One disgruntled med student isn't going to change the hiring practice of the entire healthcare sector lol. I'm just letting you know you're wrong. Have a good day my dude.

 

[AnatomyGrey12]

Sometimes an NP is absolutely the best candidate, usually for a hundred reasons or more. You'll realize that as you get out into practice.

Until your training is standardized I, and lots of medical students i.e future doctors, will never view one as the best candidate. Get used to it. If you don't like it then lobby your leadership to change.

One disgruntled med student isn't going to change the hiring practice of the entire healthcare sector lol. I'm just letting you know you're wrong. Have a good day my dude.

One? No. A couple thousand? Absolutely. The new generation of physicians is not happy with where things are.

Your leadership organization started this. It is the one who started the us vs. them mentality, we are just starting to actually fight back.

 

[762513]

As a former hospital administrator there was never a single instance where we viewed an np as a better candidate. We hired them to pocket more money and bill the same, often more.

It’s literally the only reason they get hired: cheap labor— don’t be so naive.

lol

Sometimes I forget I’m posting in the land of disgruntled med students. Enjoy your echo chamber. Happy holidays everyone.

 

[Chibucks15]

lol

Sometimes I forget I’m posting in the land of disgruntled med students. Enjoy your echo chamber. Happy holidays everyone.

if you actually ever provided a shred of actual data backing up your blanket claims maybe we could actually get somewhere

 

[LutGholein]

It really is a shame that medical students are being pushed aside(if this is the case). We need the kind of lobbying power that other professions aren’t afraid to bring to the frontline. I hate that we need to politicize our profession— to qualify our value.

 

[jw3600]

But many pharmacists do complete residencies.

And some nurses do “fellowships.” LOL.
Words barely have meaning anymore.