NMBE sells out the medical profession to the nurses

[BMBiology]

I think pharmacy techs should be allowed to dispense meds. I mean how hard is it to apply a computer generated label that cross checked all contradictions and possible side effects?

If nurses or physicians want to go into the dispensing business, then go ahead.

I also dont have a problem with a pharmacy tech who just graduated from high school and want to dispense. If patients feel it is cheaper to get their medications from a pharmacy tech or over the internet, then they may. I have no problem with that.

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[oldManDO2009]

that is a definitive argument for your profession. why in the heck do you want to become a pharmacist - the cool hours?

 

[BMBiology]

that is a definitive argument for your profession. why in the heck do you want to become a pharmacist - the cool hours?

A little defensive...aren't we? To do this:

I have a great deal of respect for the clinical pharmacist I interact with - they are able to help me determine the risk v. benefit profile for a drug. When a weird "one off" condition arises and I am just not sure I look to them for help in finding the answer. They help initiate therapy with some of the most toxic drugs to the human body - chemo drugs...the list goes on and on.

 

[oldManDO2009]

A little defensive...aren't we? To do this:

I am asking you. You seem not to care about your profession - does not change my opinion of your profession or the people I have worked with.

You seem to think that anybody should be able to do anything without appropriate training....

 

[BMBiology]

I am asking you. You seem not to care about your profession - does not change my opinion of your profession or the people I have worked with.

I dont feel the need to defend my profession. People can make up their own mind.

I also believe people should have to a choice between seeing a nurse or a physician for their medical concerns as I dont have a problem with people buying their medications from Canada because they can't afford to buy them in the U.S.

I think a lot of health care professionals want to limit peoples' options, not because they truly believe its for their patients' benefits, but because of self serving reasons.

 

[fab4fan]

I know you guys have worked hard to become a physician and it is too bad that your profession has let you down but the reality is:

(1) Nurses are taking over primary care

(2) Salary for physicians in primary care will go down.

(3) Pharmacists are not going into primary care because nurses are better trained in primary care (and they dont cost $55/hr).

(4) The FDA will create BTC medications.

I know it is getting tougher but don't let your disappointment turn into bitterness. Primary care used to belong to physicians but your profession created this demand for affortable and accessible health care. The nursing profession would not have this opportunity if your profession had not created it.

Wait a minute...what planet do you live on? Wherever it is, I want to move there, because I sure don't make $55/h. Then again, I wasn't trained/educated to do primary care. I was educated to be a nurse. Primary care is the role of the physician. At least, that's how it works where I live. We do have nurse practitioners and PAs, but in my area there are no independent NPs.

I hope if BTC meds come to fruition, then any complications arising from a pharm. dispensing them become the pharm. migraine, not the physician's. Of course, that's my Utopian dream, and it will never happen, but the pharm. should have to suffer some consequences if there's an adverse outcome. If you want more responsibility then you need to be prepared to man up when it goes bad.

 

[BMBiology]

Wait a minute...what planet do you live on? Wherever it is, I want to move there, because I sure don't make $55/h.

$55 an hour is the salary of a pharmacist, not nurse.

 

[zenman]

Nurses are not qualified to provide care at even close to the level of a physician and for now patients will have a choice. Who would you take you sick family member to - a doctor or a nurse?

My parents, who are both almost 80 see the NP (by choice) in their doctors office because she spends more time with them. I'm sure their physician oversees the NP and is probably glad of that role since they both have a range of complex health problems, ranging from arthritis to cardiac arrest and would take too much of his time just going through their meds. It's their choice. I won't tell you what they think of Medicare or the VA.

 

[oldManDO2009]

Hey zenman

sounds like a good deal for all involved....

 

[oldManDO2009]

I hope if BTC meds come to fruition, then any complications arising from a pharm. dispensing them become the pharm. migraine, not the physician's. Of course, that's my Utopian dream, and it will never happen, but the pharm. should have to suffer some consequences if there's an adverse outcome. If you want more responsibility then you need to be prepared to man up when it goes bad.

