We Choose NPs

Started by Alvarez13
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Not my shop.
We are strictly forbidden from doing procedures outside of the ER except in a code situation. ICU doc comes in for situations such as this.

At my old HCA hospital it was the same. We weren't supposed to do inpatient intubations except in a code situation. The nurses kept trying to game the system by calling Code Blue on patients who were still breathing with a heartbeat. I'd force them to call anesthesia which is something they hated doing, but were required to do under the hospital regs.

At my current job, the ED doctors are wimps, and give in all the time to go upstairs and do BS procedures all the time that the inpatient doctors are too lazy to do.
 
Yeah, what I don't think the ICU docs realize is that they are providing evidence to the world that you really don't need an MD/DO in the ICU 24/7. Because the NP can do everything they can...right? That's the message they are sending. All to make their lives a little more easier so they don't have to take nights. We've just got to be careful not to do the same thing in the ER.
I'd like to see well designed studies that actually say this. I have yet to see one.
 
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If you let NP/PAs/midlevels practice independently(no supervision)... Tons of patients could go 6 feet under leading to massive hospital law suits(if the hospital doesn't shrug enough deaths under the carpet) ....resulting in either never leaving midlevels unsupervised, increased doctor and decreased/consistent noctor employment rate and huuuge malpractise insurance for midlevels that want to practise independently.
 
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when is doctor week??? Oh wait, they don't get one, because they are evil conniving people that should help people for free just because they are doctors.
Have these m4a *****s thought of the impact of a disgruntled work force of physicians (just having taken a 30% pay cut) on quality of care?

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Have these m4a *****s thought of the impact of a disgruntled work force of physicians (just having taken a 30% pay cut) on quality of care?

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Of course they haven't. They just expect us to keep eating crow and let NP and PA salaries creep towards ours. We're just supposed to keep working out of the goodness of our hearts while getting crapped on by CMS, admin, and patients, and staring down giant student loan debt.
 
Of course they haven't. They just expect us to keep eating crow and let NP and PA salaries creep towards ours. We're just supposed to keep working out of the goodness of our hearts while getting crapped on by CMS, admin, and patients, and staring down giant student loan debt.
You know why? Docs haven't had the balls to stand up for quite some time. Thats why!
 
I had an NP working one of the two 12 hour shifts they are scheduled at our ER.
Called the scheduler and said "oh, when I picked up this shift I forgot I have to work tomorrow", got permission to leave early. I was never notified. So at hour 8, this person up and left. While I was in a room. I came out and they were just gone. Leaving me 4 hours uncovered during our busiest flux of patients.

I told the boss that if she's scheduled to work with me again I'll quit in protest.
 
This thread reminded me... We've got this nurse who, I think, has ambitions of going to NP school and just started a cosmetic business where they do facials and chemical peels, etc.. and she has started wearing a full length physician white coat to work....as a nurse. LOL. It looks so ridiculous...I have to fight to keep a straight face when I pass her in the hallway. I mean, it would still be embarrassing enough if she were an NP, but she's not even that...she seems oblivious to how silly she looks.
 
This thread reminded me... We've got this nurse who, I think, has ambitions of going to NP school and just started a cosmetic business where they do facials and chemical peels, etc.. and she has started wearing a full length physician white coat to work....as a nurse. LOL. It looks so ridiculous...I have to fight to keep a straight face when I pass her in the hallway. I mean, it would still be embarrassing enough if she were an NP, but she's not even that...she seems oblivious to how silly she looks.
its bull$hit some attendings require us to wear short white coats with buffoonery like this on constant display
i hate all white coats but damn does it piss me off
 
its bull$hit some attendings require us to wear short white coats with buffoonery like this on constant display
i hate all white coats but damn does it piss me off

I rarely wear a white coat unless I've got a hospital meeting and want to stay in my scrubs. I hate wearing them. I do wear monogrammed scrubs though so patients aren't always asking me my name and I don't have to wear my hospital badge clipped anywhere. I feel silly enough wearing one all day as an EM doc. Seeing one of our nurses wear one is beyond ridiculous.
 
