We Choose NPs

[Alvarez13]

AANP TV Commercial, 'We Choose NPs'

The American Association of Nurse Practitioners showcases two real patients who both choose to see NPs. David and Molly both think life is complicated but choosing a healthcare provider doesn't have to be, which is why they chose nurse practitioners who are accessible and really listen. They...

www.ispot.tv

We choose NPs...because they paid us too.

---

Members don't see this ad.

 

[Listen2Savage]

I've seen this on TV 3 or 4 times

Each time I'm like

 

[RustedFox]

 

[Fox800]

We choose idiots.

 

[Alvarez13]

Not only are they as smart as us, but they also eat the hearts of RNs or something to gain their power.

More like brain of a guaiac stool card.

 

[RustedFox]

My open challenge to the MLP crowd remains:
Pass USMLE Step 1/2/3, and I will give you the title of "Doctor".
But they don't want to do that: 'cause like, studying is soooo hard and stuff.

 

[Fox800]

My open challenge to the MLP crowd remains:
Pass USMLE Step 1/2/3, and I will give you the title of "Doctor".
But they don't want to do that: 'cause like, studying is soooo hard and stuff.

All that yucky book studying gets in the way of working full time (doing online assignments while patient care takes a backseat). They just need a quick, no-frills online program so they can pursue their "pa$sion for dermatology".

 

[RustedFox]

All that yucky book studying gets in the way of working full time (doing online assignments while patient care takes a backseat). They just need a quick, no-frills online program so they can pursue their "pa$sion for dermatology".

White magic is nice and easy.
Science is hard.

Patient sent to me for admission last night by Jenny McJennyson, NP-ABC123.
67 year old female "cellulitis of both legs unresponsive to antibiotics"
This poor woman was given augmentin, bactrim, and doxy with no improvement in her bilateral tib/fib cellulitis for a month. Now Jenny McJennyson sent the patient to me for admission and "IV antibiotics, because they're stronger."

Made the diagnosis in 5 seconds.
Stasis dermatitis with hemosiderin deposition. No cellulitis, whatsoever.
Patient is insistent that she was sent by "Doctor Jenny" for admission and IV antibiotics.
I wanted to punch Dr. Jenny in the mouth.


This was after Mackenzie McNurseasaurus sent me a patient from urgent care for HTN with a pressure of 16X/8X, because that's really high for him and I told him that he doesn't want to have a stroke so he needs to go RIGHT NOW." (SHE ACTUALLY FREAKING SAID THIS!)
Mackenzie actually picked up the phone to call me and let me know of this urgent referral!
I actually had her Google search the guidelines while I was on the phone with her.
Crickets.
I wanted to reach thru the phone and punch Mackenzie in the mouth.

 

[Fox800]

White magic is nice and easy.
Science is hard.

Patient sent to me for admission last night by Jenny McJennyson, NP-ABC123.
67 year old female "cellulitis of both legs unresponsive to antibiotics"
This poor woman was given augmentin, bactrim, and doxy with no improvement in her bilateral tib/fib cellulitis for a month. Now Jenny McJennyson sent the patient to me for admission and "IV antibiotics, because they're stronger."

Made the diagnosis in 5 seconds.
Stasis dermatitis with hemosiderin deposition. No cellulitis, whatsoever.
Patient is insistent that she was sent by "Doctor Jenny" for admission and IV antibiotics.
I wanted to punch Dr. Jenny in the mouth.


This was after Mackenzie McNurseasaurus sent me a patient from urgent care for HTN with a pressure of 16X/8X, because that's really high for him and I told him that he doesn't want to have a stroke so he needs to go RIGHT NOW." (SHE ACTUALLY FREAKING SAID THIS!)
Mackenzie actually picked up the phone to call me and let me know of this urgent referral!
I actually had her Google search the guidelines while I was on the phone with her.
Crickets.
I wanted to reach thru the phone and punch Mackenzie in the mouth.

Does J McJ have a supervising collaborating physician liability sponge in FL?

 

[RustedFox]

Does J McJ have a supervising collaborating physician liability sponge in FL?

