Flying scalpels and the future of health care

[Mansamusa]

Yes, it is a different model for sure and I wish the government would invest more in nursing education. But we also have to look at the evidence that finds NP care to be at least as good as physician care, even without a residency. Evidence-based practice and all that

I am 100% certain that you are not a med student. The research you cited has already been discussed and you provided no counterpoint to the critiques.

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[JamesAK]

that we're even debating nurses being equal to physicians

But where is your research that they are inferior? We need evidence to support our diagnoses and treatment plans, we should have evidence behind us if we're going to make these broad sweeping statements that a whole class of health practitioners suck and are dangerous. Please let us see your evidence.

 

[Mad Jack]

How is this even something that would come out of a medical student's mouth? I am wrong to exist because I want to help disempowered groups gain some traction? Culture and science progress because people explore ideas with each other. Generally telling someone else they shouldn't even exist because they want to help others is not exactly moving things forward

They didn't say that you shouldn't exist, merely that your mentality is the root of the downfall of America, an idea that I explored more thoroughly in one of my prior posts.

 

[JamesAK]

I am 100% certain that you are not a med student. The research you cited has already been discussed and you provided no counterpoint.

As I mentioned before, I have good friends who are NPs. What "research you cited has already been discussed and you provided no counterpoint"? Maybe I missed it. Could you please repost?

 

[JamesAK]

They didn't say that you shouldn't exist, merely that your mentality is the root of the downfall of America, an idea that I explored more thoroughly in one of my prior posts.

Helping underempowered groups not be trampled upon by the dominant group is "the root of the downfall of America?" Please explain. We are only strong when some groups of us can bully and abuse other segments of society?

 

[psychMDhopefully]

That same good nurse, if s/he doesn't like you, can decide that 3 days of constipation is something really critical for you to know about at 3 AM. Then they will refuse to take a verbal order for Dulcolax so you need to go to the floor and write it.

Crap like this should not be allowed. Ever. Basically giving half wits the authority to make young physicans lives miserable. Of course if a guy is a huge jerk they deserve it, But I could see **** like this happening with a jealous ex, or a nurse who is just jealous in general.

 

[Mad Jack]

But where is your research that they are inferior? We need evidence to support our diagnoses and treatment plans, we should have evidence behind us if we're going to make these broad sweeping statements that a whole class of health practitioners suck and are dangerous. Please let us see your evidence.

Nursing lobbies and organizations that seek to commoditize or cheapen health care have funded and designed every study to date. The studies are poorly designed for a reason. Now, when it comes to disputing a current model of care, the burden is on the person trying to prove the new model is better, not on the establishment. It's like you don't even understand how studies work, it's absolutely embarrassing. It's like a drug manufacturer going to the FDA with some half-assed, poorly designed studies that show their products to be "superior" to the current standard of care, the FDA laughing at their evidence, and then the company saying, "whatever, we are going to sell this to a vulnerable, uneducated, and unsuspecting public until you prove us wrong."

That's not how this works, that's not how any of this works.

 

[ProfMD]

But you can't practice until you have a residency- that's kind of a big difference and you're being completely disingenuous to not acknowledge it.

See above - this is not true. You can practice after 1 year of residency. A lot of people do - its called moonlighting. And, the moonlighting you do does not have to be in the field you are training in. Usually people moonlight covering EDs or urgent care centers. I have also known people to moonlight as hospitalists. All this while still in residency.

As I have said before, there are legitimate arguments against APNs having independent practice, some people on this board have made them. However, to demand RCTs proving APNs are good and then state that you do not need studies to prove that less training means less capable is disingenuous. Critically evaluating the available evidence and therefore disagreeing with the conclusions is valid - this only suggests that we do not know if they are equivalent, it does not prove that they are worse.

My point in posting is not to argue that APNs should have independent practice. We have been through that before and will get nowhere. I am only expressing my opinion that many of the arguments posted on this board are not true arguments, just assumptions not supported by fact or evidence.

 

[ProfMD]

Crap like this should not be allowed. Ever. Basically giving half wits the authority to make young physicans lives miserable. Of course if a guy is a huge jerk they deserve it, But I could see **** like this happening with a jealous ex, or a nurse who is just jealous in general.

