What nps think of us

[Cheeni17]

What NPs think of us.

NP Wikipedia Article

18 minutes ago, djmatte said:Possibly compared because they are the comparable part of the profession that is actually seen at the bed side regularly Who are ac...

allnurses.com

One of my friends pointed out this post who works as an rn and is in acnp school. Thought it was interesting to see what are up against.

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[deleted480308]

Just stay off their forums

 

[TheRealCookieMonster]

Jesus Christ...

 

[Dr. Doctor MD]

Some excerpts from that link:

"Theres a whole section on “quality of care” that is basically bogus and doesn’t care to reference or mention any articles that are based on systemic reviews that say we actually have better ourcomes than physicians in many regards."


"I work as a hospitalist in a group that is 50/50 physician and NP hospitalists. We are part of a pilot program by our company to determine if a larger pool of NPs in a group is effective and safe. Effectively our company wants to know if they can get away with this model because we are paid a lot less than the physicians, so it’s a big cost saver. We split the assignments, admissions, acuity, hours worked, committee memberships, and everything else evenly. It’s an independent practice state so there’s no co-signing. After two years, the NPs as a whole have a better satisfaction rating, lower readmission rate, equal length of stay, equal consultation frequency, fewer adverse outcomes, and fewer core metric fallouts. As a result, several of our sister hospitals are eliminating physician positions in favor of more NPs in the practice group. Since our group started this we surprisingly have more consultants that have moved to the area. No one has fled"

 

[puahate]

"Is it fake news? Is it inaccurate?



"...it can consist of online coursework with few hours of actual patient contact."

True.

"The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training."

True.

"Overall, to become an NP requires 1.5 to 3 years of post-baccalaureate training, compared to physicians who are required to complete a minimum of 7 years of post-baccalaureate training."

True.

"A new nurse practitioner has between 500 and 1,500 hours of clinical training compared with a family physician who would have more 15,000 hours of clinical training by the time certification."

True.

"Many schools have 100% acceptance rates, coursework can be 100% online, and clinical experience is limited to shadowing with no hands-on experience."

True."

At least some of these NPs aren't delusional.

 

[NYCdude]

I honestly don't give a crap what they think. The only time I'll care is if they start to make more money or if I make less.

 

[xALIAx]

I honestly don't give a crap what they think. The only time I'll care is if they start to make more money or if I make less.

attitudes like this are why our profession is destined for failure. welcome to the days of NP sorority girls who couldnt get passed orgo II to be admitting patients independently (already happening in New Mexico)

 

[puahate]

1000% THIS.

attitudes like this are why our profession is destined for failure. welcome to the days of NP sorority girls who couldnt get passed orgo II to be admitting patients independently (already happening in New Mexico)

 

[Lawpy]

What NPs think of us.

NP Wikipedia Article

18 minutes ago, djmatte said:Possibly compared because they are the comparable part of the profession that is actually seen at the bed side regularly Who are ac...

allnurses.com

One of my friends pointed out this post who works as an rn and is in acnp school. Thought it was interesting to see what are up against.

I'm just going to use @Mad Jack gif here:

 

[Goro]

What NPs think of us.

NP Wikipedia Article

18 minutes ago, djmatte said:Possibly compared because they are the comparable part of the profession that is actually seen at the bed side regularly Who are ac...

allnurses.com

One of my friends pointed out this post who works as an rn and is in acnp school. Thought it was interesting to see what are up against.

Patient safety issues?
Who cares

NPS competing with doctors over renumeration?
Who cares

NPs don't know what they don't know???
Who cares


NPs think badly of doctors?
THAT!!!!!! THAT!!!!! THAT!!!!! THAT!!! THAT!!!!

 

[RNthenDoc]

The truth is, physicians will not care until they stop making the money.

Literally nothing will be done. We don’t fight NDs who are killing scores of patients, so we cannot delude ourselves into thinking we argue against NPs because of “patient safety.” It’s money.

I haven’t seen a single thread on SDN talking about DCs and how dangerous they are. I haven’t seen a single thread about NDs and how they take people off of legitimate chemo and let them die on tumeric IVs.

Because nobody cares until it hurts their bottom line.

I think a non-inferiority study needs to be done. If there are hospitalist groups that are tracking data between randomly-assigned MDs Vs. NPs, there should be data somewhere to look at. Prove that it’s dangerous, then make a case for patient safety that will force the NP schools to standardize learning and improve education.