Dunno. But when I told the patient that Jenny McJennyson wasn't a physician, and asked her the name of the supervising physician for the nurse practitioner, the patient looked at me like I had a penis on my forehead.

The muggles... so stupid.

 

[thegenius]

This was after Mackenzie McNurseasaurus sent me a patient from urgent care for HTN with a pressure of 16X/8X, because that's really high for him and I told him that he doesn't want to have a stroke so he needs to go RIGHT NOW." (SHE ACTUALLY FREAKING SAID THIS!)
Mackenzie actually picked up the phone to call me and let me know of this urgent referral!
I actually had her Google search the guidelines while I was on the phone with her.
Crickets.
I wanted to reach thru the phone and punch Mackenzie in the mouth.

Crickets? LOL Huh?

 

[Listen2Savage]

Jenny McJennyson, NP-ABC123

lol

Mackenzie McNurseasaurus

double lol

like I had a penis on my forehead.

Damn, 3x lol

 

[doctalaughs]

White magic is nice and easy.
Science is hard.

Patient sent to me for admission last night by Jenny McJennyson, NP-ABC123.
67 year old female "cellulitis of both legs unresponsive to antibiotics"
This poor woman was given augmentin, bactrim, and doxy with no improvement in her bilateral tib/fib cellulitis for a month. Now Jenny McJennyson sent the patient to me for admission and "IV antibiotics, because they're stronger."

Made the diagnosis in 5 seconds.
Stasis dermatitis with hemosiderin deposition. No cellulitis, whatsoever.
Patient is insistent that she was sent by "Doctor Jenny" for admission and IV antibiotics.
I wanted to punch Dr. Jenny in the mouth.


This was after Mackenzie McNurseasaurus sent me a patient from urgent care for HTN with a pressure of 16X/8X, because that's really high for him and I told him that he doesn't want to have a stroke so he needs to go RIGHT NOW." (SHE ACTUALLY FREAKING SAID THIS!)
Mackenzie actually picked up the phone to call me and let me know of this urgent referral!
I actually had her Google search the guidelines while I was on the phone with her.
Crickets.
I wanted to reach thru the phone and punch Mackenzie in the mouth.

As a dermatologist I get this stasis Derm referral at least 3 times a week from an NP or PA (cellulitis or rash on legs unresponsive to antibiotics). It used to piss me off, but now it happens so often I just shrug my shoulders and take the easy money.

God forbid we have actual doctors doing primary care I’d be the first to admit we’d probably need less specialists. No one seems to realize or care in our f-uped system — for every undertrained medical provider you put out there the system “savings” are erased 10-fold by the increased referrals, testing, procedures etc.

 

[namethatsmell]

God forbid we have actual doctors doing primary care I’d be the first to admit we’d probably need less specialists. No one seems to realize or care in our f-uped system — for every undertrained medical provider you put out there the system “savings” are erased 10-fold by the increased referrals, testing, procedures etc.

I once had an NP send in a patient from an urgent care with concern of an infected bite from a large animal.

Good news for the patient was that not only was his skin unbroken and intact...but the animal didn't even penetrate his clothes.

That was the first time my head exploded and I died.

Putting a midlevel in a remotely or minimally supervised position that requires the consideration of a wide differential is the exact opposite of how we should be utilizing midlevels.

 

[TooMuchResearch]

I once had an NP send in a patient from an urgent care with concern of an infected bite from a large animal.

Good news for the patient was that not only was his skin unbroken and intact...but the animal didn't even penetrate his clothes.

That was the first time my head exploded and I died.

Putting a midlevel in a remotely or minimally supervised position that requires the consideration of a wide differential is the exact opposite of how we should be utilizing midlevels.

Even some of our experienced PAs will CT PE run febrile, tachycardic patients with pneumonia on CXR because of pleuritic chest pain and hypoxia (unless I get there in time to stop it).

 

[Alvarez13]

Even some of our experienced PAs will CT PE run febrile, tachycardic patients with pneumonia on CXR because of pleuritic chest pain and hypoxia (unless I get there in time to stop it).

