What are the best specialties to avoid the encroachment of nurses?

[MCAT guy]

What are the best specialties to avoid the encroachment of nurses?

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[Lokhtar]

Neurosurgery? Probably most surgery sup-specialties. Pathology I think too. Probably many of the IM subpecialties (though I think this probably varies a lot).

 

[MCAT guy]

Yeah but neurosurgery lifestyle is awful. Not to mention hard to match.

 

[Lokhtar]

You didn't mention that criteria .

Pathology is easy to match and has no encroachment but the job market is iffy.

 

[JaggerPlate]

Maybe you should look into Nursing ... it seems to be the only thing Noctors don't want to practice.

Other than that ... nothing is safe. Make no assumptions as far as 'they can't practice in X field' is concerned, and assume 'interest' will follow the reimbursements - OH, wait ... I mean, "interest will follow wherever the selfless noctors see a crucial gap in patient care that needs filling."

 

[bronx43]

Any surgery, radiology, and pathology.

 

[CyberKnife19]

Any surgery, radiology, and pathology.

I would add Radiation Oncology to that list.

 

[JaggerPlate]

Any surgery, radiology, and pathology.

Sucks if you don't want to undergo a notoriously awful residency process, have your job outsourced to India (I kid, I kid), or want any sort of stable employment opportunities post residency (no joke here ... go look at the path forums, frightening).

I've said it before and I'll say it again ... nothing is technically safe or off limits. You may never see a DNP wielding a scalpel and barking orders in the OR, but that doesn't mean they can't become highly involved with something like surgery and cut down the need for larger surgical teams (in a recent DNP discussion in a different forum, a member was talking about his friend who is currently becoming an 'Orthopedic NP'). Additionally, the 'specialize until they can't get you and screw the rest' mentality isn't effective and is partially why we're in this mess in the first place.

I'm not saying you shouldn't pick surg, rads, or path if you're interested and particularly like the idea of the additional security, but I think if you told a surgical PD you want to be a surgeon so Noctors don't bother you ... you might be in trouble.

 

[JaggerPlate]

I would add Radiation Oncology to that list.

You in a Rad Onc program???

 

[MCAT guy]

Sucks if you don't want to undergo a notoriously awful residency process, have your job outsourced to India (I kid, I kid), or want any sort of stable employment opportunities post residency (no joke here ... go look at the path forums, frightening).

I've said it before and I'll say it again ... nothing is technically safe or off limits. You may never see a DNP wielding a scalpel and barking orders in the OR, but that doesn't mean they can't become highly involved with something like surgery and cut down the need for larger surgical teams (in a recent DNP discussion in a different forum, a member was talking about his friend who is currently becoming an 'Orthopedic NP'). Additionally, the 'specialize until they can't get you and screw the rest' mentality isn't effective and is partially why we're in this mess in the first place.

I'm not saying you shouldn't pick surg, rads, or path if you're interested and particularly like the idea of the additional security, but I think if you told a surgical PD you want to be a surgeon so Noctors don't bother you ... you might be in trouble.

No one is saying screw the rest of 'em here.

But if there are bomb threats across the coast and I'm moving, I go move inland. I don't move to the coast.

 

[Lokhtar]

On the opposite scale...which residencies are the "most" affected?

Family Practice (or pediatrics or IM - if they are outpatient primary care), Anesthesiology....what else?

 

[Dr Oops]

No one is saying screw the rest of 'em here.

But if there are bomb threats across the coast and I'm moving, I go move inland. I don't move to the coast.

Yea but do u really wanna get stuck in something just because the chances of nurse encroachment is low?

I say do what your interested in and do your part to stop them.

Dont refer or accept referrals from them, Dont train them, Dont hire them, and tell people about their education. Part of the reason we are in this mess is because everyone wants to super sub specialize.

At this rate we are gonna have a residency for each finger of the hand.

 

[JaggerPlate]

Yea but do u really wanna get stuck in something just because the chances of nurse encroachment is low?

I say do what your interested in and do your part to stop them.

