DNPs will eventually have unlimited SOP

[SpecterGT260]

http://www.bloomberg.com/news/2013-...-doctors-as-30-million-insured-seek-care.html

My BP spikes just a little bit when I read lines like "nurses find it demeaning.... when they are restricted from doing what they know they can do".

What one "knows" is a highly subjective (and often completely incorrect) notion. They may "know" they can do something. That doesn't mean they are doing it correctly or proficiently. I understand how much information is lost in the process of going from medical student to practicing physician and how many of us tend to fall into routines of practice, but I also strongly believe that retention of even a little of it is the only safeguard we have against mediocrity in medicine. I am tired of talking to people who have little to no understanding of the pathology or physiology behind the things they try to treat. Sure, 9/10 people will be fine and fit the mould, but we sign that other 1 person up to no only most certainly succumb, but to to so while paying for some else's treatment
Medicine isn't immune. Just the other week we had a tutor (MS4) write us some practice questions which covered various therapies and she didn't understand the difference between anabolic and corticosteroids. Apparently bodybuilders are injecting glucocorticoids to beef up, oh and I have no idea what exogenous Cushing's is My point is that I believe it is vitally important to position people who can retain as much of this crap as possible because if we fall into rote protocol-driven medicine it is only the patients that suffer. and... I mean... I'm a cynical A-hole half of the time and even I can get bent out of shape by the gross injustice of allowing under-educated people to freely practice at the slow and insidious expense of patients.

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[SpecterGT260]

My favorite quote from the article:

"Doctors are under a lot of pressure financially and feel like they are losing some of their patient volumes and traditional position as captain of the ship,” said John W. Rowe, former chief executive officer of Aetna Inc. and of Mount Sinai NYU Health. At the same time, “nurses find it demeaning and unprofessional to be in a situation where they are restricted from doing what they know they can do,” he said."

Give me a break.

My buddy has taken me up in his small airplane a couple times and let me take over the controls for a little bit each time. I know I can fly a plane. So why can't I become an airline pilot?

HA! Glad I'm not the only one.

 

[Pomeshnue]

My BP spikes just a little bit when I read lines like "nurses find it demeaning.... when they are restricted from doing what they know they can do".

What one "knows" is a highly subjective (and often completely incorrect) notion. They may "know" they can do something. That doesn't mean they are doing it correctly or proficiently. I understand how much information is lost in the process of going from medical student to practicing physician and how many of us tend to fall into routines of practice, but I also strongly believe that retention of even a little of it is the only safeguard we have against mediocrity in medicine. I am tired of talking to people who have little to no understanding of the pathology or physiology behind the things they try to treat. Sure, 9/10 people will be fine and fit the mould, but we sign that other 1 person up to no only most certainly succumb, but to to so while paying for some else's treatment
Medicine isn't immune. Just the other week we had a tutor (MS4) write us some practice questions which covered various therapies and she didn't understand the difference between anabolic and corticosteroids. Apparently bodybuilders are injecting glucocorticoids to beef up, oh and I have no idea what exogenous Cushing's is My point is that I believe it is vitally important to position people who can retain as much of this crap as possible because if we fall into rote protocol-driven medicine it is only the patients that suffer. and... I mean... I'm a cynical A-hole half of the time and even I can get bent out of shape by the gross injustice of allowing under-educated people to freely practice at the slow and insidious expense of patients.

Amen

 

[MetalGearFox]

Where is the AMA on this issue?

 

[LiamNeesons]

Primary care doesn't require eleven years of training. The secret is out. Nurses will take over primary care. They will hire nurse assistants. They will run clinics. They will be the new, slightly lesser quality, more affordable family physician. They will refer to specialists at medical centers where all physicians will be specialists. All specialists will have one physician assistant who works when he doesn't want to. Maybe this will affect quality of care you ask. Not driving a nice car affects my quality of life. You do what you can afford. Some diagnoses will get missed by nurses. Diagnoses also get missed by physicians. Some people will die. But less people will die overall because all individuals will get seen by at least someone. You can go into family medicine and fight nurses for the rest of your life, or you can adapt, survive, thrive.

 

[CDI]

Where is the AMA on this issue?

I lol'd.

 

[SpecterGT260]

Primary care doesn't require eleven years of training. The secret is out. Nurses will take over primary care. They will hire nurse assistants. They will run clinics. They will be the new, slightly lesser quality, more affordable family physician. They will refer to specialists at medical centers where all physicians will be specialists. All specialists will have one physician assistant who works when he doesn't want to. Maybe this will affect quality of care you ask. Not driving a nice car affects my quality of life. You do what you can afford. Some diagnoses will get missed by nurses. Diagnoses also get missed by physicians. Some people will die. But less people will die overall because all individuals will get seen by at least someone. You can go into family medicine and fight nurses for the rest of your life, or you can adapt, survive, thrive.

