Med school prestige, MD vs DO, specialty arguments are completely toxic

[Dr. Rafiki]

Dr. Rafiki, who introduced this topic into the thread, said that what the NP in question did was a felony and was going to face jail time. Hence my question.


This is qualitatively different from the janitor stepping into a patient room with a borrowed white coat and providing patient care. What the NP did was presumably legal except for the fact she introduced herself as a doctor. Whether the law groups both cases under the same legal umbrella wasn't my question, my question was whether it's ethical to ruin someone's career and life over how they introduced themselves provided the patient was not harmed and the transgression can be avoided in the future with an institutional action.

It was a PA, actually. Though that doesn't change my opinion on the matter either way.

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[goatmed]

It's extreme but necessary response as long as aggressive midlevel campaigning exists and physicians keep losing their jobs to midlevels.

I guess you and I have to disagree here. Punishing an individual with imprisonment and taking their career for their group's advocacy feels too vicious for me even if you disagree with that group's advocacy. This person may have student debt like you and me, and may have a family to take care of as well. Punishing them with prison and a lifetime of menial jobs because you feel they attack your career opportunities is too much.

And even the notion NPs/PAs are nefarious job-takers does not ring true to me. I may be opening a can of worms with this argument, but I don't think physicians are going on unemployment at any significant number because of NPs or PAs. The most convincing argument about NPs hurting physicians I have seen in this thread is that physician jobs are less available in desirable cities, and I agree with the earlier poster that feeling attacked because it's not easy to live in a city of your desiring is incredibly entitled and I hope nobody here went into medicine because they wanted a job in a cozy city and not to worry about the job market like every other human being with a degree.

We need standards and repercussions. I'm old school. You want to eat at our table, you gotta work for it. Every physician is held to a certain standard and if you want to call yourself "Doctor" in a clinical setting like that, you better bare the responsibilities too just like us and not run the opposite direction when **** hits the fan. And I will bet that most of these mid-level would not be willing to gamble that.

Because I hear it at their school tours all the time when they come to our hospital, "It's like all the fun of being a doctor without all that responsibility LoLZZZZ".

You think you can come into our turf, with your fig scrub, lab coat, working 3 12 hrs shift, taking 2 classes and getting your DNP online with your fake research "capstone" studies, while my comrades and I are in 300K debt, haven't bought new clothes in 2 years, in before the break of dawn, out 14 hrs later and have to answer to higher ups when you f**k something up and get burden of your mistakes? No...I refused to accept that and every future physician should be just as furious.

You certainly sound passionate about your dislike for NPs, and in a thread about toxic physician behaviors no less.
But you'll notice I made no arguments about the liability to which NPs should be held by law, and you'll indeed find no arguments with me here. This isn't a question of someone escaping liability.
As for the rest of your argument, I cannot convince you to be any less bitter about who they are or what they do, but I would like to compel you to realize your years of medical student suffering don't make inflicting suffering on people of different careers, by litigation or otherwise, any more OK.

It was a PA, actually. Though that doesn't change my opinion on the matter either way.

Sorry for my mistake. Just out of curiosity, if one of your MS3/MS4 colleagues or friends introduced themselves to a patient as "Dr. ____" would you a)consider it fair and b)be compelled to make sure this student serves their time behind bars and spends the rest of their life with a criminal record, given the option to have this student get a stern talking-to or IA by the dean and continue their career? I think you can guess where I would stand here so I won't bore you with my response.

 

[Matthew9Thirtyfive]

Sorry for my mistake. Just out of curiosity, if one of your MS3/MS4 colleagues or friends introduced themselves to a patient as "Dr. ____" would you a)consider it fair and b)be compelled to make sure this student serves their time behind bars and spends the rest of their life with a criminal record, given the option to have this student get a stern talking-to or IA by the dean and continue their career? I think you can guess where I would stand here so I won't bore you with my response.

If my friend referred to herself as a doctor as an MS3 I would absolutely tell her to stop because it is extremely misleading. Anyone who is not a physician should not be calling themselves doctor in a clinical setting. We have some attendings at our school who call us doctor and even if it isn’t around patients, it makes me extremely uncomfortable.

 

[PTPuser]

I guess you and I have to disagree here. Punishing an individual with imprisonment and taking their career for their group's advocacy feels too vicious for me even if you disagree with that group's advocacy. This person may have student debt like you and me, and may have a family to take care of as well. Punishing them with prison and a lifetime of menial jobs because you feel they attack your career opportunities is too much.

And even the notion NPs/PAs are nefarious job-takers does not ring true to me. I may be opening a can of worms with this argument, but I don't think physicians are going on unemployment at any significant number because of NPs or PAs. The most convincing argument about NPs hurting physicians I have seen in this thread is that physician jobs are less available in desirable cities, and I agree with the earlier poster that feeling attacked because it's not easy to live in a city of your desiring is incredibly entitled and I hope nobody here went into medicine because they wanted a job in a cozy city and not to worry about the job market like every other human being with a degree.



You certainly sound passionate about your dislike for NPs, and in a thread about toxic physician behaviors no less.
But you'll notice I made no arguments about the liability to which NPs should be held by law, and you'll indeed find no arguments with me here. This isn't a question of someone escaping liability.
As for the rest of your argument, I cannot convince you to be any less bitter about who they are or what they do, but I would like to compel you to realize your years of medical student suffering don't make inflicting suffering on people of different careers, by litigation or otherwise, any more OK.


Sorry for my mistake. Just out of curiosity, if one of your MS3/MS4 colleagues or friends introduced themselves to a patient as "Dr. ____" would you a)consider it fair and b)be compelled to make sure this student serves their time behind bars and spends the rest of their life with a criminal record, given the option to have this student get a stern talking-to or IA by the dean and continue their career? I think you can guess where I would stand here so I won't bore you with my response.

I don't have disdain for them because they're NP. I was a nurse. My love one was missed diagnosed 3 times by an NP for her oral cancer and this particular NP was a road block at every stop when I tried advocating for a referral or even to just be seen by an attending. I don't like their education and I don't like the rogue ones that wants to be on their own.

I don't know what the perfect sentence would be when one is found at fault but I do believe there should be one strong enough that will compel one to stop mislabeling themselves again.

My rant about being called a doctor was just my own take on the situation and is in no mean trying to argue with you about repercussions.

 

[Lawpy]

I guess you and I have to disagree here. Punishing an individual with imprisonment and taking their career for their group's advocacy feels too vicious for me even if you disagree with that group's advocacy. This person may have student debt like you and me, and may have a family to take care of as well. Punishing them with prison and a lifetime of menial jobs because you feel they attack your career opportunities is too much.

And even the notion NPs/PAs are nefarious job-takers does not ring true to me. I may be opening a can of worms with this argument, but I don't think physicians are going on unemployment at any significant number because of NPs or PAs. The most convincing argument about NPs hurting physicians I have seen in this thread is that physician jobs are less available in desirable cities, and I agree with the earlier poster that feeling attacked because it's not easy to live in a city of your desiring is incredibly entitled and I hope nobody here went into medicine because they wanted a job in a cozy city and not to worry about the job market like every other human being with a degree.



You certainly sound passionate about your dislike for NPs, and in a thread about toxic physician behaviors no less.
But you'll notice I made no arguments about the liability to which NPs should be held by law, and you'll indeed find no arguments with me here. This isn't a question of someone escaping liability.
As for the rest of your argument, I cannot convince you to be any less bitter about who they are or what they do, but I would like to compel you to realize your years of medical student suffering don't make inflicting suffering on people of different careers, by litigation or otherwise, any more OK.


