Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
The burden of proof does not lie with physicians to demonstrate that nurse practitioners do not provide what is considered standard medical care, especially if they wish to practice independently.
I didn't ask for physicians to provide any proof. I asked a single individual to provide proof to support his claim
 
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
You claim one NP "does a good job" and cite that as a source for them being competent playing a provider role. Then you add on mundane requirements such as 3 years RN experience. Unless you are surgeon in that field how do you even know they are providing adequate care? RN experience is nothing like doctor experience, which med students are taught starting day one. Yes it teaches you the workflow of the hospital but that is about it. You never think like a doctor (MD/DO), because you don't have the foundations. Nurse's are taught basic principles and checklist medicine. MD/DOs are taught to follow scientific model and to think independently, challenge everything that doesn't make sense. We have different roles that are equally important for there own reasons. However, no nurse should be in charge patient care without going to medical school first. NPs only exist to keep costs down and allow lazy doctors to work less/make more. PAs shouldn't exist either, but they are taught a similar model to MD/DOs and are taught to ask medical doctors for help when they need it. Nurse are told to document 'MD aware."

What the eyes cant see the mind doesn't know.
A ton of assumptions here and complete disrespect for multiple professions. I think that you'd be surprised if you sat in on lectures at some of the top nursing schools. I'm not sure how current medicine would even function without midlevels.
 
  • Like
Reactions: emedpa
Dec 16, 2011
941
1,561
Status
  1. Resident [Any Field]
A ton of assumptions here and complete disrespect for multiple professions. I think that you'd be surprised if you sat in on lectures at some of the top nursing schools. I'm not sure how current medicine would even function without midlevels.

My medical school had a nursing school with a brick and mortar DNP program. I dated a girl in that program for 2 years and was pretty familiar with their curriculum - I was not impressed with the content covered in nursing school in the slightest.

This was at an ivy-league institution - only God knows what's going down in those online diploma mills.

My subsequent interactions with new NP graduates in the hospital only further reinforced my suspicions that DNP education is full of gaps and insufficient to actually train a provider to do anything beyond the most menial of tasks competently.



As for how medicine would function without midlevels - the United States is the only society that actually employs midlevels to this extent, and by most metrics this system is the most dysfunctional in the western world by a long shot. Literally every society is doing better than us without them, and most people I know find the idea of an independent practitioner with a 2 year degree they got on the internet treating them utterly ghastly.
 
About the Ads
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
My medical school had a nursing school with a brick and mortar DNP program. I dated a girl in that program for 2 years and was pretty familiar with their curriculum - I was not impressed with the content covered in nursing school in the slightest.

This was at an ivy-league institution - only God knows what's going down in those online diploma mills.

My subsequent interactions with new NP graduates in the hospital only further reinforced my suspicions that DNP education is full of gaps and insufficient to actually train a provider to do anything beyond the most menial of tasks competently.



As for how medicine would function without midlevels - the United States is the only society that actually employs midlevels to this extent, and by most metrics this system is the most dysfunctional in the western world by a long shot. Literally every society is doing better than us without them, and most people I know find the idea of an independent practitioner with a 2 year degree they got on the internet treating them utterly ghastly.
At some point opinions need to be backed by facts. I've never met an MD/DO that shares your opinions, and people talk a lot in the hospital. I've also never witnessed a huge difference between midlevel providers. Our NP's actually have higher patient satisfaction scores. Only provider I've seen disciplined for lack of productivity was an MD.

These horror stories are mostly just online tales
 
D

deleted480308

At some point opinions need to be backed by facts. I've never met an MD/DO that shares your opinions, and people talk a lot in the hospital. I've also never witnessed a huge difference between midlevel providers. Our NP's actually have higher patient satisfaction scores. Only provider I've seen disciplined for lack of productivity was an MD.

These horror stories are mostly just online tales
We never worked in the same systems or talked to the same doctors then...
 
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
We never worked in the same systems or talked to the same doctors then...
Exactly my point though. If the training was as atrocious as this forum makes it seem, these opinions wouldn't be so rare. This is honestly the only medical forum that I visit with such extreme opinions.