What s/he is not mentioning is that pharmacist want to bill like physicians for the consultation - so it is about money and not the consumer. When s/he spends 20 years as a pharmacist and the techs or a toaster takes over his/her job maybe a different opinion will come forth.

And I think pharmacist will be on the the hook for liability. They are stating they are specialist able to safely prescribe BTC meds - so when a person dies from a PE they will be liable because they should have know about all of the conditions and side effects associated with the drug....

 

[Alteran]

Because once again WE ARE AVOIDING THE ELEPHANT IN THE ROOM! Why in the world is there shortage of primary care docs? Because medicare and insurance companies in suit pay more for procedures than prevention. If you fix this reimbursement problem, I know many medical students would go into family medicine. But no, there will be no remedy for the actual cause of the problem, so instead we open more medical schools, dilute medicine by giving nurses doctor priviledges, give PAs way more privledges than they deserve...it just gets worse and worse.

And CuriousGeorgia, although you feel like nursing school is rigorous, its simply because its the hardest thing you have ever done. Every former nurse that is my classmate attests to the fact that nursing school is absolutely nothing like medical school. Let's get serious...this is just a stepping stone to nurse orthopods, and nurse dermatologists, and nurse radialogists.

I whole heartedly agree. The reason we're in this whole mess is because government and insurance companies feel like saving a buck or two by cutting rates for primary care physicians. Only a handful of people in my class have any desire to do family med and those doing IM have every intention of doing a profitable fellowship. The only motivation these days for getting good board scores is to NOT end up in primary care.

We as a profession have largely failed and continue to fail miserably in resuming control of our livelihoods. And if we're not up to the task of taking back our field from the hands of government and insurance companies, others will gladly dictate the terms of our own field to us. Remember, the medical field exists because of doctors and not because of government and insurance companies. And all ancillary staff exist because of us (not that they're not important but I've always been under the impression that we run the show here). So unless we want all of primary care to be dispensed by PAs, NPs, or any other mid-level practitioner concoction in the next 15 to 20 years, we're going to have to get serious.

 

[fab4fan]

What s/he is not mentioning is that pharmacist want to bill like physicians for the consultation - so it is about money and not the consumer. When s/he spends 20 years as a pharmacist and the techs or a toaster takes over his/her job maybe a different opinion will come forth.

And I think pharmacist will be on the the hook for liability. They are stating they are specialist able to safely prescribe BTC meds - so when a person dies from a PE they will be liable because they should have know about all of the conditions and side effects associated with the drug....

Thanks, but I think I'll stick with getting my OC's from a real doctor. I don't find going once a year to his office that much of a hassle, considering the possible ramifications.

 

[Taurus]

The two things that scare pharmacists the most:

Competing with pharmacy benefit management companies
Being replaced by vending machines

Wouldn't it be funny if pharmacists set up clinics in CVS's, Walgreen's, and Wal-Mart's that compete with the health clinics staffed by NP's? I'm all for that. You truly have a race to the bottom now.

 

[BMBiology]

The two things that scare pharmacists the most:

Competing with pharmacy benefit management companies
Being replaced by vending machines

PBMs and vending machines have been here for years but why is the profession doing well?

PBMs are staffed by pharmacists. Who is denying the prior authorization? Pharmacists.

And so called vending machines, they are already in California. And guess who check and verify the medication because it is placed in the machines? Pharmacists.

Wouldn't it be funny if pharmacists set up clinics in CVS's, Walgreen's, and Wal-Mart's that compete with the health clinics staffed by NP's?

CVS, Walgreens, Walmart are opening up thousands of clinics throughout the U.S. that are staffed by NPs. No need for pharmacists to set up their own clinic. Nurses can have primary care.

 

[BMBiology]

What s/he is not mentioning is that pharmacist want to bill like physicians for the consultation - so it is about money and not the consumer. \

Yes, I don't disagree it is about money and yes if something happens, the pharmacist and the pharmacy should be held liable. I figure pharmacists can't do any worse than physicians.