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Texas state law requires photo ID. I can't get away with scrubs. Also, this means I don't have to worry about someone knowing my name if I'm wearing my scrubs at the gas station on the way home.
 
We get to wear Patagonias with the school logo and our name. Much better than a white coat.
ya i've seen this, I think its just as Fd up as what the nurses are doing.

you havent earned the patagucci yet, i'd be embarrassed i looked like I was trying to come off as a resident.

also the same school where I saw this would put MD next to all their students names...
 
Dude so hilarious because there was an NP at this dump I used to work at that pulled the same ****. There's just no sense of ownership with these people.
I had an NP working one of the two 12 hour shifts they are scheduled at our ER.
Called the scheduler and said "oh, when I picked up this shift I forgot I have to work tomorrow", got permission to leave early. I was never notified. So at hour 8, this person up and left. While I was in a room. I came out and they were just gone. Leaving me 4 hours uncovered during our busiest flux of patients.

I told the boss that if she's scheduled to work with me again I'll quit in protest.

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ya i've seen this, I think its just as Fd up as what the nurses are doing.

you havent earned the patagucci yet, i'd be embarrassed i looked like I was trying to come off as a resident.

also the same school where I saw this would put MD next to all their students names...

Lol okay. No one is trying to look like anything. We are required to wear either the white coat or the Patagonia over scrubs, and no one puts MD after their name. That’s ****ing ridiculous and would get you in trouble here.
 
Lol okay. No one is trying to look like anything. We are required to wear either the white coat or the Patagonia over scrubs, and no one puts MD after their name. That’s ****ing ridiculous and would get you in trouble here.
never said it was your school chief, i'll name and shame its U of Miami

relax

but ya when I see students wearing Patagonia or north face jackets I get the same embarrassed feeling as when I see the PCT in the full-length coat.
 
never said it was your school chief, i'll name and shame its U of Miami

relax

but ya when I see students wearing Patagonia or north face jackets I get the same embarrassed feeling as when I see the PCT in the full-length coat.

That's news to me and I've never seen this bc they don't give us white coats. We have to buy and embroider our own so it must have been individual students. If it was the fleece, you may have been mistaken and it actually said, "MD Program."

And I have definitely worn my fleece on shift with no shame. Didn't realize it was a "resident" thing.
 
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That's news to me and I've never seen this bc they don't give us white coats. We have to buy and embroider our own so it must have been individual students.

And I have definitely worn my fleece on shift with no shame. Didn't realize it was a "resident" thing.
That’s because it’s not. White coats suck. Being cold sucks. A fleece solves that problem.
 
That’s because it’s not. White coats suck. Being cold sucks. A fleece solves that problem.
I've never been warmer than dressing up fully for an OSCE. So idk man, Fleeces are nice, but you can't deny that a t-shirt, button down, and white coat layers are actually pretty warm, lol. Also, our school has pretty heavy duty white coats with our names embroidered with "student physician" underneath, I like it a lot
 
That's news to me and I've never seen this bc they don't give us white coats. We have to buy and embroider our own so it must have been individual students. If it was the fleece, you may have been mistaken and it actually said, "MD Program."

And I have definitely worn my fleece on shift with no shame. Didn't realize it was a "resident" thing.
damn the student was a dbag so that makes sense now he would embroider John D. Bag MD on his coat
 
@KeikoTanaka

Responses are in italics.


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I've never been warmer than dressing up fully for an OSCE.

Yep. I hated that, too. Sweated the whole time. I remember showing up to my oral boards wearing a button-down white oxford and khakis, while 90% of others were in full suits. I never understood why they did that. I felt underdressed, but I also wanted to look at the other guys and scream: "NERRRRD!"

So idk man, Fleeces are nice, but you can't deny that a t-shirt, button down, and white coat layers are actually pretty warm, lol.

Yeah, but nobody wears that in the ER for so many reasons already enumerated and I'm not going to repeat.

Also, our school has pretty heavy duty white coats with our names embroidered with "student physician" underneath, I like it a lot

Good on them for doing that for you. Wins your school some "cool points" in my book. Good luck, homey. Hope you stick around here for a good bit.
 