It won’t happen, though.

 

[puahate]

I think a non-inferiority study needs to be done. If there are hospitalist groups that are tracking data between randomly-assigned MDs Vs. NPs, there should be data somewhere to look at. Prove that it’s dangerous, then make a case for patient safety that will force the NP schools to standardize learning and improve education.

It won’t happen, though.

Is this ethical though?

 

[operaman]

The truth is, physicians will not care until they stop making the money.

Literally nothing will be done. We don’t fight NDs who are killing scores of patients, so we cannot delude ourselves into thinking we argue against NPs because of “patient safety.” It’s money.

I haven’t seen a single thread on SDN talking about DCs and how dangerous they are. I haven’t seen a single thread about NDs and how they take people off of legitimate chemo and let them die on tumeric IVs.

Because nobody cares until it hurts their bottom line.

I think a non-inferiority study needs to be done. If there are hospitalist groups that are tracking data between randomly-assigned MDs Vs. NPs, there should be data somewhere to look at. Prove that it’s dangerous, then make a case for patient safety that will force the NP schools to standardize learning and improve education.

It won’t happen, though.

Very good point re the ND and DC. Maybe they just aren’t out in there in numbers like NPs or aren’t seen in mainstream healthcare. But you’re right they’re practicing pure quackery and openly saying they provide better care than physicians but we really don’t care that much.

I would be surprised if any randomized study would find much difference between NP and Hospitalists especially in a community hospital. So many things are fairly straightforward and don’t require much advanced knowledge; you’d expect to see the difference more pronounced among those trickier admissions but it would take a massive sample size to detect that signal amid all the pneumonia’s and CP rule outs and COPD exacerbations and a bazillion other not so acute reasons for admission. So much of it is very algorithmic and consultants can handle the weird stuff that deviates from the expected course. I know plenty of well trained NPs who do a fine job managing most things and are very humble and self aware professionals who know their own limits and are quick to ask for help when needed.

As I’ve said before I think the key moment will be when the good NPs tire of the idiots taking their jobs and depressing their wages and petition their boards of nursing to tighten up licensure requirements and mandate a certain level of competence.

 

[Cheeni17]

The truth is, physicians will not care until they stop making the money.

Literally nothing will be done. We don’t fight NDs who are killing scores of patients, so we cannot delude ourselves into thinking we argue against NPs because of “patient safety.” It’s money.

I haven’t seen a single thread on SDN talking about DCs and how dangerous they are. I haven’t seen a single thread about NDs and how they take people off of legitimate chemo and let them die on tumeric IVs.

Because nobody cares until it hurts their bottom line.

I think a non-inferiority study needs to be done. If there are hospitalist groups that are tracking data between randomly-assigned MDs Vs. NPs, there should be data somewhere to look at. Prove that it’s dangerous, then make a case for patient safety that will force the NP schools to standardize learning and improve education.

It won’t happen, though.

Did you search dc or nd. I found tons. Plus it’s not like we say it’s OK to DC it up instead of chemo lmao

 

[Cheeni17]

Jesus Christ...

It’s not dead if they are getting independent practice. Probably a more important topic than most on this subsection

 

[Cheeni17]

Patient safety issues?
Who cares

NPS competing with doctors over renumeration?
Who cares

NPs don't know what they don't know???
Who cares


NPs think badly of doctors?
THAT!!!!!! THAT!!!!! THAT!!!!! THAT!!! THAT!!!!

The in quote was about patient safely issues. Non statement of something doesn’t preclude its lack of importance. I thought goro got burned by an NP recently and had his mind changed after years of pandering nps as gods

 

[RNthenDoc]

Very good point re the ND and DC. Maybe they just aren’t out in there in numbers like NPs or aren’t seen in mainstream healthcare. But you’re right they’re practicing pure quackery and openly saying they provide better care than physicians but we really don’t care that much.

I would be surprised if any randomized study would find much difference between NP and Hospitalists especially in a community hospital. So many things are fairly straightforward and don’t require much advanced knowledge; you’d expect to see the difference more pronounced among those trickier admissions but it would take a massive sample size to detect that signal amid all the pneumonia’s and CP rule outs and COPD exacerbations and a bazillion other not so acute reasons for admission. So much of it is very algorithmic and consultants can handle the weird stuff that deviates from the expected course. I know plenty of well trained NPs who do a fine job managing most things and are very humble and self aware professionals who know their own limits and are quick to ask for help when needed.