 

[BMBiology]

-

 

[genesis09]

I wouldn't trust a tech to dispense any medications. Those computer programs are only as good as those who program them. They do miss interactions. Also, there is no standardized requirements for techs. As of today, no state requires any formal education to become a tech. Requirements range from just being 16 years old to being certified. Most Techs only have a superficial understanding of the medications. There was this long serving tech at the pharmacy where I'm at who is very allergic to sulfa medications, if she even touched the pill she would break out into a rash, and didn't realize Bactrim has a sulfa drug.

 

[Miami_med]

a future MD doesn't think so:

#1) I'm a future MD, not an MD
#2) You were quoting me out of context, and I tend to think that patient's should have more responsibility for their actions and consequences than the majority of the public does.
#3) I NEVER made an argument for the concept of the behind the counter medication. Either we believe that the medication is simple enough for the average consumer to take and evaluate or a professional who knows the patient's MEDICAL Hx needs to do it (aka a physician). Behind the counter meds are nothing but an attempt for some retail pharmacists to justify their existance, which has largely become supervising some techs at most retail chains. We are a long way from mixing herbs behind the counter, and it doesn't take the same level of expertise to give a prescribed drug that is already made and packaged. Some compounding pharmacies are the exception.

Pharmacists learn how drugs act on the body, how to dose drugs, and how drugs interact. They do NOT learn how to diagnose the patient, provide the appropriate drug, and weigh the cost and benefit between relative contraindications. What the heck is the point of a BTC drug? A pamphlet with contraindications and some instructions would work just fine, and if this isn't enough, then the patient needs to see a doctor.

 

[Taurus]

PBMs and vending machines have been here for years but why is the profession doing well?

PBMs are staffed by pharmacists. Who is denying the prior authorization? Pharmacists.

And so called vending machines, they are already in California. And guess who check and verify the medication because it is placed in the machines? Pharmacists.

Oh how naive you are. What once was done by many pharmacists can now be done by fewer pharmacists taking advantage of technology. That concept is called efficiency and your masters the CVS's, Walgreen's, and Wal-Mart's are very good at it.

CVS, Walgreens, Walmart are opening up thousands of clinics throughout the U.S. that are staffed by NPs. No need for pharmacists to set up their own clinic. Nurses can have primary care.

You didn't understand what I said. I said it would be funny if in the same Wal-Mart you have separate clinics staffed by pharms and NP's and both purport to offer the same primary care service.

 

[BMBiology]

Oh how naive you are. What once was done by many pharmacists can now be done by fewer pharmacists taking advantage of technology.

Wrong, my simple minded friend. PBMs have created another niche in pharmacy (e.g. prior authorization approval, formulary approval, etc.). I would also like to thank physicians for prescribing anything the drug reps tell them and as a result, creating PBMs. I owe you guys big time!

Most of the people working in the pharmacy are not pharmacists. They are techs and clerks and they do most of the filling. The pharmacists mainly just verify prescriptions.

Why pay someone $55/hr just to fill? You don't think your friendly Walmart has already figured that out? The technology has been here for the last 20 years and the salary for pharmacists has gone through the roft. Why? Technology = more efficient = greater profit (open new pharmacies) = greater demand for pharmacists = higher salary for pharmacists.

 

[genesis09]

Of all the major pharmacist areas, PBM is the area with the biggest growth. Fewer pharmacists are going into the traditional areas of retail and hospital. In the coming years, we will see growth in the long term care sector.
Most community pharmacies are already at the legal minimum of pharmacists. It's rare to see two pharmacists working at the same time, unless it is shift overlap time.
The purpose of BTC is to increase access to drugs which have something about them which makes regulators uneasy about self care. Many other countries have this class. FDA probably won't do anything about this until 2009 because of the election.
From what I've been told, the powers to be have been predicting the demise of retail pharmacy for years and years, and yet, it is still here. Some of the pharmacists who started in the 80s said starting salary was somewhere about $40,000. Overall average pharmacist salary just cracked $100k this past year.