Dont refer or accept referrals from them, Dont train them, Dont hire them, and tell people about their education. Part of the reason we are in this mess is because everyone wants to super sub specialize.

At this rate we are gonna have a residency for each finger of the hand.

While I know MCAT guy has made some very solid arguments opposing the DNP expansion (and I don't direct anything but 'respek' toward him) I must say that the above post is spot on

 

[AnonymousHandle]

Just playing devil's advocate here. Why would any caring physician specialist turn down a referral for a patient who would likely need it, even if they happen to come from an NP or PA?

I understand turf wars, ect., ect. but that comment seemed odd.

 

[DrBowtie]

From a nurse competition perspective only I'd say rads and path since their skill set is pretty much their brain. They have their own threats just not from nurses

Any procedural specialty/clinic based specialty is at risk. Surgery would be the safest though.

 

[deleted87716]

Just playing devil's advocate here. Why would any caring physician specialist turn down a referral for a patient who would likely need it, even if they happen to come from an NP or PA?

I understand turf wars, ect., ect. but that comment seemed odd.

I can think of two reasons.

First, the specialist will, at some point, be required to "turn the patient over the good care of doctor so-and-so." I've received letters from consultants who use that exact verbiage. If they didn't think the patient was going to get good care from nurse so-and-so, they would be violating their ethics to send the patient back to them. By not accepting referrals from those they deem unqualified, they avoid setting themselves up for this situation.

Second, referrals from unqualified practitioners may tend to be in the "stupid waste of my time" category (something that any competent primary care physician should easily be able to handle) or in the "disastrously mis-managed and FUBAR" category, wherein the specialist is forced to clean up the mess. Again, both undesirable situations avoidable by not accepting referrals from those deemed unqualified to take care of patients independently.

Before the flaming begins, be aware that I am also playing the devil's advocate in this instance.

 

[AnonymousHandle]

I can think of two reasons.

First, the specialist will, at some point, be required to "turn the patient over the good care of doctor so-and-so." I've received letters from consultants who use that exact verbiage. If they didn't think the patient was going to get good care from nurse so-and-so, they would be violating their ethics to send the patient back to them. By not accepting referrals from those they deem unqualified, they avoid setting themselves up for this situation.

Second, referrals from unqualified practitioners may tend to be in the "stupid waste of my time" category (something that any competent primary care physician should easily be able to handle) or in the "disastrously mis-managed and FUBAR" category, wherein the specialist is forced to clean up the mess. Again, both undesirable situations avoidable by not accepting referrals from those deemed unqualified to take care of patients independently.

Before the flaming begins, be aware that I am also playing the devil's advocate in this instance.

Continuing to play devil's advocate to learn something...

The second point can make some sense. The over-referral issues can tax the system and create many unwarranted expenses. But, lots of other unnecessary cost sources arise in healthcare. Hell, a patient can mismanage themselves in a whole host of ways without seeing any healthcare professional until too late and things become FUBAR for their condition.

On the first point, my contention is how would the "unqualified" referral be anymore a waste of the physician specialist's time than say a patient who personally refers themselves to a specialist regardless of a PCP or np/pa referral (say they carry a POS insurance plan)?

The patient could be argued the "least-qualified" to refer of the bunch since they carry no healthcare training, but yet they still carry they right to self-refer themselves for treatment. I highly doubt the patient would be denied a visit to the specialist if they had insurance, in fact I'm sure their business would be more than welcomed if they had legitimate issues.

Also, why would consultants dictate referral patterns? Wouldn't they be "unqualified" for medical advice unless they were a practicing physician themselves?
**Apologies, I may have misunderstood the consultant comment, but I don't understand their role in referrals other than perhaps maximizing business. If you want to share I'd be curious.

 

[deleted87716]

The patient could be argued the "least-qualified" to refer of the bunch since they carry no healthcare training, but yet they still carry they right to self-refer themselves for treatment. I highly doubt the patient would be denied a visit to the specialist if they had insurance, in fact I'm sure their business would be more than welcomed if they had legitimate issues.

