AANP et al.: "our national organizations strongly oppose the view that emergency care is solely physician-led"

[UreterIHardlyKnowHer]

Joint Statement on the Role of Advanced Practice Registered Nurses

The Emergency Nurses Association (ENA), American Association of Nurse Practitioners® (AANP), American Association of Critical-Care Nurses (AACN) and the National Association of Pediatric Nurse Practitioners (NAPNAP) believe in the power of an interprofessional approach to health care that…

www.aanp.org

What a lazy, entitled, selfish organization. These people have zero concern for patient outcomes if they think that they can play doctor with 1/12th the training.

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Members don't see this ad.

 

[Tenk]

This is actually good. We need to piss them off more so they go do their own thing and fail miserably.

 

[Noisewater-TDX]

"APRNs undertake rigorous preparation through their education and clinical training through nationally accredited graduate programs."

No they don't. The reason i went to med school over NP school was they were mostly online and highly variable in content and difficulty.

 

[betamale]

What's really sad is that I used to get transfer or ED bouncebacks from EDs that are staffed only by NPs/PAs because their systems had bylaws barring FPs/IMs from working in the ED. They did allow 1st and 2nd year ED residents to moonlight there.

So there you go

 

[sylvanthus]

“Rigorous training” hahahahhahahhah. What world are we living in?

 

[RustedFox]

“Rigorous training” hahahahhahahhah. What world are we living in?

Cause watching those online lectures while ignoring the requirements of the nursing job they're presently at is so hard.

 

[Birdstrike]

Nurse practitioners do a great job standing up for themselves and fighting for turf.

Physicians do a terrible job of it.

If “doctors are so much smarter” why are nurses winning this battle so handily?

 

[deleted126335]

Joint Statement on the Role of Advanced Practice Registered Nurses

The Emergency Nurses Association (ENA), American Association of Nurse Practitioners® (AANP), American Association of Critical-Care Nurses (AACN) and the National Association of Pediatric Nurse Practitioners (NAPNAP) believe in the power of an interprofessional approach to health care that…

www.aanp.org

What a lazy, entitled, selfish organization. These people have zero concern for patient outcomes if they think that they can play doctor with 1/12th the training.

From Anesthesia land.

 

[vm26]

Nurse practitioners do a great job standing up for themselves and fighting for turf.

Physicians do a terrible job of it.

If “doctors are so much smarter” why are they winning this battle so handily?

P/E and mid-level encroachment. One two punch taking down much of medicine. Only cure I see is total government control of HC which has its own problems.

 

[Birdstrike]

P/E and mid-level encroachment. One two punch taking down much of medicine. Only cure I see is total government control of HC which has its own problems.

Do you think “total government control” of healthcare by politicians would handle “mid-level encroachment” in a way that benefits mid-levels, or physicians?

 

[vm26]

Do you think “total government control” of healthcare by politicians would handle “mid-level encroachment” in a way that benefits mid-levels, or physicians?

Mid-levels. I guess I misspoke, as this "cure" doesn't really help physicians, simply get rids of P/E. Morbid analogy would be that the cancer is "cured" as soon as the patient passes away from it.

 

[Birdstrike]

Mid-levels. I guess I misspoke, as this "cure" doesn't really help physicians, simply get rids of P/E. Morbid analogy would be that the cancer is "cured" as soon as the patient passes away from it.

By P/E, you mean “private equity”?

 

[vm26]

By P/E, you mean “private equity”?

Yea

 

[Birdstrike]

Yea

I thought so.

Both parties are heavily funded by Wall Street and private equity, although the pendulum swings slightly past 50/50 on either side, depending on the cycle. I’m not sure politicians are going to be too quick to bankrupt the guys that bankroll them, and then it somehow accidentally helps doctors. But I suppose anything is possible.

In fact, I’m not sure anymore, what politicians do but complete orders placed by their donors. I’ve concluded that if we don’t help ourselves, no one is likely to do it for us. The good news is it can be done.