And then when they have that and start demanding the old family doc's payouts for their services....

 

[RadOnc04]

Primary care doesn't require eleven years of training. The secret is out. Nurses will take over primary care. They will hire nurse assistants. They will run clinics. They will be the new, slightly lesser quality, more affordable family physician. They will refer to specialists at medical centers where all physicians will be specialists. All specialists will have one physician assistant who works when he doesn't want to. Maybe this will affect quality of care you ask. Not driving a nice car affects my quality of life. You do what you can afford. Some diagnoses will get missed by nurses. Diagnoses also get missed by physicians. Some people will die. But less people will die overall because all individuals will get seen by at least someone. You can go into family medicine and fight nurses for the rest of your life, or you can adapt, survive, thrive.

This is so short sighted.... I do not know where this idea that primary care is "easy" comes from but its ridiculous I'm sorry. Managing these patients WELL on a consistent basis is not easy (chronic problems, social issues, etc.)

Just because NPs are coming for primary care.. doesn't mean they will stop there. Why would they? Derm, Simple Surgeries, GI, these are all on the table and have been shown on SDN before (Derm NP "residency" in Florida, GI colonoscopy "fellowship" for NPs, etc).

What we need is a UNITED front, that we will not refer to these people as "equal colleagues". I know I won't hire and/or refer to them (PAs and Family Docs (MD/DO) only)

"First they came for the communists,
and I didn't speak out because I wasn't a communist.
Then they came for the socialists,
and I didn't speak out because I wasn't a socialist.
Then they came for the trade unionists,
and I didn't speak out because I wasn't a trade unionist.
Then they came for me,
and there was no one left to speak for me."

And YES, people will get more access but will that equal better care, I say a resounding NO. I loved the analogy someone gave of an electrician. Imagine, if NPs were techs working for a bonded and insured electrician, they learned the trade the best they could by "watching" the electrician, then decided to go wire houses themselves. Most of time, the tech would probably have no problem.... but, how many houses would have to burn down (e.g. people die) before someone really took notice? (probably a good number) Any reasonable person does not allow a licensed and bonded electrician to do serious work on their house, why is the body so different? Why would you let someone inferiorly trained make serious decisions for you and your family?

 

[JShephard]

Primary care doesn't require eleven years of training. The secret is out. Nurses will take over primary care. They will hire nurse assistants. They will run clinics. They will be the new, slightly lesser quality, more affordable family physician. They will refer to specialists at medical centers where all physicians will be specialists. All specialists will have one physician assistant who works when he doesn't want to. Maybe this will affect quality of care you ask. Not driving a nice car affects my quality of life. You do what you can afford. Some diagnoses will get missed by nurses. Diagnoses also get missed by physicians. Some people will die. But less people will die overall because all individuals will get seen by at least someone. You can go into family medicine and fight nurses for the rest of your life, or you can adapt, survive, thrive.

Agreed.

To the previous poster, it has nothing to do with being easy.

The question is, does it take 11 years to train? Nurses figured out how to train faster and cheaper. This is a competition, doctor's give higher quality care bit at twice the cost. Is the government going to pay that premium or accept the lesser results and save money.

This has been played out in history and even recent government actions, I don't expect the government to pay that premium for the poor and elderly. The government isn't stupid, they take care of themselves and their friends first, always.

 

[JShephard]

This is so short sighted.... I do not know where this idea that primary care is "easy" comes from but its ridiculous I'm sorry. Managing these patients WELL on a consistent basis is not easy (chronic problems, social issues, etc.)

Just because NPs are coming for primary care.. doesn't mean they will stop there. Why would they? Derm, Simple Surgeries, GI, these are all on the table and have been shown on SDN before (Derm NP "residency" in Florida, GI colonoscopy "fellowship" for NPs, etc).

What we need is a UNITED front, that we will not refer to these people as "equal colleagues". I know I won't hire and/or refer to them (PAs and Family Docs (MD/DO) only)

"First they came for the communists,
and I didn't speak out because I wasn't a communist.
Then they came for the socialists,
and I didn't speak out because I wasn't a socialist.
Then they came for the trade unionists,
and I didn't speak out because I wasn't a trade unionist.
Then they came for me,
and there was no one left to speak for me."