Yep. I hated that, too. Sweated the whole time. I remember showing up to my oral boards wearing a button-down white oxford and khakis, while 90% of others were in full suits. I never understood why they did that. I felt underdressed, but I also wanted to look at the other guys and scream: "NERRRRD!"

We were told by our program if you don't show up in a suit they can dock some points...No idea if that was complete BS or not but I certainly didn't wanna risk it. Also my oral boards were in April in obviously the ice box known as chicago - was still snowing when I got there. Didn't mind the warmth, if anything showed up with an overcoat on top.
 
We were told by our program if you don't show up in a suit they can dock some points...No idea if that was complete BS or not but I certainly didn't wanna risk it. Also my oral boards were in April in obviously the ice box known as chicago - was still snowing when I got there. Didn't mind the warmth, if anything showed up with an overcoat on top.

Agreed. The Oral boards are arbitrary and subjective. No need to give any of the examiners an arbitrary reason to take off points.
 
Chicago Area Hospital Fires Doctors, Replaces with Cheaper Nurse Practitioners

”Due to budget constraints, Chicago-area health system Edward-Elmhurst Health reportedly plans to lay off 15 physicians from its immediate care clinics next year and replace them with nurse practitioners, sources told Becker's Hospital Review.

At what initially appeared to be a routine staff meeting on Nov. 19, physicians learned they would lose their jobs next March, according to a physician affected by the cuts.

‘This is what we are facing now — that physicians don't have job security, that cost is becoming more of a priority than patient care and safety,’ the physician said.”

 
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Chicago Area Hospital Fires Doctors, Replaces with Cheaper Nurse Practitioners

”Due to budget constraints, Chicago-area health system Edward-Elmhurst Health reportedly plans to lay off 15 physicians from its immediate care clinics next year and replace them with nurse practitioners, sources told Becker's Hospital Review.

At what initially appeared to be a routine staff meeting on Nov. 19, physicians learned they would lose their jobs next March, according to a physician affected by the cuts.

‘This is what we are facing now — that physicians don't have job security, that cost is becoming more of a priority than patient care and safety,’ the physician said.”


This was posted in the anesthesia forum. Those immediate care clinics are urgent cares, not emergency departments.
 
This was posted in the anesthesia forum. Those immediate care clinics are urgent cares, not emergency departments.
Yes, urgent cares where some doctors got their foot and rent money from, until they were fired because someone, "Chose NPs." My point is not to knock NPs because they have their role, or tell doctors the sky is falling, because it's not. It's just something to be aware of, that's all.
 
Yes, urgent cares where some doctors got their foot and rent money from, until they were fired because someone, "Chose NPs." My point is not to knock NPs because they have their role, or tell doctors the sky is falling, because it's not. It's just something to be aware of, that's all.

This isn't NPs fault. This is the fault of Physicians for not taking more active leadership roles to help establish policies that allow the medical model to be efficient while promoting Physicians as being the captain of the ship while respecting/utilizing NPs/PAs properly so everyone is happy. When you neglect/disrespect the people on your team, they lash out/don't respect you. That's common human nature.
 
This isn't NPs fault. This is the fault of Physicians for not taking more active leadership roles to help establish policies that allow the medical model to be efficient while promoting Physicians as being the captain of the ship while respecting/utilizing NPs/PAs properly so everyone is happy. When you neglect/disrespect the people on your team, they lash out/don't respect you. That's common human nature.

Where is your evidence for this? Interesting view to take, and it stinks of this victim culture narrative which is seeping through society. "Option D happened only because X was mean, nasty, and disrespectful".

I completely disagree with you and I challenge you to provide evidence that this "lash out" is the fault of physicians.

The part I do agree with is the lack of physician in leadership roles to help establish policy. We certainly need more influence in the political realm, because the AMA certainly does not reflect the thoughts of many docs.
 
Where is your evidence for this? Interesting view to take, and it stinks of this victim culture narrative which is seeping through society. "Option D happened only because X was mean, nasty, and disrespectful".

I completely disagree with you and I challenge you to provide evidence that this "lash out" is the fault of physicians.

