KEVINMD blog post on NP. (even neonatologist is fooled)

[KeikoTanaka]

They keep moving the ball. They now think it is appropriate. They will be coming for the physician title next.

I feel like NPs theoretically have the same scope as a PA. It really seems like there should be a new Flexner Report aimed at standardizing the curriculum of NP and PA schools so we can have a defined scope laid out for them. Then, in order to win back the supervision of midlevels, providers be hired full time as "Tele-supervisors" so Physicians can remotely work with midlevels in really rural areas. This obviously wouldn't apply to more populous areas. But I feel like the independent midlevel movement is really stemming from these rural states in the mid west and south. They've found a crack in the healthcare model that is much of the reason for the low level of quality healthcare in the US (#37 in the world, just above Syria) and are blaming physicians and the AMA for this low level of care when in reality it has a lot to do with access to care, rather than education and actual delivery of care by physicians. Which is why I hate when people compare us to a small country like Germany or Switzerland where you can theoretically have a good spread of physicians throughout your country, it's so small compared to the US... (Also they have a population actually interested and educated enough to be healthy on their own)

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[NicMouse64]

I feel like NPs theoretically have the same scope as a PA. It really seems like there should be a new Flexner Report aimed at standardizing the curriculum of NP and PA schools so we can have a defined scope laid out for them. Then, in order to win back the supervision of midlevels, providers be hired full time as "Tele-supervisors" so Physicians can remotely work with midlevels in really rural areas. This obviously wouldn't apply to more populous areas. But I feel like the independent midlevel movement is really stemming from these rural states in the mid west and south. They've found a crack in the healthcare model that is much of the reason for the low level of quality healthcare in the US (#37 in the world, just above Syria) and are blaming physicians and the AMA for this low level of care when in reality it has a lot to do with access to care, rather than education and actual delivery of care by physicians. Which is why I hate when people compare us to a small country like Germany or Switzerland where you can theoretically have a good spread of physicians throughout your country, it's so small compared to the US... (Also they have a population actually interested and educated enough to be healthy on their own)

Our issue is that we as a country don't know how to consume healthcare. A cough or mild fever don't need to go to the doctor. If it lasts a certain amount of time or gets worse then yes. Unfortunately with medical malpractice and various laws, resources can't say "you don't need to go to the doctor" because it's a liablity. instead everywhere says "TALK TO YOUR DOCTOR" for ANYTHING. It's just a huge waste of resources. If there were ways to improve healthcare utilization efficiency, we would need far fewer MLPs

 

[KeikoTanaka]

Our issue is that we as a country don't know how to consume healthcare. A cough or mild fever don't need to go to the doctor. If it lasts a certain amount of time or gets worse then yes. Unfortunately with medical malpractice and various laws, resources can't say "you don't need to go to the doctor" because it's a liablity. instead everywhere says "TALK TO YOUR DOCTOR" for ANYTHING. It's just a huge waste of resources. If there were ways to improve healthcare utilization efficiency, we would need far fewer MLPs

That and the fact that the US and Australia are the only countries where you're allowed to market and advertise prescription drugs. People start thinking they can take their health into their own hands because they think the commercial summed up everything they need to know about a certain condition or medication, and they urge you to talk to your doctor about, you're right: ANYTHING. (Not to mention a big factor of the cost of healthcare is the artificially inflated cost of prescriptions in the US)

I know Ron Swanson over here would disagree with this sentiment, but, we have car insurance and car inspections that allow you to drive on a road, and if you don't get those checked, you lose your driving privileges. Imagine if healthcare was the same way... Like, Healthcare will be given to you (maybe through a socialized route *Gasp*) BUT, it's not a right, it is a privilege. If you use the system wrong, you lose your PRIVILEGE to healthcare and would have to do remediation steps to get it again. Using it right would be following up with your PCP for yearly examinations, not missing appointments (Jobs would HAVE to give time off for medical purposes), properly utilizing your medications (AKA Avoiding ED because you've been in DKA 10,000 times because you neglect your insulin). A lot of this would only be possible though if we had good psychiatric systems in place, because I feel like a lot of the people who misuse the system, are unfortunately psych patients, to no fault of their own.

Idk, it's all pipe dreams, Idk how to actually fix anything lol. It'll just forever be this horrible chaotic swirl into oblivion until it gets so bad Doctors leave the system in droves forcing the capitalistic system to revamp itself to be a more favorable environment for their Doctors. It's unfortunate, but true, because as a society we are so reactive rather than proactive.

 

[deleted480308]

That and the fact that the US and Australia are the only countries where you're allowed to market and advertise prescription drugs. People start thinking they can take their health into their own hands because they think the commercial summed up everything they need to know about a certain condition or medication, and they urge you to talk to your doctor about, you're right: ANYTHING. (Not to mention a big factor of the cost of healthcare is the artificially inflated cost of prescriptions in the US)

I know Ron Swanson over here would disagree with this sentiment, but, we have car insurance and car inspections that allow you to drive on a road, and if you don't get those checked, you lose your driving privileges. Imagine if healthcare was the same way... Like, Healthcare will be given to you (maybe through a socialized route *Gasp*) BUT, it's not a right, it is a privilege. If you use the system wrong, you lose your PRIVILEGE to healthcare and would have to do remediation steps to get it again. Using it right would be following up with your PCP for yearly examinations, not missing appointments (Jobs would HAVE to give time off for medical purposes), properly utilizing your medications (AKA Avoiding ED because you've been in DKA 10,000 times because you neglect your insulin). A lot of this would only be possible though if we had good psychiatric systems in place, because I feel like a lot of the people who misuse the system, are unfortunately psych patients, to no fault of their own.

Idk, it's all pipe dreams, Idk how to actually fix anything lol. It'll just forever be this horrible chaotic swirl into oblivion until it gets so bad Doctors leave the system in droves forcing the capitalistic system to revamp itself to be a more favorable environment for their Doctors. It's unfortunate, but true, because as a society we are so reactive rather than proactive.