And YES, people will get more access but will that equal better care, I say a resounding NO. I loved the analogy someone gave of an electrician. Imagine, if NPs were techs working for a bonded and insured electrician, they learned the trade the best they could by "watching" the electrician, then decided to go wire houses themselves. Most of time, the tech would probably have no problem.... but, how many houses would have to burn down (e.g. people die) before someone really took notice? (probably a good number) Any reasonable person does not allow a licensed and bonded electrician to do serious work on their house, why is the body so different? Why would you let someone inferiorly trained make serious decisions for you and your family?

They will do it to save money.

Look, you can say we need to be united but doctors do not make hiring choices often. CEOs do. They want profit. Government wants to not spend. Those are 2 huge forces that could care less about family physicians. So I guess we'll see what happens.

 

[goofball]

Primary care doesn't require eleven years of training. The secret is out. Nurses will take over primary care. They will hire nurse assistants. They will run clinics. They will be the new, slightly lesser quality, more affordable family physician. They will refer to specialists at medical centers where all physicians will be specialists. All specialists will have one physician assistant who works when he doesn't want to. Maybe this will affect quality of care you ask. Not driving a nice car affects my quality of life. You do what you can afford. Some diagnoses will get missed by nurses. Diagnoses also get missed by physicians. Some people will die. But less people will die overall because all individuals will get seen by at least someone. You can go into family medicine and fight nurses for the rest of your life, or you can adapt, survive, thrive.

I wouldn't be so sure about FPs going the way of the dodo. A lot of people have the expectation that they deserve to see a physician, and they like the idea of having a personal physician. This may be why concierge care is booming right now.

Worst comes to worst, family practice will become a dramatically smaller field. The family physicians trained by the system will either go into academia, supervising Nurses/PAs, or concierge care. And I'd be fine with that.




And about the DNP thing, well, don't expect patients to automatically be on board with it. It's hard enough to convince patients that DO = MD and they should see DOs. The DNP thing will just baffle them further.

 

[tobi44]

I wouldn't be so sure about FPs going the way of the dodo. A lot of people have the expectation that they deserve to see a physician, and they like the idea of having a personal physician. This may be why concierge care is booming right now.

Worst comes to worst, family practice will become a dramatically smaller field. The family physicians trained by the system will either go into academia, supervising Nurses/PAs, or concierge care. And I'd be fine with that.




And about the DNP thing, well, don't expect patients to automatically be on board with it. It's hard enough to convince patients that DO = MD and they should see DOs. The DNP thing will just baffle them further.

doubtful, most patients probably don't notice the difference between an MD/DO. If a DNP walks into an exam room with a white coat and introduces themselves as doctor while writing them a prescription then I don't think the average patient is going to catch on to the difference.

 

[JShephard]

I wouldn't be so sure about FPs going the way of the dodo. A lot of people have the expectation that they deserve to see a physician, and they like the idea of having a personal physician. This may be why concierge care is booming right now.

Worst comes to worst, family practice will become a dramatically smaller field. The family physicians trained by the system will either go into academia, supervising Nurses/PAs, or concierge care. And I'd be fine with that.




And about the DNP thing, well, don't expect patients to automatically be on board with it. It's hard enough to convince patients that DO = MD and they should see DOs. The DNP thing will just baffle them further.

Exactly.

It's not smart to take an all or none prediction, it's more likely FM will still play a role but more supervising and training, or dealing with difficult cases. This is similar to what is happening in anesthesia.

 

[badasshairday]

I will eventually have full SOP.

 

[goofball]

I will eventually have full SOP.

Can't argue with that.

 

[CDI]

California bill would let pharmacists, eye docs diagnose and treat diabetes, hypertension http://t.co/Vel5dVPaFY

 

[member1000765]

The big farce about NP/PA use for primary care is that it's going to lower health care costs - it's not going to lower costs. Once NP/PA's get into the market, they're going to demand the same wages as the FP's; if you believed that you provided equivalent care, why would you expect to work for a lesser wage? You wouldn't, unless your aim was to undercut someone else's business. Care's not going to be any cheaper, it will only be lesser quality care for the same price.

As an anecdote, on vacation several years back my younger sister began experiencing high spiking fevers at night and some general constitutional symptoms. I was an MS2 at the time; I told my parents that we would treat her fever symptomatically and hydrate her, and she would be ok, but they were adamant she see a doctor. So we go to one of those outpatient quick care places to have her seen. Once in the room, there's an MD's shingle hanging on the wall, his AOA certificate, med school diploma, etc, then a PA comes in the room. I was assuming that the PA would come in, gather the history and do a quick PE, and then the MD would be in. Nope. We were seen by the PA alone, with no MD in sight. She saw my sister for probably all of 5 minutes, did a quick physical exam, told her she had a viral illness and that she would be ok. I told her that with high spiking fevers (up to 104F) it seemed to be more than a simple virus, and she could possibly have Mono. The PA looked at me like I was crazy and basically told me there was no way she had Mono, and that concluded the visit. So what was the price of seeing a PA with no MD for all of 5 minutes? $170!!! Lower cost my a....