Mine order the dimer with the CTPE. Ugh...

 

[Tenk]

Sometimes I think the NP lobby is actually funded by malpractice attorneys. They are probably all frothing at mouth over crap like this.

 

[RustedFox]

Mine order the dimer with the CTPE. Ugh...

I had a dream once where I did this because I wanted to "guess the dimer".
Then I woke up and realized how stupid and pointless that would be.

 

[RustedFox]

All that yucky book studying gets in the way of working full time (doing online assignments while patient care takes a backseat). They just need a quick, no-frills online program so they can pursue their "pa$sion for dermatology".

They do this **** all the time.
I seriously had to go to charge RN twice last night to get Kylee to do her job instead of plunking her wide-ass in front of a PC and watching a video for her "FNP" classes.

 

[GonnaBeADoc2222]

White magic is nice and easy.
Science is hard.

Patient sent to me for admission last night by Jenny McJennyson, NP-ABC123.
67 year old female "cellulitis of both legs unresponsive to antibiotics"
This poor woman was given augmentin, bactrim, and doxy with no improvement in her bilateral tib/fib cellulitis for a month. Now Jenny McJennyson sent the patient to me for admission and "IV antibiotics, because they're stronger."

Made the diagnosis in 5 seconds.
Stasis dermatitis with hemosiderin deposition. No cellulitis, whatsoever.
Patient is insistent that she was sent by "Doctor Jenny" for admission and IV antibiotics.
I wanted to punch Dr. Jenny in the mouth.


This was after Mackenzie McNurseasaurus sent me a patient from urgent care for HTN with a pressure of 16X/8X, because that's really high for him and I told him that he doesn't want to have a stroke so he needs to go RIGHT NOW." (SHE ACTUALLY FREAKING SAID THIS!)
Mackenzie actually picked up the phone to call me and let me know of this urgent referral!
I actually had her Google search the guidelines while I was on the phone with her.
Crickets.
I wanted to reach thru the phone and punch Mackenzie in the mouth.

 

[RustedFox]

Putting a midlevel in a remotely or minimally supervised position that requires the consideration of a wide differential is the exact opposite of how we should be utilizing midlevels.

Precisely. They should be the small hawk that alights on our gloved hands and takes orders.

We recently had a BAD case that I am going to write up as an M&M presentation for our group.
Here's the REAL pisser:
It was an MLP patient that even after he or she asked me what to do.... they failed to do 3/5 of the items that I instructed them to do.
It was treating hyperkalemia for the record... I told them to order the EKG, which sat on his desk for an hour or so with T-waves taller than the QRS, which was a touch wide. No D50 was given, but the kid got the insulin. Also got lactulose and NOT kayexelate.

The chart is a complete abortion, too. No MDM. No discussion of "x-and-y" with RustedFox. Just "kid is sick, admit. Lulz." Thankfully, a HEART score was included in the chart, seeing as how this was a 23 year old male with no complaint of chest pain or anginal equivalent.

What's even worse to consider is that you have an ER MLP admitting to an IM MLP, and they're both freaking dangerous.

Did I mention that I had to reschedule my deposition (was supposed to be Friday) for the MLP case that I never saw for the guy that came back dead the next day?

RustedFox's Rules:

If you're an MLP, you either do as you're told, or you own your own nonsense and I'm not involved at all in terms of responsibility.
I hope the latter never happens, for the patient's sake.

Before any of you MLPs pipe up and give anecdata about "how the doc was wrong"... that's fine. He can eat that mistake. I had to eat mine. The difference is; I have to eat yours, too. Shouldn't be that way unless you do what I tell you to do.

SPECIAL ATTENTION TO MILITARY MLPS: Listen... I never want to hear "that's how we did it in the Army/Navy/AF/Whatever". That's great. You can take care of healthy young people, aged 18-36. No, you can't do that to the 78 year old female with a CABG scar, DM, and a-fib/RVR. Now, do as you're told and pay attention; you might learn something before you kill a civilian.