 

[soeagerun2or]

The AMA crafted a letter to the editor in response to the original WSJ article and have a policy position on preventing the expansion of scope of practice by non-MD/DOs.

 

[DoctaJay]

-

Congratulations. I have rarely seen a bonified troll make it to 1000+ posts on SDN.

 

[BMBiology]

Congratulations. I have rarely seen a bonified troll make it to 1000+ posts on SDN.

 

[BMBiology]

The AMA crafted a letter to the editor in response to the original WSJ article and have a policy position on preventing the expansion of scope of practice by non-MD/DOs.

Is it the same letter the AMA crafted about DOs and how they are not qualified to practice medicine?

 

[soeagerun2or]

Is it the same letter the AMA crafted about DOs and how they are not qualified to practice medicine?

Not sure where you're going with that one. Did your mother not love you as a child?

 

[BMBiology]

The truth sometimes offends people.

 

[Doublecortin]

The AMA crafted a letter to the editor in response to the original WSJ article and have a policy position on preventing the expansion of scope of practice by non-MD/DOs.

link, please?!

 

[alpha62]

The two things that scare pharmacists the most:

Competing with pharmacy benefit management companies
Being replaced by vending machines

Wouldn't it be funny if pharmacists set up clinics in CVS's, Walgreen's, and Wal-Mart's that compete with the health clinics staffed by NP's? I'm all for that. You truly have a race to the bottom now.

Everybody wants to talk about the future. Illegal aliens are the future, get used to it. Transgender, gays, lesbians teaching your pre-schoolers, get used to it. Free syringes for addicts, get used to it.

Out of all these "non-traditional" new age americans, you've got a problem with PAs and NPs

Everybody keeps shoving diversity down all our throats. Now "celebrate" a little occupational diversity. We're here, get used to it.

 

[CigarTragic]

Oh, thank God BMBiology stopped posting in here. Now I'll actually check this thread again.

 

[Faebinder]

Oh, thank God BMBiology stopped posting in here. Now I'll actually check this thread again.

Heh, my thoughts as well. Ignore the thread long enough and a spammer goes away.

 

[Taurus]

He should have been banned for trolling.

 

[Miami_med]

He should have been banned for trolling.

It wasn't clear that this wasn't a legitimate position. As likely as it was that he was trolling, we can't ban people for having minority opinions.

 

[BMBiology]

I shouldn't be too rough on you guys. You guys work hard and deserve to make good money. I know you guys are bitter but dont your bitterness turn into hate.

 

[ForbiddenComma]

When the time comes for you to go to the ICU or to go under the knife, who do you want to be calling the shots, all else being equal?

A doctor?
Or a nurse with a small fraction of the training, no standardization to the training, and vastly lower entrance requirements to entering school?

Now ask yourself... which would your insurance company and/or Medicare prefer for you to see?

And guess whose decision is the one that matters?

Right. So there you go. Our opinions on the matter are rather trifling. In the interests of cutting costs and eliminating the traditional independence of medical providers, the insurance companies and the federal government will see to it that primary care, and likely most of everything else, will be delivered by NPs and others with, on average, vastly lower skills, intelligence, ambition, and salary.

The best and the brightest of our ambitious college grads, meanwhile, will divert themselves to more rewarding careers in finance, I-banking and the like. Medical - er I mean, nurse practitioner school will have all the glory and glamour of accounting.

And after you find yourself bleeding out after the nurse surgeon nicked your portal vein, and you experience the dying because the CRNA couldn't be bothered to keep you asleep, and you are in this situation to begin with because the NP missed your colon cancer before it threw a met to your liver, not to mention the nurse radiologist who thought that hypodense lesion on CT was just a cyst... perhaps your dying thought will be, hey, maybe there was some obscure reason why entrance requirements for independent medical practice used to be so high.