To conclude the story, once back home she continued to have the same symptoms, so my mom took her to a local medical clinic run by an MD. She mentioned the possibility of Mono to the MD, and the MD said yes, of course, it could be Mono, let's get a Monospot. What was the result? + Monospot, +EBV.

MS2 > PA

 

[deleted6669]

MS2 > PA

anecdotal bs.
I can give you lots of stories of docs making bad calls or using wrong abx, etc, pt ends up in er, sees pa who makes correct dx.
PA>attending.....
(obviously not, but isolated cases are bs and you should know that).
how about this study for PA>resident ?
Role of Physician Assistants in the accident and emergency departments in the UK
Ansari U, Ansari M, Gipson K. Accident and Emergency Department; Warwick Hospital, UK
Published in 11th International Conference on Emergency Medicine, Halifax, Nova SCotia, Canada, June 3-7 2006 and Journal of Canadian Emergency Medicine, May 2006, Vol 8 No 3 (Suppl) P583

Introduction: The Accident and Emergency departments in the UK are under severe pressure to expand their staffing levels in a bid to try and comply with the 98% target for 4-hour waiting times set by the government. Increasing staffing levels is proving to be very difficult when a majority of Staff Grades have already left or are leaving to become General Practitioners for financial gains and better working hours. This combined with a limited number of FY2 doctors being allowed to work in Accident and Emergency departments poses new challenges to staffing within Accident and Emergency. The objective of this study was to evaluate the training requirements, GMC regulations and supervision required to perform a suitable role in Accident and EMergency following the appointment of two Physician Assistants at City Hospital, Birmingham. Methods: The activities of two Physician Assistants at City Hospital were monitored for two months. All case records were reviewed and the number and type of patients seen by the assistants recorded. These were then compared with the records of those patients seen by Senior House Officers. Monitored information included number of patients seen, type of patients seen as well as the quality of the notes. Results: On average, Physician Assistants at City Hospital treated 3-5 patients/hour compared to 1.5-2.5/hour seen by Senior House Officers. Physician Assistants were able to deal with most medical, surgical, orthopaedic and gynaecological problems with minimal supervision. The medical records revealed that documentation was better by Physician Assistants. Conclusion: Senior Physician Assistants from the USA are an effective way to improve staffing within Accident and Emergency Departments with the UK. Physician Assistants saw more patients and required less supervision than Senior House Officers. Physician Assistants proved to be a cost effective method of supporting Accident and Emergency doctors at City Hospital, Birmingham.

great for the pa ego but small sample size....

 

[JourneyAgent]

Yeah. So. You can't just say PA and expect it to mean one thing. What the physician training does is get you to independent functioning upon being set loose in the wild. So I would say a 4th year medical student is superior to a new PA/NP grad along that trajectory. But we're not as useful to being plugged into being the hand of the physician just yet. Kind of like how other primates are better equipped for survival quicker but not as equipped to perform human feats of ingenuity.

A midlevel with years of experience particularly independent experience like the above PA poster will be equivalent to our newly minted to journeyman or advanced if you stay stagnant as a physician.

That evolutionary perspective is how I see the DNP movement. They are pursuing an R selection strategy of producing offspring. Lower investment, greater numbers. And in the current state of instability in the environment that strategy is more successful. Our K selection is over invested in producing self-actualized alpha predators in a food pyramid that cannot support us in enough numbers going forward.

I don't believe there is an energetic pay off in fighting the phenomenon.

 

[Instatewaiter]

how about this study for PA>resident ?

