We Choose NPs

[TheSingularity]

Whoever does this is a traitor btw

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[southerndoc]

Interesting. He closed comments.

I wonder if he went to one of the online degree mills?

My state (Georgia) is one of the most restrictive states with regards to NP practice. Georgia only allows MD's, DO's, DMD's, DDS's, and DC's to utilize the word "doctor" in any healthcare setting. Homeopathic "physicians," DNP's, etc. are not allowed by Georgia law to use the title Dr when introducing themselves to patients. Also, NP practice requires physician oversight/medical direction -- including the ability for the physician medical director to be immediately available (or his/her delegate) for any questions. Georgia holds the physician medical director personally accountable for all actions taken by the NP. NP's are not allowed to prescribe schedule II controlled substances.

 

[GeneralVeers]

Not sure why DC's get to use "doctor". They're no better than glorified massage therapists, and at worst they can be lumped in with the homeopaths.

 

[Matthew9Thirtyfive]

Not sure why DC's get to use "doctor". They're no better than glorified massage therapists, and at worst they can be lumped in with the homeopaths.

In Oregon (and NM I think), NDs are considered primary care physicians and can do all the same things a physician can do.

 

[GeneralVeers]

In Oregon (and NM I think), NDs are considered primary care physicians and can do all the same things a physician can do.

That's terrifying. I always laugh when insurance when cover things like acupuncture, but will make a needed medication Tier 3 or 4.

 

[Matthew9Thirtyfive]

That's terrifying. I always laugh when insurance when cover things like acupuncture, but will make a needed medication Tier 3 or 4.

When I was working as a corpsman on the ship, we were required to send patients with back pain to the chiropractor before sending them to physical therapy, etc. I think it was mostly to make them wait until the pain resolved on its own while making them feel like we were doing something for them lol.

 

[deleted480308]

Collaborator seems an appropriate term. If you get my drift.

In my talks with recruiters I always use the word supervisor as a matter of principle

 

[RustedFox]

That's terrifying. I always laugh when insurance when cover things like acupuncture, but will make a needed medication Tier 3 or 4.

THIS nonsense!

They hold "wellness fairs" where you can be introduced to a carousel of losers like acupuncture/chiropractor/reiki/etc. And they're all "covered and in network"


But... Go to the ER for real medicines.... Welp...

 

[Birdstrike]

How Much Should a Physician Collaborator Cost?

I am always being asked “how much should a physician collaborator cost?” I always answer, “it depends.” There are four factors you need to consider:

elitenp.com

This is unfortunate.

I know an FP who does this "physician collaborator" stuff for NPs at a corporate pharmacy while never on site. Personally I think it's bonkers. Signing my name onto all of their liability while not ever being on site to ensure they're doing the right thing?
Thanks, but, "No thanks." I don't even like doing it when I'm on site and able to see the patients.

You know damn well the minute there's some tragic outcome, "I proudly practice independently," turns into, "I hired him to supervise me and that greedy doctor just took money from me, never showed up and threw me and this poor patient to the wolves! Boo-hoo-hoo! I'm so sad for this patient and that greedy doctor just doesn't care. It's his fault!"

Any opening offer by an NP for me to provide this coverage must be at least equal to or greater than my malpractice premium, to even get a conversation started. And I still probably wouldn't do it. Suck it up and move to a state where you can bear the brunt of your own liability grenades without using me as a human shield.

 

[Birdstrike]

They hold "wellness fairs" where you can be introduced to a carousel of losers like acupuncture/chiropractor/reiki/etc. And they're all "covered and in network"

I deal with this first hand. I routinely see chiro treatments covered by insurance company including tax-payer funded insurance (Care/Caid). Fortunately, I haven't seen acupuncture, reiki therapy, massage or most of that other malarkey routinely covered in my area. I also see a lot of charlatans (usually ortho) that rip off elderly and desperate patients selling stem cell or PRP injections that don't do crap except make people $5,000-$10,000 poorer, and CBD oil that doesn't do squat except make you fail your drug test and your wallet slim down.

 

[VA Hopeful Dr]

I know an FP who does this "physician collaborator" stuff for NPs at a corporate pharmacy while never on site. Personally I think it's bonkers. Signing my name onto all of their liability while not ever being on site to ensure they're doing the right thing?
Thanks, but, "No thanks." I don't even like doing it when I'm on site and able to see the patients.

You know damn well the minute there's some tragic outcome, "I proudly practice independently," turns into, "I hired him to supervise me and that greedy doctor just took money from me, never showed up and threw me and this poor patient to the wolves! Boo-hoo-hoo! I'm so sad for this patient and that greedy doctor just doesn't care. It's his fault!"

Any opening offer by an NP for me to provide this coverage must be at least equal to or greater than my malpractice premium, to even get a conversation started. And I still probably wouldn't do it. Suck it up and move to a state where you can bear the brunt of your own liability grenades without using me as a human shield.