I agree - it should not happen, but it does. But to assume the nurses doing this are half-wits is a dangerous assumption. Some are, but many are not. Passive-aggressive, yes - half-wits, no.

 

[Psai]

Man profmd it's so obvious that you're a nurse. Notice how almost no one here has md in their name. But go on allnursing.com and everyone is prettyrn or ccrnnp with their tags being like dnp rn bsn lpn rn bsn ccrn fnpbc dnpbc bcbc

By the way, bad research is worse than no research. Look at how much damage that anti vaccine paper did

 

[Mansamusa]

As I mentioned before, I have good friends who are NPs. What "research you cited has already been discussed and you provided no counterpoint"? Maybe I missed it. Could you please repost?

"Any randomized-controlled trials? The studies looked at 1990-2008 outcomes, were NPs working independently then or did they have physician oversight?

NPs are a good addition to a team of providers, but there is no reason for them to have independent practice rights and it puts patients at risk"

And all the criticism Mad Jack posted. If any cohort study was done with so many uncontrolled and confounding factors, it would not be accepted. The study did even have independent NPs, so how can make conclusions on what independent NP outcomes would be? Why should we consider this study convincing?

 

[deleted564680]

How is this even something that would come out of a medical student's mouth? I am wrong to exist because I want to help disempowered groups gain some traction? Culture and science progress because people explore ideas with each other. Generally telling someone else they shouldn't even exist because they want to help others is not exactly moving things forward

So, slightly over half the US population is disempowered? How about all the articles and studies showing that girls are receiving better K-12 education, going to college more than boys, and graduating at higher rates than boys? Are boys more likely to enter high-paying jobs? Yes. Are boys more likely to take on leadership roles? Yes. Are girls prevented from doing either of those things? No. In fact, most businesses are looking for girls to hire.

And yes, I used the terms boy and girl so I "offended" everyone equally.

Enough is enough. I'm really tired of the "every group besides white males is disempowered" thing. The only way we'll ever have true equality is when ALL groups are treated the same in every way.

Also, I don't know if you're a medical student or nursing student or what JamesAK, but I hope you focus on your education and future patients rather than focus on things like this. It's odd and obsessive how upset you're getting over minor things that most people would agree are non-issues. You will have a hard time dealing with the realities of life in a hospital and interacting with other humans. It's a generational issue that people under 30 or so can't brush things off or cope with anything and you're being an example of that.

 

[psychMDhopefully]

I agree - it should not happen, but it does. But to assume the nurses doing this are half-wits is a dangerous assumption. Some are, but many are not. Passive-aggressive, yes - half-wits, no.

Im saying there should be rules against this call for menial things out of spite, refuse an order for Dulcolax so you have to go to the Hospital to write it? If a nurse treated me like that, i would do what I had to do to complete residency but I would have a visceral hatred for nurses from that point on.

 

[68PGunner]

Helping underempowered groups not be trampled upon by the dominant group is "the root of the downfall of America?" Please explain. We are only strong when some groups of us can bully and abuse other segments of society?

Alright, Nurse JamesAK. We don't care about your opinion. Get back to work and make us a sandwich in 10 minutes. No mustard for me please.

 

[pacman2018]

But we also have to look at the evidence that finds NP care to be at least as good as physician care, even without a residency. Evidence-based practice and all that

Jesus, it doesn't. Multiple people have pointed out the flaws in any research out there comparing the two groups. I bet you read Andrew Wakefields paper and were convinced vaccines caused autism too... It's junk research and the only reason they can promote it is because there are too many stupid people out there reading medical literature that have no idea how to even begin evaluating it. Just because someone wrote it doesn't make it true.

edit: looks like others covered similar points while I was writing this response out. glad to see I'm not the only one who has a even a basic understanding of how research works...

 

[Matthew9Thirtyfive]

The use of "girl" in the original post was clearly meant, in context, to be pejorative. It was an anti-APN post and the author used the diminutive "girl" in order to emphasize size the immaturity / inexperience of the nurses. I understand that "girl" is not always offensive, just as "boy" isn't. But seriously - in context, the use on the post in this thread was offensive and was meant to be that way. If it wasn't meant to be that way, then the author should choose his words more carefully next time.

