why such animosity towards mid levels?

[cardsurgguy]

No, I'm not a nurse or NP, I'll be starting med school next year

However, I have 5 years as a patient care tech in open heart and heart transplant ICU's as well as a stint assisting with CT surg in the OR
Never worked outpatient so it would be wrong for me to comment on that

I've worked with tons of midlevels and don't see what all of the animosity is about??

Who knows, maybe I work at a hospital that is the exception, but it seems as though they know their limitations and they refer if they are not qualified to provide care.
Or maybe the fact that all my experience has been in a tertiary teaching hospital, there's more physician oversight as compared to a primary care office, where they may have more of a chance to work w/out as much oversight.
There are a million confouding variables, but oh well

Besides, I've seen them cover many services overnight and weekends that physicians would otherwise have to do. So, albeit in a small quanity, in some cases can give physicians less of a strenuous lifestyle.

And besides, from society's perspective, we're short providers. Why not have an army of midlevels to help out with the less serious stuff (ie sniffles in a primary care setting) to free up physicians to get more done and spend more time seeing complex patients.


However, I do see the major complaints against them. There is a potential for them to do more than they are qualified.

For example, I'd **** a brick if an NP or PA who has worked in cardiology managed dilated cardiomyopathy with multiple comorbidities or the like.

But if a patient has moderately high blood pressure and simply needs a diuretic to make everything fine, then what's the big deal with a NP or PA doing this??

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[Miklos]

One of the best comments on this topic, that I've seen lately, was published last Friday in the UK's Guardian newspaper entitled: "The trouble with nurses prescribing."

Let me add that I've worked with excellent mid-levels who know the limits of their abilities.

As for some of the animosity, I believe it is because they are unwanted competition to MDs. See another thread with overlapping subject matter here.

 

[billydoc]

One of the best comments on this topic, that I've seen lately, was published last Friday in the UK's Guardian newspaper entitled: "The trouble with nurses prescribing."

Let me add that I've worked with excellent mid-levels who know the limits of their abilities.

As for some of the animosity, I believe it is because they are unwanted competition to MDs. See another thread with overlapping subject matter here.

Most animosity I see is on the forums. Much, much less in real life. In general things are drying up in the healthcare. MDs are feeling the acute impact of it. Many feel the journey into medicine wasn't worth it, esp if didn't match in the specialty of their choice. And when the harsh reality of being stuck in the rut of the primary care hits,ppl notice so-called mid-levels who are now competing not only among themselves (NP/PA) but with so-called upper-levels (MD/DO). For the most part it has nothing to do with the patient care,safety etc. It's a turf war which sometimes gets ugly. But I saw my doc yesterday (he is well established, 25+ yrs in the business).He is very excited about forming a partnership with an NP. The NP happens to be a very exp RN with lots of years in ER, and critical care. He is going to be a hospitalist,and keeping an eye on ER admits/re-admits, and on other days he'll be covering the private practice. The doc only works Mon,Wed,Fri. So other days NP is there all by himself. Believe it or not patients absolutely love him. Many try to come on those days when he is there, but not the doc. So I would filter and devide by at least 10 evrything I hear and read on these boards. It all depends on the set up. There are renagates who don't observe their limits in every profession, including MD/DO. In real life I wouldn't sweat it too much

Good Luck to All

 

[asdfaa]

Mid-levels! Oh goody, a new medical term for me. Very handy. I thought you were talking about third year residents or something.

 

[cardsurgguy]

Mid-levels! Oh goody, a new medical term for me. Very handy. I thought you were talking about third year residents or something.

haha, no, I'm talking about NP and PA

I've heard them referred to as mid level providers over the years since they provide mid level care, i.e. their scope of practice is greater than a nurse's scope of practice (and therefore provide a higher level of care than a nurse), but less than a physician's scope of practice (therefore provide a lower level of care than a physician)

I was just questioning why there seems to be so much dislike of NP/PA

I think they do a good job in providing their given level of care and are valuable parts of the system

and I was just making the point that, based on my experience, they know when they have a situation that is above what they can do based on their training and scopes of practice and will therefore refer to a physician when needed (in response to one of the criticisms that I've heard which is that they provide care that is over their scope of practice)

 