I was offered that role 5 years ago: supervising an NP at a CVS Minute Clinic. 10 miles away from my office, worked weird hours (so I might be on the hook for their questions on Saturdays/Sundays). They acted shocked when I refused to take the job ("but Doctor, its the easiest 10k/year you'll ever make!")

 

[TooMuchResearch]

Maybe for $100k, then give half the money to an anti-NP lobbying group and the rest into a protected irrevocable trust.

I was offered that role 5 years ago: supervising an NP at a CVS Minute Clinic. 10 miles away from my office, worked weird hours (so I might be on the hook for their questions on Saturdays/Sundays). They acted shocked when I refused to take the job ("but Doctor, its the easiest 10k/year you'll ever make!")

 

[Ironspy]

I was offered that role 5 years ago: supervising an NP at a CVS Minute Clinic. 10 miles away from my office, worked weird hours (so I might be on the hook for their questions on Saturdays/Sundays). They acted shocked when I refused to take the job ("but Doctor, its the easiest 10k/year you'll ever make!")

I was contacted about a “great locums job” where they would pay me a (****yy) hourly rate to come sign the charts of 3-4 NPs. They wanted to pay me for one hour/week of work bc that’s how long it would take to sign. I told them my hourly rate for that type of work was $5k/hour.

 

[Splenda88]

I was contacted about a “great locums job” where they would pay me a (****yy) hourly rate to come sign the charts of 3-4 NPs. They wanted to pay me for one hour/week of work bc that’s how long it would take to sign. I told them my hourly rate for that type of work was $5k/hour.

I am having a hard time believing someone would say that... Why does everyone think that physicians are stupid?

 

[deleted109597]

I am having a hard time believing someone would say that... Why does everyone think that physicians are stupid?

Because many of them are below average. And many have made many, many bad decisions prior to said phone call. This isn't the first doc they've called. it's not the last. People are taking it I promise.

 

[GeneralVeers]

Because many of them are below average. And many have made many, many bad decisions prior to said phone call. This isn't the first doc they've called. it's not the last. People are taking it I promise.

I work with a lot of stupid physicians. Are they good test takers? Yes. Able to make clinical decisions? No. After 10 years of practicing medicine, it shouldn't take you longer than 3 hours to disposition a patient with abdominal pain and all studies back. They always appear wracked with indecision about something that should just be a "widget" assembly line process.

 

[Listen2Savage]

I just unsubscribed from EMRA newsletter bc they sent me something written by (to use @RustedFox vernacular) Jenny McJennerson...and then i had to copy paste the next part lol... DNP, APRN, CPNP-PC, CNE, CNL, FAANP

 

[deleted480308]

I just unsubscribed from EMRA newsletter bc they sent me something written by (to use @RustedFox vernacular) Jenny McJennerson...and then i had to copy paste the next part lol... DNP, APRN, CPNP-PC, CNE, CNL, FAANP

that is sooooo many letters

 

[ShockIndex]

...NP's are not allowed to prescribe schedule II controlled substances.

I got the impression in NC that the NPs were at the forefront of the over-prescribing epidemic in my region. Not in terms of raw numbers, but way out of proportion to the numbers of NPs in practice. Moreover, it was not just the ones working at pain clinics as the primary care and behavioral health NPs were perhaps the worst of the bunch. A lot of patients being prescribed what I called the “trifecta” - an opiate, benzo, and stimulant. All for their chronic pain, anxiety, and ADHD.

 

[deleted941485]

I just unsubscribed from EMRA newsletter bc they sent me something written by (to use @RustedFox vernacular) Jenny McJennerson...and then i had to copy paste the next part lol... DNP, APRN, CPNP-PC, CNE, CNL, FAANP

The alphabet soup is a dumb marketing ploy. Patient assumes they must be an authority because they have so many acronyms after their name.

 

[deleted480308]

The alphabet soup is a dumb marketing ploy. Patient assumes they must be an authority because they have so many acronyms after their name.

Dr. SB247, bamf, sob, r2d2, scuba, acei, bmw, dkny, xoxo, mri, tolac

 

[Splenda88]

Dr. SB247, bamf, sob, r2d2, scuba, acei, bmw, dkny, xoxo, mri, tolac

Now I have a lot more respect for ya...

 

[rokshana]

Thought y’all would appreciate this...while
not dumbfounded, am amazed at the arrogance.

 

[sunshinefl]

Thought y’all would appreciate this...while
not dumbfounded, and amazed at the arrogance.

JFC

 

[TooMuchResearch]

Amazing.

Thought y’all would appreciate this...while
not dumbfounded, and amazed at the arrogance.

 

[megathunder]

The AAFA Attacks: Reasons Why Flight Attendants Should be Allowed to Fly Planes

There has been some major pushback to the article “Facing Pilot Shortage, will California Give Flight Attendants More Authority to Fly the Plane?”. Due to the alarm by the public, the A…

authenticmedicine.com

 

[Dred Pirate]

I got the impression in NC that the NPs were at the forefront of the over-prescribing epidemic in my region. Not in terms of raw numbers, but way out of proportion to the numbers of NPs in practice. Moreover, it was not just the ones working at pain clinics as the primary care and behavioral health NPs were perhaps the worst of the bunch. A lot of patients being prescribed what I called the “trifecta” - an opiate, benzo, and stimulant. All for their chronic pain, anxiety, and ADHD.

it is state dependent on who can prescribe C-II- in NC they definitely can.