I'm the author, and you are wrong. I meant it exactly the way I wrote it. She is a girl. She is 20 years old. She is a young woman. That is a girl. You choosing to be offended by something that is not offensive doesn't change my intention. I don't have to choose my words more carefully on the off chance that some privileged person might get offended.

 

[ProfMD]

Man profmd it's so obvious that you're a nurse. Notice how almost no one here has md in their name. But go on allnursing.com and everyone is prettyrn or ccrnnp with their tags being like dnp rn bsn lpn rn bsn ccrn fnpbc dnpbc bcbc

By the way, bad research is worse than no research. Look at how much damage that anti vaccine paper did

Bad research should be criticized - which is has been by people on this board. I have no complaint against that. I have complaints against assumptions without evidence to support them.

Also, just because I happen to not have a visceral hatred of APNs, does not mean I am a nurse. Believe what you will, but I am a physician - a surgeon. Graduated med school in 2003. I did submit the request for physician verification but it has not been applied yet. In fact, I tried to send another message to the SDN help desk about this, but the link is not working. Just because someone disagrees with you, it does not make them a troll.

 

[ProfMD]

I'm the author, and you are wrong. I meant it exactly the way I wrote it. She is a girl. She is 20 years old. She is a young woman. That is a girl. You choosing to be offended by something that is not offensive doesn't change my intention. I don't have to choose my words more carefully on the off chance that some privileged person might get offended.

Think what you will. Not being female, I am not personally offended by the statement, but given the tone of the rest of the post, I do not see how it could be taken as anything other than offensive. I am sorry that you fail to see that.

 

[Matthew9Thirtyfive]

How is this even something that would come out of a medical student's mouth? I am wrong to exist because I want to help disempowered groups gain some traction? Culture and science progress because people explore ideas with each other. Generally telling someone else they shouldn't even exist because they want to help others is not exactly moving things forward

This post is just further evidence. You are obviously so sheltered and out of touch with how the rest of the world lives. You want to help disempowered groups? How about women and girls in middle eastern and Asian countries who are treated like objects and imprisoned or killed for getting raped? Or girls that are forced to undergo female circumcision against their will? Or how about you go to Manila and just give a pair of pants to that family I referenced upthread? They are real, and there are thousands of them. I can tell you what street corner they live on if you want to help someone who actually needs your help.

Finding some arbitrary cause to rally behind because your life is relatively awesome doesn't make you a hero. You latched onto a word that was completely innocuous in the context in which it was used and started an argument over an issue that didn't exist.

Now you're putting words in my mouth and arguing against them. Have you taken a logic course? Fallacious arguments much?

 

[ProfMD]

Im saying there should be rules against this call for menial things out of spite, refuse an order for Dulcolax so you have to go to the Hospital to write it? If a nurse treated me like that, i would do what I had to do to complete residency but I would have a visceral hatred for nurses from that point on.

There should be rules, you are right. But it will never happen. Hospitals tend to favor the full-time nurses over the residents. Residents by nature are time-limited employees. Hospitals hope to keep nurses for the long-haul.

 

[Matthew9Thirtyfive]

Think what you will. Not being female, I am not personally offended by the statement, but given the tone of the rest of the post, I do not see how it could be taken as anything other than offensive. I am sorry that you fail to see that.

I'm sorry you are incapable of reading into context. Would you have been offended if I had been talking about a 20 year old man and said boy? Your emotional response to an innocuous statement doesn't change its actual meaning.

 

[coffee-doc]

Helping underempowered groups not be trampled upon by the dominant group is "the root of the downfall of America?" Please explain. We are only strong when some groups of us can bully and abuse other segments of society?

who are you voting for in this election, may i ask

 

[Mansamusa]

Think what you will. Not being female, I am not personally offended by the statement, but given the tone of the rest of the post, I do not see how it could be taken as anything other than offensive. I am sorry that you fail to see that.

Would the tone of the comment have been different if he said "This lady?" No, it in fact would've expressed the same tone and the same sentiment.