The part I do agree with is the lack of physician in leadership roles to help establish policy. We certainly need more influence in the political realm, because the AMA certainly does not reflect the thoughts of many docs.

I don't think this is an "angry lash out" because of anything that physicians have done, I'm sorry if the tone made it appear that way. I'm not claiming to be an expert by any means. I know many PAs and NPs, who are all very respectful of physicians and are great providers in their own right, and don't care so much about independent practice, but I also live in NY where they're a bit more limited. So, anecdotally I don't see individual mid-levels angrily lashing out against Physicians.

But, there is a lot of propaganda against physicians by the heads of these organizations that are pandering on the fears of Americans about healthcare in order to increase their power/authority and sometimes this does require bringing into light some problems Physicians have:

- Physicians are "cold" and "don't spend time with patients" - This is why you need the "heart of the nurse" treating you.
- Physicians have "unexplainably high salaries" driving the cost of healthcare up - This is why you need lower salaried people giving care, and
"because they don't earn as much, they must truly be doing it out of their own benevolence".
- Physicians are "motivated by pharmaceutical companies" to over-prescribe - This is why you need "holistic nurses" to prevent chronic illness, oh, and essential oils.
- Physicians caused the "opioid epidemic" - Meanwhile "holistic nurses" would have avoided this by promoting more "community wellness".

These organizations have never come out straight and said a lot of these things, so you're right, I cannot provide "evidence" this is back lash - but you can see subtly in propaganda and people's views on social media.

Whenever a Physician merely defends themselves, it is always made to seem like the "big giant" is just hurting the "little guy who wants nothing more than to help" for no better reason other than "controlling their turf" when in reality it is about patient safety - but they scoff at that and will post a 20 year old research study about how NP and PCP data is equal in 200 patients.

And even if many insurance companies/big hospitals don't agree with anything that NPs say, they'll still pander to them because this means more cost-savings for the people at the top.

We live in a world now where I will frequently get Ads about "best careers in America" and for ****s and giggles I'll check it out. 140k salary for a software engineer at Google. What will be in the comments? 10,000s of comments about how "They don't deserve so much money" "The disparity in America is horrible" etc etc.

I'm not saying this is a good argument for my case, but it does demonstrate how easy it is to demonize Physicians in this new American culture that demonizes high earners when "your neighbors barely can afford healthcare" - and midlevel organizations are in the perfect position to capitalize on this.
 
This isn't NPs fault. This is the fault of Physicians for not taking more active leadership roles to help establish policies that allow the medical model to be efficient while promoting Physicians as being the captain of the ship while respecting/utilizing NPs/PAs properly so everyone is happy. When you neglect/disrespect the people on your team, they lash out/don't respect you. That's common human nature.
People think this is a battle between Physicians and Mid-levels and who'll "win" and who's to blame. All of that is a waste of time and emotional energy. It's much bigger than that, and much bigger than any of us. What I mean by that is that there's always been a very large cost (salary) and training gap, between the nurse and the physician. The average cost (salary) of a registered nurse is approximately $70,000 and the average physician cost (salary) is $200,000. And the average training required for a nurse was 4 years, with the average training required for a physician is between 11 and 14 years. It's always been inefficient and unrealistic to bridge that training and cost gap without a middle tier. In other words, it makes no sense to expect a nurse with only 4 years training and earning $70K to be able to do many things physicians do, nor assume the liability of someone earning 200% more. Similarly, it makes no sense to pay physicians 3 times as much to do things nurses that cost 1/3 the amount can do and who are also in greater supply due to the lower training commitment.

In other words, the evolution of the mid-level tier, with an intermediate cost, skill level and training requirement was inevitable and necessary, and our only surprise should be that they didn't come along much sooner.
 
Necessary only for shareholders, VC, and C-suite to continue to line their pockets
Yes, healthcare shareholders, CEOs and managers like to line their pockets like they do in every industry. Yeah, it sucks that some of them are making more money than us, but don't forget we're shareholders, too. What's your 401K full of (hopefully)?
Shares.

Who's the "shareholder" of those shares?
You.