 

[Dred Pirate]

Dr. SB247, bamf, sob, r2d2, scuba, acei, bmw, dkny, xoxo, mri, tolac

Love the scuba.

I got an email from a RN at my hospital with similiar letters
I have to admit my profession (pharmacists) are nearly as bad at times.
So I responded with

Dred Pirate, PharmD, PADI OW, AOW, SSI Nitrox

 

[TooMuchResearch]

Great link.

Gov't DGAF though.

:sadface:

The AAFA Attacks: Reasons Why Flight Attendants Should be Allowed to Fly Planes

There has been some major pushback to the article “Facing Pilot Shortage, will California Give Flight Attendants More Authority to Fly the Plane?”. Due to the alarm by the public, the A…

authenticmedicine.com

 

[EMikate]

Just spent the day at the Florida State Capitol where a group of us spoke in opposition to the expanded scope of practice for NPs bill. We lost. It passed. RIP to this argument in Florida. PAs and CRNAs not included for now, I'm sure will be included soon.

 

[thegenius]

Just spent the day at the Florida State Capitol where a group of us spoke in opposition to the expanded scope of practice for NPs bill. We lost. It passed. RIP to this argument in Florida. PAs and CRNAs not included for now, I'm sure will be included soon.

Was this an open forum for discussion? What were some of the arguments and against? I can probably figure it out, just curious what was actually said.

 

[EMikate]

Was this an open forum for discussion? What were some of the arguments and against? I can probably figure it out, just curious what was actually said.

It was the meeting of the state senate appropriations committee, which (if I understand correctly-I know almost nothing about politics) is the last stop for a bill before being sent to the floor for a final vote. At this point now, the bill has passed the House and the Senate, and the final step before it is signed into law is for the two to decide on the exact language of the bill (and the governor has to approve as well). It wasn't exactly an open forum, but pretty much anyone is allowed to "testify" if you submit a card to the chairman before the meeting starts.

From what I understand, many NPs testified a few weeks ago when the bill went through the house (and passed, obviously). Yesterday many physicians and several medical students spoke. One PA and one CRNA spoke out against the bill only because they are not included in it. It only allows NPs independent practice at this time.

The main argument in favor of the bill by the representative who wrote it and senators in favor was that this is supposed to increase access to healthcare in the most rural and underserved areas of Florida. The bill specifies that independent practice APRNs must practice "general practice" (which is really not very well defined) in an area designated by the federal government as underserved for a minimum of 3 years. After this 3 years they are able to practice independently anywhere in the state of Florida. The main rebuttal to this argument was that studies done in states that already have expanded scope of practice show that these NPs are not in fact practicing in rural areas any more than physicians are, and underserved areas are remaining underserved. Another argument against this is that it creates a two-tiered healthcare system in which wealthier urban citizens have access to physicians (ie "superior training" and diagnostic skill) and the more poor rural area citizens are provided with "inferior health care" by independent APRNs. This was answered by the senators with the argument that inferior health care is better than NO healthcare. The words "primary care desert" were repeatedly thrown around describing areas like western Miami Dade county and Pinellas county, where Clearwater is. I don't live or rotate in those areas, so I am not an expert, but I don't know that I would describe any part of Miami or Clearwater as any kind of desert....

Other arguments against the bill were fairly standard things we have all heard many times and know well...
-The training of nurses is a completely different type of training and is not comparable to medical training.
-There is little to no standardization in graduate-level NP training and many if not most NP degrees are earned online with minimal shadowing experience as their "clinical" training.
-By the end of residency physicians have completed 15,000 + hours of directly supervised clinical training in order to be board eligible to practice medicine. This bill required APRNs to have completed 2,000 hours of clinical training in order to practice unsupervised.
-Midlevel providers have been shown to order more tests and prescribe more unnecessary antibiotics and opioids than physicians.

There seemed to be an overall feeling among the senators that "general practice" is very simple and involves not much more than tracking patients' BMI and giving vaccines. There was more than one occasion in which a senator commented that its not like these APRNs "will be performing brain surgery". I felt that the rebuttal to this by several family physicians that spoke was not very well articulated. They spoke about the complexity and delicate nature of managing multiple comorbid chronic illnesses, but no one really thoroughly explained what it is that primary care physicians do that would be inappropriate for APRNs to do. I think that is really where we lost the argument. The general public honestly seems to think that primary care can be performed by anyone off the street without any repercussions. I think in the future in order to win these political arguments, it is important to educate the public about what it is that doctors actually do, and why we are indispensable. I know it is sad that it has gotten to the point where we have to convince people that doctors are a necessary part of any society, but that is where we are at now.

There were other arguments made and some medmal and insurance coverage issues were briefly touched upon, but this is the main gist of what went down. Sorry for the super long post, I hope this was helpful!!