 

[zenman]

And after you find yourself bleeding out after the nurse surgeon nicked your portal vein, and you experience the dying because the CRNA couldn't be bothered to keep you asleep, and you are in this situation to begin with because the NP missed your colon cancer before it threw a met to your liver, not to mention the nurse radiologist who thought that hypodense lesion on CT was just a cyst... perhaps your dying thought will be, hey, maybe there was some obscure reason why entrance requirements for independent medical practice used to be so high.

I know what you mean, but you are aware that you can put "physician or surgeon" everywhere you used "nurse or NP" aren't you?

 

[CigarTragic]

I know what you mean, but you are aware that you can put "physician or surgeon" everywhere you used "nurse or NP" aren't you?

It is likely that the odds/percentages would be much different, however, if indeed NP's did outnumber physicians in those example scenarios 10-20 yrs from now... i.e. error rates among NP's probably higher than physicians if the number of NP's skyrockets; NP's now are probably as much of "the cream of the crop" among nurses that the field will probably ever see... watch that dwindle as well if more people become NP's

 

[Miami_med]

It is likely that the odds/percentages would be much different, however, if indeed NP's did outnumber physicians in those example scenarios 10-20 yrs from now... i.e. error rates among NP's probably higher than physicians if the number of NP's skyrockets; NP's now are probably as much of "the cream of the crop" among nurses that the field will probably ever see... watch that dwindle as well if more people become NP's

NPs largely do two things:
1. They open shop and do very low level medicine, which primarily takes the bread and butter algorithmic medicine or med student level procedures away from the MDs. This will more likely hurt the sick patients who are being subsidized by the bread and butter stuff more than the actual bread and butter patients. They will probably miss more Zebras, but they are uncommon enough in simple URI, essential HTN, etc... that we probably won't see statistical significance. Since the DNP model really looks more like MPH with some nursing skill thrown in, this "population health," idea will accept those zebra losses as being insignificant based on large scale statistical algorithms. Most of the things that they are trying to do are things that inexperienced junior residents routinely did unsupervised until the "To Err is Human" clan came in and destroyed medical training by destroying training autonomy.

2. They will continue to work within the protected environment for which they were designed. I remember we had an NP on trauma, and everyone loved the guy (myself included). He only worked about 7-4, but he did a good deal of the discharges, the annoying paperwork, he dealt with the beauracracy, and he had basic physical exam skills. He didn't want to be a doctor, didn't pretend to be, and he was happy to collect a very decent salary for his work. This is probably most NPs.

 

[drfunktacular]

NPs largely do two things:
1. They open shop and do very low level medicine, which primarily takes the bread and butter algorithmic medicine or med student level procedures away from the MDs. This will more likely hurt the sick patients who are being subsidized by the bread and butter stuff more than the actual bread and butter patients. They will probably miss more Zebras, but they are uncommon enough in simple URI, essential HTN, etc... that we probably won't see statistical significance. Since the DNP model really looks more like MPH with some nursing skill thrown in, this "population health," idea will accept those zebra losses as being insignificant based on large scale statistical algorithms. Most of the things that they are trying to do are things that inexperienced junior residents routinely did unsupervised until the "To Err is Human" clan came in and destroyed medical training by destroying training autonomy.

MiamiMed, you seem pretty well-versed in healthcare economics, so maybe you can comment on this a little further. I also doubt that NP's will take complex medical care away from physicians. The corollary, however, is that most complex medical care occurs in patients with substandard finances/health coverage, leaving MD's with the sickest, most-demanding, least-compensating patients, while NP's skim off all the easy cases and minor procedures that otherwise keep MD's in the black.

 

[deleted6669]

that most complex medical care occurs in patients with substandard finances/health coverage, leaving MD's with the sickest, most-demanding, least-compensating patients, while NP's skim off all the easy cases and minor procedures that otherwise keep MD's in the black.

