How do we stop nurse practitioners?

[deleted480308]

Not saying you don't! But perhaps for high achieving NPs we might offer a chance to take the USMLE and complete a residency program after 5 years experience and a recommendation from a hospital executive? Completing that program would then allow them more autonomy - intentionally being vague here because I don't have this fully fleshed out - in rural areas?

Maybe take all the board exams (like foreign docs do) and then be able to apply? I think they would do poorly (prior experiment showed that) but as long as the residency stated under acgme and not nursing control, I'm willing to compete

Experience may be the most important factor, and is why I'd be for more restricted entry into independent practice (i.e., minimum of 3-5 years of collaboration). Experience is the reason NPs become as good as their physician colleagues typically after years of collaboration. Majority of the NPs currently in independent practice have years of both RN experience and NP training and experience.

again, they are not as capable as physicians

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[FNP_Blix]

Maybe take all the board exams (like foreign docs do) and then be able to apply? I think they would do poorly (prior experiment showed that) but as long as the residency stated under acgme and not nursing control, I'm willing to compete
again, they are not as capable as physicians

"willing to compete"? If thats how you want to look at it, then sorry to say, you are already competing. NPs are able to practice independently in almost half the country.

 

[Chibucks15]

"willing to compete"? If thats how you want to look at it, then sorry to say, you are already competing. NPs are able to practice independently in almost half the country.

So do you think NPs could come close to passing our boards? You conveniently ignore most of what we say and pick and choose what fits your narrative


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[FNP_Blix]

So do you think NPs could come close to passing our boards? You conveniently ignore most of what we say and pick and choose what fits your narrative


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Oh like you do to me? Still waiting on some replys on some points ive made earlier. And with that said, Do you deny that we are already capable of practicing independently in almost half the country and therefore are "competing" as sb247 put it. I personally see it as all of us pitching in to serve our population, but to use his words, is that not the case already?

Regarding the USLME boards, I dont know. I saw the experiment he referenced and was too small of a population size to draw any large conclusions. In addition, that is beyond the point because we have our own credentialing process.

 

[deleted480308]

Oh like you do to me? Still waiting on some replys on some points ive made earlier. And with that said, Do you deny that we are already capable of practicing independently in almost half the country and therefore are "competing" as sb247 put it. I personally see it as all of us pitching in to serve our population, but to use his words, is that not the case already?

Regarding the USLME boards, I dont know. I saw the experiment he referenced and was too small of a population size to draw any large conclusions. In addition, that is beyond the point because we have our own credentialing process.

NPs are legally allowed to practice independently. I still propose they are not capable. The two are different discussions.

 

[857770]

Even the NPs that are not independent providers, do not have enough supervision. Physicians just signing their charts after a certain length of time without seeing the patients is not supervision. It is dangerous.

 

[FNP_Blix]

Not once during this discussion have you guys proven how NPs are any more "dangerous" than physicians. Give examples and data.

 

[deleted480308]

Not once during this discussion have you guys proven how NPs are any more "dangerous" than physicians. Give examples and data.

They have significantly less training than physicians. Do you deny that?

 

[jdav_7]

They have significantly less training than physicians. Do you deny that?

I think the point he's making is that I could train for years to build bridges, but I might reach a certain threshold of experience/training where my outcomes won't be significantly better by continuing to train. I obviously don't think medicine is comparable to bridge building, but it would great to see some critical number data to compare the two provider groups. Ex) how many cases performing an esophagectomy would it take for an NP to get the same outcome rate as a typical physician?

 

[WisNeuro]

I think the point he's making is that I could train for years to build bridges, but I might reach a certain threshold of experience/training where my outcomes won't be significantly better by continuing to train. I obviously don't think medicine is comparable to bridge building, but it would great to see some critical number data to compare the two provider groups. Ex) how many cases performing an esophagectomy would it take for an NP to get the same outcome rate as a typical physician?

Valid question, and one that every aspect of healthcare should be concerned with. What amount of training, in any discipline, is necessary and sufficient? You probably won't see much movement on that any time soon. Those who are in or done with their training firmly believe that is the only way to go. That and turf protectionism will quash any real attempt at understanding or gathering new critical data to answer the question at hand.

 

[jdav_7]

Valid question, and one that every aspect of healthcare should be concerned with. What amount of training, in any discipline, is necessary and sufficient? You probably won't see much movement on that any time soon. Those who are in or done with their training firmly believe that is the only way to go. That and turf protectionism will quash any real attempt at understanding or gathering new critical data to answer the question at hand.