Sorry for my mistake. Just out of curiosity, if one of your MS3/MS4 colleagues or friends introduced themselves to a patient as "Dr. ____" would you a)consider it fair and b)be compelled to make sure this student serves their time behind bars and spends the rest of their life with a criminal record, given the option to have this student get a stern talking-to or IA by the dean and continue their career? I think you can guess where I would stand here so I won't bore you with my response.

A lot of them endanger patient care with bad decisions because the quality of their education and training is highly variable. Sorry but i don't have much sympathy for them

 

[Damson]

A lot of them endanger patient care with bad decisions because the quality of their education and training is highly variable. Sorry but i don't have much sympathy for them

lawper pls change name backkk

 

[goatmed]

If my friend referred to herself as a doctor as an MS3 I would absolutely tell her to stop because it is extremely misleading. Anyone who is not a physician should not be calling themselves doctor in a clinical setting. We have some attendings at our school who call us doctor and even if it isn’t around patients, it makes me extremely uncomfortable.

100% with you on that, I'm just questioning what a reasonable repercussion for doing it is. Telling your friend or even telling a supervisor so the supervisor will compel them to correct their behavior both seem OK.

I don't have disdain for them because they're NP. I was a nurse. My love one was missed diagnosed 3 times by an NP for her oral cancer and this particular NP was a road block at every stop when I tried advocating for a referral or even to just be seen by an attending. I don't like their education and I don't like the rogue ones that wants to be on their own.

I don't know what the perfect sentence would be when one is found at fault but I do believe there should be one strong enough that will compel one to stop mislabeling themselves again.

My rant about being called a doctor was just my own take on the situation and is in no mean trying to argue with you about repercussions.

Sorry to hear about your loved one. I agree arguments from quality hold water and should be used to advocate to hospital administrations and legislators regarding who they allow to practice independently. I just don't think this one should take the brunt of the blame because her career is a misguided attempt to fill gaps in access to physicians and lower exorbitant costs of care.

A lot of them endanger patient care with bad decisions because the quality of their education and training is highly variable. Sorry but i don't have much sympathy for them

Then you should take issue with the institutions that train them irregularly and those that give them the right to practice beyond what a reasonable scope is. It doesn't mean you should send one to jail over it because they misrepresented themselves in the absence of patient harm. The issues you complain about are issues of the career and not something this particular allied health professional is being blamed for.
Supporting the punishment of people because of their group belonging comes pretty close to what I would call discriminatory treatment for lack of a better word, and, in the spirit of this thread, very much a toxic behavior. This is not how you legitimize your grievances in the eyes of legislators or the public or make them see that the current system needs reform for the sake of patients, but rather how you legitimize the view medicine is a guild like any other trying to protect, as PTPuser put it, its "turf".

 

[Neopolymath]

100% with you on that, I'm just questioning what a reasonable repercussion for doing it is. Telling your friend or even telling a supervisor so the supervisor will compel them to correct their behavior both seem OK.


Sorry to hear about your loved one. I agree arguments from quality hold water and should be used to advocate to hospital administrations and legislators regarding who they allow to practice independently. I just don't think this one should take the brunt of the blame because her career is a misguided attempt to fill gaps in access to physicians and lower exorbitant costs of care.



Then you should take issue with the institutions that train them irregularly and those that give them the right to practice beyond what a reasonable scope is. Not that you should send one to jail over it because they misrepresented themselves in the absence of patient harm. The issues you complain about are issues of the career and not something this particular allied health professional is being blamed for.
Supporting the punishment of people because of their group belonging comes pretty close to what I would call discriminatory treatment for lack of a better word, and, in the spirit of this thread, very much a toxic behavior. This is not how you legitimize your grievances in the eyes of legislators or the public or make them see that the current system needs reform for the sake of patients, but rather how you legitimize the view medicine is a guild like any other trying to protect, as PTPuser put it, its "turf".

They started a war. There are casualties of war. Forgive me for not weeping for people actively engaging in behavior that their orgs are fighting for that are bad. Unfortunately, examples will be made and patients will suffer. Not our fault or problem. We aren't the ones acting stupid or advocating for dumb things.

Your attitude is what will get us the same training pathway/debt/problems but 100k wages because of BS virtue signalling and shaming people for looking out for physician interests. I'm thankful most people aren't so naive otherwise we would all be like lawyers and pharmacists.

 

[Lawpy]

100% with you on that, I'm just questioning what a reasonable repercussion for doing it is. Telling your friend or even telling a supervisor so the supervisor will compel them to correct their behavior both seem OK.


Sorry to hear about your loved one. I agree arguments from quality hold water and should be used to advocate to hospital administrations and legislators regarding who they allow to practice independently. I just don't think this one should take the brunt of the blame because her career is a misguided attempt to fill gaps in access to physicians and lower exorbitant costs of care.



Then you should take issue with the institutions that train them irregularly and those that give them the right to practice beyond what a reasonable scope is. It doesn't mean you should send one to jail over it because they misrepresented themselves in the absence of patient harm. The issues you complain about are issues of the career and not something this particular allied health professional is being blamed for.
Supporting the punishment of people because of their group belonging comes pretty close to what I would call discriminatory treatment for lack of a better word, and, in the spirit of this thread, very much a toxic behavior. This is not how you legitimize your grievances in the eyes of legislators or the public or make them see that the current system needs reform for the sake of patients, but rather how you legitimize the view medicine is a guild like any other trying to protect, as PTPuser put it, its "turf".

That's hard to do as a student or trainee since doing so will only result in getting slammed by the malignant attendings and admins for "professionalism".

 

[Splenda88]

 

[PTPuser]

100% with you on that, I'm just questioning what a reasonable repercussion for doing it is. Telling your friend or even telling a supervisor so the supervisor will compel them to correct their behavior both seem OK.


Sorry to hear about your loved one. I agree arguments from quality hold water and should be used to advocate to hospital administrations and legislators regarding who they allow to practice independently. I just don't think this one should take the brunt of the blame because her career is a misguided attempt to fill gaps in access to physicians and lower exorbitant costs of care.



Then you should take issue with the institutions that train them irregularly and those that give them the right to practice beyond what a reasonable scope is. It doesn't mean you should send one to jail over it because they misrepresented themselves in the absence of patient harm. The issues you complain about are issues of the career and not something this particular allied health professional is being blamed for.
Supporting the punishment of people because of their group belonging comes pretty close to what I would call discriminatory treatment for lack of a better word, and, in the spirit of this thread, very much a toxic behavior. This is not how you legitimize your grievances in the eyes of legislators or the public or make them see that the current system needs reform for the sake of patients, but rather how you legitimize the view medicine is a guild like any other trying to protect, as PTPuser put it, its "turf".

No one is putting a gun to these people's head and ordering them to call themselves "doctor" or they'll be shot. They know damn well what they're doing. That alone makes it enough for a hard repercussion.

 

[libertyyne]

100% with you on that, I'm just questioning what a reasonable repercussion for doing it is. Telling your friend or even telling a supervisor so the supervisor will compel them to correct their behavior both seem OK.


Sorry to hear about your loved one. I agree arguments from quality hold water and should be used to advocate to hospital administrations and legislators regarding who they allow to practice independently. I just don't think this one should take the brunt of the blame because her career is a misguided attempt to fill gaps in access to physicians and lower exorbitant costs of care.