 

[ProfMD]

Maybe when you undergrads get out in the real world, you will realize that the words you choose and the way people interpret them do matter. Should they matter? Perhaps not. But that is the 21st century world we live in.

Also, I did not have a particularly emotional response to your use of the word "girl" in the initial post. However, someone was offended. That suggests that maybe it was a poor choice. The fact that no one seems willing to acknowledge this is unfortunate.

 

[Señor S]

Every nurse on the internet posts this as if I'm going to read it or care. I've read quite a few nursing articles in my time and the complete lack of understanding of how to formulate a proper question, the absence of rigorous research methods, the poor data gathering/analysis and incredibly low quality of discussion is very strange. I doubt that they have even heard of the hawthorne effect, confounding bias, selection bias, etc. as I have never heard them discuss any of it. And yet nursing students spend much more time writing papers on the health disparities of the chachi population in ecuador than on things that matter like pharmacology and pathology. They do get rather familiar with following apa style though in that oh so critical bsn/msn/dnp which I'm sure will come in very handy when that paroxysmal a fib patient comes in.

There is nothing worse than overconfidence, especially when combined with inexperience and a subpar education

Almost no medical professionals know how to properly evaulate/conduct research either, hence the ongoing replication crisis. Just repeating the "physicians are better because they go to school longer" mantra and relaying your own anecotes isn't going to convince most of the public, especially when they didn't even see the MD during their last "doctor" visit.

 

[Mansamusa]

Maybe when you undergrads get out in the real world, you will realize that the words you choose and the way people interpret them do matter. Should they matter? Perhaps not. But that is the 21st century world we live in.

Saying "you undergrads," now that is an attempt to elevate yourself and discredit us. I am no undergrad and have spent plenty of time in the real world. In the real world, no one would have noticed the use of the word girl because it was such an insignificant part of what the commenter was saying. None of the emphasis was placed on "girl" and the only reason JamesAK drew attention to it was to argue without addressing the points the poster was making

 

[ProfMD]

Saying "you undergrads," now that is an attempt to elevate yourself and discredit us. I am no undergrad and have spent plenty of time in the real world. In the real world, no one would have noticed the use of the word girl because it was such an insignificant part of what the commenter was saying. None of the emphasis was placed on "girl" and the only reason JamesAK drew attention to it was to argue without addressing the points the poster was making

Were you offended? I'm sorry. I thought undergrad was an accepted term. Since your profile says "Medical student (accepted)" I assumed you were in college.

I guess words to matter after all.

 

[Matthew9Thirtyfive]

Maybe when you undergrads get out in the real world, you will realize that the words you choose and the way people interpret them do matter. Should they matter? Perhaps not. But that is the 21st century world we live in.

Also, I did not have a particularly emotional response to your use of the word "girl" in the initial post. However, someone was offended. That suggests that maybe it was a poor choice. The fact that no one seems willing to acknowledge this is unfortunate.

You are now doing the very thing you accused me of doing (which I was not, in fact, doing). And I already have my degree. I'm also 32 years old and have been around the world. I have studied in Israel. I have been on a 5th fleet deployment and visited both rich and poor countries during that time. What I learned is that our country is so privileged that people like you two literally have nothing to worry about, so you fabricate offenses and causes to rally behind.

What is unfortunate is that you represent a larger group of sheltered children who get offended by nothing and then put the blame on whomever did or said whatever innocuous thing you choose to find offense this week. Grow up.

 

[Mansamusa]

Were you offended? I'm sorry. I thought undergrad was an accepted term. Since your profile says "Medical student (accepted)" I assumed you were in college.

I guess words to matter after all.

No- I was not offended. It just seems that you and JamesAK would prefer to use methods to discredit other poster rather than engage in discussions.

 

[deleted564680]

You are now doing the very thing you accused me of doing (which I was not, in fact, doing). And I already have my degree. I'm also 32 years old and have been around the world. I have studied in Israel. I have been on a 5th fleet deployment and visited both rich and poor countries during that time. What I learned is that our country is so privileged that people like you two literally have nothing to worry about, so you fabricate offenses and causes to rally behind.