The problem is the arrogance required to think you can decide centrally on all the solutions and force required to try.....both are bad

The answer is to let people use health care to whatever degree they can afford and their doctor ethically chooses to sell. When you run out of money or doctors willing to fill your request, you don’t get any more

 

[KeikoTanaka]

The problem is the arrogance required to think you can decide centrally on all the solutions and force required to try.....both are bad

The answer is to let people use health care to whatever degree they can afford and their doctor ethically chooses to sell. When you run out of money or doctors willing to fill your request, you don’t get any more

I wish I could say I agree, because in my heart of hearts, I do believe in the libertarian mindset here. But, at the end of the day I know my generation coming up and they are very ... disenchanted with the whole system, so they're turning to people like Alexandria Ocasio Cortez who is fighting for socialistic systems without having any idea about actually paying for it. So in a way to appease them...(And perhaps educate them on supply and demand and how the real world actually works) if we could have a hybrid system that enhanced certain aspects of our healthcare, maybe the pendulum wouldn't swing so hard to the socialist side (B/c for some reason even with Trump in power they think more Government is the answer, when this should be living proof as to why you wouldn't want too strong of a government, lol). And this disenchantment goes towards everything.... anti-vaxxers, people wanting chiropractors as their PCPs, like, there is just so much misinformation and lack of trust in our healthcare system, and as a future physician I would like to promote better ways of accessing care and lead to a healthier population so that our healthcare system can begin working the way it was intended and not cost so much.

Laws don't dictate culture, but I do think that they can help stimulate change in culture. If you had laws like in Japan with companies being taxed more for hiring obese employees, you'll eventually (hopefully) see small changes that can lead to longstanding cultural changes and a healthier population. So is it arrogant to centrally decide solutions for people? Yes. But, if everyone agreed that was the norm because they were brought up in a culture where health and education were stressed, pushing it doesn't seem as arrogant anymore.

 

[deleted480308]

I wish I could say I agree, because in my heart of hearts, I do believe in the libertarian mindset here. But, at the end of the day I know my generation coming up and they are very ... disenchanted with the whole system, so they're turning to people like Alexandria Ocasio Cortez who is fighting for socialistic systems without having any idea about actually paying for it. So in a way to appease them...(And perhaps educate them on supply and demand and how the real world actually works) if we could have a hybrid system that enhanced certain aspects of our healthcare, maybe the pendulum wouldn't swing so hard to the socialist side (B/c for some reason even with Trump in power they think more Government is the answer, when this should be living proof as to why you wouldn't want too strong of a government, lol). And this disenchantment goes towards everything.... anti-vaxxers, people wanting chiropractors as their PCPs, like, there is just so much misinformation and lack of trust in our healthcare system, and as a future physician I would like to promote better ways of accessing care and lead to a healthier population so that our healthcare system can begin working the way it was intended and not cost so much.

Laws don't dictate culture, but I do think that they can help stimulate change in culture. If you had laws like in Japan with companies being taxed more for hiring obese employees, you'll eventually (hopefully) see small changes that can lead to longstanding cultural changes and a healthier population. So is it arrogant to centrally decide solutions for people? Yes. But, if everyone agreed that was the norm because they were brought up in a culture where health and education were stressed, pushing it doesn't seem as arrogant anymore.

It absolutely seems just as arrogant, you are just describing a situation where you want people to get used to being controlled.

 

[Cryc_to_the_point]

People are looking to socialism because they've forgotten the horrors of communism... We don't have a free market in healthcare, we have a rather socialized and rigid system that doesn't work. Add more right?

 

[KeikoTanaka]

It absolutely seems just as arrogant, you are just describing a situation where you want people to get used to being controlled.

We mandate K-12 education, you can't just opt out. Even if you do you have to have proof that they are being educated by their parents in a home-school fashion. So, why is it okay to control people by mandating education? It's because it is for the benefit of our people/to improve the US standing in the world/prepare our citizens for the economic landscape of tomorrow. We even have school district taxes for people even if you don't have kids going to school! No one will come out against K-12 education though because we understand the benefits. But then why is it unfair to create more stringent healthcare laws to do the same? We're just getting unhealthier and unhealthier, soon we won't even have a healthy enough population to join the armed forces because we're so fat that kids can't complete the physical tests. At that point it becomes a national security issue. Obviously this is a big slippery slope argument... But shouldn't that be the goal of our healthcare system? Also I said earlier it could still be a privilege rather than a right - if you don't want to partake, don't, but then you better have your own money in place to take care of you when you do need it - or just die - survival of the fittest.

 

[KeikoTanaka]

PS I apologize for taking this thread way off course.

 

[deleted480308]

We mandate K-12 education, you can't just opt out. Even if you do you have to have proof that they are being educated by their parents in a home-school fashion. So, why is it okay to control people by mandating education? It's because it is for the benefit of our people/to improve the US standing in the world/prepare our citizens for the economic landscape of tomorrow. We even have school district taxes for people even if you don't have kids going to school! No one will come out against K-12 education though because we understand the benefits. But then why is it unfair to create more stringent healthcare laws to do the same? We're just getting unhealthier and unhealthier, soon we won't even have a healthy enough population to join the armed forces because we're so fat that kids can't complete the physical tests. At that point it becomes a national security issue. Obviously this is a big slippery slope argument... But shouldn't that be the goal of our healthcare system? Also I said earlier it could still be a privilege rather than a right - if you don't want to partake, don't, but then you better have your own money in place to take care of you when you do need it - or just die - survival of the fittest.

We shouldn’t mandate k-12 in the way we do now. Double standard solved

 

[KeikoTanaka]

We shouldn’t mandate k-12 in the way we do now. Double standard solved

Like I said, I appreciate the libertarian mindset, but lines definitely need to be drawn. I think extremism of any political view can be dangerous, which is why you hear of "horrors of communism and socialism" - these happened in governments where the ideologies were extreme. But libertarianism can be extreme too... like saying we should not mandate K-12. I would never get behind something that is inherently going to weaken the American public by ill preparing our citizens, therefore threatening the future of our country.