Then you should take issue with the institutions that train them irregularly and those that give them the right to practice beyond what a reasonable scope is. It doesn't mean you should send one to jail over it because they misrepresented themselves in the absence of patient harm. The issues you complain about are issues of the career and not something this particular allied health professional is being blamed for.
Supporting the punishment of people because of their group belonging comes pretty close to what I would call discriminatory treatment for lack of a better word, and, in the spirit of this thread, very much a toxic behavior. This is not how you legitimize your grievances in the eyes of legislators or the public or make them see that the current system needs reform for the sake of patients, but rather how you legitimize the view medicine is a guild like any other trying to protect, as PTPuser put it, its "turf".

Please give me an single instance where a nurse practioner was jailed for misrepresenting her credentials as "doctor' . You wont find any.
Also The person who reported it went to the PA's supervising physician and got nothign but blow back, so going up the chain to medical board was completely appropriate when you are not getting an appropriate response.

That person chose to identify themselves in a manner that is against the law, and against the code of conduct of the professional body. There are literally systems and people in place to make the determination of how they should be reprimanded accordingly. But I am willing to bet a relatively large sum of money they are not going to be going to jail. so your entire premise is faulty.

 

[Matthew9Thirtyfive]

100% with you on that, I'm just questioning what a reasonable repercussion for doing it is. Telling your friend or even telling a supervisor so the supervisor will compel them to correct their behavior both seem OK

Practicing medicine without a license should result in repercussions. Misrepresenting yourself intentionally should not be tolerated because that’s not going to suddenly stop when they graduate.

 

[PTPuser]

BTW, defending medicine and the physician community should not be looked at as "toxic".

Just because I don't want a bunch of mid-level with script pad who orders cough medicine for lisinopril reaction and watering down the profession doesn't make me bat soup level bad.

 

[gjpearce]

I'm on a rotation where my attending introduced his PA as "doctor" and explained that she'll be doing most of the precepting. She introduces herself as a "doctor on the (service) team" to the patients right in front of the attending.

I brought up how inappropriate this was and actually is illegal in my state to mislead patients by calling yourself doctor as a non-physician and he filed a "professionalism" complaint against me to my school.

So this profession is f***ed and I can't wait to gain financial independence a go full time real estate investing cuz damn this life is a nightmare.

I BELIEVE THE PROFESSION IS DOOMED WHEN ANYBODY IN A WHITE JACKET IS CONSIDERED A DOCTOR!

 

[goatmed]

They started a war. There are casualties of war. Forgive me for not weeping for people actively engaging in behavior that their orgs are fighting for that are bad. Unfortunately, examples will be made and patients will suffer. Not our fault or problem. We aren't the ones acting stupid or advocating for dumb things.

Your attitude is what will get us the same training pathway/debt/problems but 100k wages because of BS virtue signalling and shaming people for looking out for physician interests. I'm thankful most people aren't so naive otherwise we would all be like lawyers and pharmacists.

You sound very bitter about mid-levels. Do you think PAs and NPs wake up every morning and think "today I'm gonna set out to do things that should be left to physicians and take their jobs and be reckless"? Should we respond to their encroachment into our "turf" by finding reasons to put them in jail?
"Casualties of war" sounds fine until it's your relative or friend whose life you ruined over a dispute regarding your career opportunities. If sympathy for another hospital worker seems like BS virtue signaling to you then I don't know what to tell you, but if I did it would go something like this.

I never shamed anyone for "looking out for physician interests," I criticized them for thinking that putting someone behind bars because they threaten physician interests is an acceptable means of doing so. I've made my case above and you can read it.

But God forbid we, members of one of the postgraduate careers which rejects the most applicants have to get jobs in places we don't want like lawyers and pharmacists!

That's hard to do as a student or trainee since doing so will only result in getting slammed by the malignant attendings and admins for "professionalism".

I don't know the full story of Dr. Rafiki or whether he/she had a conversation with his hospital administration where he explained that using the title is a felony and that it is both in the school's and the hospital's interest as well as ethical for patient care that the behavior stop. If this all happened and he found no resolution or received retaliation, going higher up the ladder seems reasonable. I don't know what kind of infrastructure exists in other people's medical schools, but mine has multiple avenues to discuss professionalism concerns (hotlines, scores of administration members, an office of the ombudsman) and specific guidelines against retaliation for bringing those up to an attending or administration member. I would expect the tightly regulating LCME had made these standard in schools.

Please give me an single instance where a nurse practioner was jailed for misrepresenting her credentials as "doctor' . You wont find any.
Also The person who reported it went to the PA's supervising physician and got nothign but blow back, so going up the chain to medical board was completely appropriate when you are not getting an appropriate response.

That person chose to identify themselves in a manner that is against the law, and against the code of conduct of the professional body. There are literally systems and people in place to make the determination of how they should be reprimanded accordingly. But I am willing to bet a relatively large sum of money they are not going to be going to jail. so your entire premise is faulty.

I'm taking Dr. Rafiki as not exaggerating when he/she says this person committed a felony punishable with jail and doesn't care if this happens. Going off these comments I made my argument that it is an vicious punishment. I didn't make this premise, maybe you can take it up with them.

Practicing medicine without a license should result in repercussions. Misrepresenting yourself intentionally should not be tolerated because that’s not going to suddenly stop when they graduate.

Certainly, and those repercussions should reflect the gravity of the misrepresentation and the harm that resulted. This seems perfectly solvable with institutional actions that both punish and deter future transgressions of this type without throwing another person's life down the drain.

BTW, defending medicine and the physician community should not be looked at as "toxic".

Just because I don't want a bunch of mid-level with script pad who orders cough medicine for lisinopril reaction and watering down the profession doesn't make me bat soup level bad.

See my response to Neopolymath above. Defending the work of physicians is not toxic and neither is arguing that NP/PA work reduces the quality of patient care, but treating or speaking of allied health professionals derogatorily or looking to punish them for being allied health professionals is.


I'm sorry if my next response takes a while, it seems that the number of people I must respond to grows exponentially with each post I make.

 

[PTPuser]

You sound very bitter about mid-levels. Do you think PAs and NPs wake up every morning and think "today I'm gonna set out to do things that should be left to physicians and take their jobs and be reckless"? Should we respond to their encroachment into our "turf" by finding reasons to put them in jail?
"Casualties of war" sounds fine until it's your relative or friend whose life you ruined over a dispute regarding your career opportunities. If sympathy for another hospital worker seems like BS virtue signaling to you then I don't know what to tell you, but if I did it would go something like this.

I never shamed anyone for "looking out for physician interests," I criticized them for thinking that putting someone behind bars because they threaten physician interests is an acceptable means of doing so. I've made my case above and you can read it.

But God forbid we, members of one of the postgraduate careers which rejects the most applicants have to get jobs in places we don't want like lawyers and pharmacists!



I don't know the full story of Dr. Rafiki or whether he/she had a conversation with his hospital administration where he explained that using the title is a felony and that it is both in the school's and the hospital's interest as well as ethical for patient care that the behavior stop. If this all happened and he found no resolution or received retaliation, going higher up the ladder seems reasonable. I don't know what kind of infrastructure exists in other people's medical schools, but mine has multiple avenues to discuss professionalism concerns (hotlines, scores of administration members, an office of the ombudsman) and specific guidelines against retaliation for bringing those up to an attending or administration member. I would expect the tightly regulating LCME had made these standard in schools.



I'm taking Dr. Rafiki as not exaggerating when he/she says this person committed a felony punishable with jail and doesn't care if this happens. Going off these comments I made my argument that it is an vicious punishment. I didn't make this premise, maybe you can take it up with them.


Certainly, and those repercussions should reflect the gravity of the misrepresentation and the harm that resulted. This seems perfectly solvable with institutional actions that both punish and deter future transgressions of this type without throwing another person's life down the drain.