Where are all the patient complaints? Patient deaths? Where is all the data suggesting that PA's have better outcomes?

Where is anything besides anecdotal evidence and opinions that suggest that, in general, nurse practitioners lack the education to properly care for patients?
 
Dec 16, 2011
941
1,561
Status
  1. Resident [Any Field]
At some point opinions need to be backed by facts. I've never met an MD/DO that shares your opinions, and people talk a lot in the hospital. I've also never witnessed a huge difference between midlevel providers. Our NP's actually have higher patient satisfaction scores. Only provider I've seen disciplined for lack of productivity was an MD.

These horror stories are mostly just online tales

"I think your training pathway sucks and is detrimental to patient care without proper oversight" isn't exactly a collegial water-cooler topic of discussion so obviously people aren't going to chat sh!t about how egregious midlevel training (mostly NP training) is. The internet mostly gives you unfiltered opinions and while a lot of it is noise, the fact that on literally any forum where physicians congregate these opinions are pretty rampant and openly espoused should tell you something.


As for patient satisfaction scores - they mean pretty much nothing in the grand scheme of things. If I gave all of my patients xanax and z packs I could have tremendous satisfaction scores but it doesn't mean I'm doing right by them and plenty of studies suggest that patient satisfaction is negatively correlated with outcomes.





Exactly my point though. If the training was as atrocious as this forum makes it seem, these opinions wouldn't be so rare. This is honestly the only medical forum that I visit with such extreme opinions.

Where are all the patient complaints? Patient deaths? Where is all the data suggesting that PA's have better outcomes?

Where is anything besides anecdotal evidence and opinions that suggest that, in general, nurse practitioners lack the education to properly care for patients?

Do you ask for data every time you put on a seatbelt? Or a helmet? Or a parachute?

I mean I've never seen an RCT for skydiving with a parachute vs without, but I imagine the outcomes in the experimental arm would be quite poor.


There are plenty of reasons why there's a lack of robust data truly comparing MDs to midlevels or NPs to PAs. Very few patients will actually agree to be enrolled in a study where their care has literally no physician oversight and the places where patients are desperate enough to do that generally don't have the resources to actually produce quality research. Furthermore, due to most state, local and hospital laws and bylaws, you rarely have midlevels truly alone, and so more often than not somewhere there is somebody (supervising physician, consulting subspecialist, etc) who gets involved before the dumpster fire engulfs the whole neighbourhood. Finally, many of these patients who have no access to physicians also have little or no access to attorneys, so when they suffer the consequences of poor medical care (whether that be at the hands of a midlevel or a doc) they don't have much recourse to seek restitution.
 
Last edited:
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
"I think your training pathway sucks and is detrimental to patient care without proper oversight" isn't exactly a collegial water-cooler topic of discussion so obviously people aren't going to chat sh!t about how egregious midlevel training (mostly NP training) is. The internet mostly gives you unfiltered opinions and while a lot of it is noise, the fact that on literally any forum where physicians congregate these opinions are pretty rampant and openly espoused should tell you something.


As for patient satisfaction scores - they mean pretty much nothing in the grand scheme of things. If I gave all of my patients xanax and z packs I could have tremendous satisfaction scores but it doesn't mean I'm doing right by them and plenty of studies suggest that patient satisfaction is negatively correlated with outcomes.







Do you ask for data every time you put on a seatbelt? Or a helmet? Or a parachute?

I mean I've never seen an RCT for skydiving with a parachute vs without, but I imagine the outcomes in the experimental arm would be quite poor.