 

[GonnaBeADoc2222]

Jealousy (didn't have the stuff for med school, we make way more money for perceived "same work"), and general stupidity have combined to make midlevels such as these.

 

[TooMuchResearch]

Jealousy (didn't have the stuff for med school, we make way more money for perceived "same work"), and general stupidity have combined to make midlevels such as these.

MLP that works elsewhere tells me they do the exact same job as the physicians and the physicians see the MLPs' sick patients "only to take credit for it."

 

[Listen2Savage]

MLP that works elsewhere tells me they do the exact same job as the physicians and the physicians see the MLPs' sick patients "only to take credit for it."

Is this MLP chaperone clause built into most contracts nowadays?

I've heard if you are the "supervising doc" and you aren't even signing their charts you can still be liable, I get that.

My question is, with the feared residency expansion (HCA mostly down here in FL), shouldn't you guys be combating the perceived softening of reimbursement from the MLP angle as well? Like ey, sign your own bs chart.

 

[Listen2Savage]

Also do you guys ever call an audible mid-shift and say bro... I'm not signing any more of your charts, find someone else.

 

[thegenius]

Patient sent to me for admission last night by Jenny McJennyson, NP-123ABC.

This was after Mackenzie McNurseasaurus sent me a patient from urgent care for HTN with a pressure of 16X/8X, because

I think Mackenzie is hotter than Jenny. But just by a little.

 

[TooMuchResearch]

Also do you guys ever call an audible mid-shift and say bro... I'm not signing any more of your charts, find someone else.

We (my group) at least have some ability to train our MLPs and guide management, assuming they tell us about the patients before too much is done.

We don't sign their charts but write our own supervisory notes. No, there really isn't the ability to have someone else do it, unless I'm too busy in which case the MLP would have probably already gone to someone else.

 

[RustedFox]

Also do you guys ever call an audible mid-shift and say bro... I'm not signing any more of your charts, find someone else.

Can't do that when you're the only doc on the floor.

 

[RustedFox]

I think Mackenzie is hotter than Jenny. But just by a little.

In my mind's eye, they're both overweight.

 

[MechEDoc]

What's even worse to consider is that you have an ER MLP admitting to an IM MLP, and they're both freaking dangerous.

I feel like I am calling fewer and fewer consults due to this. I call cardiology and they send down an noctor that knows less than me, I call ortho and they send noctor, etc. etc.

WTF?

 

[thegenius]

In my mind's eye, they're both overweight.

The only Mackenzie I know is actually quite pretty, so maybe I’m biased or something. Like hindsight bias? Recency bias? There has to be a bias named for this.

 

[thegenius]

I feel like I am calling fewer and fewer consults due to this. I call cardiology and they send down an noctor that knows less than me, I call ortho and they send noctor, etc. etc.

WTF?

It's like the walking dead...zombies everywhere. Instead its nurse practitioners everywhere. In all disciplines.

Back in the day, before I was alive, we valued things like history, physical exam, pattern recognition, and a variety of other time-honored techniques to uncover pathology. Doctors would spend 45 minutes with a patient to really try to figure out why they had their symptoms.

Nowadays, we test. That's basically all that we do. And we prescribe pills. Test and Pills. Test'n'Pills. That should be the name of a clinic. If the test says "Positive - You Have Strep Throat" any tom dick and harry can look in a book and see what to do with a positive strep test. We don't use Centor criteria anymore...we don't spend time with patients.

Hence the belief that we don't need doctors in as high of frequency as we used to. Because just order the test and look up in a book what to do.
In come nurses! Mid levels! PAs NPs RNs, mid levels, APCs, and a variety of other acronyms that none of us really understand. They all have 1/4 the training we do, yet make 1/2 our salary.

Who wants to join my nationwide chain of Test'n'Pills clinics?

 

[TooMuchResearch]

It's like the walking dead...zombies everywhere. Instead its nurse practitioners everywhere. In all disciplines.

Back in the day, before I was alive, we valued things like history, physical exam, pattern recognition, and a variety of other time-honored techniques to uncover pathology. Doctors would spend 45 minutes with a patient to really try to figure out why they had their symptoms.