Couldn't agree more. There are still debates whether limiting residency to 80 hour work weeks is sufficient training today.

 

[FNP_Blix]

They have significantly less training than physicians. Do you deny that?

I believe that our training, for what our role is designed to achieve, is adequate and despite what you believe, has proven to be.

 

[857770]

I believe that our training, for what our role is designed to achieve, is adequate and despite what you believe, has proven to be.

You don't have enough education and training in medicine to make that determination. I mean PAs have better training than NPs, and they don't have half the training that physicians do. As far as the studies go, they weren't worth the dust that we walk on.

 

[WisNeuro]

You don't have enough education and training in medicine to make that determination. I mean PAs have better training than NPs, and they don't have half the training that physicians do. As far as the studies go, they weren't worth the dust that we walk on.

To be fair, there is no empirically established length/breadth of education/training that determines who can make that determination. That's kind of the point of the argument, that there is a somewhat arbitrarily established bar that has been set. And, when asked why the bar is where it is, the only answer is, because that's where it was set.

 

[WisNeuro]

Considering how many people die each year from medical errors made by physicians, it would only seem reasonable to me that medical training could be longer, if anything. As someone else mentioned, part of the push against work hour restrictions for residents is the fact that even at 80 hrs per week for 3-7 years, residents aren't learning everything, even after they already completed 4 years of medical school and 2-4 years of pre-medical basic science coursework. When someone's entire scientific and medical training consists of 3 years, versus 9+, that is even worse.

I don't personally advocate for removing work hour restrictions, though, because I think working someone for 120 hours per week is inhumane, but the point about them having less training time is reasonable.


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While the sentiment makes logical sense, things that have made logical sense have not always survived empirical scrutiny. I'm definitely on the side of more training is probably better, we deal with in in my field because of PsyD diploma mills all the time. But, I still think all of healthcare could benefit from better outcome studies and studies focused on what kind and how length of training influences meaningful clinical outcomes. Until then, we're doing a lot of arbitrary goal setting.

 

[Mad Jack]

I agree that you guys are great diagnosticians (most of the time). Being physicians and all, you are expected to be. But as NPs, we actually do possess a very strong masters degree and DNP. To me its impressive that there are some NPs that I have met with (just) an MSN that outshine some physicians in many respects. For myself, I've met physicians that didnt know or think of certain differentials that I thought of. Like I had a really good physician not know what donovanosis was. He just automatically assumed that this patient we had that had genital lesions had HSV, chlamydia, syphillis or something more common. But when I joked and said it could potentially be donovanosis (which is very rare but possible) he shrugged it off and didnt know what I was talking about.

He didn't know what it was because you used outdated terminology that no one used in the literature. Granuloma inguinale is the proper name used by people that aren't practicing old-timey folk medicine. Did you also consider consumption while you were at it?

 

[FNP_Blix]

You don't have enough education and training in medicine to make that determination. I mean PAs have better training than NPs, and they don't have half the training that physicians do. As far as the studies go, they weren't worth the dust that we walk on.

I beg to differ. Outside of the internet, you know, in the real world where probably half of you have no experience in, NPs run the ICUs, outpatient clinics, private practices, etc. Our influence continues to expand as our profession continues to grow. And while you sit there behind your computers, typing and trying to tear me down, there is an NP making some clinical decision to save a patients life. Hopefully one day you will learn to accept the reality that we aren't going anywhere. Quit being bitter and suck it up that we didn't have to go to med school to achieve the same outcomes as physicians, and move on.

 

[FNP_Blix]

He didn't know what it was because you used outdated terminology that no one used in the literature. Granuloma inguinale is the proper name used by people that aren't practicing old-timey folk medicine. Did you also consider consumption while you were at it?

Okay whatever you want to tell yourself. He didnt know because he didnt know. And no, its not an outdated term. They are used interchangeably...maybe just stick to psych madjack

 

[FNP_Blix]

Considering how many people die each year from medical errors made by physicians, it would only seem reasonable to me that medical training could be longer, if anything. As someone else mentioned, part of the push against work hour restrictions for residents is the fact that even at 80 hrs per week for 3-7 years, residents aren't learning everything, even after they already completed 4 years of medical school and 2-4 years of pre-medical basic science coursework. When the length of an NP's entire scientific and medical training can be as low as 3 years, versus 9+, that is even worse.