 

[Listen2Savage]

It was the meeting of the state senate appropriations committee, which (if I understand correctly-I know almost nothing about politics) is the last stop for a bill before being sent to the floor for a final vote. At this point now, the bill has passed the House and the Senate, and the final step before it is signed into law is for the two to decide on the exact language of the bill (and the governor has to approve as well). It wasn't exactly an open forum, but pretty much anyone is allowed to "testify" if you submit a card to the chairman before the meeting starts.

From what I understand, many NPs testified a few weeks ago when the bill went through the house (and passed, obviously). Yesterday many physicians and several medical students spoke. One PA and one CRNA spoke out against the bill only because they are not included in it. It only allows NPs independent practice at this time.

The main argument in favor of the bill by the representative who wrote it and senators in favor was that this is supposed to increase access to healthcare in the most rural and underserved areas of Florida. The bill specifies that independent practice APRNs must practice "general practice" (which is really not very well defined) in an area designated by the federal government as underserved for a minimum of 3 years. After this 3 years they are able to practice independently anywhere in the state of Florida. The main rebuttal to this argument was that studies done in states that already have expanded scope of practice show that these NPs are not in fact practicing in rural areas any more than physicians are, and underserved areas are remaining underserved. Another argument against this is that it creates a two-tiered healthcare system in which wealthier urban citizens have access to physicians (ie "superior training" and diagnostic skill) and the more poor rural area citizens are provided with "inferior health care" by independent APRNs. This was answered by the senators with the argument that inferior health care is better than NO healthcare. The words "primary care desert" were repeatedly thrown around describing areas like western Miami Dade county and Pinellas county, where Clearwater is. I don't live or rotate in those areas, so I am not an expert, but I don't know that I would describe any part of Miami or Clearwater as any kind of desert....

Other arguments against the bill were fairly standard things we have all heard many times and know well...
-The training of nurses is a completely different type of training and is not comparable to medical training.
-There is little to no standardization in graduate-level NP training and many if not most NP degrees are earned online with minimal shadowing experience as their "clinical" training.
-By the end of residency physicians have completed 15,000 + hours of directly supervised clinical training in order to be board eligible to practice medicine. This bill required APRNs to have completed 2,000 hours of clinical training in order to practice unsupervised.
-Midlevel providers have been shown to order more tests and prescribe more unnecessary antibiotics and opioids than physicians.

There seemed to be an overall feeling among the senators that "general practice" is very simple and involves not much more than tracking patients' BMI and giving vaccines. There was more than one occasion in which a senator commented that its not like these APRNs "will be performing brain surgery". I felt that the rebuttal to this by several family physicians that spoke was not very well articulated. They spoke about the complexity and delicate nature of managing multiple comorbid chronic illnesses, but no one really thoroughly explained what it is that primary care physicians do that would be inappropriate for APRNs to do. I think that is really where we lost the argument. The general public honestly seems to think that primary care can be performed by anyone off the street without any repercussions. I think in the future in order to win these political arguments, it is important to educate the public about what it is that doctors actually do, and why we are indispensable. I know it is sad that it has gotten to the point where we have to convince people that doctors are a necessary part of any society, but that is where we are at now.

There were other arguments made and some medmal and insurance coverage issues were briefly touched upon, but this is the main gist of what went down. Sorry for the super long post, I hope this was helpful!!

very helpful thanks for the long write up

western miami dade a desert? lol ok...

this is crazy

when are hospitals gonna get wise to this and start advertising "dont pay the same amount to see a MLPs, only see DOCTORS at xyz regional"

when are doctors gonna start publicly lobbying against MLPs, like they've done against us?

As an attending I'll testify against NPs that mismanage pts, i dont givafuk.

 

[RustedFox]

1.) Clearwater is anything but a primary care desert.
2.) I already tell all of my acquaintances to "demand to see a physician". It's being well-received in general.
3.) I can't wait for the Jennies to start being sued. They're tying their own nooses with this bill.
4.) No NP will get any help from me in the community if they call for a curbside consult. ******* ER referrals will be met with unkind phone calls and me throwing the NP under the bus in discussions with the patient.
5.) I'm day-drinking today. Poke me and I will write probably hilarious things.

 

[deleted126335]

It was the meeting of the state senate appropriations committee, which (if I understand correctly-I know almost nothing about politics) is the last stop for a bill before being sent to the floor for a final vote. At this point now, the bill has passed the House and the Senate, and the final step before it is signed into law is for the two to decide on the exact language of the bill (and the governor has to approve as well). It wasn't exactly an open forum, but pretty much anyone is allowed to "testify" if you submit a card to the chairman before the meeting starts.

From what I understand, many NPs testified a few weeks ago when the bill went through the house (and passed, obviously). Yesterday many physicians and several medical students spoke. One PA and one CRNA spoke out against the bill only because they are not included in it. It only allows NPs independent practice at this time.