See my response to Neopolymath above. Defending the work of physicians is not toxic and neither is arguing that NP/PA work reduces the quality of patient care, but treating or speaking of allied health professionals derogatorily or looking to punish them for being allied health professionals is.


I'm sorry if my next response takes a while, it seems that the number of people I must respond to grows exponentially with each post I make.

I don't bully them nor look down on them. I care when they say they're better than us. I care when patients take their sh**ty advice and lack of proper care is infiltrated because my "Noctor" told me I'm fine when I'm not so I'm just gonna power through it and we deal with the trainwrecks aftermath.

I'm not interested in punishing them randomly.

Just because someone wasn't harm in that scenario, doesn't make it right.

 

[libertyyne]

You sound very bitter about mid-levels. Do you think PAs and NPs wake up every morning and think "today I'm gonna set out to do things that should be left to physicians and take their jobs and be reckless"? Should we respond to their encroachment into our "turf" by finding reasons to put them in jail?
"Casualties of war" sounds fine until it's your relative or friend whose life you ruined over a dispute regarding your career opportunities. If sympathy for another hospital worker seems like BS virtue signaling to you then I don't know what to tell you, but if I did it would go something like this.

I never shamed anyone for "looking out for physician interests," I criticized them for thinking that putting someone behind bars because they threaten physician interests is an acceptable means of doing so. I've made my case above and you can read it.

But God forbid we, members of one of the postgraduate careers which rejects the most applicants have to get jobs in places we don't want like lawyers and pharmacists!



I don't know the full story of Dr. Rafiki or whether he/she had a conversation with his hospital administration where he explained that using the title is a felony and that it is both in the school's and the hospital's interest as well as ethical for patient care that the behavior stop. If this all happened and he found no resolution or received retaliation, going higher up the ladder seems reasonable. I don't know what kind of infrastructure exists in other people's medical schools, but mine has multiple avenues to discuss professionalism concerns (hotlines, scores of administration members, an office of the ombudsman) and specific guidelines against retaliation for bringing those up to an attending or administration member. I would expect the tightly regulating LCME had made these standard in schools.



I'm taking Dr. Rafiki as not exaggerating when he/she says this person committed a felony punishable with jail and doesn't care if this happens. Going off these comments I made my argument that it is an vicious punishment. I didn't make this premise, maybe you can take it up with them.


Certainly, and those repercussions should reflect the gravity of the misrepresentation and the harm that resulted. This seems perfectly solvable with institutional actions that both punish and deter future transgressions of this type without throwing another person's life down the drain.



See my response to Neopolymath above. Defending the work of physicians is not toxic and neither is arguing that NP/PA work reduces the quality of patient care, but treating or speaking of allied health professionals derogatorily or looking to punish them for being allied health professionals is.


I'm sorry if my next response takes a while, it seems that the number of people I must respond to grows exponentially with each post I make.

Non of your arguments make any sense in the context of that the person reporting them is not responsible for the outcome of breaking the law its like blaming a witness to testified at a murder trial for the murderer getting life imprisonment.

Another thing that you have glossed over is that there are some states where not reporting a felony crime is in itself a crime. So you would rather some medical student get in trouble for not reporting a crime.

 

[Neopolymath]

You sound very bitter about mid-levels. Do you think PAs and NPs wake up every morning and think "today I'm gonna set out to do things that should be left to physicians and take their jobs and be reckless"? Should we respond to their encroachment into our "turf" by finding reasons to put them in jail?
"Casualties of war" sounds fine until it's your relative or friend whose life you ruined over a dispute regarding your career opportunities. If sympathy for another hospital worker seems like BS virtue signaling to you then I don't know what to tell you, but if I did it would go something like this.

I never shamed anyone for "looking out for physician interests," I criticized them for thinking that putting someone behind bars because they threaten physician interests is an acceptable means of doing so. I've made my case above and you can read it.

But God forbid we, members of one of the postgraduate careers which rejects the most applicants have to get jobs in places we don't want like lawyers and pharmacists!

It's hard to keep up when you keep moving the goalposts (the reason you keep getting so many replies to your posts) so first I'll address that I am not "bitter" about midlevels. I have no reason to be. In fact, many are my friends and family and most of them are team players fulfilling their intended role in healthcare. I would have no problem saying any of this to them and we have had discussions like this. Most midlevels agree that these organizations and vocal minority are a threat to their sweet gig and agree with us that the need to even bring these issues up is absurd.There is clearly a contingent of them (and their orgs) who do in fact wake up every morning and do exactly what you said they don't. I can't begin to explain how ignorant it sounds to say otherwise given that is EXACTLY what these people are doing. I can't really help you here. Go out in real life or search for 5 seconds on here to see evidence of this.

Good strawman about some hypothetical family member going to facing problems at the hands of someone reporting illegal and unethical behavior. Good thing none of the midlevels I'm friends with and care about do anything that would warrant them getting in trouble and breaking established rules or standards of care. See how that works? No one advocates for taking midlevels out back and shooting them for existing or something. The fact that you equate the support for consequences for bad behavior with lack of sympathy is further evidence that you are arguing in bad faith. I mean, really?

And yes, your post is naive and is absolutely virtue signaling. God forbid someone verbalized a desire for an easier time going to some geographic location. Is that post a little silly, sure, but it doesn't change that the job market is and will be affected by these issues. You can admonish everyone else for not being a martyr with you all you want but saying it over and over isn't going to make it real. Go ask the anesthesiologists fed up with the ASA's approach how this play nice with bad guys tactic because they were brainwashed by their organizations idea is working for them.

 

[goatmed]

I don't bully them nor look down on them. I care when they say they're better than us. I care when patients take their sh**ty advice and lack of proper care is infiltrated because my "Noctor" told me I'm fine when I'm not so I'm just gonna power through it and we deal with the trainwrecks aftermath.

I've never heard an NP said they were better than physicians, but other than that there's nothing wrong with feeling bad about that or advocating for the law to fix it

I'm not interested in punishing them randomly.

Great, we agree there

Just because someone wasn't harm in that scenario, doesn't make it right.

Nor did I imply that it was. Only said that the punishment should be more proportionate to the magnitude of the crime.

Non of your arguments make any sense in the context of that the person reporting them is not responsible for the outcome of breaking the law its like blaming a witness to testified at a murder trial for the murderer getting life imprisonment.

This would hold true if the only way to resolve this, as is the case in a murder, was to report the person to the police/justice system. Both the PA and the student are under a hospital administration where escalation is not necessary

Another thing that you have glossed over is that there are some states where not reporting a felony crime is in itself a crime. So you would rather some medical student get in trouble for not reporting a crime.

More of a reason to go to the hospital administration first if it is indeed a crime not to report a felony, because if the hospital's administration and/or legal counsel believes and has knowledge (by student report) that a felony has been committed and must be reported to the authorities they are equally if not more liable to do so.

If what you speculate is indeed the case and the student went to the administration, the administration would have been the first to cover their ass by contacting the authorities. And had they chosen to cover it up and do nothing against the law, then you have a case of a hospital administration in fact covering for a PA pretending to be a doctor, which would implicate both the PA and the so-called malignant administration and make a stronger case not just against this individual but for every hospital admin and health professional to make sure this doesn't happen again under the auspices of their institution.

If it isn't the case, then the administration can take non-legal action against the employee and make sure it doesn't happen again (or they can talk to the medicine board and ruin this person's life nonetheless, but that is the prerogative of the employer)

But no, I don't advocate any student commit crimes. If it is indeed a crime to pursue a non-legal solution then the student should cover their own ass by all means regardless of whether the law or its enforcement is excessive or not (and you've already read my opinion on it). It simply didn't seem like Dr. Rafiki was doing this out of fear of legal repercussions for not telling the medicine board, but out of a sentiment that the person should be behind bars, and hence my argument about whether this is a merited response. Students should follow the law above all though, I'm with you there.