 

[deleted480308]

Like I said, I appreciate the libertarian mindset, but lines definitely need to be drawn. I think extremism of any political view can be dangerous, which is why you hear of "horrors of communism and socialism" - these happened in governments where the ideologies were extreme. But libertarianism can be extreme too... like saying we should not mandate K-12. I would never get behind something that is inherently going to weaken the American public by ill preparing our citizens, therefore threatening the future of our country.

I think it's a reach to call what happens in many k-12 "preparing our citizens"

 

[KeikoTanaka]

I think it's a reach to call what happens in many k-12 "preparing our citizens"

I can't speak for every school in every district, but I think the majority of us who are now successful (or at least on track to be working professionals) can at least in part attribute some of their success to their inspirational teachers/classmates/classes offered by their K-12 education. You get out what you put in. But, at least I was afforded the opportunity to attend.

 

[deleted480308]

I can't speak for every school in every district, but I think the majority of us who are now successful (or at least on track to be working professionals) can at least in part attribute some of their success to their inspirational teachers/classmates/classes offered by their K-12 education. You get out what you put in. But, at least I was afforded the opportunity to attend.

opportunity is vastly different than required

and I had maybe a handful of inpiring teachers, if you're honest you will also admit that the vast majority are not the stuff movies are made about

 

[762513]

I think it's a reach to call what happens in many k-12 "preparing our citizens"

He’s not libertarian at all when it comes to the government restricting NP practice laws. He’s only liberatian when it works in his own benefit.,

Licensing
“Libertarians support the right of every person to earn and honest and peaceful living through the voluntary exchange of goods and services. Accordingly, we oppose occupational and other licensing laws that infringe on this right or treat it as a state-granted privilege.”
Www.lp.org/platform/

 

[KeikoTanaka]

opportunity is vastly different than required

and I had maybe a handful of inpiring teachers, if you're honest you will also admit that the vast majority are not the stuff movies are made about

As a LGBT guy growing up in a suburban white high school, of course I experienced laughable things that made me pretty upset going through school. But, I grew and became a better person because of it. I even lost 80 pounds because of my inspiring health teacher and now have competed in a bodybuilding competition 7 years after graduation. They prepared me for getting into a good undergraduate college and now into medical school. Just because the government mandates something doesn't mean it's innately bad... I think the "government" is a big bad word that people throw out to blame for inefficiencies in our systems, and for many things that is the case. But in reality it's just some well intended middle-aged woman named Janice working a desk job just trying to respond to complaints/make a living/make a difference to better people's lives - the intent is good - the execution on the other hand is where things get tricky.

And our insurance system is ****ed up beyond repair, and that's by letting the free market go at it, so, perhaps not every evil just lies in government.

He’s not libertarian at all when it comes to the government restricting NP practice laws. He’s only liberatian when it works in his own benefit.,

As for this, I see where he's coming from even if it's against his libertarian stances. There are standards for a reason (even if set by the government and licensing bodies) and by NPs gaining independence, you're artificially lowering the standards needed by healthcare providers to practice medicine, which can down the road can lead to a two-tiered healthcare system - which, back to my other points about policies that directly are possibly bad for the American public as a whole - I have to say I don't want to see. Poor patients see NPs and wealthier patient's see Physicians, exacerbating the health disparities in our country. If NPs want independence, they should meet the same standards as other independent practitioners (DOs/MDs), which means taking the same boards and certification exams. Otherwise, they should be supervised. Or, DOs and MDs should have a load off of our curriculum because clearly much of our school is a waste of time and money. But, tbh, I don't think it is.

 

[762513]

As a LGBT guy growing up in a suburban white high school, of course I experienced laughable things that made me pretty upset going through school. But, I grew and became a better person because of it. I even lost 80 pounds because of my inspiring health teacher and now have competed in a bodybuilding competition 7 years after graduation. They prepared me for getting into a good undergraduate college and now into medical school. Just because the government mandates something doesn't mean it's innately bad... I think the "government" is a big bad word that people throw out to blame for inefficiencies in our systems, and for many things that is the case. But in reality it's just some well intended middle-aged woman named Janice working a desk job just trying to respond to complaints/make a living/make a difference to better people's lives - the intent is good - the execution on the other hand is where things get tricky.

And our insurance system is ****ed up beyond repair, and that's by letting the free market go at it, so, perhaps not every evil just lies in government.



As for this, I see where he's coming from even if it's against his libertarian stances. There are standards for a reason (even if set by the government and licensing bodies) and by NPs gaining independence, you're artificially lowering the standards needed by healthcare providers to practice medicine, which can down the road can lead to a two-tiered healthcare system - which, back to my other points about policies that directly are possibly bad for the American public as a whole - I have to say I don't want to see. Poor patients see NPs and wealthier patient's see Physicians, exacerbating the health disparities in our country. If NPs want independence, they should meet the same standards as other independent practitioners (DOs/MDs), which means taking the same boards and certification exams. Otherwise, they should be supervised. Or, DOs and MDs should have a load off of our curriculum because clearly much of our school is a waste of time and money. But, tbh, I don't think it is.

It may be that his deviation from the libertarian party line is based on common sense and a greater view of social responsibility... it’s just awfully convenient that it also is a pretty good decision for his career in medicine.

 

[deleted480308]

As a LGBT guy growing up in a suburban white high school, of course I experienced laughable things that made me pretty upset going through school. But, I grew and became a better person because of it. I even lost 80 pounds because of my inspiring health teacher and now have competed in a bodybuilding competition 7 years after graduation. They prepared me for getting into a good undergraduate college and now into medical school. Just because the government mandates something doesn't mean it's innately bad... I think the "government" is a big bad word that people throw out to blame for inefficiencies in our systems, and for many things that is the case. But in reality it's just some well intended middle-aged woman named Janice working a desk job just trying to respond to complaints/make a living/make a difference to better people's lives - the intent is good - the execution on the other hand is where things get tricky.