There are plenty of reasons why there's a lack of robust data truly comparing MDs to midlevels or NPs to PAs. Very few patients will actually agree to be enrolled in a study where their care has literally no physician oversight and the places where patients are desperate enough to do that generally don't have the resources to actually produce quality research. Furthermore, due to most state, local and hospital laws and bylaws, you rarely have midlevels truly alone, and so more often than not somewhere there is somebody (supervising physician, consulting subspecialist, etc) who gets involved before the dumpster fire engulfs the whole neighbourhood. Finally, many of these patients who have no access to physicians also have little or no access to attorneys, so when they suffer the consequences of poor medical care (whether that be at the hands of a midlevel or a doc) they don't have much recourse to seek restitution.
I dont need data to know that a seatbelt works because it is both common sense and the evidence is everywhere.
 

Apollyon

Screw the GST
Lifetime Donor
Nov 24, 2002
21,620
6,921
SCREW IT!
I dont need data to know that a seatbelt works because it is both common sense and the evidence is everywhere.
Just a note - I'm not a mod, but, nurses that beat their drum loudly on a site for doctors will eventually be directed to leave. Equitable? Debatable, but we are a LOT more tolerant than Allnurses are to docs!
 

VA Hopeful Dr

Senior Member
Jul 28, 2004
23,358
36,141
Status
  1. Attending Physician
Exactly my point though. If the training was as atrocious as this forum makes it seem, these opinions wouldn't be so rare. This is honestly the only medical forum that I visit with such extreme opinions.

Where are all the patient complaints? Patient deaths? Where is all the data suggesting that PA's have better outcomes?

Where is anything besides anecdotal evidence and opinions that suggest that, in general, nurse practitioners lack the education to properly care for patients?
Patient complaints, really? The Cost of Satisfaction The fact that midlevels get fewer complaints could actually be a bad thing.

The problem is that most midlevels in high risk areas are either fairly heavily supervised or have a limited role. Its in lower risk areas where there is usually less supervision and more latitude allowed (primary care, ED fast track) and poor outcomes in that area are less likely and/or will take longer to develop. I'm FM, if an NP doesn't manage diabetes quite as well as I do it could take 10 years for any adverse outcomes.

I supervise 2 NPs and while they are both pretty good at their jobs I see things on a daily basis that are "wrong" but its on super low risk stuff (omnicef for sinus infections, short courses of valium for back pain, pointless labs) so who cares? I also get multiple questions about management on a daily basis whereas the other MD and I ask each other stuff about once a month.
 
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
Just a note - I'm not a mod, but, nurses that beat their drum loudly on a site for doctors will eventually be directed to leave. Equitable? Debatable, but we are a LOT more tolerant than Allnurses are to docs!
What? I've done absolutely nothing wrong. I can't question a claim? I haven't talked bad about docs or anything.
 
About the Ads
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)

Here’s a list of studies. I don’t know what you’re expecting demanding proof? You want him to perform a randomized control trial right here and now? Lol
I wasn't questioning whether a physician was better prepared to practice than a midlevel. That is obviously the case and data isn't really needed to support that claim imo. I also don't believe that midlevels should practice independently.

My question was whether or not an NP's education was adequate to see patients while under direct supervision from an MD. My claim was that, if supervised, a PA and an NP fuction at near the same level. I bring this up because I see the argument about the curriculum differences between PA's and NP's fairly often but I dont think that anyone questions a PA's ability to treat patients.

I wasn't trying to start some big argument. I was honestly just curious about any studies that may exist suggesting that PA's are better providers than NP's.
 
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
Patient complaints, really? The Cost of Satisfaction The fact that midlevels get fewer complaints could actually be a bad thing.

The problem is that most midlevels in high risk areas are either fairly heavily supervised or have a limited role. Its in lower risk areas where there is usually less supervision and more latitude allowed (primary care, ED fast track) and poor outcomes in that area are less likely and/or will take longer to develop. I'm FM, if an NP doesn't manage diabetes quite as well as I do it could take 10 years for any adverse outcomes.

I supervise 2 NPs and while they are both pretty good at their jobs I see things on a daily basis that are "wrong" but its on super low risk stuff (omnicef for sinus infections, short courses of valium for back pain, pointless labs) so who cares? I also get multiple questions about management on a daily basis whereas the other MD and I ask each other stuff about once a month.
Good post.