 

[Sushirolls]

P/E and mid-level encroachment. One two punch taking down much of medicine. Only cure I see is total government control of HC which has its own problems.

Or get the government out of health care!

• End certificate of need. Which allows greater ease of opening ones own facilities.
• End the 2 year ban of physicians who opt out of medicare. Allow people to bill medicare out of network.
• Be vocal, unabashed and advertise we are physician - not a poorly trained midlevel - create PAC like ads for PSA announcements about differences
• Require insurance companies to pay all their contracted parties the same rate - in all states, in all localities, openly published reimbursement rates

 

[vm26]

Or get the government out of health care!

• End certificate of need. Which allows greater ease of opening ones own facilities.
• End the 2 year ban of physicians who opt out of medicare. Allow people to bill medicare out of network.
• Be vocal, unabashed and advertise we are physician - not a poorly trained midlevel - create PAC like ads for PSA announcements about differences
• Require insurance companies to pay all their contracted parties the same rate - in all states, in all localities, openly published reimbursement rates

If anything we are moving closer to govt run HC. Doesn't the Biden administration want to drop the eligibility age for medicare? Many on the left feel that this does not go far enough and want a public option.

Problem is physicians are the ones that initially hired mid-levels to provide care (and make money off of them). Cannot turn the clock back on this.

More mid-level programs are opening up and Congress in proposing increasing resident training spots. My guess is the Govt. has realized that they can not get rid of big private insurers/large consolidated HC systems so the game-plan now is to simply flood the field-add more physicians and midlevels to the market, continue to increase scope of practice for mid-levels, and drastically drive down the cost of labor.

 

[Make Or Break]

If anything we are moving closer to govt run HC. Doesn't the Biden administration want to drop the eligibility age for medicare? Many on the left feel that this does not go far enough and want a public option.

Problem is physicians are the ones that initially hired mid-levels to provide care (and make money off of them). Cannot turn the clock back on this.

More mid-level programs are opening up and Congress in proposing increasing resident training spots. My guess is the Govt. has realized that they can not get rid of big private insurers/large consolidated HC systems so the game-plan now is to simply flood the field-add more physicians and midlevels to the market, continue to increase scope of practice for mid-levels, and drastically drive down the cost of labor.

The future is going to be weird. I can’t imagine choosing to go through all this debt and school without an eventual payoff.

 

[WilcoWorld]

Or get the government out of health care!

• Require insurance companies to pay all their contracted parties the same rate - in all states, in all localities, openly published reimbursement rates

That sounds like you're involving the government...

 

[AlbinoHawk DO]

The midlevel problem will continue as long as simp physicians keep training them and willing to co-sign their notes

If NPs are independent and not practicing medicine but instead "healthcare, " it's inappropriate for doctors to train or supervise. Let them sink on their own

 

[Backpack234]

What ever happened to the PPP (Physician for Patient Protection) group that was recruiting members last year? If I remember correctly this was exactly their fight

 

[vm26]

What ever happened to the PPP (Physician for Patient Protection) group that was recruiting members last year? If I remember correctly this was exactly their fight

Very hard for physicians to carry through on this sort of thing. Each of our specialties have their own agenda and there is simply very little unity unless multiple fields get hit and then they unite with varying success (eg. delaying last years CMS cuts from E/D).

I remember a few years ago there was a move to get away from specialty board certification given how much of it is simply money-making masquerading as QA/patient safety. Have not really heard about this lately.

 

[aafisahar]

Nurse practitioners do a great job standing up for themselves and fighting for turf.

Physicians do a terrible job of it.

If “doctors are so much smarter” why are nurses winning this battle so handily?

Doctors think this is a patient safety issue and work that angle (eg training, safety, etc)

NP think it's a money issue (cost savings, "expansion of coverage", same work for less pay).

Who do you think administrators and politicians will listen to?

Money will win over patients' well-being 100/100 in America.

 

[Birdstrike]

Doctors think this is a patient safety issue and work that angle (eg training, safety, etc)

NP think it's a money issue (cost savings, "expansion of coverage", same work for less pay).