Introduction: The Accident and Emergency departments in the UK are under severe pressure to expand their staffing levels in a bid to try and comply with the 98% target for 4-hour waiting times set by the government. Increasing staffing levels is proving to be very difficult when a majority of Staff Grades have already left or are leaving to become General Practitioners for financial gains and better working hours. This combined with a limited number of FY2 doctors being allowed to work in Accident and Emergency departments poses new challenges to staffing within Accident and Emergency. The objective of this study was to evaluate the training requirements, GMC regulations and supervision required to perform a suitable role in Accident and EMergency following the appointment of two Physician Assistants at City Hospital, Birmingham. Methods: The activities of two Physician Assistants at City Hospital were monitored for two months. All case records were reviewed and the number and type of patients seen by the assistants recorded. These were then compared with the records of those patients seen by Senior House Officers. Monitored information included number of patients seen, type of patients seen as well as the quality of the notes. Results: On average, Physician Assistants at City Hospital treated 3-5 patients/hour compared to 1.5-2.5/hour seen by Senior House Officers. Physician Assistants were able to deal with most medical, surgical, orthopaedic and gynaecological problems with minimal supervision. The medical records revealed that documentation was better by Physician Assistants. Conclusion: Senior Physician Assistants from the USA are an effective way to improve staffing within Accident and Emergency Departments with the UK. Physician Assistants saw more patients and required less supervision than Senior House Officers. Physician Assistants proved to be a cost effective method of supporting Accident and Emergency doctors at City Hospital, Birmingham.

great for the pa ego but small sample size....

That is a crap study. First tiny sample size.

I never understand why they do studies with worthless metrics. I mean I could see 20 patients per hour and write baller notes yet take absolute crap care of the patients... In the ED who cares what your notes look like. All that matters is that you can triage the patients and take care of them enough until the floor doctors take over. Why not actually grade the quality of patient care. I realize it is a harder study to do but quality of notes? Really?

No one dies from note-penia. They do die from sh:tty care

Also in the UK they have a strange system where you do foundation years yet aren't really allowed to do much. An FY2 doctor would be the equivalent of a late in the year intern/beginning 2nd year.

What the physician training does is get you to independent functioning upon being set loose in the wild. So I would say a 4th year medical student is superior to a new PA/NP grad along that trajectory. But we're not as useful to being plugged into being the hand of the physician just yet. Kind of like how other primates are better equipped for survival quicker but not as equipped to perform human feats of ingenuity.

A midlevel with years of experience particularly independent experience like the above PA poster will be equivalent to our newly minted to journeyman or advanced if you stay stagnant as a physician.

That evolutionary perspective is how I see the DNP movement. They are pursuing an R selection strategy of producing offspring. Lower investment, greater numbers. And in the current state of instability in the environment that strategy is more successful. Our K selection is over invested in producing self-actualized alpha predators in a food pyramid that cannot support us in enough numbers going forward.

I don't believe there is an energetic pay off in fighting the phenomenon.

Having seen a few years of new interns, I can tell you for certain that a new intern is essentially worthless. An experienced PA is much better than an intern. Usually about equivalent to a 2nd year resident.

 

[JourneyAgent]

That is a crap study. First tiny sample size.

I never understand why they do studies with worthless metrics. I mean I could see 20 patients per hour and write baller notes yet take absolute crap care of the patients... In the ED who cares what your notes look like. All that matters is that you can triage the patients and take care of them enough until the floor doctors take over. Why not actually grade the quality of patient care. I realize it is a harder study to do but quality of notes? Really?

No one dies from note-penia. They do die from sh:tty care

Also in the UK they have a strange system where you do foundation years yet aren't really allowed to do much. An FY2 doctor would be the equivalent of a late in the year intern/beginning 2nd year.



Having seen a few years of new interns, I can tell you for certain that a new intern is essentially worthless. An experienced PA is much better than an intern. Usually about equivalent to a 2nd year resident.

Yeah fine. If you'd read what I wrote with any sense of subtlety, you would have noted that I delineated 2 trajectories. One designed to be pluggable and functional. The other designed to produce independence. 1 year 2 year resident. Experienced PA. This is not the language of a precise mathematics.

 

[Didierdrogba]

The big farce about NP/PA use for primary care is that it's going to lower health care costs - it's not going to lower costs. Once NP/PA's get into the market, they're going to demand the same wages as the FP's; if you believed that you provided equivalent care, why would you expect to work for a lesser wage? You wouldn't, unless your aim was to undercut someone else's business. Care's not going to be any cheaper, it will only be lesser quality care for the same price.

this makes a lot of sense

 

[Cello]

If the public is really concerned with being seen by a physician, perhaps the AMA should launch a public awareness campaign with the intention of educating the public to the term "physician" rather than the more nebulous "doctor" title. For example, "the physician will see you now."

I suspect however that most people couldn't care less who sees them if the price is right.

 

[xenotype]

If the public is really concerned with being seen by a physician, perhaps the AMA should launch a public awareness campaign with the intention of educating the public to the term "physician" rather than the more nebulous "doctor" title. For example, "the physician will see you now."