I don't personally advocate for removing work hour restrictions, though, because I think working someone for 120 hours per week is inhumane, but the point about them having less training time is reasonable.


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I dont know of any path to become an NP in 3 years. From start (as brand new nursing student and pre reqs) to finish (MSN or DNP) schooling is bw 6-8 years, plus clinical experience as an RN (varies but on average 10-11 years of RN experience).

 

[FNP_Blix]

The program at my school admits students with no nursing experience, and they graduate in three years. There is also a program in my home state that is online.

It's also worth noting that nursing experience is not equivalent to experience practicing medicine.


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So they are RNs but with no experience going into the program. That means they are BSN and then just went right in. Yea, I personally wouldn't advocate for that either but no program takes you from nothing to having an MSN in 3 years.

RN experience makes all the difference. I just completely disagree with that.

 

[Mad Jack]

Okay whatever you want to tell yourself. He didnt know because he didnt know. And no, its not an outdated term. They are used interchangeably...maybe just stick to psych madjack

Except it's now improper to call it donovanosis, because the causative organism was renamed- formerly Calymmatobacterium donovani, it is now Klebsiella granulomatis care of genomics. It's like calling Pneumocystis jiroveci Pneumocystis carinii.

In medicine, words mean things and proper terminology is important. That's why you'll find zero references to donovanosis on the boards, but you'll find plenty to granuloma inguinale.

 

[FNP_Blix]

Except it's now improper to call it donovanosis, because the causative organism was renamed- formerly Calymmatobacterium donovani, it is now Klebsiella granulomatis care of genomics. It's like calling Pneumocystis jiroveci Pneumocystis carinii.

In medicine, words mean things and proper terminology is important. That's why you'll find zero references to donovanosis on the boards, but you'll find plenty to granuloma inguinale.

Fair enough. But the term Ive heard used still

 

[Chibucks15]

I beg to differ. Outside of the internet, you know, in the real world where probably half of you have no experience in, NPs run the ICUs, outpatient clinics, private practices, etc. Our influence continues to expand as our profession continues to grow. And while you sit there behind your computers, typing and trying to tear me down, there is an NP making some clinical decision to save a patients life. Hopefully one day you will learn to accept the reality that we aren't going anywhere. Quit being bitter and suck it up that we didn't have to go to med school to achieve the same outcomes as physicians, and move on.

And while sure there's one NP making a good call (that a doc would've made too) there's about 50 getting their butts bailed out by a supervising doc who changes the plan of care. Seen it myself in my clinical experiences...even though I know you believe all of us future docs have no life experiences


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[Chibucks15]

So they are RNs but with no experience going into the program. That means they are BSN and then just went right in. Yea, I personally wouldn't advocate for that either but no program takes you from nothing to having an MSN in 3 years.

RN experience makes all the difference. I just completely disagree with that.

Nursing experience helps with how to do things like place lines, etc. and MAYBE presentations of common ailments. But I guarantee there's gonna be many atypical presentations of ailments that an NP won't pick up on because they don't have the schooling...and that patient will die. There was that case at the VA just a little while ago with a similar effect


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[FNP_Blix]

Nursing experience helps with how to do things like place lines, etc. and MAYBE presentations of common ailments. But I guarantee there's gonna be many atypical presentations of ailments that an NP won't pick up on because they don't have the schooling...and that patient will die. There was that case at the VA just a little while ago with a similar effect


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You don't want to go there. That is, referencing cases of negligence or mal practice suits. Can pull a whole laundry list of things physicians did that where so obviously incorrect. That being said, I think we went as far as this discussion can go. I have nothing more to really say to you guys.

 

[Chibucks15]

You don't want to go there. That is, referencing cases of negligence or mal practice suits. Can pull a whole laundry list of things physicians did that where so obviously incorrect. That being said, I think we went as far as this discussion can go. I have nothing more to really say to you guys.