Who do you think administrators and politicians will listen to?

Money will win over patients' well-being 100/100 in America.

I think you've answered my question by saying, in effect, doctors are losing this battle because they've chosen an ineffective persuasion strategy of trying to convince administrators and politicians patient safety is more important than money, compared to the effective and more persuasive strategy used by NPs, of convincing administrators money is all important. And that physicians have chosen to double down on their losing strategy the more it loses, preferring to "lose ethically" rather than "win unethically."

Am I correct?

 

[sylvanthus]

We can use money and patient safety to our advantage if we so it right.

Let patients know that they are paying the same whether they see a physician or a midlevel. Get them to demand to see physicians. Educate the public on the difference.

 

[sylvanthus]

Bahh who am I kidding patients in general dont care who gives them their unnecessary antibiotics, xrays, labs, and pain meds.

I sorta had a brief moment of hope there. Back to the misery.

 

[order66.exe]

The only thing that would save doctors is rolling back tort reform and changing professional norms to inform patients of midlevel mismanagement and encouraging patients to consult an attorney. The threat of malpractice is the only thing that protected this profession

 

[Birdstrike]

The only thing that would save doctors is rolling back tort reform and changing professional norms to inform patients of midlevel mismanagement and encouraging patients to consult an attorney. The threat of malpractice is the only thing that protected this profession

I'm not sure I can get on board with the "threat of malpractice" having been a net positive for profession of Medicine.

 

[aafisahar]

I think you've answered my question by saying, in effect, doctors are losing this battle because they've chosen an ineffective persuasion strategy of trying to convince administrators and politicians patient safety is more important than money, compared to the effective and more persuasive strategy used by NPs, of convincing administrators money is all important. And that physicians have chosen to double down on their losing strategy the more it loses, preferring to "lose ethically" rather than "win unethically."

Am I correct?

The way to really win is to let NPs have their cake. Don't work jobs with midlevels, don't cosign charts, don't proctor them. Let CMGs use 100% midlevels in shops. Let the word out to malpractice lawyers on said shops. The way to win this is to force PE out of the game. Sure some patients will get hurt and die. You need to break some eggs to make an omelet.

 

[turkeyjerky]

The way to really win is to let NPs have their cake. Don't work jobs with midlevels, don't cosign charts, don't proctor them. Let CMGs use 100% midlevels in shops. Let the word out to malpractice lawyers on said shops. The way to win this is to force PE out of the game. Sure some patients will get hurt and die. You need to break some eggs to make an omelet.

Lol. 2005 called, it wants its strategy back.

 

[southerndoc]

The way to really win is to let NPs have their cake. Don't work jobs with midlevels, don't cosign charts, don't proctor them. Let CMGs use 100% midlevels in shops. Let the word out to malpractice lawyers on said shops. The way to win this is to force PE out of the game. Sure some patients will get hurt and die. You need to break some eggs to make an omelet.

I think most hospitals will have trouble with this and balk at the idea. Rural hospitals or those that staff their ER's with non-EM trained individuals may not have an issue with it.

 

[FutureInternist]

The way to really win is to let NPs have their cake. Don't work jobs with midlevels, don't cosign charts, don't proctor them. Let CMGs use 100% midlevels in shops. Let the word out to malpractice lawyers on said shops. The way to win this is to force PE out of the game. Sure some patients will get hurt and die. You need to break some eggs to make an omelet.

A lot of jobs require it now, so even less of a choice now than it was before.

Best one can do is not have NP/PA students but that is also fighting a losing battle.

One of my friends, printed out the Doc vs PA/NP training hours graphic that has been floating around for a while, added their own commentary about hospitals not caring about pts as long as they could save $, and then got them distributed to every floor of the hospital (via a 3rd person).
His next step was going to be to go send it to local news and hopefully make a bigger stink, but he was so close to retirement that he decided to ride it out.
Still... balls of steel to do even just that

 

[Splenda88]

"APRNs undertake rigorous preparation through their education and clinical training through nationally accredited graduate programs."