[billydoc]

haha, no, I'm talking about NP and PA

I've heard them referred to as mid level providers over the years since they provide mid level care, i.e. their scope of practice is greater than a nurse's scope of practice (and therefore provide a higher level of care than a nurse), but less than a physician's scope of practice (therefore provide a lower level of care than a physician)

I was just questioning why there seems to be so much dislike of NP/PA

I think they do a good job in providing their given level of care and are valuable parts of the system

and I was just making the point that, based on my experience, they know when they have a situation that is above what they can do based on their training and scopes of practice and will therefore refer to a physician when needed (in response to one of the criticisms that I've heard which is that they provide care that is over their scope of practice)

The scope of practice varies from State to State. Quite offten it is vaguely defined. And NPs could legally do anything, other than specified by the law what they couldn't. I'm trying to think of something outside of major surgery, which BTW MDs who are not sergeons can't do either. I can't seem to find any prohibitions for the NP in the primary care settings.I couldn't comment on PA's scope of practice, sinse most States require direct supervision of them by MD/DO,where it is absolutely NOT for NPs. But I know that PAs are practicing in many specialty areas, which many docs could only dream about,doing the very things specialty docs do. I've never heard,though, anybody refering to the NP/PA as "mid-level". Ihis must be an SDN or pre-med to residency thing. Many ppl are simply delusional when they go into medicine. These days the only "upper levels" in the whole health industry seem to be the ppl who are paying us, or somehow regulating, and telling us what to do. Very few of those hold MD/DO degrees. So if you are not the "P" as in president, then you are "p" on Sadly but true.

 

[Jambi]

I couldn't comment on PA's scope of practice, sinse most States require direct supervision of them by MD/DO,where it is absolutely NOT for NPs. But I know that PAs are practicing in many specialty areas, which many docs could only dream about,doing the very things specialty docs do.

Don't fool yourself, NP's are "supervised" just like PA's, only the NP's call it "collaboration." Maybe it helps them sleep at night but it's still physician oversight.

I've never heard,though, anybody refering to the NP/PA as "mid-level". Ihis must be an SDN or pre-med to residency thing.

Mid-level is a very common term used to describe exactly where PA/NP's fit into the health care team.

 

[billydoc]

Don't fool yourself, NP's are "supervised" just like PA's, only the NP's call it "collaboration." Maybe it helps them sleep at night but it's still physician oversight.


Mid-level is a very common term used to describe exactly where PA/NP's fit into the health care team.

My good friend Jambi!
I'm not fooling myself, and I'm answering to the OP from personal exp. At least in NY, where I am, NPs are not supervised. The collaboration is what it is. Usually "Hi! How are you" talk once in 3 month. Sometimes a nice lunch. But many NPs choose to work in the group practice because having a doc, esp the specialist on-site works well for both patient, and practitioners. Pt is attended right there, and referrals are going in both directions . I hope you are not going to be delusional, and tell me that, no, it isn't so. There are idiots in every profession, not only in medicine or health field. There is no point in creating another PA vs NP vs MD vs DO thread. Just find your place under the sun, and be happy. As for referring to NP/PA as mid-level I know that the term exists. However I have yet to hear anybody really using it. And I'm praticing in the very much mainstream World.

Have a good one

 

[hcc]

No, I'm not a nurse or NP, I'll be starting med school next year

However, I have 5 years as a patient care tech in open heart and heart transplant ICU's as well as a stint assisting with CT surg in the OR
Never worked outpatient so it would be wrong for me to comment on that

I've worked with tons of midlevels and don't see what all of the animosity is about??

Who knows, maybe I work at a hospital that is the exception, but it seems as though they know their limitations and they refer if they are not qualified to provide care.
Or maybe the fact that all my experience has been in a tertiary teaching hospital, there's more physician oversight as compared to a primary care office, where they may have more of a chance to work w/out as much oversight.
There are a million confouding variables, but oh well

Besides, I've seen them cover many services overnight and weekends that physicians would otherwise have to do. So, albeit in a small quanity, in some cases can give physicians less of a strenuous lifestyle.

And besides, from society's perspective, we're short providers. Why not have an army of midlevels to help out with the less serious stuff (ie sniffles in a primary care setting) to free up physicians to get more done and spend more time seeing complex patients.


However, I do see the major complaints against them. There is a potential for them to do more than they are qualified.

For example, I'd **** a brick if an NP or PA who has worked in cardiology managed dilated cardiomyopathy with multiple comorbidities or the like.