Docs aren't the only ones at fault there's just more of us. I'm sure we can pull a whole laundry list of things nurses did that we're so obviously incorrect too. Your statements are just not supported and no matter how much we refute your argument you say the same things. Go try to rock the MCAT like you said you so obviously could then come talk to us. Easier said than done


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[jdav_7]

Docs aren't the only ones at fault there's just more of us. I'm sure we can pull a whole laundry list of things nurses did that we're so obviously incorrect too. Your statements are just not supported and no matter how much we refute your argument you say the same things. Go try to rock the MCAT like you said you so obviously could then come talk to us. Easier said than done


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I'm curious how hard the MCAT would actually be for an average Joe... so many interesting research questions arising

 

[FNP_Blix]

Docs aren't the only ones at fault there's just more of us. I'm sure we can pull a whole laundry list of things nurses did that we're so obviously incorrect too. Your statements are just not supported and no matter how much we refute your argument you say the same things. Go try to rock the MCAT like you said you so obviously could then come talk to us. Easier said than done


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Hey dont get upset that im challenging you and point out things wrong with physicians when your the one here tearing my profession apart. Dont you see how it is hypocritical of you to bring up some random VA case on a NP that messed up and then put our whole profession on the cutting block when physicians have equally demonstrated moments of incompetence? You and other physicians like yourself simply do not like being challenged and cant accept that NPs are practicing medicine equally as good as physicians in certain specialties without going through the same path as a physician. You hold resentment because its a tough pill to swallow. I get it.

 

[deleted480308]

So they are RNs but with no experience going into the program. That means they are BSN and then just went right in. Yea, I personally wouldn't advocate for that either but no program takes you from nothing to having an MSN in 3 years.

RN experience makes all the difference. I just completely disagree with that.

Direct from non-related bachelors to MSN in 2 years.... Master's Entry in Nursing (MSN) for Non-Nurses Program | Rush University

 

[FNP_Blix]

Direct from non-related bachelors to MSN in 2 years.... Master's Entry in Nursing (MSN) for Non-Nurses Program | Rush University

But still must hold RN license. These programs are somewhat similar to PA programs where they come in with variable levels of experience and bachelors degrees and then are practicing in 2-3 years.

 

[deleted480308]

But still must hold RN license. These programs are somewhat similar to PA programs where they come in with variable levels of experience and bachelors degrees and then are practicing in 2-3 years.

no. no it's not for RNs. It takes someone without any nursing background at all to a MSN in 2 years.

and for fun, here's one from no nursing at all to NP in 4 years. Programs

 

[Chibucks15]

Hey dont get upset that im challenging you and point out things wrong with physicians when your the one here tearing my profession apart. Dont you see how it is hypocritical of you to bring up some random VA case on a NP that messed up and then put our whole profession on the cutting block when physicians have equally demonstrated moments of incompetence? You and other physicians like yourself simply do not like being challenged and cant accept that NPs are practicing medicine equally as good as physicians in certain specialties without going through the same path as a physician. You hold resentment because its a tough pill to swallow. I get it.

I never said docs don't screw up. Nowhere near close to that so don't take my words out of context. Plenty do and pay the price for it. I'm just saying that full autonomy for NPs in anything but a minute clinic could be deemed bringing subpar care to the patient population (as evidenced by massive disparity in education), especially staffing with those NPs that do any of the above listed programs. Not demeaning the profession as a whole...there are some incredible NPs who know their role and EDUCATION LEVEL and are happy with it and are huge parts of the healthcare team. But then there are some like you who just want to see who shouts the loudest about patient outcomes because you saw doctors be mean at the bedside before and I'm sorry to break it to you, but you need to realize you aren't gonna win this. There are many many NPs out there who chose the route as an easier way to get to be a 'doctor'. Until standards get raised to even PA standards I will not feel comfortable with full autonomy anywhere besides CVS at the most.

 

[KGflyboy]

I beg to differ. Outside of the internet, you know, in the real world where probably half of you have no experience in, NPs run the ICUs, outpatient clinics, private practices, etc. Our influence continues to expand as our profession continues to grow. And while you sit there behind your computers, typing and trying to tear me down, there is an NP making some clinical decision to save a patients life. Hopefully one day you will learn to accept the reality that we aren't going anywhere. Quit being bitter and suck it up that we didn't have to go to med school to achieve the same outcomes as physicians, and move on.

What hospital has an ICU run by NPs? I've worked in many hospitals, and I've never once admitted a patient to an NP in any department, let alone an ICU.

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[857770]

I beg to differ. Outside of the internet, you know, in the real world where probably half of you have no experience in, NPs run the ICUs, outpatient clinics, private practices, etc. Our influence continues to expand as our profession continues to grow. And while you sit there behind your computers, typing and trying to tear me down, there is an NP making some clinical decision to save a patients life. Hopefully one day you will learn to accept the reality that we aren't going anywhere. Quit being bitter and suck it up that we didn't have to go to med school to achieve the same outcomes as physicians, and move on.