What is unfortunate is that you represent a larger group of sheltered children who get offended by nothing and then put the blame on whomever did or said whatever innocuous thing you choose to find offense this week. Grow up.

This x1000. Really the true issue here.

 

[ProfMD]

So you are offended when I call you an undergrad? I'm sorry - I'll admit that this was a poor choice of words and choose them more carefully next time.

And, as I said, I was not offended by you original post, but clearly JamesAK was. The fact that you refuse to acknowledge this and instead attack both of us as "children" is unfortunate.

Also, I have not been on deployment (thank you for your service) but I did do my 4 years of med school, 8 years of post grad training, and have been in practice for 5 years. I am nearly 40 years old and am married with 2 kids. So, I do not think that I "represent a larger group of sheltered children." And, in case you were wondering, I do find this statement offensive.

 

[Mansamusa]

So you are offended when I call you an undergrad? I'm sorry - I'll admit that this was a poor choice of words and choose them more carefully next time.

And, as I said, I was not offended by you original post, but clearly JamesAK was. The fact that you refuse to acknowledge this and instead attack both of us as "children" is unfortunate.

Also, I have not been on deployment (thank you for your service) but I did do my 4 years of med school, 8 years of post grad training, and have been in practice for 5 years. I am nearly 40 years old and am married with 2 kids. So, I do not think that I "represent a larger group of sheltered children." And, in case you were wondering, I do find this statement offensive.

I already said that I believe JamesAk (a male) was only feigning offense to detract from the fact that he had no counterpoints pertaining to the actual discussion at hand. It was mud slinging

 

[ProfMD]

I already said that I believe JamesAk (a male) was only feigning offense to detract from the fact that he had no counterpoints pertaining to the actual discussion at hand. It was mud slinging

And that, in my opinion, is a fair criticism of JamsAK. However, it seems to have been lost in all the counter-mudslinging from a number of others on this thread.

 

[Psai]

So you are offended when I call you an undergrad? I'm sorry - I'll admit that this was a poor choice of words and choose them more carefully next time.

And, as I said, I was not offended by you original post, but clearly JamesAK was. The fact that you refuse to acknowledge this and instead attack both of us as "children" is unfortunate.

Also, I have not been on deployment (thank you for your service) but I did do my 4 years of med school, 8 years of post grad training, and have been in practice for 5 years. I am nearly 40 years old and am married with 2 kids. So, I do not think that I "represent a larger group of sheltered children." And, in case you were wondering, I do find this statement offensive.

Go on vacation with your family man, it's memorial day. Don't waste your life sitting on the internet arguing with undergrads

 

[Matthew9Thirtyfive]

So you are offended when I call you an undergrad? I'm sorry - I'll admit that this was a poor choice of words and choose them more carefully next time.

No apologies necessary for that. I don't get offended by innocuous words on the Internet, even if they don't really apply to me.

And, as I said, I was not offended by you original post, but clearly JamesAK was. The fact that you refuse to acknowledge this and instead attack both of us as "children" is unfortunate.

Sure seemed like you were. I acknowledged several times that he is indeed offended. It is his offense with something that is completely benign because he has nothing to actually be worried about that I take issue with. He can be offended if he wants, but to waste time trying to shame other people into apologizing for using words in their intended meaning is annoying.

Also, I have not been on deployment (thank you for your service) but I did do my 4 years of med school, 8 years of post grad training, and have been in practice for 5 years. I am nearly 40 years old and am married with 2 kids. So, I do not think that I "represent a larger group of sheltered children." And, in case you were wondering, I do find this statement offensive.

I appreciate all your experience. But just because you are older with kids doesn't mean you don't act like a child. You may be totally rational in real life for all I know. Being offended by inconsequential stuff is, to me, a sign of immaturity with regard to the realities of the world. I apologize for not phrasing it better.

 

[ProfMD]

Go on vacation with your family man, it's memorial day. Don't waste your life sitting on the internet arguing with undergrads

I'm on call. Just finished rounding and writing notes.

 

[Matthew9Thirtyfive]

I'm on call. Just finished rounding and writing notes.