It's hard to keep up when you keep moving the goalposts (the reason you keep getting so many replies to your posts)

I don't think I have done it once. Maybe you have some examples.

In fact the reason I have gotten so many responses is that I espoused an opinion unpopular among the SDN crowd.

Do you think PAs and NPs wake up every morning and think "today I'm gonna set out to do things that should be left to physicians and take their jobs and be reckless"

so first I'll address that I am not "bitter" about midlevels. I have no reason to be. In fact, many are my friends and family and most of them are team players fulfilling their intended role in healthcare. I would have no problem saying any of this to them and we have had discussions like this. Most midlevels agree that these organizations and vocal minority are a threat to their sweet gig and agree with us that the need to even bring these issues up is absurd.There is clearly a contingent of them (and their orgs) who do in fact wake up every morning and do exactly what you said. I can't begin to explain how ignorant it sounds to say otherwise given that is EXACTLY what these people are doing. I can't really help you here.

Surely you have proof that this is the case beyond your intuitions, right? Or maybe you were approached by a PAs-for-independent-practice shill who told you their nefarious plan. That your worldview sounds like a caricature I just made up may reflect more upon your feelings than my ignorance.

Good strawman about some hypothetical family member going to facing problems.

I don't think that's what a strawman means, but OK.

Good thing none of the midlevels I'm friends with and care about don't do anything that would warrant them getting in trouble and breaking established rules or standards of care. See how that works? No one advocates for taking midlevels out back and shooting them or something. The fact that you equate the support for consequences for bad behavior with lack of sympathy is further evidence that you are arguing in bad faith. I mean, really?

Except I never said that there should be no consequences at all and that advocating for consequences is equivalent to a lack of sympathy, and you can go back through all my text and see if I did. I of course also never said anyone was arguing for "taking the midlevels out back and shooting them". The insinuation that this is what I said is in fact what a strawman is, in case you're confused about the meaning of the word.

What I said, rather, and I encourage you to read back, is that seeking jail for this bad behavior is excessive when a less perverse punishment can correct it and deter it and that disregarding that because these are "casualties of war" as you describe them shows a lack of sympathy. But your response that nobody advocates for "taking the midlevels out back and shooting them" already tells me you can grasp that there is such a thing as excessive punishment. Maybe next time you respond you can argue about whether the punishment for this case is excessive rather than misrepresenting my opinion.

And yes, your post is naive and is absolutely virtue signaling. God forbid someone verbalized a desire for an easier time going to some geographic location. Who cares? You can admonish everyone else for not being a martyr with you all you want but saying it over and over isn't going to make it real.

Verbalizing a desire to live in a nice place is not wrong, nor did I say that either. I want to live in a nice house in Nantucket island with my own practice, but if I think I'm entitled to it there is something wrong with my expectations. People on the premed forum are told many times, even by people who moderate SDN and work in school administrations, that they should not feel entitled to enter into a medical school because their grades are so and so or they put so much work into their CV. I don't think this is in fact "virtue signaling," whatever that means, nor that this type of advice stops applying when you finish medical school or residency. The world doesn't owe you the professional opportunities you prefer and realizing and pointing this out doesn't make you a "martyr".

 

[Neopolymath]

I don't think I have done it once. Maybe you have some examples.

In fact the reason I have gotten so many responses is that I espoused an opinion unpopular among the SDN crowd.




Surely you have proof that this is the case beyond your intuitions, right? Or maybe you were approached by a PAs-for-independent-practice shill who told you their nefarious plan. That your worldview sounds like a caricature I just made up may reflect more upon your feelings than my ignorance.



I don't think that's what a strawman means, but OK.




Except I never said that there should be no consequences at all and that advocating for consequences is equivalent to a lack of sympathy, and you can go back through all my text and see if I did. I of course also never said anyone was arguing for "taking the midlevels out back and shooting them". The insinuation that this is what I said is in fact what a strawman is, in case you're confused about the meaning of the word.

What I said, rather, and I encourage you to read back, is that seeking jail for this bad behavior is excessive when a less perverse punishment can correct it and deter it and that disregarding that because these are "casualties of war" as you describe them shows a lack of sympathy. But your response that nobody advocates for "taking the midlevels out back and shooting them" already tells me you can grasp that there is such a thing as excessive punishment. Maybe next time you respond you can argue about whether the punishment for this case is excessive rather than misrepresenting my opinion.




Verbalizing a desire to live in a nice place is not wrong, nor did I say that either. I want to live in a nice house in Nantucket island with my own practice, but if I think I'm entitled to it there is something wrong with my expectations. People on the premed forum are told many times, even by people who moderate SDN and work in school administrations, that they should not feel entitled to enter into a medical school because their grades are so and so or they put so much work into their CV. I don't think this is in fact "virtue signaling," whatever that means, nor that this type of advice stops applying when you finish medical school or residency. The world doesn't owe you the professional opportunities you prefer and realizing and pointing this out doesn't make you a "martyr".

You really tipped your hand here. Thanks for putting the bolded up top so I learned not to put any effort into reading any more of your posts or responding to the rest of it. A person who can't even acknowledge the existence of something as prominent as the AANA, DNP independent practice pushes, and other regularly discussed examples of what you essentially mockingly call a conspiracy theory isn't someone posting in good faith. There is no point in discussing something you are almost assuredly in denial about or willfully ignorant of for the sake of being contrarian in this thread.

And just a note: A strawman argument is an intentionally misrepresented proposition that is set up because it is easier to defeat than an opponent's real argument. I think we agree here on the definition. "People shouldn't do illegal things and then they won't worry about facing repercussions (and the incredibly unlikely jail time you keep harping on)" "But what if it was your relative or friend whose life you ruined over a dispute regarding your career opportunities" Great, you win. It's a non-classic presentation of a strawman. Your response is that people are out here advocating to ruin or jail people who did nothing wrong when no one has made that argument.

Good luck out there. Peace.

 

[goatmed]

You really tipped your hand here. Thanks for putting the bolded up top so I learned not to put any effort into reading any more of your posts or responding. A person who can't even acknowledge the existence of something as prominent as the AANA, DNP independent practice pushes, and other regularly discussed examples of what you essentially mockingly call a conspiracy theory isn't someone posting in good faith. There is no point in discussing something you are almost assuredly in denial about or willfully ignorant of for the sake of being contrarian in this thread.

Notice I called neither the AANA or DNP independent practice advocates a conspiracy theory. They are openly associations which advocate for the jobs of CRNAs like the AMA advocates for physician jobs and paychecks, which doesn't entail disingenuousness even if the quality of their research is, well, what you'd expect from people who lack a background in research. At no point have I advocated that, as these organizations suggest, the scope of midlevels should be expanded nor will I argue for that position right now. I also don't believe NPs and PAs are as a group intentionally rooting to be more reckless or practicing with disregard to an obvious deficit because they wanna make a buck off the patient's expense, nor do I see a mention of recklessness or disregard for safety in patient care in the case mentioned by Dr. Rafiki.

But even this argument is extraneous to the point I sought to advance when I first posted on this thread and to which you responded, that no matter how bad the professional organization is, any severity of punishment is not justified for the person in question. In your words, jail was OK because it's "another casualty of war"- a position that does sound bitter, and is at odds with your later statement that you're OK with many midlevels since you have friends and family who work as such, but just not with the AANA or those pushing for independent practice (I don't see any evidence this person was doing that). I never did see your response as to what you would do if one of your friends or relatives did what Dr. Rafiki said. It's a shame I'll never find out.

non-classic presentation of a strawman

Not one at all, I didn't distort your argument by asking if your opinion would be the same if the person in question was your relative.