No. They are working under the extension of the intensivist's license. Don't go around embarrassing yourself by making statements like this. You will look foolish in front of an intensivist. He/she will have a field day!

 

[FNP_Blix]

I never said docs don't screw up. Nowhere near close to that so don't take my words out of context. Plenty do and pay the price for it. I'm just saying that full autonomy for NPs in anything but a minute clinic could be deemed bringing subpar care to the patient population (as evidenced by massive disparity in education), especially staffing with those NPs that do any of the above listed programs. Not demeaning the profession as a whole...there are some incredible NPs who know their role and EDUCATION LEVEL and are happy with it and are huge parts of the healthcare team. But then there are some like you who just want to see who shouts the loudest about patient outcomes because you saw doctors be mean at the bedside before and I'm sorry to break it to you, but you need to realize you aren't gonna win this. There are many many NPs out there who chose the route as an easier way to get to be a 'doctor'. Until standards get raised to even PA standards I will not feel comfortable with full autonomy anywhere besides CVS at the most.

As I said in my argument before, NPs are what we have right now until there are more doctors to do the job. That will likely take decades and until then, physicians and the population need our help. Putting unnecessary restrictions on NPs is not the solution. And as I told sb247, once physicians reach saturation, then I will be more than happy to relinquish independent practice. But in the mean time, we are going to continue making headway and moving forward with lobbying and increasing our authority, one state at a time. There are many other smart people out there besides physicians that realize the importance of our role, including in independent practice. Policy makers and the public realize the importance of our role. So if anybody is winning, it is nurse practitioners and their mission of increasing access to care to millions of people.

 

[857770]

Hey dont get upset that im challenging you and point out things wrong with physicians when your the one here tearing my profession apart. Dont you see how it is hypocritical of you to bring up some random VA case on a NP that messed up and then put our whole profession on the cutting block when physicians have equally demonstrated moments of incompetence? You and other physicians like yourself simply do not like being challenged and cant accept that NPs are practicing medicine equally as good as physicians in certain specialties without going through the same path as a physician. You hold resentment because its a tough pill to swallow. I get it.

The research wasn't worth crap. But, you keep repeating that it has been demonstrated that NPs are just as good as physicians. Again: It was never proven! You are just demonstrating that NPs have poor skills in interpreting research studies.

 

[Chibucks15]

As I said in my argument before, NPs are what we have right now until there are more doctors to do the job. That will likely take decades and until then, physicians and the population need our help. Putting unnecessary restrictions on NPs is not the solution. And as I told sb247, once physicians reach saturation, then I will be more than happy to relinquish independent practice. But in the mean time, we are going to continue making headway and moving forward with lobbying and increasing our authority, one state at a time. There are many other smart people out there besides physicians that realize the importance of our role, including in independent practice. Policy makers and the public realize the importance of our role. So if anybody is winning, it is nurse practitioners and their mission of increasing access to care to millions of people.

You're honestly saying that after practicing independently for a decade plus that NPs will gladly just fade into the background? That's really not how human psychology works...

 

[FNP_Blix]

The research wasn't worth crap. But, you keep repeating that it has been demonstrated that NPs are just as good as physicians. Again: It was never proven! You are just demonstrating that NPs have poor skills in interpreting research studies.

And you just demonstrated that you don't know how to read. Please re-read the full sentence that you just put in bold.

 

[Chibucks15]

As I said in my argument before, NPs are what we have right now until there are more doctors to do the job. That will likely take decades and until then, physicians and the population need our help. Putting unnecessary restrictions on NPs is not the solution. And as I told sb247, once physicians reach saturation, then I will be more than happy to relinquish independent practice. But in the mean time, we are going to continue making headway and moving forward with lobbying and increasing our authority, one state at a time. There are many other smart people out there besides physicians that realize the importance of our role, including in independent practice. Policy makers and the public realize the importance of our role. So if anybody is winning, it is nurse practitioners and their mission of increasing access to care to millions of people.

Policy makers see the saving money...that's really all theyre concerned with

 

[FNP_Blix]

Policy makers see the saving money...that's really all theyre concerned with

No. I have a friend who is on bill to be senate and works intimately on healthcare policy. There truly is an access problem. The sentiment on the hill as he states is, "we need all hands on deck." When will you just accept that as truth? There is crisis and NPs help mitigate it.