This is the first Veterans/Armed Forces/Memorial Day that I haven't been on duty or on deployment in a while, so I feel you. I did have duty Friday though when everyone else had off, but at least I got 3 days in a row.

 

[ProfMD]

No apologies necessary for that. I don't get offended by innocuous words on the Internet, even if they don't really apply to me.



Sure seemed like you were. I acknowledged several times that he is indeed offended. It is his offense with something that is completely benign because he has nothing to actually be worried about that I take issue with. He can be offended if he wants, but to waste time trying to shame other people into apologizing for using words in their intended meaning is annoying.



I appreciate all your experience. But just because you are older with kids doesn't mean you don't act like a child. You may be totally rational in real life for all I know. Being offended by inconsequential stuff is, to me, a sign of immaturity with regard to the realities of the world. I apologize for not phrasing it better.

So no I am a child and immature? I would find this offensive in real life. Less so on the Internet of course. In my experience, though, people resort to ad hominem attacks when they have nothing else to offer.

 

[Matthew9Thirtyfive]

So no I am a child and immature? I would find this offensive in real life. Less so on the Internet of course. In my experience, though, people resort to ad hominem attacks when they have nothing else to offer.

Maybe you misread. I said that the behavior of taking offense to things that are not offensive due to living in a place where the vast majority of people have nothing to worry about is an immature world view. I also apologized for not stating that more clearly and just calling you a child.

But yes, I do think that you and, to a much greater extent, the other poster displayed an immaturity.

 

[JamesAK]

The quality of the evidence is extremely poor. It's like saying building cars out of particle board has been proven to be completely safe because you crash-tested then at 10 miles per hour with foam bumpers. These are studies that only an idiot or someone with an agenda would find adequate.

What do you mean "extremely poor"? Explain how so

 

[IM88]

we also have to look at the evidence that finds NP care to be at least as good as physician care, even without a residency. Evidence-based practice and all that

Just because you keep repeating this statement doesn't make it true. This is a very broad claim, which isn't supported by the current evidence. You don't seem to acknowledge any questions about the flawed methodology with the studies you cite, and don't seem to be proposing any further rigorous research into the issue. Whether you like it or not, physicians currently represent the "gold standard" in patient care. When new drugs or diagnostics are introduced, they are compared against the gold standard drug or test. Physicians have minimum training requirements that far exceed those of any physician extenders. While some NPs may have years of valuable clinical experience as RNs, an 18 month accelerated training program doesn't seem like the appropriate path to completely independent practice and prescribing rights. If NPs want full autonomy, they should be compared to the gold standard in rigorous studies. While supervised NPs that care for well-controlled asthma patients may provide equivalent care to physicians, extrapolating that data to make the claim that unsupervised "NP care is at least as good as physician care" is at best completely unscientific, and at worst dangerous or deadly for patients.

 

[JamesAK]

I am 100% certain that you are not a med student. The research you cited has already been discussed and you provided no counterpoint to the critiques.

Medical students can't have persuasive, articulate NP friends?

 

[JamesAK]

Man profmd it's so obvious that you're a nurse. Notice how almost no one here has md in their name. But go on allnursing.com and everyone is prettyrn or ccrnnp with their tags being like dnp rn bsn lpn rn bsn ccrn fnpbc dnpbc bcbc

By the way, bad research is worse than no research. Look at how much damage that anti vaccine paper did

But wouldn't it be strange if medical students put "MD" in their names?

 

[JamesAK]

who are you voting for in this election, may i ask

Since I don't think any human (especially any medical student) should vote for Trump, since he's all about hatred, bigotry, sexism and greed, I will vote for the candidate who is more likely to put public health at the forefront, and it looks like that will be Hillary

 

[Mansamusa]

Medical students can't have persuasive, articulate NP friends?

There is really no point discussing things with you, because again you aren't addressing the concerns I raised with the studies.