No they don't. The reason i went to med school over NP school was they were mostly online and highly variable in content and difficulty.

Ditto. Soon to finish IM residency and I am ultimately happy with my decision even though some thought I was crazy.

 

[Splenda88]

I thought so.

Both parties are heavily funded by Wall Street and private equity, although the pendulum swings slightly past 50/50 on either side, depending on the cycle. I’m not sure politicians are going to be too quick to bankrupt the guys that bankroll them, and then it somehow accidentally helps doctors. But I suppose anything is possible.

In fact, I’m not sure anymore, what politicians do but complete orders placed by their donors. I’ve concluded that if we don’t help ourselves, no one is likely to do it for us. The good news is it can be done.

How? Should we keep making it more difficult for physicians to practice medicine or should we just say f... it and reform med school curriculum to 2-yr preregs, 3-yr med and 2-5 years residency. There will be no incentive for people (NP/PA) to take shortcut since you will only need 7-10 yrs to become an attending.

 

[betamale]

How? Should we keep making it more difficult for physicians to practice medicine or should we just say f... it and reform med school curriculum to 2-yr preregs, 3-yr med and 2-5 years residency. There will be no incentive for people (NP/PA) to take shortcut since you will only need 7-10 yrs to become an attending.

Or let them get an MD in 2 yrs (pass USMLE 1-3 and do 3rd yr core rotations) + residency. MD remains gold standard

 

[Porfirio]

View attachment 336187

NP student: "I just don't wanna waste brain space"

Um, that's kinda important to know?

www.midlevel.wtf

Sadly, no one will care. Admin wants cheaper cogs to maximize thin margins for profit, patients want more testing and scanning, government will just print more money or create more rules to make downward pressure on costs which in turn promotes Admin actions to find cheaper cogs. The game is over and no one cares about evidence.

Too many market forces are colluding to push MDs out.

 

[Birdstrike]

How? Should we keep making it more difficult for physicians to practice medicine or should we just say f... it and reform med school curriculum to 2-yr preregs, 3-yr med and 2-5 years residency. There will be no incentive for people (NP/PA) to take shortcut since you will only need 7-10 yrs to become an attending.

How is it possible? I say "it's possible" under the general principle of anything being possible. That doesn't mean it's easy. That doesn't even mean it's likely to happen. But it is possible. I think that has to be the attitude when faced with any difficult task, however unlikely.

As far your proposed solution, would streamlining medical school curriculum, be a part of the solution?

I do recall a heck of a lot of time wasted, thinking, "I'm never going to use this knowledge." Countless hours performing menial tasks devoid of any educational value as cheap labor and to 'build character.' Countless, worthless undergrad and medical school prerequisites to make me "well rounded" but contributed nothing directly valuable to my medical education and current practice. Despite being promised it would, I'm not sure any of that served any purpose, other than enriching educational institutions and student loan bankers.

Yes, absolutely, streamlining medical education has to be part of the solution.

 

[Birdstrike]

Sadly, no one will care. Admin wants cheaper cogs to maximize thin margins for profit, patients want more testing and scanning, government will just print more money or create more rules to make downward pressure on costs which in turn promotes Admin actions to find cheaper cogs. The game is over and no one cares about evidence.

Too many market forces are colluding to push MDs out.

Their goal is to have an army of low cost worker-bees around doing the work, and a token physician or two around to "make sure it's being done right," and to take the blame when it's not. That fact is not in doubt. They've been very open about this goal.

 

[blue.jay]

How? Should we keep making it more difficult for physicians to practice medicine or should we just say f... it and reform med school curriculum to 2-yr preregs, 3-yr med and 2-5 years residency. There will be no incentive for people (NP/PA) to take shortcut since you will only need 7-10 yrs to become an attending.

I am not sure if schools are so generous to give away one year of tuition fees. On the other hand if you propose to make medical school 5-6 years, or increase residency length (make all EM residencies 4 years) or add bogus fellowships; that they will happily work on making it happen.