The main argument in favor of the bill by the representative who wrote it and senators in favor was that this is supposed to increase access to healthcare in the most rural and underserved areas of Florida. The bill specifies that independent practice APRNs must practice "general practice" (which is really not very well defined) in an area designated by the federal government as underserved for a minimum of 3 years. After this 3 years they are able to practice independently anywhere in the state of Florida. The main rebuttal to this argument was that studies done in states that already have expanded scope of practice show that these NPs are not in fact practicing in rural areas any more than physicians are, and underserved areas are remaining underserved. Another argument against this is that it creates a two-tiered healthcare system in which wealthier urban citizens have access to physicians (ie "superior training" and diagnostic skill) and the more poor rural area citizens are provided with "inferior health care" by independent APRNs. This was answered by the senators with the argument that inferior health care is better than NO healthcare. The words "primary care desert" were repeatedly thrown around describing areas like western Miami Dade county and Pinellas county, where Clearwater is. I don't live or rotate in those areas, so I am not an expert, but I don't know that I would describe any part of Miami or Clearwater as any kind of desert....

Other arguments against the bill were fairly standard things we have all heard many times and know well...
-The training of nurses is a completely different type of training and is not comparable to medical training.
-There is little to no standardization in graduate-level NP training and many if not most NP degrees are earned online with minimal shadowing experience as their "clinical" training.
-By the end of residency physicians have completed 15,000 + hours of directly supervised clinical training in order to be board eligible to practice medicine. This bill required APRNs to have completed 2,000 hours of clinical training in order to practice unsupervised.
-Midlevel providers have been shown to order more tests and prescribe more unnecessary antibiotics and opioids than physicians.

There seemed to be an overall feeling among the senators that "general practice" is very simple and involves not much more than tracking patients' BMI and giving vaccines. There was more than one occasion in which a senator commented that its not like these APRNs "will be performing brain surgery". I felt that the rebuttal to this by several family physicians that spoke was not very well articulated. They spoke about the complexity and delicate nature of managing multiple comorbid chronic illnesses, but no one really thoroughly explained what it is that primary care physicians do that would be inappropriate for APRNs to do. I think that is really where we lost the argument. The general public honestly seems to think that primary care can be performed by anyone off the street without any repercussions. I think in the future in order to win these political arguments, it is important to educate the public about what it is that doctors actually do, and why we are indispensable. I know it is sad that it has gotten to the point where we have to convince people that doctors are a necessary part of any society, but that is where we are at now.

There were other arguments made and some medmal and insurance coverage issues were briefly touched upon, but this is the main gist of what went down. Sorry for the super long post, I hope this was helpful!!

It will increase access- At the expense of quality. Of course, nobody can acknowledge that they are shaving on quality. So they have to make the argument that there isn’t that much to know for most routine care.


Sent from my iPhone using SDN mobile

 

[RustedFox]

It will increase access- At the expense of quality. Of course, nobody can acknowledge that they are shaving on quality. So they have to make the argument that there isn’t that much to know for most routine care.


Sent from my iPhone using SDN mobile

The acknowledgement will only come when the attorneys pick them clean like the vultures they are.

 

[Listen2Savage]

1.) Clearwater is anything but a primary care desert.
2.) I already tell all of my acquaintances to "demand to see a physician". It's being well-received in general.
3.) I can't wait for the Jennies to start being sued. They're tying their own nooses with this bill.
4.) No NP will get any help from me in the community if they call for a curbside consult. ******* ER referrals will be met with unkind phone calls and me throwing the NP under the bus in discussions with the patient.
5.) I'm day-drinking today. Poke me and I will write probably hilarious things.

what are you drinking?

RF strikes me as a mimosa guy

 

[GeneralVeers]

I can't imagine they will have much independent practice in large cities due to hospital fear of litigation. Also their malpractice premiums are likely to b huge given that you are essentially taking a random person off the street, given them a stethoscope and telling them to go practice by themselves.

 

[Listen2Savage]

I can't imagine they will have much independent practice in large cities due to hospital fear of litigation. Also their malpractice premiums are likely to b huge given that you are essentially taking a random person off the street, given them a stethoscope and telling them to go practice by themselves.

ya won't the malpractice premiums be the ultimate barrier to independent practice?

The insurance companies are a lot of things, but not stupid.

What are their insurance costs in states that already have independent practice?

 

[GeneralVeers]

ya won't the malpractice premiums be the ultimate barrier to independent practice?

The insurance companies are a lot of things, but not stupid.

What are their insurance costs in states that already have independent practice?

Don't know the numbers, but just based on logic, NPs will probably have higher rates of litigation since they will likely have higher miss rates for emergent conditions, probably give inappropriate treatments, and be a easier, juicier target for an attorney than an educated physician.

 

[Listen2Savage]

Don't know the numbers, but just based on logic, NPs will probably have higher rates of litigation since they will likely have higher miss rates for emergent conditions, probably give inappropriate treatments, and be a easier, juicier target for an attorney than an educated physician.

theyll probably lobby for NP medmal tort reform...

AND GET IT!!!