And our insurance system is ****ed up beyond repair, and that's by letting the free market go at it, so, perhaps not every evil just lies in government.

The insurance problem in the county (particularly the portability problem) is largely due to govt. During the war the govt instituted wage restrictions so employers started offering insurance to recruit labor and the govt later started requiring employers of a certain size to offer group insurance.

And Janice is not benign, sometimes Janice "just doing her job" is definitely not a role of govt

As for this, I see where he's coming from even if it's against his libertarian stances. There are standards for a reason (even if set by the government and licensing bodies) and by NPs gaining independence, you're artificially lowering the standards needed by healthcare providers to practice medicine, which can down the road can lead to a two-tiered healthcare system - which, back to my other points about policies that directly are possibly bad for the American public as a whole - I have to say I don't want to see. Poor patients see NPs and wealthier patient's see Physicians, exacerbating the health disparities in our country. If NPs want independence, they should meet the same standards as other independent practitioners (DOs/MDs), which means taking the same boards and certification exams. Otherwise, they should be supervised. Or, DOs and MDs should have a load off of our curriculum because clearly much of our school is a waste of time and money. But, tbh, I don't think it is.

I'm not sure who you are responding to here because I have a few people on ignore, but I don't like professional licensing at all. I would prefer a literal free for all from a govt standpoint. What I abhor slightly more though is the govt intervening under the guise of patient safety to have a hand in professional regulation and then lying to the public about midlevel and physician equivalence.

 

[KeikoTanaka]

It may be that his deviation from the libertarian party line is based on common sense and a greater view of social responsibility... it’s just awfully convenient that it also is a pretty good decision for his career in medicine.

Well, in a way, I think the libertarian mindset is one of privilege and or hardwork. You wouldn't see a poor kid in the inner-city saying "Life is fair because all decisions made either set us up for failure or success and it is all of our own doings that will lead us to where we end up in the future" because at the end of the day, they have a ****ty life because of actions done by their parents, not by him. Because of where they are, they have to do way more to get to where the average middle-class person is. Now, perhaps on that kid's way through their ascension from poverty to middle-class, they could easily develop a "rugged individualistic" and libertarian mindset, but you have to go through those challenges to be able to look back and see it from the other side. Whereas a rich kid growing up with hardworking parents can easily jump onto this mindset.

The problem is, the mindset can only be seen from the people who have already put in the work to make something of themselves - and unfortunately the majority of our population just has too many extrinsic and intrinsic factors working against them to even begin that ascension. But perhaps making healthcare more accessible could help those on the bottom be healthier to make that climb to see the mindset?

 

[KeikoTanaka]

I'm not sure who you are responding to here because I have a few people on ignore.

Oh, then never mind, I won't even try to jump into the middle of that haha

 

[deleted480308]

Well, in a way, I think the libertarian mindset is one of privilege and or hardwork. You wouldn't see a poor kid in the inner-city saying "Life is fair because all decisions made either set us up for failure or success and it is all of our own doings that will lead us to where we end up in the future" because at the end of the day, they have a ****ty life because of actions done by their parents, not by him. Because of where they are, they have to do way more to get to where the average middle-class person is. Now, perhaps on that kid's way through their ascension from poverty to middle-class, they could easily develop a "rugged individualistic" and libertarian mindset, but you have to go through those challenges to be able to look back and see it from the other side. Whereas a rich kid growing up with hardworking parents can easily jump onto this mindset.

The problem is, the mindset can only be seen from the people who have already put in the work to make something of themselves - and unfortunately the majority of our population just has too many extrinsic and intrinsic factors working against them to even begin that ascension. But perhaps making healthcare more accessible could help those on the bottom be healthier to make that climb to see the mindset?

or maybe the govt providing free stuff demotivates people to "make something of themself" while also harming those who did "make something of themself" by making them pay for the others

 

[KeikoTanaka]

The insurance problem in the county (particularly the portability problem) is largely due to govt. During the war the govt instituted wage restrictions so employers started offering insurance to recruit labor and the govt later started requiring employers of a certain size to offer group insurance.

And Janice is not benign, sometimes Janice "just doing her job" is definitely not a role of govt

When you say war, do you mean during a literal war? Or just a war between government and insurance companies? When/How did the govt institute wage restrictions, on physicians? So then they were like wait we can use insurance to make more money? Then the insurance billing thing got started?

That's actually pretty fascinating, I didn't really know the whole history behind private insurance in healthcare

 

[deleted480308]

When you say war, do you mean during a literal war? Or just a war between government and insurance companies? When/How did the govt institute wage restrictions, on physicians? So then they were like wait we can use insurance to make more money? Then the insurance billing thing got started?

That's actually pretty fascinating, I didn't really know the whole history behind private insurance in healthcare

Health insurance in the United States - Wikipedia

 

[Gurby]

I think it's a reach to call what happens in many k-12 "preparing our citizens"

Sorry to derail this further but I'm really curious to hear what you think we should do about education in the US, from a libertarian point of view?

I was lucky enough to win the zip code lottery and go to a great high school. I think education is great.
I also did enough work and volunteering in the inner city to know that you are absolutely correct - many people are utterly failed by system we have now.

...what do?

 

[deleted480308]

Sorry to derail this further but I'm really curious to hear what you think we should do about education in the US, from a libertarian point of view?

I was lucky enough to win the zip code lottery and go to a great high school. I think education is great.
I also did enough work and volunteering in the inner city to know that you are absolutely correct - many people are utterly failed by system we have now.

...what do?

The most libertarian model would be stop all govt education and let parent's either home school or buy their own education or let the kids do trade/apprencticeship.

the middle ground should be 100% voucher programs. If the govt is going to take $7k per kid from tax payers for education, that money can "follow the kid" to whatever public or private option they want. It's about time to admit that the public school system fails dramatically in a lot of neighborhoods and letting those kids have some portability would be helpful

 

[762513]

How are parents who have experienced generational poverty and were themselves failed by the educational system expected to possess the knowledge necessary to teach a child to read?