As I’ve said before I think the key moment will be when the good NPs tire of the idiots taking their jobs and depressing their wages and petition their boards of nursing to tighten up licensure requirements and mandate a certain level of competence.

There are about 77k DCs and I'm not sure how many Naturopaths. My issue is that even though they are fewer, they actively kill patients.

As in, ACTIVELY KILL THEM. This has been a large issue in my community.

I believe that a physician provides superior care than an NP, but I'd much rather my loved ones see an NP than go die of some weird IV infusion at one of the quack clinics.


I 100% agree with the rest of your post. The problem is that UTD and other resources are powerful enough that even a poorly-trained NP may be able to muddle through just fine. If thats the case, though, how do we convince HCA et al that physician care is worth the extra 100K/year?

 

[NicMouse64]

Naturopaths and DCs don't want hospital privileges and are not pushing to practice the same "flavor" of medicine. As I have said before there will always be a market for pseudoscience. There is not much we can do about that. What we can do is assure the best quality care for the patients that our profession (physicians) treat.

 

[operaman]

There are about 77k DCs and I'm not sure how many Naturopaths. My issue is that even though they are fewer, they actively kill patients.

As in, ACTIVELY KILL THEM. This has been a large issue in my community.

I believe that a physician provides superior care than an NP, but I'd much rather my loved ones see an NP than go die of some weird IV infusion at one of the quack clinics.


I 100% agree with the rest of your post. The problem is that UTD and other resources are powerful enough that even a poorly-trained NP may be able to muddle through just fine. If thats the case, though, how do we convince HCA et al that physician care is worth the extra 100K/year?

Yeah I run into the alternative medicine stuff when talking to friends and colleagues from my prior career. They’re very easily drawn in to such things; not sure the best way to go about fighting it other than to offer a legit medical perspective and then let the chips fall where they may.

How to convince HCA that physicians are worth an extra 100k per year? In light of the resources you note like UTD plus the growing use of AI-driven resources, I think I have to conclude that maybe we aren’t worth that much more in certain roles. Not a popular opinion but perhaps one worth pondering.

We have much more extensive training but much of that is probably overkill, especially for the bread and butter stuff managed in smaller community hospitals. Probably makes more sense having the MDs supervise or focus more on the difficult cases. Sure the NPs may miss something here and there, but so do doctors and the truth is the misses only rarely result in true harm. Just like technology made it possible for CRNAs to deliver safe anesthesia care, so has it enabled other midlevels to bridge the knowledge gap with their MD colleagues.

At its core we have to continually ask ourselves what it is we can do that nobody else can do. Not an easy question!

 

[RNthenDoc]

Yeah I run into the alternative medicine stuff when talking to friends and colleagues from my prior career. They’re very easily drawn in to such things; not sure the best way to go about fighting it other than to offer a legit medical perspective and then let the chips fall where they may.

How to convince HCA that physicians are worth an extra 100k per year? In light of the resources you note like UTD plus the growing use of AI-driven resources, I think I have to conclude that maybe we aren’t worth that much more in certain roles. Not a popular opinion but perhaps one worth pondering.

We have much more extensive training but much of that is probably overkill, especially for the bread and butter stuff managed in smaller community hospitals. Probably makes more sense having the MDs supervise or focus more on the difficult cases. Sure the NPs may miss something here and there, but so do doctors and the truth is the misses only rarely result in true harm. Just like technology made it possible for CRNAs to deliver safe anesthesia care, so has it enabled other midlevels to bridge the knowledge gap with their MD colleagues.

At its core we have to continually ask ourselves what it is we can do that nobody else can do. Not an easy question!

Surgery.
For now.

 

[operaman]

Surgery.
For now.

True. Some procedures can probably be safely done by midlevels - anything you would let a pgy1-2 do unsupervised could probably be done by a trained midlevel. But for now patients may be ok with an NP writing their z pack script but not cutting them open.

I think there are also higher level thinking and cognitive functions - the assimilation and integration of complex info and applying to to complex situations. That’s just a smaller part of what physicians currently do, though at least for me that’s the fun part along with operating.

 

[Tenk]

A lion doesn’t concern himself with the opinions of sheep.