I suspect however that most people couldn't care less who sees them if the price is right.

This is true but most people of means will demand to be seen by an MD. Concierge care is going to explode and many primary care MDs with some business sense will make plenty of money.

People still buy Tylenol over the cheapo store brand acetaminophen even at a 30% increase in price. That's when they know there is little difference. Imagine if they think there is a substantial one. Would anyone rather have a Hyundai Sonata over a M-Benz S class?

 

[JourneyAgent]

This is true but most people of means will demand to be seen by an MD. Concierge care is going to explode and many primary care MDs with some business sense will make plenty of money.

People still buy Tylenol over the cheapo store brand acetaminophen even at a 30% increase in price. That's when they know there is little difference. Imagine if they think there is a substantial one. Would anyone rather have a Hyundai Sonata over a M-Benz S class?

It'll be interesting to see how medical schools and their applicants approach this with their admissions dogma. It's gonna get harder to justify the line that claims they're called to help the down trodden when the debt load is prohibitive against anything but going after the money.

 

[PrideNeverDie]

i can practically write the commercial

old black man: when my family gets sick, the only person i trust is my physician
soccer mom: when my kids are hurt, the only person they see is my physician
little cute kid: when i get a booboo, my physician makes me feel good

I walk up to the kid and she gives me a hug ... screen zooms to a closeup of me
"Hi, my name is Dr.PrideNeverDie. In these uncertain times, make sure the person treating your loved ones is the best."

this message was brought to you by "Your friendly, neighborhood physician"

 

[calvnandhobbs68]

i can practically write the commercial

old black man: when my family gets sick, the only person i trust is my physician
soccer mom: when my kids are hurt, the only person they see is my physician
little cute kid: when i get a booboo, my physician makes me feel good

I walk up to the kid and she gives me a hug ... screen zooms to a closeup of me
"Hi, my name is Dr.PrideNeverDie. In these uncertain times, make sure the person treating your loved ones is the best."

this message was brought to you by "Your friendly, neighborhood physician"

"When your family members are sick, why take a chance? Every licensed physician you see has had over 15,000 hours of clinical training and has completed a minimum of three years of training after medical school, something other professions just can't claim."

Seriously, maybe we should get new jobs running advertising for the AMA.

 

[JourneyAgent]

"When your family members are sick, why take a chance? Every licensed physician you see has had over 15,000 hours of clinical training and has completed a minimum of three years of training after medical school, something other professions just can't claim."

Seriously, maybe we should get new jobs running advertising for the AMA.

I want on the team.


My commercial has us all stached supreme. Odd collored suits from the 70's. Hopelessy out of date haircuts. Ala Ron Burgandy. And then we swagger around a doctors office doing unimaginably sexist and insensitive ****. Smackin butts and then pointing as if to say....you're welcome. Cutting off patients in the first few words. Then launching into a sel-absorbed soliloquy that goes nowhere. And then slinging some drugs. And interrupting the patient again after we asked them if they have any questions.

Just all around awesome. Then we have some tightwad militant NP as a juxtaposition.

The point implied: do you want all this talky sensitive BS. Or do you want to be seen by somebody who rocks with his junk out.

 

[PrideNeverDie]

"When your family members are sick, why take a chance? Every licensed physician you see has had over 15,000 hours of clinical training and has completed a minimum of three years of training after medical school, something other professions just can't claim."

Seriously, maybe we should get new jobs running advertising for the AMA.

thanks for putting my commercial to shame LOL

15k hours and 3 years ... no one can defend

 

[zenman]

i can practically write the commercial

old black man: when my family gets sick, the only person i trust is my physician
soccer mom: when my kids are hurt, the only person they see is my physician
little cute kid: when i get a booboo, my physician makes me feel good

I walk up to the kid and she gives me a hug ... screen zooms to a closeup of me
"Hi, my name is Dr.PrideNeverDie. In these uncertain times, make sure the person treating your loved ones is the best."

this message was brought to you by "Your friendly, neighborhood physician who I had to drive 150 miles to see."

Let me fix this for you.

 

[zenman]

thanks for putting my commercial to shame LOL

15k hours and 3 years ... no one can defend

USA: 4 yrs premed, 4 yrs med school, 3 plus years residence =11 + years

Thailand: 1 year premed, 2 yrs preclinical, 3 years clinical = 6 years

My wife has had 2 elective surgeries and if I ever need any I'll be right back there. Everything from the doorman at the front to the international chef in the cafeteria to my couch being made to the free newspaper to the less than $1 I owed after insurance. Plus her surgeon made and give my wife a DVD of her surgery. Even walked her through the DVD to show what he had done. Both hospitals I've been in were examples of what the hospitals in the USA should strive for.