 

[Cryc_to_the_point]

Well, in a way, I think the libertarian mindset is one of privilege and or hardwork. You wouldn't see a poor kid in the inner-city saying "Life is fair because all decisions made either set us up for failure or success and it is all of our own doings that will lead us to where we end up in the future" because at the end of the day, they have a ****ty life because of actions done by their parents, not by him. Because of where they are, they have to do way more to get to where the average middle-class person is. Now, perhaps on that kid's way through their ascension from poverty to middle-class, they could easily develop a "rugged individualistic" and libertarian mindset, but you have to go through those challenges to be able to look back and see it from the other side. Whereas a rich kid growing up with hardworking parents can easily jump onto this mindset.

The problem is, the mindset can only be seen from the people who have already put in the work to make something of themselves - and unfortunately the majority of our population just has too many extrinsic and intrinsic factors working against them to even begin that ascension. But perhaps making healthcare more accessible could help those on the bottom be healthier to make that climb to see the mindset?

Have you ever heard of Thomas Sowell? He beat the odds. He basically disagrees with this whole post.

 

[KeikoTanaka]

Have you ever heard of Thomas Sowell? He beat the odds. He basically disagrees with this whole post.

I have not, care to explain how he would disagree? I'm assuming he is someone who like I said "ascended" poverty and created a sociopolitical ideology about disparities?

 

[Cryc_to_the_point]

 

[KeikoTanaka]

Thanks, I'll give this a watch when I take a break from Anatomy lol

 

[jbax42]

I've never had this discussion before (NP vs MD) but I have had many discussions over proper titles in a customer setting as a microelectronics engineer and in a research setting as a bioengineering scientist/researcher specializing in neurological treatments (nerve regeneration, artificial limbs, genetic alterations, etc). Btw, you often do have patients in a research setting depending on the stage of the trial. Never once have we had the discussion over an earned title. It was typically over less clear situations where the title wasn't specifically earned. PhD, MD, DNP, etc. was irrelevant. The individual always is expected to introduce themselves by their proper title Dr. Xxx. Sometimes more detail is given in title, sometimes not. What is always given is the role being performed. "Hi, I'm Dr. man. I am in charge of Xxx.". The MD, PhD, DNP aspects are not important. Nor should they be. The only thing that's important is their role and responsibility. The title isn't even important, it's just a sign of respect for hard work earned. This was proper behavior regardless of setting patient was being monitored or seen in. The bottom line is that we are expected to have the capability to do our jobs.

I don't expect an MD to have my level of knowledge about neurology or genetics unless he's doing research. I've seen things that an MD would never see in a patient setting without the extra uncontrollable variables to cloud my interpretation of the data. I only expect them to understand the results of my papers and be able to apply them (in regards to providers not involved in research). They don't expect me to have complete knowledge of systemic responses of overall body under those many possible uncontrollable variables. Just like the DNP is expected to have a better understanding of the impact on the patient themselves and overall outcome (holistic) and not just the outcome of their specific conditions as well as the impact on the patients life. In other words, just because a treatment exists, it doesnt mean it will be adhered to or desired by the patient. (Those are all just examples). We all know the disease, the systems affected, and the treatment but our experiences, and therefore perspectives, are different.

In regards to the NP vs MD debate which keeps coming up here, after being involved in this discussion, I'm happy that it's happening (integration of focused system level healthcare provider). The trend is in NPs favor worldwide and research in places which have given NPs the ability to practice are showing consistent positive results from independently practicing NPs. So the argument that they aren't capable has been thoroughly disproved by independent research from what I've read. That said, as far as I'm aware, those NPs all had considerable experience. The only thing I would like see added is an experience requirement that other licensed professions dealing with public safety are required to possess.

Other than that, I think this is good for the field and good for MDs. Not just because it will reduce their load, but because it will lead to more small businesses and more affordable Healthcare which are both good for the economy and society. Also, hopefully it will change the culture I'm seeing in this discussion where people believes their superior or more capable than others based on easily deconstructed arguments. I hope this is primarily an issue with med students and that they grow out of it with experience because I have not noticed this level of superiority complex in any professional.

 

[jbax42]

There are standards for a reason (even if set by the government and licensing bodies) and by NPs gaining independence, you're artificially lowering the standards needed by healthcare providers to practice medicine, which can down the road can lead to a two-tiered healthcare system - which, back to my other points about policies that directly are possibly bad for the American public as a whole - I have to say I don't want to see. Poor patients see NPs and wealthier patient's see Physicians, exacerbating the health disparities in our country. If NPs want independence, they should meet the same standards as other independent practitioners (DOs/MDs), which means taking the same boards and certification exams. Otherwise, they should be supervised. Or, DOs and MDs should have a load off of our curriculum because clearly much of our school is a waste of time and money. But, tbh, I don't think it is.

Hmm... Maybe you should answer this question. And really think about it because this is what the very experienced doctors who worked with the nurses to create the NP program would have had to do. What parts of your knowledge base, do you need to function as an independent provider in a primary care function? I'm not sure if you have ever taught a class or prepared students for a job but this is a common thing that must be addressed when doing so. After you answer that question, you may find yourself surprised at how little you need compared to what you learned. That's OK, that is normal for every field. That's because the US higher education system prepares you for a wide variety of possibilities by giving you a very thorough overarching background.

NP seems to be very different than PA in regards to their education focus. PA program appears to be a shortened replica of the MD program. You go into after finishing your undergrad studies and take a quick version of everything MDs take. Even rotations are like MD and split across 6-7 areas but for much shorter time. In other words, they can function as assistants like the title explains.

NP training appears to significantly different. It focuses on a very specific job. It would be like an MD only learning about Family practice and the necessary information for it. They also typically require 2 years experience as a RN for acceptance differentiating it from PA (and MD) since this provides a different perspective and experience on patient care. Will it be successful? I don't know but it appears to be fundamentally different than PAs and were never meant to be a mid level provider. It appears to be a focused provider from a nursing perspective. The name they chose should have alluded to that. Nurse practitioner.