...And a good evening to you

 

[PTPuser]

I also don't believe NPs and PAs are as a group intentionally rooting to be more reckless or practicing with disregard to an obvious deficit because they wanna make a buck off the patient's expense, nor do I see a mention of recklessness or disregard for safety in patient care in the case mentioned by Dr. Rafiki.

But even this argument is extraneous to the point I sought to advance when I first posted on this thread and to which you responded, that no matter how bad the professional organization is, any severity of punishment is not justified for the person in question. In your words, jail was OK because it's "another casualty of war"- a position that does sound bitter, and is at odds with your later statement that you're OK with many midlevels since you have friends and family who work as such, but just not with the AANA or those pushing for independent practice (I don't see any evidence this person was doing that). I never did see your response as to what you would do if one of your friends or relatives did what Dr. Rafiki said. It's a shame I'll never find out.

They don't have to outright say they're better than doctors...it's all in their propaganda and advertisement.

Pull up any of those bullsh*t videos posted by the AANP about NP etc and you will see.

"We focus on patients!" what, we focus on dogs?

"Increasingly, patients are recognizing the importance of prevention and early intervention to avoid health complications, and NPs are providers who embrace this wellness-first model".

"Average Years of Experience: 11" Most bullsh*t number I've ever seen.

So when reading between the lines, do you see how this can undermine our education compared to theirs? Average PCP years of experience is 11...what prevents them from saying that their is just the same.

These are some of the things that make them reckless and a disregard to patient care.

You keep saying the punishment is too harsh. Why should the punishment be any less for someone who knowingly misidentified themselves.

Yeah, my friends and family aren't stupid enough to call themselves Dr in a clinical settings. They know better and are not in the business of falsely misidentifying themselves at such as scale.

 

[goatmed]

They don't have to outright say they're better than doctors...it's all in their propaganda and advertisement.

Pull up any of those bullsh*t videos posted by the AANP about NP etc and you will see.

"We focus on patients!" what, we focus on dogs?

Regular RNs say this as well, which is to mean that they have more time per patient than an attending when in a mixed team. I realize it doesn't mean anyone else is any less competent, and don't find something offensive in people trying to put their profession in a positive light.

"Increasingly, patients are recognizing the importance of prevention and early intervention to avoid health complications, and NPs are providers who embrace this wellness-first model".

"Average Years of Experience: 11" Most bullsh*t number I've ever seen.

So when reading between the lines, do you see how this can undermine our education compared to theirs? Average PCP years of experience is 11...what prevents them from saying that their is just the same.

Agree it is a meaningless number to say they've been working for 10 years on average. Maybe the average RN has also worked for 10 years and it doesn't make them competent to do doctor stuff. But again, this is a professional organization trying to show its members in a positive light, not "undermining our education" or saying doctors are incompetent. And I reiterate, I'm not arguing for the position what the AANA advocates for is correct. In fact, they might be advocating for the worst positions and it still doesn't make every single CRNA responsible and deserving of punishment on behalf of the AANA.

These are some of the things that make them reckless and a disregard to patient care.

I don't think that the advocacy of the AANA has some logically necessary correspondence with the recklessness or the bad intentions of practitioners on the ground. I would hope that my attendings and I are not held accountable for the AMA's lobbying against more residency training spots in the 1990s, which didn't help against midlevel creep.

You keep saying the punishment is too harsh. Why should the punishment be any less for someone who knowingly misidentified themselves.

Because punishment is a means to 1)Bring justice to victims of a transgression 2)Deter future instances of the behavior. Seeing as the victim of this transgression was the patient on the receiving end of the misrepresentation and that the patient was not materially harmed by the misrepresentation, punishment with jail is harsh. I ask you the same question I asked Dr. Rafiki, if one of your classmates misrepresented themselves in front of you would you seek jail for them or try to solve the issue with the person and the administration first?

Yeah, my friends and family aren't stupid enough to call themselves Dr in a clinical settings. They know better and are not in the business of falsely misidentifying themselves at such as scale.

Notice I didn't ask if your (or rather, the person I was responding to) friends or family were stupid enough, but what they would do if those people made such a transgression, and more specifically if their response would be to seek prison.

As to whether prison will actually be the end-result, I will repeat myself one more time: I didn't introduce this possibility into the conversation, I simply walked into a conversation where this was introduced by the person telling the story. If prison isn't even a possibility, then Rafiki can clarify their message and my argument is moot.

 

[Matthew9Thirtyfive]

treating or speaking of allied health professionals derogatorily or looking to punish them for being allied health professionals is.

Demanding NPs and PAs use appropriate titles and not mislead patients by implying they are physicians is not treating them derogatorily.

 

[Matthew9Thirtyfive]

I swear physicians and med students are like blasted from the beginning that even trying to defend the appropriate use of titles somehow means we have some slimy motivation. That’s how good and pervasive their propaganda is.

There are schools with “inter professional” classes that are basically just sessions where med students are brainwashed into thinking they have no more knowledge or value than anyone else on the team, and that midlevels know just as much as physicians, nurses protect patients from doctors killing them, etc.

 

[Kardio]

Page 4 of this lol

 

[Dr. Rafiki]

@goatmed bruh all I did was report someone to their licensing body for using their license inappropriately. Not sure why that's so unthinkable to you.

 

[Iz_FtB]

Clarity and honesty should be the goal in any patient interaction.
The push for mid-level independence is rooted in obfuscation. It's an attempt at siphoning off the inherent trust people have in physicians for their own professional advancement. These aren't altruistic, patient minded advocates out to expand care. They're ego-driven, inferiority complex addled professionals trying to bite off more than they can chew.
If physicians are accepted as having the gold standard level of training in medicine, it should only be with a physician's consent that a discipline be gauged as being sufficiently trained to practice independently, or otherwise to identify themselves as a doctor to patients who understand the above to be encompassed in that term.

 

[goatmed]

Demanding NPs and PAs use appropriate titles and not mislead patients by implying they are physicians is not treating them derogatorily.

And at no point did I say that anybody should just allow them to use an inappropriate title and mislead patients. Surely you noticed that I agreed with you this wasn't OK. That wasn't what I referred to, I hope the fact people do speak derogatorily about them in the medical internet-sphere is not news to you.

I swear physicians and med students are like blasted from the beginning that even trying to defend the appropriate use of titles somehow means we have some slimy motivation. That’s how good and pervasive their propaganda is.

See above.

There are schools with “inter professional” classes that are basically just sessions where med students are brainwashed into thinking they have no more knowledge or value than anyone else on the team, and that midlevels know just as much as physicians, nurses protect patients from doctors killing them, etc.

I've had both classes and rotations with PAs and at no point was I made to feel or was I told that I had no more knowledge or value than anyone else on the team or that midlevels know as much than physicians, or that doctors are killing patients while nurses protect them. If this is your experience, I'm sorry to hear that. What I know has happened in those interprofessional classes was attendings telling cohorts of PA students that they needed to stop taking physician jobs, which seemed grossly inappropriate to tell a bunch of students given the power differential.

@goatmed bruh all I did was report someone to their licensing body for using their license inappropriately. Not sure why that's so unthinkable to you.

It isn't "unthinkable to me," it just seemed like going through this length and testifying to get someone thrown in jail, as you said, was excessive. Is telling a hospital administrator instead "unthinkable" to you?