Do you believe that their education is so limited that, even with direct supervision and limited roles, they are still a danger to their patients?
 
Dec 21, 2008
1,376
117
Status
  1. Attending Physician
My question was whether or not an NP's education was adequate to see patients while under direct supervision from an MD. My claim was that, if supervised, a PA and an NP fuction at near the same level. I bring this up because I see the argument about the curriculum differences between PA's and NP's fairly often but I dont think that anyone questions a PA's ability to treat patients.

At some point within the realm of a supervisory relationship, you have to ask yourself whether the person you're supervising is actually improving your ability to deliver healthcare, or rather just making more work for the physician who would be better off just seeing the patient themselves.
 
  • Like
Reactions: SXMMD
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
You say this as if patient satisfaction is somehow correlated with the quality of healthcare delivered. Being nice doesn't mean you're good at medicine; it means you're good at satisfying arbitrary metrics.
I agree but there is not much else to go by
 
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
At some point within the realm of a supervisory relationship, you have to ask yourself whether the person you're supervising is actually improving your ability to deliver healthcare, or rather just making more work for the physician who would be better off just seeing the patient themselves.
This would be a tough task for a lot of hospitals. During the day, my ED staffs 3 physicians and 3 midlevels. We are a level 3 trauma center. So my hospital alone would need 6 physicians during the day and 3 more at night. In cities that nobody wants to live in, they struggle to hire two MD's.
 
Dec 21, 2008
1,376
117
Status
  1. Attending Physician
This would be a tough task for a lot of hospitals.

What would be a tough task, assessing a PA or NP's value? I'm sure they're valuable to administration in the sense of "someone's better than no one and we don't have to pay as much." I'm not saying there aren't good NPs; however, it's rather difficult to judge what quality you'll get from any one individual because the training isn't even remotely standardized.

However, my point was that if administration told you that you're responsible for being a supervisor for someone who's more of a liability than an asset and, by the way, you're liable for any mistakes made by them along the way, would you be happy about being in that role? I personally would rather work alone, but that is not our current practice environment or climate. Bonus kick in the pants that they can basically migrate across specialties without any formalized extra training to do so.
 
Oct 28, 2019
369
558
Status
  1. Attending Physician
A ton of assumptions here and complete disrespect for multiple professions. I think that you'd be surprised if you sat in on lectures at some of the top nursing schools. I'm not sure how current medicine would even function without midlevels.

At some point opinions need to be backed by facts. I've never met an MD/DO that shares your opinions, and people talk a lot in the hospital. I've also never witnessed a huge difference between midlevel providers. Our NP's actually have higher patient satisfaction scores. Only provider I've seen disciplined for lack of productivity was an MD.

These horror stories are mostly just online tales

Take your inferiority complex to facebook.
 
About the Ads

scoopdaboop

Probationary Status
Jun 24, 2019
565
506
Status
  1. Medical Student
Good post.

Do you believe that their education is so limited that, even with direct supervision and limited roles, they are still a danger to their patients?

They are not a danger if they do what they are trained. The NP education is basically just fluff and their role in anywhere other than primary care is to do 1-2 tasks so the physician can bill more. In primary care, they still miss the fairly obvious stuff and kill people. The CRNA training pathway is obviously much better than a NP and it has to be for obvious reasons.


The problem comes when the NP that learns on the job with the helping hand of the physician now thinks he or she can just go out and be an independent provider. Then, you get stories like the above.

TBH, I don't even think NP's are going to take any physician jobs when stories like the above come out. A hospital loses a ton of money due to 1 error, when they could have just hired a physician for say 2-3x the salary per year and saved a ton of more money, AND had the physician take the mal practice hit.

Hell, even most NP's don't actually do what they so eloquently say they will do, that is "work in rural America to fill the provider shortage", what a load of baloney, and I imagine that is because most of them realize they are nothing but a physicians tool to do medial tasks that a physician can train a scribe to do if they really wanted to do.
 