 

[Nurse2MD2018]

Do medical schools teach current issues in healthcare? On the hierarchy of current treats to pt safety/outcomes midlevels seeking independent practice is the least of our worries.

 

[deleted480308]

Do medical schools teach current issues in healthcare? On the hierarchy of current treats to pt safety/outcomes midlevels seeking independent practice is the least of our worries.

that's not true

 

[Nurse2MD2018]

that's not true

Care to elaborate?

 

[Goro]

The in quote was about patient safely issues. Non statement of something doesn’t preclude its lack of importance. I thought goro got burned by an NP recently and had his mind changed after years of pandering nps as gods

Don't engage in hyperbole, it's unbecoming of you. For a long time I found the midlevel bashing to be unseemly and a lot of it was not motivated by patient concerns, but more in the realm of "nurses R taking R jobs! and honest-to-Gawd misogyny as well.

I didn't get burned by an NP, but a family member was, and so I am now firmly in the camp that they're only good for sniffles and shots.

Getting back to the OP, what the wise Tenk posted was a thread ender.

 

[MedicineZ0Z]

The truth is, physicians will not care until they stop making the money.

Literally nothing will be done. We don’t fight NDs who are killing scores of patients, so we cannot delude ourselves into thinking we argue against NPs because of “patient safety.” It’s money.

I haven’t seen a single thread on SDN talking about DCs and how dangerous they are. I haven’t seen a single thread about NDs and how they take people off of legitimate chemo and let them die on tumeric IVs.

Because nobody cares until it hurts their bottom line.

I think a non-inferiority study needs to be done. If there are hospitalist groups that are tracking data between randomly-assigned MDs Vs. NPs, there should be data somewhere to look at. Prove that it’s dangerous, then make a case for patient safety that will force the NP schools to standardize learning and improve education.

It won’t happen, though.

NDs and DCs are in quack medicine. It's a different patient market.

I'm just going to use @Mad Jack gif here:

View attachment 258988

Not sure if you're being serious. Midlevels are the biggest (and basically only) threat to medicine.


Anyway, let the OP's post be a lesson to how you navigate midlevels as you go forward. Be polite and nice and professional (to everyone). But never teach midlevels or assist them aka their groups in anyway.

 

[MedicineZ0Z]

that's not true

Well.. some will indirectly tell you to propel them (midlevels) as high as you can. Two types of doctors support midlevels:

1. those who profit off of them
2. those out of touch with reality

 

[NicMouse64]

Well.. some will indirectly tell you to propel them (midlevels) as high as you can. Two types of doctors support midlevels:

1. those who profit off of them
2. those out of touch with reality

The situation we have today is mostly caused by category 1.

 

[HisLovePerfects]

I mean, actual evidence supports NPs substituting for physicians, at least in primary care scenarios.

 

[deleted480308]

I mean, actual evidence supports NPs substituting for physicians, at least in primary care scenarios.

Except it doesn’t. That review includes supervised nps.

 

[deleted480308]

Care to elaborate?

Independent midlevels practicing medicine without the appropriate supervision is a dangerous proposition

 

[MedicineZ0Z]

I mean, actual evidence supports NPs substituting for physicians, at least in primary care scenarios.

I'm not exaggerating, I could teach my mom over a month how to do the stuff they measure in these "studies" that compare NPs to doctors and see "equal or better outcomes" with my mom doing those exact same tasks.
When all you do is look at cheerleading based medicine and super simple patients, of course you will have the same outcomes.

The general population as a whole isn't super sick or something with loads of complex horses or zebras everywhere. What it comes down to is defending the turf for good reason. Why should doctors limit their income and increase their workload per patient by only seeing complex ones? That's ridiculous and absurd by every measure. And for the "simple" patients that fall through the cracks of statistics and get mismanaged by an NP, is it fair to them?

No reason for a country like the US to deliver suboptimal healthcare.

 

[DO2015CA]

I mean, actual evidence supports NPs substituting for physicians, at least in primary care scenarios.

Lol. This is the study they always quote but it is such a poor study. Not only were they not unsupervised but also they chose ramifications like patient satisfaction. Of course NPs have higher patient satisfaction. It’s known that when you get your way you will be more satisfied. Regardless if that drug is warranted.

Also, if you go to the actual studies not just that link and look at the actual methods. Their better BP control was totally bunk. Bp control outcomes take years to measure because it takes years for the bad outcomes. We control BP for the outcomes not to control the numbers for the sake of controlling numbers.