And with that, I'm signing out of this thread as well, since I'm at that stage where I repeat myself over and over and the arguments don't really advance anywhere. Before anyone misinterprets or misrepresents what I have said, I will leave a summary of my arguments:

1. In the case of Dr. Rafiki, I think a response that doesn't involve jail time or ruining a person's life would have been more appropriate. This does not mean I think the person should have seen no repercussions at all, or that I support "midlevel creep" or the AANA or similar professional advocacy groups, or that I'm brainwashed to support midlevels being better than students. I'm sure a forum full of intelligent medical students and professionals can appreciate nuance.

2. Criticism of the growing role of midlevel providers is perfectly acceptable, and should be directed towards that role and the organizations, administrators and legislators who allow it to happen and not your team's NP who is doing his or her job for which they have been hired. Whether or not you agree with their job or you think that their professional advocacy groups are cancerous or maleficent, you should be as polite and sympathetic to your coworkers as you are with your medical colleagues and would want to be treated by your own colleagues, residents and attendings. In the particular case above I argue that if your MS3 colleague on rotations misrepresented themselves, stupid and dishonest as it may be, your first response would be to talk to them or to your dean, not to a licensing body so that they might be prosecuted.

And with that, I'm done.

 

[Matthew9Thirtyfive]

And at no point did I say that anybody should just allow them to use an inappropriate title and mislead patients. Surely you noticed that I agreed with you this wasn't OK. That wasn't what I referred to, I hope the fact people do speak derogatorily about them in the medical internet-sphere is not news to you.

Okay, so then what was the point of bringing that up? No one here is arguing that we should be talking derogatorily toward NPs and PAs. At least I didn’t see that.

 

[Matthew9Thirtyfive]

I've had both classes and rotations with PAs and at no point was I made to feel or was I told that I had no more knowledge or value than anyone else on the team or that midlevels know as much than physicians, or that doctors are killing patients while nurses protect them.

I know you’re “done” but this hasn’t been my experience. At my school it is made clear that the physician is the captain, but that we work as part of a team.

However, I do know some people who go to a school where that has been their experience. Some of them have been totally beat down with it and have literally argued with me that saying an NP doesn’t know as much as an MD is derogatory and devaluing members of the team, since all members are equally important and skilled.

 

[slowthai]

However, I do know some people who go to a school where that has been their experience. Some of them have been totally beat down with it and have literally argued with me that saying an NP doesn’t know as much as an MD is derogatory and devaluing members of the team, since all members are equally important and skilled.

I've been on this merry go round before. Not a fun ride. What was it again? "Collaboration, not do what I tell you?"

 

[Matthew9Thirtyfive]

I've been on this merry go round before. Not a fun ride. What was it again? "Collaboration, not do what I tell you?"

It’s just more of the everyone is the same, everyone gets a trophy, no one is different or knows any more or less than anyone else.

 

[Osminog]

There has been a long-standing, widely lauded effort to convert hierarchies within the healthcare team (e.g., "physician on top, then mid-level, then nurse, then CNA") into a more team-based dynamic—one in which no one is "above" or "below" anybody else and everybody is just an equal player on the team. What originally sparked this push were reasonable concerns about physicians' abuse of power and healthcare workers' reluctance to file reports on those above them on the totem pole.

For a non-hierarchical team to function (whether in healthcare or elsewhere), team members' roles have to be clearly designated, with sharp boundaries between members' duties. When these boundaries are vague or absent, members' roles blur into one another. This leads to a great deal of confusion and tension, and ultimately leads to undesirable outcomes. Sadly, this seems to be what is happening in the mid-level situation. To illustrate:

What is the role of a physician? To provide medical care.
What is the role of an autonomously practicing NP? To provide medical care... but deferring to physicians' expertise when confronted with complex cases.

Not only is the boundary between these roles vague, but it's also impractical. For this boundary to work, NPs would have to accurately distinguish between simple and complex cases, despite their lack of understanding of or exposure to complex cases; we would have to somehow expect NPs to not mistakenly label deceptively complex cases as simple ones. Well, if physicians and NPs are "equal" players in the healthcare team and if there is no clear, enforceable boundary between their roles, then of course NPs will push to encroach on the duties that have traditionally been reserved for physicians. Why wouldn't they?

The only solution to this dilemma, in my opinion, is to eliminate mid-level autonomy and to reinstate a culture of hierarchy among healthcare professionals (albeit a gentler one that includes more legal protections for whistleblowers and stricter punishments for those who abuse authority). That way, the role of a mid-level in the United States will forever be, "provides medical care under the direction and close supervision of a physician."

 

[LutGholein]

What I know has happened in those interprofessional classes was attendings telling cohorts of PA students that they needed to stop taking physician jobs, which seemed grossly inappropriate to tell a bunch of students given the power differential.

I cannot imagine physicians, let alone medical students saying this openly in these inter professional classes.

As someone who has had to attend these meetings, it’s been mostly centered on physicians not being “patient-centered” enough along with telling us medical students that we are essentially the problem in modern healthcare because of XYZ. Those classes serve to push an agenda.

 

[futureapppsy2]

Curious how you all think psychologists factor into this, as psychologists aren’t midlevels (minimum requirements for independent practice are a 5 year doctorate and postdoctoral fellowship). Most of my colleagues in healthcare settings introduce themselves as “I’m Dr. X, a [insert speciality here] psychologist.”

 

[Lawpy]

Curious how you all think psychologists factor into this, as psychologists aren’t midlevels (minimum requirements for independent practice are a 5 year doctorate and postdoctoral fellowship). Most of my colleagues in healthcare settings introduce themselves as “I’m Dr. X, a [insert speciality here] psychologist.”

i call psychologists Dr. since imo they're professionals like psychiatrists.

 

[FutureSurgical]

I honestly lost interest keeping up with the current arguments being held currently about mid-levels and physicians.

While I believe PAs and NPs are pretty vital to the healthcare setting (in general; there are exceptions,) they should not blur the lines between their role and the role of the MD/DO (shocker, I know.)

Physicians, by the time they complete a 4-year residency, will have accumulated 10,000-15,000 hours of hands-on care and shadowing (from M3 to residency graduation.) During that whole time, the student/training resident is not allowed to practice independently and must obtain strict number of hours in different areas of their choice in medicine. After going through one of the hardest post-undergraduate education and going through some of the toughest on-the-job training, then a budding doctor practice independently.

If you take a look at the DNP model, it is preferred you have one year experience in a field of nursing. It doesn't describe which field or what area of medicine to practice in (unlike CRNA schools, which require/recommend 1 year of cc work.) You spend 40 hours a week (maybe) shadowing DNPs and physicians in different areas of medicine while taking online courses and working on a project to graduate. And each area of medicine is split into either 2-hour or 4-hour events in 1-2 days. When they earn their degree, they are allowed to practice independently if they are licensed in a state that allows them to do so. They accumulate 600-800 hours total during their schooling as well.

Do you see the disparity and why many people, like me, get pissed off when APP's give themselves the title of "doctor" in a clinical setting? In medical school, I'm sure I will be given lectures by DNP's and will happily call them "Dr. X" in that setting. In the clinic? They're "X, the Nurse Practitioner."

This video gives a more concise overview of what I'm talking about.

 

[Matthew9Thirtyfive]

Curious how you all think psychologists factor into this, as psychologists aren’t midlevels (minimum requirements for independent practice are a 5 year doctorate and postdoctoral fellowship). Most of my colleagues in healthcare settings introduce themselves as “I’m Dr. X, a [insert speciality here] psychologist.”