Actually, quite a few specialists in my neck of the woods require patients to be referred by their primary care physicians even if it isn't required by their insurance. This is done purely to cut down on BS self-referrals (e.g., seeing an orthopedic/spine surgeon for a one-week history of low-back pain).

Also, why would consultants dictate referral patterns? Wouldn't they be "unqualified" for medical advice unless they were a practicing physician themselves?

"Consultant" in this context is synonymous with "specialist."

 

[Sneezing]

Every specialty is at risk. The real issue is when you go out in practice will you do so in a manner that emphasizes the difference?

Will you sign an insurance contract that equates you to an (D)NP? Or will you chose the better paying insurance companies or simply go cash only? A physician is still the gold standard and what patients want. So, if healthcare is to be over run by under trained mid levels establish yourself as the physician and professional you are.

I'd be less concerned about whether the specialty is being encroached upon by those undertrained, but more concerned if the specialty can escape the politics, drama, and restrictions of being tied to a hospital and insurance companies.

Choose a specialty that can go cash only. Primary care is ripe and an ideal time to establish oneself. As obama's changes flood the system with patients on government insurance the daily work life in the hospital will be highly stressful and any thing but patient centered. Those with cash will be irrate and seek out those (physicians) who can spend time with their patients in a positive healing manner.

The issue is bigger than just mid-levels.

 

[Socrates25]

On the opposite scale...which residencies are the "most" affected?

Family Practice (or pediatrics or IM - if they are outpatient primary care), Anesthesiology....what else?

Although all 3 of FP/IM/peds are at high risk from nurse invasion, I'd say pediatrics is SLIGHTLY less at risk compared to the other 2.

The reason is this -- the term "pediatrician" has a brand name that cant be easily taken away/usurped by nurses. The term "family physician" or "internist" dont have the same brand name and the roles are little more easily obfuscated.

A nurse (even a doctor nurse DNP) cant claim they are a pediatrician.

 

[bronx43]

Although all 3 of FP/IM/peds are at high risk from nurse invasion, I'd say pediatrics is SLIGHTLY less at risk compared to the other 2.

The reason is this -- the term "pediatrician" has a brand name that cant be easily taken away/usurped by nurses. The term "family physician" or "internist" dont have the same brand name and the roles are little more easily obfuscated.

A nurse (even a doctor nurse DNP) cant claim they are a pediatrician.

Say what? These semantic differences are of negligible importance, as titles and the connotations they convey are dynamic and malleable. The term "doctor" was once thought to be as clear cut as they come in the medical context, but obviously those lines were easily blurred. DNPs can simply established a branch of their field and call themselves "nurse pediatricians."

But overall, I would agree with Sneezing that the threat from mid-levels are overblown in these forums. There are far greater threats to the well-being of your future career than down-market competitors.

 

[womp]

Any of the surgical subspecialties like urology, ortho, ENT...

You may have surgical assists, but no patient would trust a nurse or PA to be in charge of the surgery. They might tolerate being prescribed diabetes medication from a nurse, but an ACL repair or a bladder reconstruction? Unlikely.

But the surgical subspecialties are more vulnerable to future Medicare cuts and global payment schemes that do their utmost to screw the surgeon.

So it's a mixed bag.

Best way to go is to do something that is not too Medicare/Medicaid dependent, and where nurses would feel extremely overextended. There aren't that many though.

 

[PlutoBoy]

DNPs can simply established a branch of their field and call themselves "nurse pediatricians."

Or nediatricians, pedianurse, nurseatrician...

 

[JaggerPlate]

Or nediatricians, pedianurse, nurseatrician...

+ 1 for nurseatrician.

'just like a pediatrician ... except that we're smarter, care more about patients, and never kick puppies in our free time like the EVIL, money grubbing DO/MDs'

You think that will fit on a business card?

 

[hithere3387]

+ 1 for nurseatrician.