The study focused on relatively short durations for BP controls for the NP portions then compared those numbers to already published physician numbers that were longer durations. Hawthorne effect bias can easily be at play in the NP portion, it is easy to control your numbers short term because you know you are a part of a study. It becomes harder to keep up the right control the longer the study goes on

 

[NicMouse64]

Lol. This is the study they always quote but it is such a poor study. Not only were they not unsupervised but also they chose ramifications like patient satisfaction. Of course NPs have higher patient satisfaction. It’s known that when you get your way you will be more satisfied. Regardless if that drug is warranted.

Also, if you go to the actual studies not just that link and look at the actual methods. Their better BP control was totally bunk. Bp control outcomes take years to measure because it takes years for the bad outcomes. We control BP for the outcomes not to control the numbers for the sake of controlling numbers.

The study focused on relatively short durations for BP controls for the NP portions then compared those numbers to already published physician numbers that were longer durations. Hawthorne effect bias can easily be at play in the NP portion, it is easy to control your numbers short term because you know you are a part of a study. It becomes harder to keep up the right control the longer the study goes on

futhermore, when mortality and morbidity aren't being effectively measured who knows if the BP control was at the expense of patient outcomes.

 

[Nurse2MD2018]

Not sure if you're being serious. Midlevels are the biggest (and basically only) threat to medicine.

Not even trying to be demeaning but have you worked in a hospital in any capacity other than being a student?
I can assure you that administrators who chase profit over pt outcomes, reimbursement practices, insurance companies and patient satisfaction scores pose more of a threat to medicine. Certain subspecalities that have very few fellowships and limited residents rotating through such as peditratic CV could not even function at the capacity they do without midlevels. For instance my hospital system has two CV surgeons, residents for some reason are not allowed to rotate through their service. On any given day we have at least 20 patients on the service, either waiting for surgery, in recovery or dealing with some acute issues. Without the midlevels, our two surgeons who are already overworked and share call 365 days a year would be required to limit their time in the OR to provide care for these pts who are inpatient. As well as cover clinics. This would then limit the amount of procedures they could perform, which would result in negative consequences for those patients waiting. As you can see its not always an issue of profit for every physician who supports midlevels.

 

[NicMouse64]

Not even trying to be demeaning but have you worked in a hospital in any capacity other than being a student?
I can assure you that administrators who chase profit over pt outcomes, reimbursement practices, insurance companies and patient satisfaction scores pose more of a threat to medicine. Certain subspecalities that have very few fellowships and limited residents rotating through such as peditratic CV could not even function at the capacity they do without midlevels. For instance my hospital system has two CV surgeons, residents for some reason are not allowed to rotate through their service. On any given day we have at least 20 patients on the service, either waiting for surgery, in recovery or dealing with some acute issues. Without the midlevels, our two surgeons who are already overworked and share call 365 days a year would be required to limit their time in the OR to provide care for these pts who are inpatient. As well as cover clinics. This would then limit the amount of procedures they could perform, which would result in negative consequences for those patients waiting. As you can see its not always an issue of profit for every physician who supports midlevels.

This is exactly why midlevels are an impending threat. Admin don't care about replacing physicians even if patients suffer if it makes them more money. Midlevels order more tests and get paid less, but have better patient satisfaction scores. So yes, admin and greedy docs have perpetuated this mess. But this kumbaya let's work "together" against "the man" is not just wrong it is not in the best interest of physicians and their patients' health.

 

[Nurse2MD2018]

This is exactly why midlevels are an impending threat. Admin don't care about replacing physicians even if patients suffer if it makes them more money. Midlevels order more tests and get paid less, but have better patient satisfaction scores. So yes, admin and greedy docs have perpetuated this mess. But this kumbaya let's work "together" against "the man" is not just wrong it is not in the best interest of physicians and their patients' health.

So how will restricting practice rights change the current landscape? How should we address hospital systems without certain fellowship programs? Make residents work more hours?
How will you fill the gap of lack of primary care in rural areas? Tell your classmate to stop gunning for surgical specialties?