Last edited:
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
What would be a tough task, assessing a PA or NP's value? I'm sure they're valuable to administration in the sense of "someone's better than no one and we don't have to pay as much." I'm not saying there aren't good NPs; however, it's rather difficult to judge what quality you'll get from any one individual because the training isn't even remotely standardized.

However, my point was that if administration told you that you're responsible for being a supervisor for someone who's more of a liability than an asset and, by the way, you're liable for any mistakes made by them along the way, would you be happy about being in that role? I personally would rather work alone, but that is not our current practice environment or climate. Bonus kick in the pants that they can basically migrate across specialties without any formalized extra training to do so.
I meant that it would be hard to adequately staff a lot of ED's if there weren't any midlevels. My hospital alone would need to hire 6-10 additional physicians in the ED.
 
  • Like
Reactions: emedpa
Dec 21, 2008
1,376
117
Status
  1. Attending Physician
I meant that it would be hard to adequately staff a lot of ED's if there weren't any midlevels. My hospital alone would need to hire 6-10 additional physicians in the ED.

I wasn't arguing to get rid of them; it is clear that they are here to stay. My point was that their role is an administrative "solution," rather than one that physicians asked for.
 
About the Ads

scoopdaboop

Probationary Status
Jun 24, 2019
565
506
Status
  1. Medical Student
I meant that it would be hard to adequately staff a lot of ED's if there weren't any midlevels. My hospital alone would need to hire 6-10 additional physicians in the ED.

I actually agree with you. An ED is a place where a midlevel can lessen the burden of low level acuity patients for physicians. Many physicians I scribed with said they appreciated that. Still, I think "choosing NPs" and being a "NP only ED" is foolish, and often times these places will have physicians from other specialties be willing to help/cover their booty.
 
Sep 2, 2014
26
14
Status
  1. Pre-Health (Field Undecided)
I actually agree with you. An ED is a place where a midlevel can lessen the burden of low level acuity patients for physicians. Many physicians I scribed with said they appreciated that. Still, I think "choosing NPs" and being a "NP only ED" is foolish, and often times these places will have physicians from other specialties be willing to help/cover their booty.
If people want to choose an NP for primary care we should let them.

However, no ED should ever be ran without a physician. I certainly wouldn't go there.
 
Mar 10, 2011
75
103
Status
  1. Fellow [Any Field]
  2. Attending Physician
If people want to choose an NP for primary care we should let them.

However, no ED should ever be ran without a physician. I certainly wouldn't go there.

The problem with unsupervised NP/PAs even in primary care (without even addressing how hard good primary care is) is that we live in an insurance based model. NP delivered primary care is not cash only. Therefore, if a patient sees an NP in primary care who is reimbursed by the same insurance I pay for and the NP misses a diagnosis, orders an unnecessary test, or mismanages diabetes, then the higher long term costs are passed onto me too. Providing healthcare is not an individual transaction. Furthermore, the government should be focused on protecting patients no matter the care setting.

We should all be striving for the highest quality, safest care for our patients; not using the legislature to pad our wallets through pay parity and independent practice. NPs and PAs can help with individual, low risk tasks in patient care and chronic disease follow up; but NPs, need to get their schooling in order. NP/PAs should not be doing an initial consult for a specialty without the physician also seeing the patient. Neither should be independent and physicians need to actually supervise. Finally, admins who only see $$$ need to stop trying to practice medicine by dictating how to deliver care without any medical background.

I think NP/PAs can help a lot in the ED. However, the way they are utilized is key. I don't find much value in working with them for ESI 3,2,1 patients as it is often faster to see them myself which I have to do anyway. For the low acuity that have been triaged they are useful. While an MD/DO can see those patients too, the triage MD/DO already did and I don't think it is inappropriate to utilize the NP/PA there. I am weary of the NP/PA in in triage who triages patients to another NP/PA. While triage shifts are grueling, I find the workups more appropriate when triaged by MD/DO and patients are more satisfied because they always see a physician.
 