Nowadays, we test. That's basically all that we do. And we prescribe pills. Test and Pills. Test'n'Pills. That should be the name of a clinic. If the test says "Positive - You Have Strep Throat" any tom dick and harry can look in a book and see what to do with a positive strep test. We don't use Centor criteria anymore...we don't spend time with patients.

Hence the belief that we don't need doctors in as high of frequency as we used to. Because just order the test and look up in a book what to do.
In come nurses! Mid levels! PAs NPs RNs, mid levels, APCs, and a variety of other acronyms that none of us really understand. They all have 1/4 the training we do, yet make 1/2 our salary.

Who wants to join my nationwide chain of Test'n'Pills clinics?

What's the buy in?

 

[jw3600]

It's like the walking dead...zombies everywhere. Instead its nurse practitioners everywhere. In all disciplines.

Back in the day, before I was alive, we valued things like history, physical exam, pattern recognition, and a variety of other time-honored techniques to uncover pathology. Doctors would spend 45 minutes with a patient to really try to figure out why they had their symptoms.

Nowadays, we test. That's basically all that we do. And we prescribe pills. Test and Pills. Test'n'Pills. That should be the name of a clinic. If the test says "Positive - You Have Strep Throat" any tom dick and harry can look in a book and see what to do with a positive strep test. We don't use Centor criteria anymore...we don't spend time with patients.

Hence the belief that we don't need doctors in as high of frequency as we used to. Because just order the test and look up in a book what to do.
In come nurses! Mid levels! PAs NPs RNs, mid levels, APCs, and a variety of other acronyms that none of us really understand. They all have 1/4 the training we do, yet make 1/2 our salary.

Who wants to join my nationwide chain of Test'n'Pills clinics?

Agree with point. But centor criteria is crap.

 

[thegenius]

What's the buy in?

Considering we can hire NPs or PAs or any two letter acronym and continue to bill high, we will make a fortune. Buy-in is $100K!!! LOL

Test'n'Pills coming to a town near you.

 

[NYEMMED]

They can have the NP/PA solo if they wish, but if they value their life I would recommend against it if they are any more than a level 4 in the ED.

 

[TooMuchResearch]

Considering we can hire NPs or PAs or any two letter acronym and continue to bill high, we will make a fortune. Buy-in is $100K!!! LOL

Test'n'Pills coming to a town near you.

I'm in.

 

[gutonc]

Considering we can hire NPs or PAs or any two letter acronym and continue to bill high, we will make a fortune. Buy-in is $100K!!! LOL

Test'n'Pills coming to a town near you.

You're pretty late to the game man.

 

[MechEDoc]

The only Mackenzie I know is actually quite pretty, so maybe I’m biased or something. Like hindsight bias?

Which part was the nice part of "Mackenzie"?

 

[KeikoTanaka]

Never seen this on TV, what channels you guys watching?

This is a big attack on PCPs. Unfortunately if more students don't pursue Primary Care as a specialty, we won't have the numbers to quell the fear of the "primary care deficit" which is the biggest fuel for NP expansion

 

[RustedFox]

Never seen this on TV, what channels you guys watching?

This is a big attack on PCPs. Unfortunately if more students don't pursue Primary Care as a specialty, we won't have the numbers to quell the fear of the "primary care deficit" which is the biggest fuel for NP expansion

You're absolutely correct.
But it has to be more appealing to the young doc.
That won't happen unless the insurers and admins and everyone else play ball and stop screwing things up.

I had a thread on this awhile back. Pretty sure it was entitled: "Hey, insurers; you're doing it wrong."

 

[KeikoTanaka]

You're absolutely correct.
But it has to be more appealing to the young doc.
That won't happen unless the insurers and admins and everyone else play ball and stop screwing things up.

I had a thread on this awhile back. Pretty sure it was entitled: "Hey, insurers; you're doing it wrong."

Were you ever deciding between primary care and emergency medicine at any point in your medical career? And, hypothetically, you were forced to go into primary care right now and repeat residency, however you had a magic wand that could let you change it in anyway. What would you change to make the job of PCP more appealing to be something you would choose over EM?