My sister is in NP school. Some of her self-setup clinical rotations were completely unsupervised. Her clinical preceptor would leave her alone to figure things out on her own. She said that she would feel completely uncomfortable working independently and that her classmates feel the same. She and her classmates told me that independent practice rights are just a powerplay by the NP leaders and that the majority of NPs prefer sticking to healthcare teams. They do not want the liability of independent practice. She also complained that there are no residencies for NPs because she has very little NP clinical experience and she laments the fact that their anatomy knowledge is relatively limited. So my anecdote conflicts with your anecdote

 

[JamesAK]

Were you offended? I'm sorry. I thought undergrad was an accepted term. Since your profile says "Medical student (accepted)" I assumed you were in college.

I guess words to matter after all.

Depends what country the medical student is in--US it would be grad school, UK medical school is an undergraduate program from what I understand. Anybody know about other countries?

 

[JamesAK]

Just because you keep repeating this statement doesn't make it true. This is a very broad claim, which isn't supported by the current evidence. You don't seem to acknowledge any questions about the flawed methodology with the studies you cite, and don't seem to be proposing any further rigorous research into the issue. Whether you like it or not, physicians currently represent the "gold standard" in patient care. When new drugs or diagnostics are introduced, they are compared against the gold standard drug or test. Physicians have minimum training requirements that far exceed those of any physician extenders. While some NPs may have years of valuable clinical experience as RNs, an 18 month accelerated training program doesn't seem like the appropriate path to completely independent practice and prescribing rights. If NPs want full autonomy, they should be compared to the gold standard in rigorous studies. While supervised NPs that care for well-controlled asthma patients may provide equivalent care to physicians, extrapolating that data to make the claim that unsupervised "NP care is at least as good as physician care" is at best completely unscientific, and at worst dangerous or deadly for patients.

"Gold standard" is a cultural norm, perhaps built up by our god-like image on TV. "Gold-standard" isn't science and we can hardly go around waving a gold banner to prove we are better than NPs. We need studies. I will find more, since everyone is underimpressed with the meta-analysis!

 

[ProfMD]

Maybe you misread. I said that the behavior of taking offense to things that are not offensive due to living in a place where the vast majority of people have nothing to worry about is an immature world view. I also apologized for not stating that more clearly and just calling you a child.

But yes, I do think that you and, to a much greater extent, the other poster displayed an immaturity.

I am sorry that you see my posts as immature. I was merely asking people to show respect to others and stick with attacking the argument rather than the argue-er.

I understand that there are areas of the world where there are much bigger problems. That does not mean we can't be civil to each other here.

 

[Psai]

See above - this is not true. You can practice after 1 year of residency. A lot of people do - its called moonlighting. And, the moonlighting you do does not have to be in the field you are training in. Usually people moonlight covering EDs or urgent care centers. I have also known people to moonlight as hospitalists. All this while still in residency.

As I have said before, there are legitimate arguments against APNs having independent practice, some people on this board have made them. However, to demand RCTs proving APNs are good and then state that you do not need studies to prove that less training means less capable is disingenuous. Critically evaluating the available evidence and therefore disagreeing with the conclusions is valid - this only suggests that we do not know if they are equivalent, it does not prove that they are worse.

My point in posting is not to argue that APNs should have independent practice. We have been through that before and will get nowhere. I am only expressing my opinion that many of the arguments posted on this board are not true arguments, just assumptions not supported by fact or evidence.

Do you have any evidence that you can do a better job than a college student? Why shouldn't we just replace all surgeons with surgery board certified college grads? We can call these providers "sturgeons" and give them a doctorate in sturgery. You have no evidence or data to prove that you can do a better job than these sturgeon doctors. I'm sure we can get rid of you and replace you with a board certified sturgeon who is just as good but cheaper since you have no evidence saying otherwise.

 

[JamesAK]

http://www.ncbi.nlm.nih.gov/pubmed/23772723
Patients co-managed by NPs and physicians did better than when they were managed by physicians alone
Percentage of care received by
APRN-MD MD
fall prevention 80% vs. 34%
urinary incontinence 66% vs 19%
dementia 59% vs. 38%

http://www.medscape.com/viewarticle/723986 "care provided by NPs is as effective as, and no different from, that of physicians in terms of health status, treatment practices, and prescribing behavior. Moreover, NPs achieved consistently better results than their physician colleagues on measures of patient follow-up, consultation time, satisfaction, and the provision of screening, assessment, and counseling."