 

[EMikate]

It was a disheartening and frustrating day for sure. There was so much ignorance of how this whole thing works... Comments from senators like "My mother is an RN! How DARE you call RNs incompetent! (Obviously no one said anything about RNs period...especially not that they are incompetent). Several senators were like "well I go see an NP all the time and I turned out fine" (For one thing, you probably don't have the long list of comorbid conditions that many of the rural poor and elderly have, and for another thing that NP you are seeing is being supervised by a physician!!!).

I think a lot of the reason the day went poorly for physicians is that we have a PR problem in general. People love to hate doctors and love to glorify nurses. It's just the way this country is right now. The "brain of a doctor, heart of a nurse" campaign hit us pretty hard, unfortunately.

 

[GeneralVeers]

I'm sure most people think their NPs are great, because they do lots of tests and give out ABX. That's all Americans really want when they go the doctor: tests and pills.

 

[thegenius]

It was the meeting of the state senate appropriations committee, which (if I understand correctly-I know almost nothing about politics) is the last stop for a bill before being sent to the floor for a final vote. At this point now, the bill has passed the House and the Senate, and the final step before it is signed into law is for the two to decide on the exact language of the bill (and the governor has to approve as well). It wasn't exactly an open forum, but pretty much anyone is allowed to "testify" if you submit a card to the chairman before the meeting starts.

From what I understand, many NPs testified a few weeks ago when the bill went through the house (and passed, obviously). Yesterday many physicians and several medical students spoke. One PA and one CRNA spoke out against the bill only because they are not included in it. It only allows NPs independent practice at this time.

The main argument in favor of the bill by the representative who wrote it and senators in favor was that this is supposed to increase access to healthcare in the most rural and underserved areas of Florida. The bill specifies that independent practice APRNs must practice "general practice" (which is really not very well defined) in an area designated by the federal government as underserved for a minimum of 3 years. After this 3 years they are able to practice independently anywhere in the state of Florida. The main rebuttal to this argument was that studies done in states that already have expanded scope of practice show that these NPs are not in fact practicing in rural areas any more than physicians are, and underserved areas are remaining underserved. Another argument against this is that it creates a two-tiered healthcare system in which wealthier urban citizens have access to physicians (ie "superior training" and diagnostic skill) and the more poor rural area citizens are provided with "inferior health care" by independent APRNs. This was answered by the senators with the argument that inferior health care is better than NO healthcare. The words "primary care desert" were repeatedly thrown around describing areas like western Miami Dade county and Pinellas county, where Clearwater is. I don't live or rotate in those areas, so I am not an expert, but I don't know that I would describe any part of Miami or Clearwater as any kind of desert....

Other arguments against the bill were fairly standard things we have all heard many times and know well...
-The training of nurses is a completely different type of training and is not comparable to medical training.
-There is little to no standardization in graduate-level NP training and many if not most NP degrees are earned online with minimal shadowing experience as their "clinical" training.
-By the end of residency physicians have completed 15,000 + hours of directly supervised clinical training in order to be board eligible to practice medicine. This bill required APRNs to have completed 2,000 hours of clinical training in order to practice unsupervised.
-Midlevel providers have been shown to order more tests and prescribe more unnecessary antibiotics and opioids than physicians.

There seemed to be an overall feeling among the senators that "general practice" is very simple and involves not much more than tracking patients' BMI and giving vaccines. There was more than one occasion in which a senator commented that its not like these APRNs "will be performing brain surgery". I felt that the rebuttal to this by several family physicians that spoke was not very well articulated. They spoke about the complexity and delicate nature of managing multiple comorbid chronic illnesses, but no one really thoroughly explained what it is that primary care physicians do that would be inappropriate for APRNs to do. I think that is really where we lost the argument. The general public honestly seems to think that primary care can be performed by anyone off the street without any repercussions. I think in the future in order to win these political arguments, it is important to educate the public about what it is that doctors actually do, and why we are indispensable. I know it is sad that it has gotten to the point where we have to convince people that doctors are a necessary part of any society, but that is where we are at now.

There were other arguments made and some medmal and insurance coverage issues were briefly touched upon, but this is the main gist of what went down. Sorry for the super long post, I hope this was helpful!!

This was very helpful. I often think this is an argument doctors cannot win. Maybe 50 years ago we could win this, when patients spent 20 minutes with their doctors for ear aches and 1 hour for complex problems (there is a little bit of hyperbole here).