 

[RustedFox]

Great questions:

Were you ever deciding between primary care and emergency medicine at any point in your medical career?

Yes. A much younger me thought that I was destined for FM (at first), and then IM. Then, I got wise to things.

And, hypothetically, [if] you were forced to go into primary care right now and repeat residency, however you had a magic wand that could let you change it in anyway. What would you change to make the job of PCP more appealing to be something you would choose over EM?

This is probably better answered by the FM folks that frequent this forum, but I'll chime in:

1. Insurers that made things simple and easy, and did the right thing instead of trying to be obstructionist and obfuscatory.
2. Reimbursements that reflected the cost savings on the health system by taking care of things in the outpatient world instead of forcing the FM folks to punt to the ER for every little thing. (Perfect example: the referrals for blood transfusions... there is NO reason why this needs to be sent to the ER, but to get approval is too time consuming and difficult... thus, the patient gets sent to the ER, where the insurer simply pays more for the same thing that would have been done anyways. This can be extrapolated to any visit that starts or ends with "I was sent by my doctor for admission.")
3. A medical education that didn't cost north of 300K.

I could go on.

 

[206705]

Reading this thread got me like...

And stop lumping PAs in with NPs. It's disrespectful to Dr. Jenny, DNP-FUBAR-AGAAAAACNP.

 

[Restart13]

AAEM/RSA just called out AMA for not doing enough for advocating for physician led care.

On another note is the lack of caring led by the ivory tower older physicians who either don’t care or have been working for so long that it doesn’t matter to them anymore? Corruption by insurance companies? Worried about public backlash?

I can’t speak for everyone but at least in the residency hospitals, most younger residents who grew up in the generation of massively high student debt era almost all agree it’s BS that we have to compete with midlevels. Hopefully when the new washes out the old at all levels of leadership we’ll start to see some change for once.

 

[Boatswain2PA]

They should be the small hawk that alights on our gloved hands and takes orders

You may not practice or run your ED the way you project yourself here, but if you do then YOU could be the reason your MLPs suck.

I'm pretty damn good at what I do, and the BC EPs I work PRN with are constantly wanting me to come on full time in that shop.

But I wouldnt work more than one shift with someone with the attitude you present here. Want me to sit on your finger and be your bitch-boy? I'll leave a little present on your scrubs as I fly away, leaving you to hire another new grad NP. Good luck with that.

 

[Groove]

Can you imaging the MLP outcry if the AMA started a campaign about how doctors are better than MLPs and interviewed pt's who had thought they were seeing a doctor, only to find out it was an NP, etc.. and now since seeing an MD/DO, they are feeling so much better and getting much better care, etc.. LOL, oh man... the rage hate that would ensue. Yet, it's perfectly ok for them to wage war against us.

Way too much PC pacifism within organized physician groups these days.

 

[GonnaBeADoc2222]

You may not practice or run your ED the way you project yourself here, but if you do then YOU could be the reason your MLPs suck.

I'm pretty damn good at what I do, and the BC EPs I work PRN with are constantly wanting me to come on full time in that shop.

But I wouldnt work more than one shift with someone with the attitude you present here. Want me to sit on your finger and be your bitch-boy? I'll leave a little present on your scrubs as I fly away, leaving you to hire another new grad NP. Good luck with that.

Nah.

They suck because they suck. And most suck. Even the ones that don't suck, still kinda suck. I'd trust an end of year PGY1 EM resident more than 95% of the midlevels I've encountered. I'm really glad you're one of the good ones boatswain, sounds like I would enjoy working with you.

Again, not our job to train them up once they hit the ED. That's what midlevel school is for. And if you're not up to snuff after that, you can do one of those new fangled midlevel EM residencies.

 

[Listen2Savage]

Want me to sit on your finger and be your bitch-boy?

bro its in your name. ASSISTANT

 

[Boatswain2PA]

No problem with being an assistant. I don't think any MLPs should have full independence. Thankfully there are great docs out there who know how to lead.