Last edited:

Matthew9Thirtyfive

Giving the side eye
Administrator
Jan 11, 2016
19,674
33,281
Status
  1. Medical Student
At some point opinions need to be backed by facts. I've never met an MD/DO that shares your opinions, and people talk a lot in the hospital. I've also never witnessed a huge difference between midlevel providers. Our NP's actually have higher patient satisfaction scores. Only provider I've seen disciplined for lack of productivity was an MD.

These horror stories are mostly just online tales

You might want to go on r/noctor. There are literally a dozen posts a day at least of NPs (and some PAs) completely ****ing up, and multiple cases where mismanagement by the midlevel either nearly killed the patient or have caused the patient to have a permanent disability and/or shortened life span. It is atrocious. These are mistakes even I wouldn't make as a medical student.

And as far as "proof"*, there are a number of studies showing NP care is inferior to physicians or cost more/order more tests/prescribe more antibiotics or opioids, as well as debunking the propaganda that they are “filling the doctor shortage.”

*I put it in quotes, because we don't really "prove" things in science, we just accumulate evidence. So the more correct statement is that there is significant evidence that MLP care is worse and/or more expensive.

Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. Comparing Hospitalist-Resident to Hospitalist-Midlevel Practitioner Team Performance on Length of Stay and Direct Patient Care Cost - PubMed
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082
Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. Comparison of Diagnostic Imaging Ordering Patterns
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. Differences in antibiotic prescribing among physicians, residents, and nonphysician clinicians - PubMed
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract
Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-8256(17)30071-6/fulltext
Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Editor's choice: Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants
NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. Comparing Nurse Practitioner and Physician Prescribing of Psychotropic Medications for Medicaid-Insured Youths - PubMed
(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. Factors influencing unexpected disposition after orthopedic ambulatory surgery - PubMed
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns - PubMed
Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. Anesthesiologist direction and patient outcomes - PubMed
Only 25% of all NPs in Oregon, an independent practice state, practiced in primary care settings. https://oregoncenterfornursing.org/...020_PrimaryCareWorkforceCrisis_Report_Web.pdf
96% of NPs had regular contact with pharmaceutical representatives. 48% stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. "Under the radar": nurse practitioner prescribers and pharmaceutical industry promotions - PubMed
85.02% of malpractice cases against NPs were due to diagnosis (41.46%), treatment (30.79%) and medication errors (12.77%). The malpractice cases due to diagnosing errors was further stratified into failure to diagnose (64.13%), delay to diagnose (27.29%), and misdiagnosis (7.59%). Nurse practitioner malpractice data: Informing nursing education - PubMed
Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits .While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level. Comparison of Diagnostic Imaging Ordering Patterns
Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence based best practices. The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators - PubMed
 

doctalaughs

Member
Jul 9, 2003
1,095
1,291
Visit site
Status
The real question is NOT whether midlevels are “adequate enough to not kill a significant number of patients.”

The real question is why the richest country on earth (while spending double the GDP of other nations) is stuck with these inferior-trained “providers.” Every other first world country manages to provide MD-level care for the vast majority of patient interactions.

If US consumers were smart they would be questioning why they are paying so much more for an inferior product. Even the midlevels cannot deny they have a fraction of the education/training. Unfortunately, US consumers are dumb enough to keep paying while getting crapped on. This whole “we choose NPs” is just fancy propaganda to persuade people to continue enjoying their crap-sandwich.
 

Fox800

Go to the ER now to see if you have coronavirus.
Aug 29, 2006
1,302
1,315
Deep in the heart of queso.
Status
  1. Attending Physician
The real question is NOT whether midlevels are “adequate enough to not kill a significant number of patients.”

The real question is why the richest country on earth (while spending double the GDP of other nations) is stuck with these inferior-trained “providers.” Every other first world country manages to provide MD-level care for the vast majority of patient interactions.

If US consumers were smart they would be questioning why they are paying so much more for an inferior product. Even the midlevels cannot deny they have a fraction of the education/training. Unfortunately, US consumers are dumb enough to keep paying while getting crapped on. This whole “we choose NPs” is just fancy propaganda to persuade people to continue enjoying their crap-sandwich.