Actually a fair %(maybe 40%) of the pts I see are low paying, relatively low acuity/bread and butter/scut work type things. these are the most demanding pts(as in they complain a lot). I work a lot of night shifts so I see lots of dental pain, back pain, pelvic pain,rectal bleeds, uti, med refills, minor injury type stuff among the unemployed and those without insurance( ie stuff docs don't want to see). most of the higher acuity stuff I see is in older folks who at least have medicare( MI's, sepsis, CVA, diverticulitis, etc). they are always very grateful for the care they receive and are much sicker than the avg loudmouth 3 am pt with a benign or non-emergent chronic condition.
last yr I was running a code at 2 am and a pt with chronic back back in the next room kept coming into the room asking when they would be seen. unbelieveable; cpr in progress, pt intubated, ej lines, etc and this lady is yelling about her percocet refill(she never got it).
certainly the avg trauma pt population is both higher acuity and poorly reimbursed but the trade off is that these are the cases em md's like to do. that's why they went md instead of pa/np, for the 10-15% of cases that they manage much better than a midlevel; crashing multisystem dz medical and trauma pts who are labor intensive and require multiple procedures and consults. while I can do these( and do ) most of the em docs run them more smoothly.

 

[Miami_med]

MiamiMed, you seem pretty well-versed in healthcare economics, so maybe you can comment on this a little further. I also doubt that NP's will take complex medical care away from physicians. The corollary, however, is that most complex medical care occurs in patients with substandard finances/health coverage, leaving MD's with the sickest, most-demanding, least-compensating patients, while NP's skim off all the easy cases and minor procedures that otherwise keep MD's in the black.

It really depends on how the payment system goes. Most patients prefer to see a doctor. There are a few who don't care and a lot who don't know what a NP, DNP, PA, etc... is, but assume that they must know what they're doing or they wouldn't be licensed to practice. The only system in which NPs actually take these cases in large numbers from MDs is if they charge less money to do them. Nurses are well paid, and on an hour to hour basis, taking too much less almost makes it not worth it to become an independent DNP. Remember, their overhead is still the same. A 10% cut in pay equals a 20-40% drop in profit.

Like I said, doctors will probably drop the more complex patients in order to pursue the easier cases with better profit margins. We already see that. There are a million primary care docs that send every non-cold to a specialist and try to collect for the consult. It's this type of practice (which the current payment system encourages) that makes it look like DNPs can practice primary care in the first place. If we ever move towards a system in which people pay cash for primary care, the first victims will be the independent DNPs, because they can't take less enough to overcome not being an MD when the savings isn't spread out over 100,000 patients. Under the current system, the victim becomes the complex patient who is actually sick. Doctors will still make money either way unless the government essentially makes it impossible. The culprit won't be the DNP.

 

[Taurus]

In my opinion, if these health clinics at Wal-Mart's, CVS, Walgreens staffed by DNP's are successful, that's a good sign for physicians. It means that if consumers are willing to spend $50+ cash for a 15 minute visit to a DNP for a cold then those same consumers probably would be willing to spend the same amount or more with a physician. It just proves that there is a consumer base who's willing to pay good cash for their health needs. If consumers have the option of going to either a DNP or physician and the cost and wait time are the same, then I believe that most consumers would choose a physician over a DNP.

DNP's would be able to compete only if they drop their price a lot. It shall be interesting to see how this unfolds.

 

[oldManDO2009]

In my opinion, if these health clinics at Wal-Mart's, CVS, Walgreens staffed by DNP's are successful, that's a good sign for physicians. It means that if consumers are willing to spend $50+ cash for a 15 minute visit to a DNP for a cold then those same consumers probably would be willing to spend the same amount or more with a physician. It just proves that there is a consumer base who's willing to pay good cash for their health needs. If consumers have the option of going to either a DNP or physician and the cost and wait time are the same, then I believe that most consumers would choose a physician over a DNP.

DNP's would be able to compete only if they drop their price a lot. It shall be interesting to see how this unfolds.

physicians and other health care services need to be upfront with cost.