Eliminating their right to independent practice is not taking away their right to practice. What is stopping a hospital from hiring 1 physician for every 10midlevel they hire and then having that physician oversee those individuals?
I once had a neurosurg PA miss/ignore signs of increased ICP in a pt with a shunt malfunction, the ED team also did not seem to care( staff by all MDs) because according to them the vitals were “stable” even thought the pt was neurologically deteriorating. By the time I escalated the situation to the neurosurg attending who was blissfully sleeping at home we were basically stringing mannitol and running like hell to the OR. If this pt died and a lawsuit ensured that PA and attending asses would be on the line, not just the PA. If you want to practice on your own and play baby doc, the when s**t hits the fan only your license should be in question.

If our true interest is patient outcomes, subject midlevels to stricter orentiation practices, have them sit for oral, not just written boards. Change the way in which they renew their license by having them take retake boards every 5-10 years to ensure safe practices instead of the current practice of just doing CEs.

 

[deleted480308]

So how will restricting practice rights change the current landscape? How should we address hospital systems without certain fellowship programs? Make residents work more hours?
How will you fill the gap of lack of primary care in rural areas? Tell your classmate to stop gunning for surgical specialties?

Eliminating their right to independent practice is not taking away their right to practice. What is stopping a hospital from hiring 1 physician for every 10midlevel they hire and then having that physician oversee those individuals?
I once had a neurosurg PA miss/ignore signs of increased ICP in a pt with a shunt malfunction, the ED team also did not seem to care( staff by all MDs) because according to them the vitals were “stable” even thought the pt was neurologically deteriorating. By the time I escalated the situation to the neurosurg attending who was blissfully sleeping at home we were basically stringing mannitol and running like hell to the OR. If this pt died and a lawsuit ensured that PA and attending asses would be on the line, not just the PA. If you want to practice on your own and play baby doc, the when s**t hits the fan only your license should be in question.

If our true interest is patient outcomes, subject midlevels to stricter orentiation practices, have them sit for oral, not just written boards. Change the way in which they renew their license by having them take retake boards every 5-10 years to ensure safe practices instead of the current practice of just doing CEs.

if the goal is patient outcomes, midlevels should be adequately supervised by a physician

 

[Splenda88]

The general population as a whole isn't super sick or something with loads of complex horses or zebras everywhere. What it comes down to is defending the turf for good reason. Why should doctors limit their income and increase their workload per patient by only seeing complex ones? That's ridiculous and absurd by every measure. And for the "simple" patients that fall through the cracks of statistics and get mismanaged by an NP, is it fair to them?

No reason for a country like the US to deliver suboptimal healthcare.

I have seen many docs say crazy stuff like that... It's absurd that some physicians think we should take on these kinds of liabilities to accommodate other healthcare professionals.

 

[Nurse2MD2018]

if the goal is patient outcomes, midlevels should be adequately supervised by a physician

So when you have two neurosurgeons in a Level 1 trauma facility they should be required to work 24/7 365 to ensure that they adequately supervising their midlevels right?

 

[deleted480308]

So when you have two neurosurgeons in a Level 1 trauma facility they should be required to work 24/7 365 to ensure that they adequately supervising their midlevels right?

surgeons are a finite resource, not everywhere can have a neurosurgeon 24/7. If you find that untenable, then train more surgeons. A midlevel is not a replacement for a surgeon, they can be a very useful extender

 

[Nurse2MD2018]

surgeons are a finite resource, not everywhere can have a neurosurgeon 24/7. If you find that untenable, then train more surgeons. A midlevel is not a replacement for a surgeon, they can be a very useful extender

This logic is so flawed and let’s me know this discussion is headed nowhere.

 

[Splenda88]

NP think we are a bunch of elitists that only care about the $$$

 

[deleted480308]

This logic is so flawed and let’s me know this discussion is headed nowhere.

properly trained people is the thing you are saying is in shortage. The answer to that is to make more properly trained people, not promote those who aren't and pretend they are

You may not like the answer but it isn't flawed

 

[HisLovePerfects]

Lol. This is the study they always quote but it is such a poor study. Not only were they not unsupervised but also they chose ramifications like patient satisfaction. Of course NPs have higher patient satisfaction. It’s known that when you get your way you will be more satisfied. Regardless if that drug is warranted.

Also, if you go to the actual studies not just that link and look at the actual methods. Their better BP control was totally bunk. Bp control outcomes take years to measure because it takes years for the bad outcomes. We control BP for the outcomes not to control the numbers for the sake of controlling numbers.