Why does it happen? Because it lines the pockets of CMGs and hospital systems who embrace nursing culture.

When you bring up the point of spending so much money on healthcare, the popular answer is to quit paying "those rich greedy doctors" so much.
 
Dec 19, 2010
7,632
7,780
Status
What you need to be doing every day as a physician, is to successfully persuade patients and more importantly, hospital administrators, that you provide greater value to them per dollar paid, than mid-levels. If you can successfully do this, you have nothing to worry about, and any worry or resentment towards mid-levels, is wasted energy. If you cannot successfully do this, then you're headed towards extinction.
 
Sep 17, 2013
359
509
Status
  1. Resident [Any Field]
Just a note - I'm not a mod, but, nurses that beat their drum loudly on a site for doctors will eventually be directed to leave. Equitable? Debatable, but we are a LOT more tolerant than Allnurses are to docs!
The real question is NOT whether midlevels are “adequate enough to not kill a significant number of patients.”

The real question is why the richest country on earth (while spending double the GDP of other nations) is stuck with these inferior-trained “providers.” Every other first world country manages to provide MD-level care for the vast majority of patient interactions.

If US consumers were smart they would be questioning why they are paying so much more for an inferior product. Even the midlevels cannot deny they have a fraction of the education/training. Unfortunately, US consumers are dumb enough to keep paying while getting crapped on. This whole “we choose NPs” is just fancy propaganda to persuade people to continue enjoying their crap-sandwich.


Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare​

You can find it on amazon; fantastic book that can help educate the public on the danger of midlevels especially independent practice by MLPs.

What is hilarious is you can see the immediate 1 star review backlash by these midlevels the instant this released, without reading or purchasing the book, in an attempt to stifle any dissent.
 
May 26, 2019
93
302
Status
  1. Resident [Any Field]

Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare​

You can find it on amazon; fantastic book that can help educate the public on the danger of midlevels especially independent practice by MLPs.

What is hilarious is you can see the immediate 1 star review backlash by these midlevels the instant this released, without reading or purchasing the book, in an attempt to stifle any dissent.
Hopefully this book garners more traction.
 
  • Like
Reactions: Fox800 and wamcp
Sep 1, 2020
7
14
Just got home from my shift, saw that the CMO of one of the big three CMG‘s just sent out an email to all providers extolling NP’s for “NP Week.”

Two interesting points. One: he said they bring a “unique perspective” and focus more on illness, then disease. Sounds similar to the NP spin. NP’s care more, and thus are better then MD’s! How his email came across: They care more then doctors!!

Second point: NP’s are important, and we will ensure that they all learn how to do all advanced procedures. Cited: Central lines, intubations, chest tubes, and others. This is really, really not helpful for docs.
 
Sep 17, 2013
359
509
Status
  1. Resident [Any Field]
Hopefully this book garners more traction.
i bought it and intend to five star a legitimate review. The more popular the book rises the charts, the more likely that laypersons will see it while browsing
 
Jan 22, 2019
2,640
2,473
Status
  1. Resident [Any Field]

Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare​

You can find it on amazon; fantastic book that can help educate the public on the danger of midlevels especially independent practice by MLPs.

What is hilarious is you can see the immediate 1 star review backlash by these midlevels the instant this released, without reading or purchasing the book, in an attempt to stifle any dissent.
One of the reviewers.

"This book is criminal and grossly manipulative. It is poisonous to the patient-provider relationship by harboring and encouraging distrust in PAs/NPs who are competent, highly trained professional with expertise."

"I’m sure most people are not aware that PA school is equally competitive, if not MORE competitive, than medical school. They frequently have much smaller class sizes and a significantly higher number of applications. Google individual program statistics if you do not believe me.The curriculum is the SAME; both based off the medical model. PAs curriculum is extremely accelerated, with M-F class from 8am-5pm. PAs and doctors have the same scope of practice with one exception: cannot perform surgery alone or freely prescribe schedule I medications. THATS IT."

Lol...
 

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.
About the Ads