'just like a pediatrician ... except that we're smarter, care more about patients, and never kick puppies in our free time like the EVIL, money grubbing DO/MDs'

You think that will fit on a business card?

maybe not a business card; but, i'm sure there's a way to work it onto an ID badge.

 

[JaggerPlate]

maybe not a business card; but, i'm sure there's a way to work it onto an ID badge.

Maybe on the back of a long white coat too!!!

 

[Limey]

Damn. Don't tell me the USA suffers from noctors as well. I just thought it was our stupid governments way of saving money and crapping on the medical profession. (not that they actually save money).

I say do what your interested in and do your part to stop them.

Dont refer or accept referrals from them, Dont train them, Dont hire them, and tell people about their education. Part of the reason we are in this mess is because everyone wants to super sub specialize.

Damn right. If I ever get some joker of a noctor coming to "treat" me when I am ill, I will not hesitate to ask for someone who has completed medical school.

 

[Limey]

+ 1 for nurseatrician.

'just like a pediatrician ... except that we're smarter, care more about patients, and never kick puppies in our free time like the EVIL, money grubbing DO/MDs'

You think that will fit on a business card?

At least you don't have 'attending nurses'.

Here in the UK we have 'nurse consultants'.

 

[JaggerPlate]

At least you don't have 'attending nurses'.

Here in the UK we have 'nurse consultants'.

Give it time. They will get whatever they want.

 

[MCAT guy]

So basically only surgery is safe, right?

I've looked at some EM, Anesthesiology and even PMR. Sometimes I think a 3-4 year residency would be nicer than 5 + fellowship (1 or 2), 7 years is a long time to let that interest capitalize.

 

[Reductio]

So basically only surgery is safe, right?

I've looked at some EM, Anesthesiology and even PMR. Sometimes I think a 3-4 year residency would be nicer than 5 + fellowship (1 or 2), 7 years is a long time to let that interest capitalize.

No way. In Primary Care, EM, Gas, they'll take your job. But in Surgery and its subspecialties, you'll be working right along with them . Just do a google search on surgery or surgical nurse practitioner and see how many job postings, papers, etc show up.

They're everywhere. ENT, Ortho, CT, Vascular....

 

[Instatewaiter]

No way. In Primary Care, EM, Gas, they'll take your job. But in Surgery and its subspecialties, you'll be working right along with them . Just do a google search on surgery or surgical nurse practitioner and see how many job postings, papers, etc show up.

They're everywhere. ENT, Ortho, CT, Vascular....

Yeah but they are "my b!tch" type positions- basically someone who will funnel patients into the OR by doing a surgeon's clinic or take care of floor patients so that the surgeons can do what they really want... be in the OR.

 

[womp]

+ 1 for nurseatrician.

'just like a pediatrician ... except that we're smarter, care more about patients, and never kick puppies in our free time like the EVIL, money grubbing DO/MDs'

You think that will fit on a business card?

It'll fit on the white coat:

Teresa Brown, RN, BSN (Hons), MSN, DNP, RN-BC, APRN, PNP, ADN, FAAN

 

[deleted87716]

It'll fit on the white coat:

Teresa Brown, RN, BSN (Hons), MSN, DNP, RN-BC, APRN, PNP, ADN, FAAN

I can top that.

Blue Dog, MD, FAAFP, BS, EMT, BLS, OMG, LOL, WTF, LMAO, BYOB.

 

[duswdav]

Maybe on the back of a long white coat too!!!

does anyone have a problem with me getting my favorite number i wore while playing baseball embroidered on the back of my jersey white coat along with my name?

this:

**hah, im deadly with paint.**

 

[Reductio]

What's interesting to me about this is that surgery ISN'T the most demanding of tasks. But, the mental process behind other specialties doesn't seem to phase those that encourange the expansion of undertrained nurses into the redefinition of the practice of medicine.

I agree.... and it has more to do with the politicians that make the scope-of-care rules, than anything else.

We as physicians - say general internists, know when WE are pushing the limits of our mental expertise, and need to consult a specialist.