The study focused on relatively short durations for BP controls for the NP portions then compared those numbers to already published physician numbers that were longer durations. Hawthorne effect bias can easily be at play in the NP portion, it is easy to control your numbers short term because you know you are a part of a study. It becomes harder to keep up the right control the longer the study goes on

The trials showed no difference not only in surrogate outcomes like blood pressure and "patient satisfaction," but also in ER visits, hospitalizations, pain, physical functioning, and reported quality-of-life. Mortality was also equivalent. While trial duration was usually short (mean 14 months), the large number of participants (36,529) and the corresponding tight confidence interval makes up for this. True, for chronic disease management (e.g., hypertension, diabetes) it is duration of follow up that matters more; but in my opinion, maintaining a good BP/HbA1c is most of the work in mitigating mortality from these diseases and the data show that nurses do this as well as physicians (the Hawthorne effect would apply equally to the physicians as well as the nurses under study).

Since most NP trials received some supervision (though this was typically either a doctor being available for consultation or annual meetings with a doctor, not direct supervision), I agree that NPs should not practice completely independently except in certain circumstances.

 

[Osminog]

NP = Not Proficient (at the practice of medicine).

A two-year online degree program with no academic prerequisites and a 100% acceptance rate doesn't give you the same experience and skills that you gain from a comprehensive, rigorous medical school education and 3+ years of residency training. There's no doubt that NPs, on average, have significantly less medical knowledge and skill than physicians. Why would anybody think that NPs' patient outcomes (not in terms of subjective patient evaluations but in terms of patient health) would be better?

Also, the AllNurses forum is like a giant cringe compilation in text form. For the sake of one's sanity, it's inadvisable to read anything on that site.

 

[NicMouse64]

So how will restricting practice rights change the current landscape? How should we address hospital systems without certain fellowship programs? Make residents work more hours?
How will you fill the gap of lack of primary care in rural areas? Tell your classmate to stop gunning for surgical specialties?

Eliminating their right to independent practice is not taking away their right to practice. What is stopping a hospital from hiring 1 physician for every 10midlevel they hire and then having that physician oversee those individuals?
I once had a neurosurg PA miss/ignore signs of increased ICP in a pt with a shunt malfunction, the ED team also did not seem to care( staff by all MDs) because according to them the vitals were “stable” even thought the pt was neurologically deteriorating. By the time I escalated the situation to the neurosurg attending who was blissfully sleeping at home we were basically stringing mannitol and running like hell to the OR. If this pt died and a lawsuit ensured that PA and attending asses would be on the line, not just the PA. If you want to practice on your own and play baby doc, the when s**t hits the fan only your license should be in question.

If our true interest is patient outcomes, subject midlevels to stricter orentiation practices, have them sit for oral, not just written boards. Change the way in which they renew their license by having them take retake boards every 5-10 years to ensure safe practices instead of the current practice of just doing CEs.

Your status as a medical student becomes suspicious with this comment. You could've used my/our, but used "your". Physicians go rural more than NPs. Train more physicians. There is your answer.

 

[NicMouse64]

The trials showed no difference not only in surrogate outcomes like blood pressure and "patient satisfaction," but also in ER visits, hospitalizations, pain, physical functioning, and reported quality-of-life. Mortality was also equivalent. While trial duration was usually short (mean 14 months), the large number of participants (36,529) and the corresponding tight confidence interval makes up for this. True, for chronic disease management (e.g., hypertension, diabetes) it is duration of follow up that matters more; but in my opinion, maintaining a good BP/HbA1c is most of the work in mitigating mortality from these diseases and the data show that nurses do this as well as physicians (the Hawthorne effect would apply equally to the physicians as well as the nurses under study).

Since most NP trials received some supervision (though this was typically either a doctor being available for consultation or annual meetings with a doctor, not direct supervision), I agree that NPs should not practice completely independently except in certain circumstances.

How did they measure mortality? This study and the 6 they quote have atrocious methods for evaluating mortality. Did you know that if a patient didn't call back they were "excluded" from the study in 2 of the studies? What if they were dead? How did they follow the patient's health? This is a poorly put together literature review being used for political purposes.

 

[Nurse2MD2018]

Your status as a medical student becomes suspicious with this comment. You could've used my/our, but used "your". Physicians go rural more than NPs. Train more physicians. There is your answer.

Lol I love how no one has yet to propose any realistic solutions to the questions I posted. An incoming M1, if you care that much you can look up my activities on on here or would you like for me to send you my acceptance letters