In many places, psychologists are not permitted to use the title Dr. in a hospital setting, for the same reasons why midlevels can’t. However, outside of that they have a PhD. They’ve earned the title, and honestly I would have no problem calling a psychologist doctor in a clinical setting since they are practicing clinical psychology at the doctoral level.

 

[ThetisAntithesis]

So put yourself in their shoes. You're the PCP and you want to introduce yourself. You are a fully independent practitioner. You're not willing to spend the first two minutes with every patient discussing the intricacies of your state's various PCP credentials.

What do you say? Hello I'm what?

"Hello, I'm X and I'm a nurse practitioner"

Although, here's the thing, patients will call just about anyone who's treating them a "doctor" so aside from others actively calling themselves "Dr X" when they're not, then it's a bit more patient-driven.

 

[Matthew9Thirtyfive]

"Hello, I'm X and I'm a nurse practitioner"

Although, here's the thing, patients will call just about anyone who's treating them a "doctor" so aside from others actively calling themselves "Dr X" when they're not, then it's a bit more patient-driven.

Yeah if a patient calls you doctor and you aren’t, you correct them. But if they keep doing it, it’s not on you. I wouldn’t fault an NP for a patient calling them doctor when they’ve been clear about their role and title.

 

[efle]

Can I request anyone who considers PCP NPs to be dangerously ignorant relative to the typical PCP MD/DO, to provide me the best single study they've come across on the topic? I would be very ready to change my views if I could see data that it was dangerous. When I google a bit all I find is stuff like thisJAMA paper.

It got >1000 citations since then, pretty high profile, so I assume it must have sparked some backlash and a few rigorous studies that contradicted the idea of NPs being fine as independent PCPs?

 

[FutureSurgical]

Can I request anyone who considers PCP NPs to be dangerously ignorant relative to the typical PCP MD/DO, to provide me the best single study they've come across on the topic? I would be very ready to change my views if I could see data that it was dangerous. When I google a bit all I find is stuff like thisJAMA paper.

It got >1000 citations since then, pretty high profile, so I assume it must have sparked some backlash and a few rigorous studies that contradicted the idea of NPs being fine as independent PCPs?

Lozada MJ, Raji MA, Goodwin JS, Kuo YF. Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns [published online ahead of print, 2020 Apr 24]. J Gen Intern Med. 2020;10.1007/s11606-020-05823-0. doi:10.1007/s11606-020-05823-0

Here it describes who prescribed more opioids: Physicians or Mid-Levels

Lohr RH, West CP, Beliveau M, et al. Comparison of the quality of patient referrals from physicians, physician assistants, and nurse practitioners. Mayo Clin Proc. 2013;88(11):1266-1271. doi:10.1016/j.mayocp.2013.08.013

This paper describes which practitioner handles more complex cases efficiently (quality of referrals, clearly explaining the problem to the patient, etc.)

The thing is, there really needs to be studies that look at the true independence and treatment of patients. E.g. NPs and other APPs diagnosing, treating, and any associated follow-up without oversight of a PCP. No study that I know of like that exist.

Edit: I don’t know anyone here or in the clinical setting that considers APPs dangerously negligent or ignorant, assuming they operate in their level of knowledge and care. You’re trying to take the whole “NPs shouldn’t call themselves ‘doctor’” to an extreme. Don’t frame this as a “NPs are either dangerous to mankind or they’re similar to doctors in most every way.”

 

[efle]

Lozada MJ, Raji MA, Goodwin JS, Kuo YF. Opioid Prescribing by Primary Care Providers: a Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns [published online ahead of print, 2020 Apr 24]. J Gen Intern Med. 2020;10.1007/s11606-020-05823-0. doi:10.1007/s11606-020-05823-0

Hmm my issue with this is that they're comparing the far right tail of the two groups. The actual data makes the PCP MDs look worse re narcotic scrips for 95%+ of providers included. It's just that the outlying worst 1-5% percent of offenders are skewed the other direction. My guess is that this has more to do with the entry requirements to the professions than the schooling/training/job. A degenerate who will hand out opiates like candy is a lot less likely to get into med school. If they had reported more standard measures like median and IQR for the same metrics, I think it would actually paint a directly opposite picture.

Spoiler: Figure

My concern with the Mayo proceedings paper is that only 10% of Mayo referrals come from PAs/NPs, probably because much of the major population centers in the region like Milwaukee and Chicago are in states that do not allow PA/NP to be independent PCPs. Is there anything randomized or that looks at health outcomes?

Don’t frame this as a “NPs are either dangerous to mankind or they’re similar to doctors in most every way.”

I don't mean to frame it that way. I made my opinion on PCP NP's being their patients' doctor clear already. This is purely because I see people mention constantly that NPs provide inferior care, and I was wondering what sources could back it up. It's hard to imagine all those dozens of states allowing it to occur if we've shown it to be dangerous.

 

[Captain_Falcon]

I don't mean to frame it that way. I made my opinion on PCP NP's being their patients' doctor clear already. This is purely because I see people mention constantly that NPs provide inferior care, and I was wondering what sources could back it up. It's hard to imagine all those dozens of states allowing it to occur if we've shown it to be dangerous.

There are a lot of dangerous things allowed by all forms of government in terms of legality. I kinda get your point, but it doesnt line up with reality. Tobacco and alcohol are the easiest examples. It would save the government and healthcare billions of dollars without having to take care of the bad outcomes from tobacco/alcohol abuse.

With that said, I've read in different threads on here the legality and ethics of actually running a RCT to compare mid level care to physician care. I'm pretty sure you had a lot of posts in that thread so you know the limitations reality has in regards to actually getting a study done like that

 

[efle]

There are a lot of dangerous things allowed by all forms of government in terms of legality. I kinda get your point, but it doesnt line up with reality. Tobacco and alcohol are the easiest examples. It would save the government and healthcare billions of dollars without having to take care of the bad outcomes from tobacco/alcohol abuse.

With that said, I've read in different threads on here the legality and ethics of actually running a RCT to compare mid level care to physician care. I'm pretty sure you had a lot of posts in that thread so you know the limitations reality has in regards to actually getting a study done like that

True, but we do carefully regulate those areas, and if we found out someone was making an unacceptable, dangerous product we would shut it down (remember Four Loko?)

I do not remember that thread. The jama paper I linked was a RCT putting people in midlevel vs physician care.

 

[Captain_Falcon]

True, but we do carefully regulate those areas, and if we found out someone was making an unacceptable, dangerous product we would shut it down (remember Four Loko?)

I do not remember that thread. The jama paper I linked was a RCT putting people in midlevel vs physician care.

How do we carefully regulate alcohol and tobacco?

I'll try and find the thread on here that I mentioned above

 

[efle]

How do we carefully regulate alcohol and tobacco?

I'll try and find the thread on here that I mentioned above

Try opening a bar without doing any paperwork where you sell your home brewed concoctions to the public and let me know
We allow people to be dumb, but it's not the wild west out here. If we performed studies demonstrating that patients who got NP primary care were having significantly worse outcomes, those studies would matter.

 

[Neopolymath]

Can I request anyone who considers PCP NPs to be dangerously ignorant relative to the typical PCP MD/DO, to provide me the best single study they've come across on the topic? I would be very ready to change my views if I could see data that it was dangerous. When I google a bit all I find is stuff like thisJAMA paper.

It got >1000 citations since then, pretty high profile, so I assume it must have sparked some backlash and a few rigorous studies that contradicted the idea of NPs being fine as independent PCPs?

Anesthesia has many discussions on this topic. It is unethical and would not meet IRB approval to have a true test of outcomes. It is impossible to actually study this until NPs are working fully and completely separate and independent in large quantities.