But to a politician or a lawyer, medical treatment is just following a cookbook, and anyone can do it. NPs encourage this idea, and expand their scope.

Meanwhile sewing in an aortic valve is mind numbing tedium, though it requires manual dexterity... but to a non-medico (like a politician) it just seems complex. So, getting that sort of thing legally approved is more difficult. Not because its more complicated, but because it just sounds complicated... and maybe because a complication caused by an improper suture is easier to find on forensic pathology than having missed an improper antibody or protein of some sort.

The NPs, while evil and disingenuous, probably wholeheartedly believe what they're saying. Because, their curriculum is a self-contained internally complete world - they only know about the horses, never even heard of zebras, let alone when and how to look for them. Its what they're trained to do - identify and treat the most common diseases. If medicine really were that easy - only horses and no zebras, then I'm sure NPs could do a lot of good. It isnt, but NPs have convinced the politicians that it is.

So, what's going to happen is..... NPs will gain more power in the next few decades. Patients will be diagnosed with horses, live with horses, die with horses. If patients have a zebra, nobodys going to know about it - they'll just live and die with a really atypical horse. In fact, politicians might like that - horses are less costly than zebras.

It will put medicine back a hundred years, but everyone can live happily in their ignorance.

 

[JaggerPlate]

I agree.... and it has more to do with the politicians that make the scope-of-care rules, than anything else.

We as physicians - say general internists, know when WE are pushing the limits of our mental expertise, and need to consult a specialist.

But to a politician or a lawyer, medical treatment is just following a cookbook, and anyone can do it. NPs encourage this idea, and expand their scope.

Meanwhile sewing in an aortic valve is mind numbing tedium, though it requires manual dexterity... but to a non-medico (like a politician) it just seems complex. So, getting that sort of thing legally approved is more difficult. Not because its more complicated, but because it just sounds complicated... and maybe because a complication caused by an improper suture is easier to find on forensic pathology than having missed an improper antibody or protein of some sort.

The NPs, while evil and disingenuous, probably wholeheartedly believe what they're saying. Because, their curriculum is a self-contained internally complete world - they only know about the horses, never even heard of zebras, let alone when and how to look for them. Its what they're trained to do - identify and treat the most common diseases. If medicine really were that easy - only horses and no zebras, then I'm sure NPs could do a lot of good. It isnt, but NPs have convinced the politicians that it is.

So, what's going to happen is..... NPs will gain more power in the next few decades. Patients will be diagnosed with horses, live with horses, die with horses. If patients have a zebra, nobodys going to know about it - they'll just live and die with a really atypical horse. In fact, politicians might like that - horses are less costly than zebras.

It will put medicine back a hundred years, but everyone can live happily in their ignorance.

Great post

 

[zenman]

The NPs, while evil and disingenuous, probably wholeheartedly believe what they're saying. Because, their curriculum is a self-contained internally complete world - they only know about the horses, never even heard of zebras, let alone when and how to look for them. Its what they're trained to do - identify and treat the most common diseases. If medicine really were that easy - only horses and no zebras, then I'm sure NPs could do a lot of good. It isnt, but NPs have convinced the politicians that it is.

So, what's going to happen is..... NPs will gain more power in the next few decades. Patients will be diagnosed with horses, live with horses, die with horses. If patients have a zebra, nobodys going to know about it - they'll just live and die with a really atypical horse. In fact, politicians might like that - horses are less costly than zebras.

It will put medicine back a hundred years, but everyone can live happily in their ignorance.

Don't be an idiot fellow. NP's,myself included, look for zebras all the time. Even found one this morning that had been running past a bunch of physicians that apparently didn't know how to pick up on subtle clues about Bipolar Disorder, thereby delaying appropriate treatment by half the patient's life.

 

[Reductio]

Don't be an idiot fellow. NP's,myself included, look for zebras all the time. Even found one this morning that had been running past a bunch of physicians that apparently didn't know how to pick up on subtle clues about Bipolar Disorder, thereby delaying appropriate treatment by half the patient's life.