 

[calvnandhobbs68]

USA: 4 yrs premed, 4 yrs med school, 3 plus years residence =11 + years

Thailand: 1 year premed, 2 yrs preclinical, 3 years clinical = 6 years

My wife has had 2 elective surgeries and if I ever need any I'll be right back there. Everything from the doorman at the front to the international chef in the cafeteria to my couch being made to the free newspaper to the less than $1 I owed after insurance. Plus her surgeon made and give my wife a DVD of her surgery. Even walked her through the DVD to show what he had done. Both hospitals I've been in were examples of what the hospitals in the USA should strive for.

+1 year of internship + 2 years of tenure in a rural area before they're allowed to practice on their own

Wow check it out that still adds up to more than an NP.

Also, comparing a medical tourist hospital that caters to relatively rich foreigners to the general healthcare system in the US is...well a dishonest comparison at best. I can find hospitals and surgery centers like that in the US too (take a look at your local plastic surgeon's office).

 

[Instatewaiter]

USA: 4 yrs premed, 4 yrs med school, 3 plus years residence =11 + years

Thailand: 1 year premed, 2 yrs preclinical, 3 years clinical = 6 years

My wife has had 2 elective surgeries and if I ever need any I'll be right back there. Everything from the doorman at the front to the international chef in the cafeteria to my couch being made to the free newspaper to the less than $1 I owed after insurance. Plus her surgeon made and give my wife a DVD of her surgery. Even walked her through the DVD to show what he had done. Both hospitals I've been in were examples of what the hospitals in the USA should strive for.

Not really sure what the point of your post was but it's a little mis-informed. I think you're trying to show that the lack of clinical education that NPs get is analogous to the medical training in Thailand. However, you forgot to add ALL OF RESIDENCY. But thanks for playing.

Here's EM training for instance in Thailand
US EM training, 4 years pre-med, 4 yrs med school, 3 years residency= 11 years

Thailand EM training- 1 year premed, 2 yrs preclinical, 3 years clinical, 1 year internship, 2 years of tenure in a rural area, 3 years of EM trainning = 12 years

 

[PikminOC]

Not really sure what the point of your post was but it's a little mis-informed. I think you're trying to show that the lack of clinical education that NPs get is analogous to the medical training in Thailand. However, you forgot to add ALL OF RESIDENCY. But thanks for playing.

Here's EM training for instance in Thailand
US EM training, 4 years pre-med, 4 yrs med school, 3 years residency= 11 years

Thailand EM training- 1 year premed, 2 yrs preclinical, 3 years clinical, 1 year internship, 2 years of tenure in a rural area, 3 years of EM trainning = 12 years

Be sure to consider the source. What is zenman's job? He's not a phyisician.

 

[Instatewaiter]

Be sure to consider the source. What is zenman's job? He's not a phyisician.

He's a psych np who has a decidedly new age/quackery tilt. A few years back he was telling us about the benefits of shamans.

 

[Instatewaiter]

He's a psych np who has a decidedly new age/quackery tilt. A few years back he was telling us about the benefits of shamans.

But Thailand does have decent medical care

 

[PikminOC]

But Thailand does have decent medical care

If you want to pay to go to Thailand.

 

[Instatewaiter]

Because the care there is so inexpensive, many insurance plans will cover not only the trip but also the expenses for staying over there. In the end, it is often cheaper to fly you over there than to get medical care here.

 

[OphthoBio]

I was considering go into nursing for a while, and in some of the classes, the instructors were already telling students that they'd have expanded SOP if they went the DNP route (almost bragging, as if the nursing students were one-upping the pre-meds).

My biggest problem with it is the fact that nurses have basically zero science background (besides 1 class on chemistry and a clinical microbiology course). Other than that, pathophysiology and pharmacology for nurses is learned through straight memorization.

 

[farnk20]

My biggest problem with it is the fact that nurse have basically zero science background (besides 1 class on chemistry and a clinical microbiology course). Other than that, pathophysiology and pharmacology for nurses is learned through straight memorization.

+1. If I'm a lawyer and SOP is the same, suing the NP/PA for malpractice over the MD is a no-brainer. Greater SOP + less training = more liability and a field day for ambulance chasers.

 

[Mad Jack]

If you want to pay to go to Thailand.

It really makes sense for things like orthopedic procedures. It costs between 30k and 60k less to have a knee replacement done there vs here, for instance. For a person without insurance, that can be a year or two of after-tax wages. The 2k plane flight is a drop in the bucket.