If the value of those shares go up, what happens?
You, the "shareholder" become wealthier and just might, maybe just maybe, might be able to retire and get out before you stroke out.

And yes, somewhere in those companies of which you hold shares, there's someone down the line there's a working stiff that resents you the big bad "shareholder" and those guys who you pay (CEOs/Admin) to increase the value of your shares. And he's probably a shareholder, too, with a company match to boot.
 
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Don't really see your point.

Of course companies like Ford are going to have shareholders.

The fact that we allowed health care entities to "go public" and subsequently allowed the VC infiltration when I can't even take a pen from a pharma rep is absolutely bonkers.
Yes, healthcare shareholders, CEOs and managers like to line their pockets like they do in every industry. Yeah, it sucks that some of them are making more money than us, but don't forget we're shareholders, too. What's your 401K full of (hopefully)?
Shares.

Who's the "shareholder" of those shares?
You.

If the value of those shares go up, what happens?
You, the "shareholder" become wealthier and just might, maybe just maybe, might be able to retire and get out before you stroke out.

And yes, somewhere in those companies of which you hold shares, there's someone down the line there's a working stiff that resents you the big bad "shareholder" and those guys who you pay (CEOs/Admin) to increase the value of your shares. And he's probably a shareholder, too, with a company match to boot.

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Yes, healthcare shareholders, CEOs and managers like to line their pockets like they do in every industry. Yeah, it sucks that some of them are making more money than us, but don't forget we're shareholders, too. What's your 401K full of (hopefully)?
Shares.

Who's the "shareholder" of those shares?
You.

If the value of those shares go up, what happens?
You, the "shareholder" become wealthier and just might, maybe just maybe, might be able to retire and get out before you stroke out.

And yes, somewhere in those companies of which you hold shares, there's someone down the line there's a working stiff that resents you the big bad "shareholder" and those guys who you pay (CEOs/Admin) to increase the value of your shares. And he's probably a shareholder, too, with a company match to boot.
Vast majority of hospitals are not-for-profit or nonprofit and not publicly owned.
 
Vast majority of hospitals are not-for-profit or nonprofit and not publicly owned.
Kinda?

25% of hospitals are for-profit.

56% non-profit

19% government in some form.

Its also widely variable by state. Texas, for instance, has over 50% of their hospitals by for-profit. Same with Nevada and Florida. NY, by contrast, has 0% for-profits.

Now the data I found is for community hospitals only (which are 85% of all hospitals). This makes sense as university hospitals are almost never for-profit.
 
Kinda?

25% of hospitals are for-profit.

56% non-profit

19% government in some form.

Its also widely variable by state. Texas, for instance, has over 50% of their hospitals by for-profit. Same with Nevada and Florida. NY, by contrast, has 0% for-profits.

Now the data I found is for community hospitals only (which are 85% of all hospitals). This makes sense as university hospitals are almost never for-profit.
The data I found said 18% are for profit. So 82% are nonprofit in some fashion. Maybe it’s 25%, but my point stands that most hospitals are not publicly owned and we are not shareholders.
 
Vast majority of hospitals are not-for-profit or nonprofit
There's no such thing. All hospitals obsess over profits, the only difference is that some call them "profits" and others don't. The distinction is only for tax purposes. Not-for-profit or not, they all want to earn more money than they lose every year. The only difference is the for profit hospitals call that surplus revenue "profits" and distribute it to the administrators, shareholders and some back into the hospital. The not for profit hospitals don't call their surplus revenue profits, but they still make that extra money. And yes, they tell you that all that money goes back to the hospital, and some does go back into hospital improvements (just like for profit hospitals spend some money on improvement) but you can bet your right arm and leg that they redistribute a very, very large portion back to the funds used to pay salaries. And who's salaries and bonuses does the majority of that money go back to fund? Does it go back to you? Not much of it. Back to the nurses? Not much of it. Oh yeah, you guessed it, just like in the for profit hospitals, that excess revenue finds it back to the pool of money used to pay the CEOs, CFOs, CMOs and other administrators.