Im sure they do.... especially in New Mexico. The fact still remains that NPs are trained to identify and treat the common conditions over their 2 years; while physicians are trained and expected to identify, or suspect all common and rare conditions in their 7+ years. Education + experience can equalize the playing field to a degree.

I'm sure that the bunch of physicians were trained to identify mental illness and refer appropriately, if not trained to identify and treat Bipolar itself. Saying they "apparently didn't know how to pick up on subtle clues about Bipolar Disorder, thereby delaying appropriate treatment by half the patient's life." sounds like you're accusing them of willfully harming the patient. Also, they "apparently" didnt know how to pick up on subtle clues... but you did. Do NPs read a different psychiatry text? Ive read parts of Kaplan and Sadock - are those clues mentioned in there? If they are, shame on the physicians, and congrats on clinching the Dx. If they aren't, please point us to the journal article where they're discussed.

 

[deleted87716]

Don't be an idiot fellow. NP's,myself included, look for zebras all the time. Even found one this morning that had been running past a bunch of physicians that apparently didn't know how to pick up on subtle clues about Bipolar Disorder, thereby delaying appropriate treatment by half the patient's life.

I don't think I'd classify something with a prevalence of nearly 3% in the US adult population as a "zebra."

It's always easier to be right when you're the second (or third, or fourth, etc.) person seeing the patient. Even a blind squirrel finds a nut once in a while.

Furthermore, having a "bunch" of physicians (e.g., fragmented care) significantly increases the chance of a missed diagnosis.

 

[zenman]

Im sure they do.... especially in New Mexico. The fact still remains that NPs are trained to identify and treat the common conditions over their 2 years; while physicians are trained and expected to identify, or suspect all common and rare conditions in their 7+ years. Education + experience can equalize the playing field to a degree.

I'm sure that the bunch of physicians were trained to identify mental illness and refer appropriately, if not trained to identify and treat Bipolar itself. Saying they "apparently didn't know how to pick up on subtle clues about Bipolar Disorder, thereby delaying appropriate treatment by half the patient's life." sounds like you're accusing them of willfully harming the patient. Also, they "apparently" didnt know how to pick up on subtle clues... but you did. Do NPs read a different psychiatry text? Ive read parts of Kaplan and Sadock - are those clues mentioned in there? If they are, shame on the physicians, and congrats on clinching the Dx. If they aren't, please point us to the journal article where they're discussed.

The majority of the time zebras aren't around. It's all the common conditions that impact the majority of people and cause a lot of distress and damage. Maybe those trained in zebra hunting get too comfortable and forget the basics...and the clues...while others like me, even it we don't know the name of every frickin disease on the planet, can pick up subtle clues or clues staring you in the face, that something is not right on Route 66. I think we have to blame ourselves if we don't make sure we know what the heck we're doing. None of us are perfect, but we shouldn't be slacking off either.

 

[zenman]

I don't think I'd classify something with a prevalence of nearly 3% in the US adult population as a "zebra."

It's always easier to be right when you're the second (or third, or fourth, etc.) person seeing the patient. Even a blind squirrel finds a nut once in a while.

Furthermore, having a "bunch" of physicians (e.g., fragmented care) significantly increases the chance of a missed diagnosis.

I figured someone would come up with this and sure enough, it's Blue Dog! The first in line should have picked it up.

 

[CyberKnife19]

You in a Rad Onc program???

Sorry for the delayed response, I don't come to this forum often. I will begin my training in Radiation Oncology on July 1st.

If you want to avoid the encroachment of the RN, go into RadOnc b/c I think ~98% of nurses have a visceral reaction when the subjects of Physics, Radiation Biology, true EBM, phase II/III RCT's, etc. are brought up. Just poking a little fun, not trying to fire up the RN's.

 

[Reductio]

Sorry for the delayed response, I don't come to this forum often. I will begin my training in Radiation Oncology on July 1st.