 

[MBVT]

I just spoke to it more fully in the "Should Physicians let NP/PA's take over Primary Care and Anesthesia" thread, but the reality is that NP's and PA's already have taken over primary care, at least in rural areas. It is all but impossible to find an MD internist or family practitioner that is taking new patients. NP's and PA's already outnumber the MD's and most are fully booked, not taking on new patients. Without the NP's and PA's a major swath of the population in non-urban/suburban areas would have no primary care at all. Good, bad, or indifferent, the NP's and PA's are all we have available to us anymore.

 

[Chibucks15]

I just spoke to it more fully in the "Should Physicians let NP/PA's take over Primary Care and Anesthesia" thread, but the reality is that NP's and PA's already have taken over primary care, at least in rural areas. It is all but impossible to find an MD internist or family practitioner that is taking new patients. NP's and PA's already outnumber the MD's and most are fully booked, not taking on new patients. Without the NP's and PA's a major swath of the population in non-urban/suburban areas would have no primary care at all. Good, bad, or indifferent, the NP's and PA's are all we have available to us anymore.

I have zero problem with primary care situations and rural issues. But the new NPs coming out don't want to go to northern idaho to practice. They want to work in the big city hospitals and 'good' areas to live. That's where I have issues. They view it more as a pay bump and getting to be a 'doctor'. Its the same way with physicians...the shortage is there because there is a maldistribution of available physicians. Its human nature

 

[Chibucks15]

No. I have a friend who is on bill to be senate and works intimately on healthcare policy. There truly is an access problem. The sentiment on the hill as he states is, "we need all hands on deck." When will you just accept that as truth? There is crisis and NPs help mitigate it.

we need all hands on deck at clinics out in the boonies. not in major city centers, which is where many NPs head

 

[Mad Jack]

But still must hold RN license. These programs are somewhat similar to PA programs where they come in with variable levels of experience and bachelors degrees and then are practicing in 2-3 years.

PAs have 2,000-3,000 hours of advanced-level clinical training. APRNs get less than 700. PAs operate under physicians. APRNs often don't. It's apples to oranges.

 

[Mad Jack]

No. I have a friend who is on bill to be senate and works intimately on healthcare policy. There truly is an access problem. The sentiment on the hill as he states is, "we need all hands on deck." When will you just accept that as truth? There is crisis and NPs help mitigate it.

Alright, restrict NP licenses to rural practice and primary care in underserved areas. Then we've got a deal.

 

[FNP_Blix]

PAs have 2,000-3,000 hours of advanced-level clinical training. APRNs get less than 700. PAs operate under physicians. APRNs often don't. It's apples to oranges.

You're right, it is apples and oranges. PAs do 2-3 thousand hours because they are being trained as "generalists." They switch specialities at the drop of a hat. They also require more training because you don't know what kind of prior experience they have. A majority of NPs have 10-11 years of RN experience and are far easier to train than PAs. The hospital I currently work in would much rather hire NPs for that reason, because they are far more confident in their skills. The other reason why NPs do not require as many hours is because we specialize only in certain areas of primary care. That is, psych NPs can only work in psych, acute care NPs cannot work in pediatric primary care, etc. RNs typically have thousands of hours of on the job experience in addition to the clinical rotations they fulfilled during their undergrad. NP school is designed as an extension of that education to an "advance practice nurse" level. The model of education is entirely different, and just comparing the number of clinical hours is misleading and a misrepresentation of our education and abilities.

 

[FNP_Blix]

we need all hands on deck at clinics out in the boonies. not in major city centers, which is where many NPs head

Wrong again. In urban areas, there are access issues too. Populations are larger, and you have more indigent people there that can't get medical services because either they have no insurance, or the doctors in those areas won't take medicare or medicaid. There are other restrictions at the micro level. I used this example earlier, but one example is like the diabetic patient that needs a diabetic shoe. Are you seriously telling me that an NP can't order that shoe because he/she needs a physician signature? These restrictions in some states absolutely need to be lifted because they are ridiculous.

 

[FNP_Blix]

Alright, restrict NP licenses to rural practice and primary care in underserved areas. Then we've got a deal.

How insightful.

 

[Mad Jack]

How insightful.

It'll solve the crisis of the underserved. I thought that was your goal? Or is that bull****?

 

[FNP_Blix]

It'll solve the crisis of the underserved. I thought that was your goal? Or is that bull****?

MadJack, we've debated extensively before and you already know my position, and I already know yours. What do you want?