So it doesn't really matter whether the hospitals tax status is for profit or not. The administrators still work the accounting such that excess revenues goes back to raising their salaries, and they drool over that money as much as the administrators at for profit hospitals do. They just can't call it "profits" and cut a check to themselves that day. But they can have the Board of Directors vote to raise their salaries by whatever amount they want, and that's what they do.

If you still think there's really such a thing as "not for profit" hospitals, in actual practice, tell me which hospitals are "for losses." Because if there are for profit hospitals, and not all hospitals are "for profit," there must necessary be hospitals that are the opposite, and "for losses."

So, we agree that there's such a thing as "for profit" hospitals.
But, for the ones that are not, which ones are "for loses"?
 
Don't really see your point.

Of course companies like Ford are going to have shareholders.

The fact that we allowed health care entities to "go public" and subsequently allowed the VC infiltration when I can't even take a pen from a pharma rep is absolutely bonkers.


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Now you're onto Stark and anti-kickback laws. That's a whole other discussion. And yes, it's screwed up.
 
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There's no such thing. All hospitals obsess over profits, the only difference is that some call them "profits" and others don't. The distinction is only for tax purposes. Not-for-profit or not, they all want to earn more money than they lose every year. The only difference is the for profit hospitals call that surplus revenue "profits" and distribute it to the administrators, shareholders and some back into the hospital. The not for profit hospitals don't call their surplus revenue profits, but they still make that extra money. And yes, they tell you that all that money goes back to the hospital, and some does go back into hospital improvements (just like for profit hospitals spend some money on improvement) but you can bet your right arm and leg that they redistribute a very, very large portion back to the funds used to pay salaries. And who's salaries and bonuses does the majority of that money go back to fund? Does it go back to you? Not much of it. Back to the nurses? Not much of it. Oh yeah, you guessed it, just like in the for profit hospitals, that excess revenue finds it back to the pool of money used to pay the CEOs, CFOs, CMOs and other administrators.

So it doesn't really matter whether the hospitals tax status is for profit or not. The administrators still work the accounting such that excess revenues goes back to raising their salaries, and they drool over that money as much as the administrators at for profit hospitals do. They just can't call it "profits" and cut a check to themselves that day. But they can have the Board of Directors vote to raise their salaries by whatever amount they want, and that's what they do.

If you still think there's really such a thing as "not for profit" hospitals, in actual practice, tell me which hospitals are "for losses." Because if there are for profit hospitals, and not all hospitals are "for profit," there must necessary be hospitals that are the opposite, and "for losses."

So, we agree that there's such a thing as "for profit" hospitals.
But, for the ones that are not, which ones are "for loses"?
I agree with all this... my point of contention is that profit hospitals can be publicly owned and nonprofit are not. Therefore there are no average physician shareholders of a nonprofit hospital.
 
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.

The unfortunate reality is that if you use something like Centor as a reason not to prescribe antibiotics, all you’ve done is pretty much guarantee a bounce back. Best just to sprinkle some holy amoxicillin on the supplicant and tell them to go in peace.

As far as antibiotic stewardship goes, tell the Ag industry to quit carpet bombing their livestock with it first.
 
The unfortunate reality is that if you use something like Centor as a reason not to prescribe antibiotics, all you’ve done is pretty much guarantee a bounce back. Best just to sprinkle some holy amoxicillin on the supplicant and tell them to go in peace.

As far as antibiotic stewardship goes, tell the Ag industry to quit carpet bombing their livestock with it first.

So as long as Ag carpet bombs their livestock with antibiotics, which accounts for 70-80% of all Abx usage in the US, it's OK for us to just give abx to everyone with a sore throat?
 
So as long as Ag carpet bombs their livestock with antibiotics, which accounts for 70-80% of all Abx usage in the US, it's OK for us to just give abx to everyone with a sore throat?
No, so long as patient satisfaction is a thing and we get penalized for it everyone gets antibiotics for their sore throats.
 
No, so long as patient satisfaction is a thing and we get penalized for it everyone gets antibiotics for their sore throats.

So why not just do a rapid strep screen that way if negative you don’t write a prescription, the patient has an objective test stating they don’t need antibiotics, everyone is happy.