 

[Mad Jack]

+1. If I'm a lawyer and SOP is the same, suing the NP/PA for malpractice over the MD is a no-brainer. Greater SOP + less training = more liability and a field day for ambulance chasers.

Anyone else smelling a JD in their post residency future? A physician lawyer could really go to town on a midlevel's knowledge base (particularly NPs, as PAs have a much better general medical knowledge base in their curriculum) and qualifications, and ask them questions about the case that might be unanswerable by the midlevel given their educational background. It would make them look really awful on the stand, and probably result in easy wins.

I think NPs and PAs have a place in the system, but that place is not independent practice. This is why litigation needs to happen. Even if NPs and PAs were to have outcomes equal to physicians (which I doubt, but just for the sake of argument), they would by extension have an equal malpractice and complication rate. Which means equal malpractice premiums that would make many fields of practice simply unaffordable.

 

[TooMuchResearch]

Anyone else smelling a JD in their post residency future? A physician lawyer could really go to town on a midlevel's knowledge base (particularly NPs, as PAs have a much better general medical knowledge base in their curriculum) and qualifications, and ask them questions about the case that might be unanswerable by the midlevel given their educational background. It would make them look really awful on the stand, and probably result in easy wins.

I think NPs and PAs have a place in the system, but that place is not independent practice. This is why litigation needs to happen. Even if NPs and PAs were to have outcomes equal to physicians (which I doubt, but just for the sake of argument), they would by extension have an equal malpractice and complication rate. Which means equal malpractice premiums that would make many fields of practice simply unaffordable.

You know who doesn't like lots of really complicated, trying to belittle the opposing party with your superior knowledge, medical questions? Juries.

 

[Mad Jack]

You know who doesn't like lots of really complicated, trying to belittle the opposing party with your superior knowledge, medical questions? Juries.

It's all about how you come off. I used to do sales, where my job was balancing fear, kindness, sneakiness, and helpfulness in a way that made even the worst of products and services seem like a great idea. Being a malpractice lawyer has a lot of the same angles to it. You are selling ideas, planting seeds in the jury's head, making them think that you sincerely want to right an injustice and that you are not some bloodsucker feeding off of the failure of others. You have to make the defendant look incompetent but stay likable, make yourself look smart but not arrogant- it is a hard balance and part of the reason good lawyers make so much money. I think it would be fun, and I could sleep well at night because I actually believe that midlevel independent practice should be stopped and that I would be doing the public a great service.

 

[fastlane]

This is true but most people of means will demand to be seen by an MD. Concierge care is going to explode and many primary care MDs with some business sense will make plenty of money.

People still buy Tylenol over the cheapo store brand acetaminophen even at a 30% increase in price. That's when they know there is little difference. Imagine if they think there is a substantial one. Would anyone rather have a Hyundai Sonata over a M-Benz S class?

DNPs refer to themselves as DOCTORS in the healthcare setting. As in... hello, I'm Dr. so-and-so. The average patient has no idea that this means a "Doctor of Nursing". They will just assume that is a Doctor of Medicine.

 

[PikminOC]

DNPs refer to themselves as DOCTORS in the healthcare setting. As in... hello, I'm Dr. so-and-so. The average patient has no idea that this means a "Doctor of Nursing". They will just assume that is a Doctor of Medicine.

This already occurs with Phd's in the hospital. I worked with a phd psychologist who lost her psychology license due to diddling with a patient. Then she got an NP degree and prescribes medication. So she introduces herself as "dr" to patients.

There are a lot of other "doctors" out there.....and the patient is already scared and confused...

 

[PikminOC]

You know who doesn't like lots of really complicated, trying to belittle the opposing party with your superior knowledge, medical questions? Juries.

Please look up Jeannette Martello, MD JD.

 

[PikminOC]

It really makes sense for things like orthopedic procedures. It costs between 30k and 60k less to have a knee replacement done there vs here, for instance. For a person without insurance, that can be a year or two of after-tax wages. The 2k plane flight is a drop in the bucket.

Thanks, I did not think of that. How is infection control in 3rd works countries?

 

[Mad Jack]

Thanks, I did not think of that. How is infection control in 3rd works countries?

Just like the USA, it depends on the hospital. Many tourist hospitals in Thailand and Singapore have great reputations for quality of care and patient satisfaction from what I have read over the years. There are horror stories as well, but there always will be when surgery is involved. Bumrungrad Medical Center is a good example of one of the better hospitals out there, as it was the first one to be internationally accredited by the Joint Commission. They essentially meet U.S. standards.