So I don't think they diminish the MD at all. I think they add perspective to the field and bring back the discussion of "what is necessary to do the job?". The only people who can make it diminish their role are MDs. It's all about how you frame it. You guys/girls seem to be belittling Yourselves by implying that just because someone else can do it, it must be easy or make your degree worth less. How about, they were prepared for the role and have the capacity to do that specific job?

Bottom line is that the nurses lobbying power is stronger than physicians and there is a societal need for NPs to be able independently practice. They will win this battle. They want independence and they will get it. Smart business would be finding a way to make them codependent because they clearly aren't going to settle for complete dependence.

 

[Cryc_to_the_point]

NP training appears to significantly different. It focuses on a very specific job. It would be like an MD only learning about Family practice and the necessary information for it. They also typically require 2 years experience as a RN for acceptance differentiating it from PA (and MD) since this provides a different perspective and experience on patient care. Will it be successful? I don't know but it appears to be fundamentally different than PAs and were never meant to be a mid level provider. It appears to be a focused provider from a nursing perspective. The name they chose should have alluded to that. Nurse practitioner.

NPs were never designed to be independent practitioners. They were originally created as a stopgap that would defer to physicians when available and augment physician lead care when they were available. Further, the NP curriculum is loaded with fluff which PAs have none of. Nursing theory, poor quality "research," and a hilariously short clinical requirement are the hallmarks of the lackluster DNP curriculum of today.

All the above could be changed, and if it were, many in medicine would be far more welcoming. The issue is NPs want to point to some incredibly biased and limited scope studies and say in effect "NP = MD," without actually earning it. If you cannot understand how that flies in the face of those of us who either have or are studying to care for people independently then I think you're being willfully dense.

 

[762513]

NPs were never designed to be independent practitioners. They were originally created as a stopgap that would defer to physicians when available and augment physician lead care when they were available. Further, the NP curriculum is loaded with fluff which PAs have none of. Nursing theory, poor quality "research," and a hilariously short clinical requirement are the hallmarks of the lackluster DNP curriculum of today.

All the above could be changed, and if it were, many in medicine would be far more welcoming. The issue is NPs want to point to some incredibly biased and limited scope studies and say in effect "NP = MD," without actually earning it. If you cannot understand how that flies in the face of those of us who either have or are studying to care for people independently then I think you're being willfully dense.

This is incorrect. NP’s were designed to function independently in rural settings that physicians were not present in.,

 

[NicMouse64]

I've never had this discussion before (NP vs MD) but I have had many discussions over proper titles in a customer setting as a microelectronics engineer and in a research setting as a bioengineering scientist/researcher specializing in neurological treatments (nerve regeneration, artificial limbs, genetic alterations, etc). Btw, you often do have patients in a research setting depending on the stage of the trial. Never once have we had the discussion over an earned title. It was typically over less clear situations where the title wasn't specifically earned. PhD, MD, DNP, etc. was irrelevant. The individual always is expected to introduce themselves by their proper title Dr. Xxx. Sometimes more detail is given in title, sometimes not. What is always given is the role being performed. "Hi, I'm Dr. man. I am in charge of Xxx.". The MD, PhD, DNP aspects are not important. Nor should they be. The only thing that's important is their role and responsibility. The title isn't even important, it's just a sign of respect for hard work earned. This was proper behavior regardless of setting patient was being monitored or seen in. The bottom line is that we are expected to have the capability to do our jobs.

I don't expect an MD to have my level of knowledge about neurology or genetics unless he's doing research. I've seen things that an MD would never see in a patient setting without the extra uncontrollable variables to cloud my interpretation of the data. I only expect them to understand the results of my papers and be able to apply them (in regards to providers not involved in research). They don't expect me to have complete knowledge of systemic responses of overall body under those many possible uncontrollable variables. Just like the DNP is expected to have a better understanding of the impact on the patient themselves and overall outcome (holistic) and not just the outcome of their specific conditions as well as the impact on the patients life. In other words, just because a treatment exists, it doesnt mean it will be adhered to or desired by the patient. (Those are all just examples). We all know the disease, the systems affected, and the treatment but our experiences, and therefore perspectives, are different.

In regards to the NP vs MD debate which keeps coming up here, after being involved in this discussion, I'm happy that it's happening (integration of focused system level healthcare provider). The trend is in NPs favor worldwide and research in places which have given NPs the ability to practice are showing consistent positive results from independently practicing NPs. So the argument that they aren't capable has been thoroughly disproved by independent research from what I've read. That said, as far as I'm aware, those NPs all had considerable experience. The only thing I would like see added is an experience requirement that other licensed professions dealing with public safety are required to possess.

Other than that, I think this is good for the field and good for MDs. Not just because it will reduce their load, but because it will lead to more small businesses and more affordable Healthcare which are both good for the economy and society. Also, hopefully it will change the culture I'm seeing in this discussion where people believes their superior or more capable than others based on easily deconstructed arguments. I hope this is primarily an issue with med students and that they grow out of it with experience because I have not noticed this level of superiority complex in any professional.

Lol you still haven't answered my p-value question. Just stop, we know you are a poser lol. like seriously how many times am I gonna have to ask you a basics stats question until you prove you have all this "experience" you say you have?

 

[Cryc_to_the_point]

This is incorrect. NP’s were designed to function independently in rural settings that physicians were not present in.,

You are incorrect. Unless you mean "independent to a limited degree and under the authority of a remote physician." They were not created as a different brand of FM physician, no matter how badly you wish they were.

 

[NicMouse64]

This is incorrect. NP’s were designed to function independently in rural settings that physicians were not present in.,

What he said ^^. That's just what you guys like to jump on lol. What is it with NPs and thinking they are somehow experts in rural medicine?

 

[762513]

What he said ^^. That's just what you guys like to jump on lol. What is it with NPs and thinking they are somehow experts in rural medicine?

I didn't say a thing about being a expert in rural medicine. Read what was written.