But if a patient has moderately high blood pressure and simply needs a diuretic to make everything fine, then what's the big deal with a NP or PA doing this??

I am a np student, alright down boys and girls, just listen to my story for a moment. I work as an rn in a teaching facility. I work with a cardiac surgical team that has midlevels that take care of all the daily items while the surgeons are in surgery. The surgeons do rounds with them at 7 am and 5 pm and are available via beeper during the day if needed. The midlevels are very carefull not to overstep their bounds hence they reap the wrath of a cardiac surgeon. I will say that I owe all the residents and interns I have ever encountered (especially in July) an apology. I have a new found respect. I now understand the stress of raising a family, working, doing class, and clinical for endless hours. I also want to say that my preceptor is a hospitalist and is definitly teaching me that I would be nuts to practice without utilizing the physician I am working under when I am in over my head. The residents I work with know I am in school for NP and are very helpful to me and I have not encountered any bad will from them. And yes, I have groveled and told them that I have an enormous amount of respect and patience with them now. See, sometimes I have the answer and sometimes they have the answer and now we help each other through the day, even if it means just knowing where the grab n go food is.
Please try to remember NP's are nurses, we work and learn from a nursing perspective, you are medical doctors, you work and learn from a medical perspective. Together we can give great care to the patients.

 

[cardsurgguy]

I am a np student, alright down boys and girls, just listen to my story for a moment. I work as an rn in a teaching facility. I work with a cardiac surgical team that has midlevels that take care of all the daily items while the surgeons are in surgery. The surgeons do rounds with them at 7 am and 5 pm and are available via beeper during the day if needed. The midlevels are very carefull not to overstep their bounds hence they reap the wrath of a cardiac surgeon. I will say that I owe all the residents and interns I have ever encountered (especially in July) an apology. I have a new found respect. I now understand the stress of raising a family, working, doing class, and clinical for endless hours. I also want to say that my preceptor is a hospitalist and is definitly teaching me that I would be nuts to practice without utilizing the physician I am working under when I am in over my head. The residents I work with know I am in school for NP and are very helpful to me and I have not encountered any bad will from them. And yes, I have groveled and told them that I have an enormous amount of respect and patience with them now. See, sometimes I have the answer and sometimes they have the answer and now we help each other through the day, even if it means just knowing where the grab n go food is.
Please try to remember NP's are nurses, we work and learn from a nursing perspective, you are medical doctors, you work and learn from a medical perspective. Together we can give great care to the patients.

I agree.

I previously have worked on the heart transplant unit of a teaching hospital. The two transplant coordinators are NP's (or 1 NP and 1 PA, I forgot, it's been years).
They do such a good job. Especially with patient education about all of the drugs that the patients have to take after transplant and education about the transplant process (rejection, biopsies, etc...).
If pts received only the education from docs, they'd have no idea about anything. These two are great at what they do.

If they are working on the floor and a patient needs some pain meds or is nautious, then they will prescribe some lortab or purcocet, or some phenergen.
However, they know that they should not be adjusting primacor or dobutamine dosages for heart failure of pre-transplant pts. or adjusting settings for balloon pump patients.

Another plus is that they are enjoyable to work with b/c they were really nice and pleasant people. No "I'm the greatest thing since sliced bread" egos from a lot of the docs around.


Oh yeah, I'd like to point out, when I said this in my original post...

I'd **** a brick if an NP or PA who has worked in cardiology managed dilated cardiomyopathy with multiple comorbidities or the like.

I should have made clear that I didn't mean that this just applies for NP or PA.
I personally believe this is true for a primary care physician as well (ie family practice, internal medicine). If I had cardiomyopathy with renal failure, there's no way I'd want either of the two aforementioned physicians managing it. A cardiologist should be managing my condition.

 

[tigershark]

What animosity?

I've never seen any in a professional setting.

Mid-levels = $$$$$ for doctors

 

[beezar]

What has really turned ugly is the CRNA vs. MD anesthesiologist thing with regards to CRNAs having independent practice... The animosity between the two representing organizations, and many CRNAs and MDs is just so tiresome and ridiculous... what's sad is that both groups try to tout the fact that it is all about patient care, when in reality, it is all about $$$$$$$$ and big egos in both.

Sorry, had to vent.