But what do patients and congressman see these days? They are saying to themselves - Why do I need an expensive doctor for:

- I have a sore throat. There is a swab that says "yes I need antibiotics" or "no I don't need antibiotics".
- I have repeated blood pressure measurements between 145-170. I feel fine. I need HTN medication.
- my bad cholesterol is high, because I don't eat well and don't exercise. I want some pills.
- my urine smells and hurts. Can I just have some antibiotics?
- I need a work note
- I need a school note
- my threw my shoulder out 6 weeks ago playing sports. I need some help getting it better
- when should I schedule my screening mammogram?
- when should I schedule my screening c-scope?
- I need my child's vaccines
- my child is running around with snot coming out of his nose, and his temperature is 101.1. Is he going to be OK?
- my low back has been killing me doing all this work. I need some extra pills and a work note
- I need a school note
- Am I pregnant?
- I've been coughing for 2 weeks. Can I have some antibiotics?
- I've been coughing for 1 week. Can I have some antibiotics?
- I've been coughing for 2 days. Can I have some antibiotics?
- I've been coughing for 2 months. Can I have some antibiotics?
- I'm throwing up and having diarrhea after eating potato salad that's been sitting out for 2 days. Can I have some antibiotics?
- I have the flu
- I have a headache that I always get

The problem we are encountering is that we have much more technology that we did 50 years ago, and patients are more knowledgeable than they were 50 years ago. Medicine is very slowly changing and becoming demystified. Couple that with rising costs and ER visits that cost $2000 and this is what we get.

It's not doctors fault that the congressman said in the hearings

There was more than one occasion in which a senator commented that its not like these APRNs "will be performing brain surgery".

I don't think a well-organized physician coalition could have prevented the slow course change this massive cruiseliner called "The Health Care Boat" has been making.

 

[thegenius]

1.) Clearwater is anything but a primary care desert.
2.) I already tell all of my acquaintances to "demand to see a physician". It's being well-received in general.
3.) I can't wait for the Jennies to start being sued. They're tying their own nooses with this bill.
4.) No NP will get any help from me in the community if they call for a curbside consult. ******* ER referrals will be met with unkind phone calls and me throwing the NP under the bus in discussions with the patient.
5.) I'm day-drinking today. Poke me and I will write probably hilarious things.

I'll join you here out on the West Coast. I specifically like #2, 3, 4. I know nothing about #1.

 

[thegenius]

theyll probably lobby for NP medmal tort reform...

AND GET IT!!!

OMG

That will be the day I leave medicine. I promise.

If NP's lobby and get medmal tort reform, then I will publically pronounce all doctors idiots

 

[thegenius]

I'm sure most people think their NPs are great, because they do lots of tests and give out ABX. That's all Americans really want when they go the doctor: tests and pills.

I've already started that company. Test'n'Pills!

I'm hiring people now and will sign a contract protecting all who impugn those practice medicine without an MD or DO.

 

[RustedFox]

what are you drinking?

RF strikes me as a mimosa guy

Earlier, it was Deep Eddy Grapefruit flavored vodka + grapefruit juice.

I have a grapefruit tree. My favorite fruit.

I went home, watched "Brockmire", played PS4 (Blasphemous) and napped out. Now, I'm switching to Coors light.

 

[sunshinefl]

It was the meeting of the state senate appropriations committee, which (if I understand correctly-I know almost nothing about politics) is the last stop for a bill before being sent to the floor for a final vote. At this point now, the bill has passed the House and the Senate, and the final step before it is signed into law is for the two to decide on the exact language of the bill (and the governor has to approve as well). It wasn't exactly an open forum, but pretty much anyone is allowed to "testify" if you submit a card to the chairman before the meeting starts.

From what I understand, many NPs testified a few weeks ago when the bill went through the house (and passed, obviously). Yesterday many physicians and several medical students spoke. One PA and one CRNA spoke out against the bill only because they are not included in it. It only allows NPs independent practice at this time.

The main argument in favor of the bill by the representative who wrote it and senators in favor was that this is supposed to increase access to healthcare in the most rural and underserved areas of Florida. The bill specifies that independent practice APRNs must practice "general practice" (which is really not very well defined) in an area designated by the federal government as underserved for a minimum of 3 years. After this 3 years they are able to practice independently anywhere in the state of Florida. The main rebuttal to this argument was that studies done in states that already have expanded scope of practice show that these NPs are not in fact practicing in rural areas any more than physicians are, and underserved areas are remaining underserved. Another argument against this is that it creates a two-tiered healthcare system in which wealthier urban citizens have access to physicians (ie "superior training" and diagnostic skill) and the more poor rural area citizens are provided with "inferior health care" by independent APRNs. This was answered by the senators with the argument that inferior health care is better than NO healthcare. The words "primary care desert" were repeatedly thrown around describing areas like western Miami Dade county and Pinellas county, where Clearwater is. I don't live or rotate in those areas, so I am not an expert, but I don't know that I would describe any part of Miami or Clearwater as any kind of desert....

Other arguments against the bill were fairly standard things we have all heard many times and know well...
-The training of nurses is a completely different type of training and is not comparable to medical training.
-There is little to no standardization in graduate-level NP training and many if not most NP degrees are earned online with minimal shadowing experience as their "clinical" training.
-By the end of residency physicians have completed 15,000 + hours of directly supervised clinical training in order to be board eligible to practice medicine. This bill required APRNs to have completed 2,000 hours of clinical training in order to practice unsupervised.
-Midlevel providers have been shown to order more tests and prescribe more unnecessary antibiotics and opioids than physicians.