You are incorrect. Unless you mean "independent to a limited degree and under the authority of a remote physician." They were not created as a different brand of FM physician, no matter how badly you wish they were.

I never said they were created as a different brand of FM. Read what was written.

I am an NP. I should know where the first program is and what it was created for.

https://cspcs.sanford.duke.edu/site...se_practitioners_and_physician_assistants.pdf

 

[jbax42]

Lol you still haven't answered my p-value question. Just stop, we know you are a poser lol. like seriously how many times am I gonna have to ask you a basics stats question until you prove you have all this "experience" you say you have?

The reason I'm not acknowledging your post is because you still have not provided me with any reference. If you have done even a remote amount of research, you would know that p values is often used incorrectly and must be considered in context to ensure it is properly interpreted. If you would like me to review a paper, post it. And I will inform you of the significance of its p value.

In general and in theory, if used and interpreted correctly, it can help test the validity of a null hypothesis (no correlation between two characteristics), given all other assumptions hold, by providing the probability of getting a result that is at least as high as that observed. In practice, that is not always the case and we do not rely solely on it. So this conversation is irrelevant.

 

[Cryc_to_the_point]

I didn't say a thing about being a expert in rural medicine. Read what was written.

I never said they were created as a different brand of FM. Read what was written.

I am an NP. I should know where the first program is and what it was created for.

https://cspcs.sanford.duke.edu/site...se_practitioners_and_physician_assistants.pdf

My grandmother was one of the first NPs in our state. I know the history. Your cited link says not one thing about the roughly 15 years (1965-1980) of supervised practice NPs in CO did before being granted "independent practice." They were not created to be autonomous, or more accurately not in the full extend that the word is used at this point.

 

[jbax42]

What he said ^^. That's just what you guys like to jump on lol. What is it with NPs and thinking they are somehow experts in rural medicine?

"In the late 1950s and early 1960s, physicians began mentoring and collaborating with nurses who had clinical experience. In addition, increasing specialization in medicine led a large number of physicians out of primary care, creating a shortage of primary care physicians and leaving many areas, especially rural areas, medically underserved. In 1965, the Medicare and Medicaid programs provided health care coverage to low-income women, children, the elderly, and people with disabilities. The sudden availability of coverage increased the demand for expanded primary care services. Because physicians were unable to meet this demand, nurses "stepped into the breach." Nursing leaders believed that nurses were qualified to expand their roles and meet the need."

That's literally the history of NP word for word. They were definitely created to practice independent in rural areas. It's literally recorded history. They were never meant to be under physicians.

 

[Cryc_to_the_point]

Where does it say independently? Show me. Because it doesn't. PAs provide the exact same capability... yet they don't require independence.

 

[jbax42]

Where does it say independently? Show me. Because it doesn't. PAs provide the exact same capability... yet they don't require independence.

I think it's implied if the issue is that there are no physicians in these areas and they needed someone to come work in these areas. The history supports this implication. You can't expect oversight if the issue is that there was no one there to provide oversight. Hence why most states which originally allowed NP private practice are states where MDs historically do not like to go (rural, low pay).

 

[jbax42]

My grandmother was one of the first NPs in our state. I know the history. Your cited link says not one thing about the roughly 15 years (1965-1980) of supervised practice NPs in CO did before being granted "independent practice." They were not created to be autonomous, or more accurately not in the full extend that the word is used at this point.

That's a bit misleading. The practice was created in Colorado and with the intention of independent practice or autonomy. The 15 years you speak of were out of necessity, not desire or intention:

"Health care professionals were concerned that NPs were not qualified to provide medical care that physicians usually delivered without the supervision of a physician.

During the 1970s and 1980s, Nurse Practitioners took up the task of validating their profession. The lack of a credentialing process and training paired with the improvements in health care put pressure on NPs to showcase their abilities and their overall benefit to health care. NPs used this time to document patient satisfaction with their care and create criteria and standards of practice. They also monitored the overall increase of the availability of primary care to patients throughout the country via evidence-based studies.

During the late 1980s, Nurse Practitioners did not have provider status in the eyes of the government. This meant their services had no designated monetary value and were not reimbursable. Lacking this status, NPs were not viewed as autonomous health care providers, making the utilization of their services difficult. During this time, reimbursement typically came via a paycheck from a physician or hospital."

Etc etc. Until they got their right to practice.

The point is that from everything I've read, it was always meant to be independent. It was only under supervision of physician due to necessity of having to develop their profession and get paid and respected due to how new it was. Not due to intentions. Those were made very clear.

Btw, everything I posted in quotes is from medline or Simmons college which has a public page dedicated to the history of nurse practitioner with citations. Well, Both have citations.

 

[KeikoTanaka]

Oversight of NPs in rural areas is very possible with the use of technology that did not exist in the 1960s, or even late 80s. No one is willing to incorporate the technology to do it though. It would be good for both physicians and NPs and the patients in the long run.

 

[NicMouse64]

That's a bit misleading. The practice was created in Colorado and with the intention of independent practice or autonomy. The 15 years you speak of were out of necessity, not desire or intention:

"Health care professionals were concerned that NPs were not qualified to provide medical care that physicians usually delivered without the supervision of a physician.

During the 1970s and 1980s, Nurse Practitioners took up the task of validating their profession. The lack of a credentialing process and training paired with the improvements in health care put pressure on NPs to showcase their abilities and their overall benefit to health care. NPs used this time to document patient satisfaction with their care and create criteria and standards of practice. They also monitored the overall increase of the availability of primary care to patients throughout the country via evidence-based studies.

During the late 1980s, Nurse Practitioners did not have provider status in the eyes of the government. This meant their services had no designated monetary value and were not reimbursable. Lacking this status, NPs were not viewed as autonomous health care providers, making the utilization of their services difficult. During this time, reimbursement typically came via a paycheck from a physician or hospital."

Etc etc. Until they got their right to practice.

The point is that from everything I've read, it was always meant to be independent. It was only under supervision of physician due to necessity of having to develop their profession and get paid and respected due to how new it was. Not due to intentions. Those were made very clear.