If you want to avoid the encroachment of the RN, go into RadOnc b/c I think ~98% of nurses have a visceral reaction when the subjects of Physics, Radiation Biology, true EBM, phase II/III RCT's, etc. are brought up. Just poking a little fun, not trying to fire up the RN's.

Hey...! We got that in IM (some more than others)... They still won't leave us alone.

 

[JaggerPlate]

I figured someone would come up with this and sure enough, it's Blue Dog! The first in line should have picked it up.

Damn, you can even catch clues and diagnose things before they occur ... You're like "House, N.P.!" - which clearly means you're smarter than the dumb physicians who waste all their time "memorizing the names of every frickin disease on the planet" and counting their money instead of rolling up their sleeves and doing the real work. I'll pat you on the back if you ever want to take a break and stop doing it yourself.

 

[JaggerPlate]

Sorry for the delayed response, I don't come to this forum often. I will begin my training in Radiation Oncology on July 1st.

If you want to avoid the encroachment of the RN, go into RadOnc b/c I think ~98% of nurses have a visceral reaction when the subjects of Physics, Radiation Biology, true EBM, phase II/III RCT's, etc. are brought up. Just poking a little fun, not trying to fire up the RN's.

I still think nursing is the way to go if you want to avoid the encroachment of nurses. Seems to be the only healthcare field they don't want to run. Thanks for the tip though!

 

[zenman]

Damn, you can even catch clues and diagnose things before they occur ... You're like "House, N.P.!" - which clearly means you're smarter than the dumb physicians who waste all their time "memorizing the names of every frickin disease on the planet" and counting their money instead of rolling up their sleeves and doing the real work. I'll pat you on the back if you ever want to take a break and stop doing it yourself.

You're really funny. However, the above is more true than you realize. I do have abilities you probably don't have, but it's due to exploring other fields vs keeping my nose stuck in one area and believing that's the holy grail.

If I have a healthy ego it's due to other people patting me on the back. That's one of the reasons I have no trouble confronting the idiots running around.

 

[JaggerPlate]

You're really funny. However, the above is more true than you realize. I do have abilities you probably don't have, but it's due to exploring other fields vs keeping my nose stuck in one area and believing that's the holy grail.

If I have a healthy ego it's due to other people patting me on the back. That's one of the reasons I have no trouble confronting the idiots running around.

Hahahahahahaha. God, you're unreal. I don't even want to take a wild guess at your actual self-perception or the things you think that you aren't sharing with this community. It must feel satisfying to live in such a warm little bubble of delusion. Keep "confronting those idiots" and catching those wild zebras (while also being able to catch the simple stuff stupid, ******* doctors miss).

I don't know what the world would do without you Nurse. Also, remember to thank Mary Mundinger from time to time for those back pats. You make her proud little propaganda soldier.

 

[zenman]

Hahahahahahaha. God, you're unreal. I don't even want to take a wild guess at your actual self-perception or the things you think that you aren't sharing with this community. It must feel satisfying to live in such a warm little bubble of delusion. Keep "confronting those idiots" and catching those wild zebras (while also being able to catch the simplw stuff stupid, ******* doctors miss).

I don't know what the world would do without you Nurse. Also, remember to thank Mary Mundinger from time to time for those back pats. You make her proud little propaganda soldier.

I don't give a hoot about Mary Mundinger. Anytime you want to think I'm delusional come talk to the psychiatrists I work with. I try my best to be good at what I do because even my presentation instills confidence in my patients, thereby improving their condition.

 

[AzEMMD]

You're really funny. However, the above is more true than you realize. I do have abilities you probably don't have, but it's due to exploring other fields vs keeping my nose stuck in one area and believing that's the holy grail.

If I have a healthy ego it's due to other people patting me on the back. That's one of the reasons I have no trouble confronting the idiots running around.

This is a perfect example of the ego that these nurses have. They think that they know everything, but the reality is is that they don't know what they don't know (there's a whole other world of medicine that most nurses don't know exists). The thought that less training, less academic rigor, and less overall experience will lead to a better practitioner is laughable. In the end it's the patients that suffer.