There seemed to be an overall feeling among the senators that "general practice" is very simple and involves not much more than tracking patients' BMI and giving vaccines. There was more than one occasion in which a senator commented that its not like these APRNs "will be performing brain surgery". I felt that the rebuttal to this by several family physicians that spoke was not very well articulated. They spoke about the complexity and delicate nature of managing multiple comorbid chronic illnesses, but no one really thoroughly explained what it is that primary care physicians do that would be inappropriate for APRNs to do. I think that is really where we lost the argument. The general public honestly seems to think that primary care can be performed by anyone off the street without any repercussions. I think in the future in order to win these political arguments, it is important to educate the public about what it is that doctors actually do, and why we are indispensable. I know it is sad that it has gotten to the point where we have to convince people that doctors are a necessary part of any society, but that is where we are at now.

There were other arguments made and some medmal and insurance coverage issues were briefly touched upon, but this is the main gist of what went down. Sorry for the super long post, I hope this was helpful!!

Wow thank you for the thorough write-up. I’m a lifelong Floridian wanting to practice in Florida. (Current M3)

1.) Clearwater is anything but a primary care desert.
2.) I already tell all of my acquaintances to "demand to see a physician". It's being well-received in general.
3.) I can't wait for the Jennies to start being sued. They're tying their own nooses with this bill.
4.) No NP will get any help from me in the community if they call for a curbside consult. ******* ER referrals will be met with unkind phone calls and me throwing the NP under the bus in discussions with the patient.
5.) I'm day-drinking today. Poke me and I will write probably hilarious things.

Can verify #1. I live in Clearwater where I am completing 3rd year rotations. Primary care is readily available.

It was a disheartening and frustrating day for sure. There was so much ignorance of how this whole thing works... Comments from senators like "My mother is an RN! How DARE you call RNs incompetent! (Obviously no one said anything about RNs period...especially not that they are incompetent). Several senators were like "well I go see an NP all the time and I turned out fine" (For one thing, you probably don't have the long list of comorbid conditions that many of the rural poor and elderly have, and for another thing that NP you are seeing is being supervised by a physician!!!).

I think a lot of the reason the day went poorly for physicians is that we have a PR problem in general. People love to hate doctors and love to glorify nurses. It's just the way this country is right now. The "brain of a doctor, heart of a nurse" campaign hit us pretty hard, unfortunately.

Can I use this in my advertising since I was an RN? (well, am... my license is active for another year. Long enough to see if I matched before I let it go.)

This was very helpful. I often think this is an argument doctors cannot win. Maybe 50 years ago we could win this, when patients spent 20 minutes with their doctors for ear aches and 1 hour for complex problems (there is a little bit of hyperbole here).

But what do patients and congressman see these days? They are saying to themselves - Why do I need an expensive doctor for:

- I have a sore throat. There is a swab that says "yes I need antibiotics" or "no I don't need antibiotics".
- I have repeated blood pressure measurements between 145-170. I feel fine. I need HTN medication.
- my bad cholesterol is high, because I don't eat well and don't exercise. I want some pills.
- my urine smells and hurts. Can I just have some antibiotics?
- I need a work note
- I need a school note
- my threw my shoulder out 6 weeks ago playing sports. I need some help getting it better
- when should I schedule my screening mammogram?
- when should I schedule my screening c-scope?
- I need my child's vaccines
- my child is running around with snot coming out of his nose, and his temperature is 101.1. Is he going to be OK?
- my low back has been killing me doing all this work. I need some extra pills and a work note
- I need a school note
- Am I pregnant?
- I've been coughing for 2 weeks. Can I have some antibiotics?
- I've been coughing for 1 week. Can I have some antibiotics?
- I've been coughing for 2 days. Can I have some antibiotics?
- I've been coughing for 2 months. Can I have some antibiotics?
- I'm throwing up and having diarrhea after eating potato salad that's been sitting out for 2 days. Can I have some antibiotics?
- I have the flu
- I have a headache that I always get

The problem we are encountering is that we have much more technology that we did 50 years ago, and patients are more knowledgeable than they were 50 years ago. Medicine is very slowly changing and becoming demystified. Couple that with rising costs and ER visits that cost $2000 and this is what we get.

It's not doctors fault that the congressman said in the hearings



I don't think a well-organized physician coalition could have prevented the slow course change this massive cruiseliner called "The Health Care Boat" has been making.

Some of the hardest anti-mid level people on this forum will hate on me for this, but... a couple of these things *are* okay for mid levels. My PCP is in an office with 2 other doctors and 1 shared NP. Today, I needed my AAMC immunization forms signed for 4th year elective apps. I called at 10am and got a 3:30 appt with the NP and got it done.

 

[MechEDoc]

In light of the new COVID-19 outbreak / hysteria / real threat. I really see a niche for NPs! After all, good precautions include limiting patients to one nurse and one provider to minimize staff exposure... Which means we send in a NP! After all they are both a nurse and a provider and they have the heart of a nurse and the brain of a doctor! Win, win!

Oh wait, the last three 2019-nCoV patients I saw the NP was strangely absent...