Btw, everything I posted in quotes is from medline or Simmons college which has a public page dedicated to the history of nurse practitioner with citations. Well, Both have citations.

Hey man....P-value.....ya ok.

 

[Cryc_to_the_point]

That's a bit misleading. The practice was created in Colorado and with the intention of independent practice or autonomy. The 15 years you speak of were out of necessity, not desire or intention:

"Health care professionals were concerned that NPs were not qualified to provide medical care that physicians usually delivered without the supervision of a physician.

During the 1970s and 1980s, Nurse Practitioners took up the task of validating their profession. The lack of a credentialing process and training paired with the improvements in health care put pressure on NPs to showcase their abilities and their overall benefit to health care. NPs used this time to document patient satisfaction with their care and create criteria and standards of practice. They also monitored the overall increase of the availability of primary care to patients throughout the country via evidence-based studies.

During the late 1980s, Nurse Practitioners did not have provider status in the eyes of the government. This meant their services had no designated monetary value and were not reimbursable. Lacking this status, NPs were not viewed as autonomous health care providers, making the utilization of their services difficult. During this time, reimbursement typically came via a paycheck from a physician or hospital."

Etc etc. Until they got their right to practice.

The point is that from everything I've read, it was always meant to be independent. It was only under supervision of physician due to necessity of having to develop their profession and get paid and respected due to how new it was. Not due to intentions. Those were made very clear.

Btw, everything I posted in quotes is from medline or Simmons college which has a public page dedicated to the history of nurse practitioner with citations. Well, Both have citations.

You present me nothing about that intention, it's all "read in." The issue is, NPs never did validate their "right," to independent practice. They lobbied for it, but never proved much of anything. The reality is that physician remote oversight basically has no downside. I think the oversight is needed and funny enough, so did many of the first generation of NPs. They didn't have a chip on their shoulder.

 

[NicMouse64]

You present me nothing about that intention, it's all "read in." The issue is, NPs never did validate their "right," to independent practice. They lobbied for it, but never proved much of anything. The reality is that physician remote oversight basically has no downside. I think the oversight is needed and funny enough, so did many of the first generation of NPs. They didn't have a chip on their shoulder.

Don't respond or read his stuff. he can't even explain basic statistics to us.

 

[jbax42]

Oversight of NPs in rural areas is very possible with the use of technology that did not exist in the 1960s, or even late 80s. No one is willing to incorporate the technology to do it though. It would be good for both physicians and NPs and the patients in the long run.

I'll say this again. I think practices should be required to have both a physician and NP. Not necessarily in a supervisory role. In a codependent relationship. Physicians fail horribly at patient centered care. Imho, They often understand the disease more than the person. Studies have shown that this leads to poor health in patients because it affects patient compliance with treatment. This is something that the NP model of Healthcare practictioning seems to address which could account for why their success rates in studies have been similar to MDs. In other words, if you can't get your patients to comply with the treatments then the treatment has failed. I think they could leverage each other's strength. I don't think it's a one is better than the other situation. At least when it comes to primary care.

It would be like an civil engineer telling an architect that they require their oversight. It's simply not true. They are both tackling the problem from two different viewpoints but will up at the same goal if working independently with minor differences (one will be more design oriented and the other will be more practical) . That said, when working together as equals and leveraging each other, they can develop an amazing masterpiece.

You have to realize that there is more than one way to do everything and each way will have its limits and benefits. Don't get stuck in the mindset that one way is the best way. It's a horribly limiting mindset. Our current medical model that physicians follow (disease centered care) works far better in a hospital setting than in primary care setting. There are plenty of studies showing this. The NP model appears to address these issues. Studies have shown that patient adherence in NP managed clinics was significantly higher leading to better patient outcomes in caring for their conditions long term.

That said, I find it interesting that even with higher adherence, they would only able to get similar patient outcomes as physicians. Some studies were higher but most were about equal or so close that it's within the margin of error. If they have higher adherence, with all other variables holding, the outcome should be consistently higher. That's why I think they should leverage each other and acknowledge that they both suck in certain areas (we all have weaknesses) and need each for better patient health. Stop trying to be someone else's superior and just be their coworker.

 

[deleted480308]

I'll say this again. I think practices should be required to have both a physician and NP. Not necessarily in a supervisory role. In a codependent relationship. Physicians fail horribly at patient centered care. Imho, They often understand the disease more than the person. Studies have shown that this leads to poor health in patients because it affects patient compliance with treatment. This is something that the NP model of Healthcare practictioning seems to address which could account for why their success rates in studies have been similar to MDs. In other words, if you can't get your patients to comply with the treatments then the treatment has failed. I think they could leverage each other's strength. I don't think it's a one is better than the other situation. At least when it comes to primary care.

It would be like an civil engineer telling an architect that they require their oversight. It's simply not true. They are both tackling the problem from two different viewpoints but will up at the same goal if working independently with minor differences (one will be more design oriented and the other will be more practical) . That said, when working together as equals and leveraging each other, they can develop an amazing masterpiece.

You have to realize that there is more than one way to do everything and each way will have its limits and benefits. Don't get stuck in the mindset that one way is the best way. It's a horribly limiting mindset. Our current medical model that physicians follow (disease centered care) works far better in a hospital setting than in primary care setting. There are plenty of studies showing this. The NP model appears to address these issues. Studies have shown that patient adherence in NP managed clinics was significantly higher leading to better patient outcomes in caring for their conditions long term.

That said, I find it interesting that even with higher adherence, they would only able to get similar patient outcomes as physicians. Some studies were higher but most were about equal or so close that it's within the margin of error. If they have higher adherence, with all other variables holding, the outcome should be consistently higher. That's why I think they should leverage each other and acknowledge that they both suck in certain areas (we all have weaknesses) and need each for better patient health. Stop trying to be someone else's superior and just be their coworker.

Docs don't fail at care, the NPs haven't been shown to be equivalent

You're dropping cliches that mean nothing