I have called physician's office and asked what there cash cost is and have got everything from a straight answer to we don't know until your billed. These front office people are hurting physician opportunity for cash paying customers. If I am told 50 dollars i am more likely to consider this then maybe 100 to 400 depending on the billing codes - I am outta there.

I paid cash for an MRI once --> billed 1000 dollars cash at time of service 400 dollars - no ambiguity.

 

[Faebinder]

physicians and other health care services need to be upfront with cost.

I have called physician's office and asked what there cash cost is and have got everything from a straight answer to we don't know until your billed. These front office people are hurting physician opportunity for cash paying customers. If I am told 50 dollars i am more likely to consider this then maybe 100 to 400 depending on the billing codes - I am outta there.

I paid cash for an MRI once --> billed 1000 dollars cash at time of service 400 dollars - no ambiguity.

I agree with the above statement.

 

[Strength&Speed]

I agree with the above statement.

I agree too. They should clearly list prices. Among the dumbest things I ever heard was from an idealistic medicine professor who discouraged having residents learn about the "cost" of doing things, only doing what was best for the patient. This is ******ed, because exorbitant costs are what have killed us. And frankly, a 1% improvement on a condition often isn't worth the 100% increase in cost. Good intentions....but shortsighted.

And from my standpoint...nurses can go ahead and take primary care. Physicians are too expensive to do most primary care anyways. They should be seeing the complex patients and technical problems most times anyway. General maintenance of when to get health care screening, checkups, etc should be done by less skilled employees.

 

[Faebinder]

And from my standpoint...nurses can go ahead and take primary care. Physicians are too expensive to do most primary care anyways. They should be seeing the complex patients and technical problems most times anyway. General maintenance of when to get health care screening, checkups, etc should be done by less skilled employees.

I disagree with that point. Very shortsighted and will result in the ER becoming the primary care of medicine.

 

[soonereng]

Very shortsighted and will result in the ER becoming the primary care of medicine.

Well, that's pretty much happening regardless...

 

[Taurus]

And from my standpoint...nurses can go ahead and take primary care. Physicians are too expensive to do most primary care anyways. They should be seeing the complex patients and technical problems most times anyway. General maintenance of when to get health care screening, checkups, etc should be done by less skilled employees.

Can you imagine what it would be like if the nurses dominated primary care and determined who to refer patients to? Remember, the DNP's are claiming to be just as good as any PCP's and can work autonomously with their measly 1000 clinical training hours vs. over 12000 for a PCP. As a medical specialist, do you want to be at the mercy of some nurse for referrals?

Given their history at trying to grab any scope they can, I wouldn't put it pass the nurses to try to get into the medical specialties or create their own residencies. What if then the DNP's prefer to refer their patients to a nursing derm, GI, or cards over a medical specialist? By not looking into ramifications of their decisions is how medicine got itself into trouble in the first place.

 

[Faebinder]

Well, that's pretty much happening regardless...

People get killed by drunk drivers every day, that doesn't make it right or acceptable.

ER acting like primary care costs you the tax payer insane amount of money. Maybe you arent feeling it now cause you are not paying that much in taxes as a student.

 

[soonereng]

People get killed by drunk drivers every day, that doesn't make it right or acceptable.

ER acting like primary care costs you the tax payer insane amount of money. Maybe you arent feeling it now cause you are not paying that much in taxes as a student.

I didn't say it was right or acceptable that the ER is becoming primary care for the masses. I just said it was already happening, and it isn't the nurses' fault. You can't blame something on someone when it's already happening with physicians at the wheel. That was my point.

And as an aside, it's amusing for you to assume that you know anything about my tax status. I'm a nontrad who worked as an engineer for 7 years (and I still am consulting) and my wife currently works as an NP, and we have paid our fair share of the fallout of EMTALA and those who already think we have free healthcare who just don't bother to pay their bill.

Also, it isn't just the taxpayers that get extra cost added on. It is every person who has any services performed at a hospital. They increase the cost of everything else to offset the abuse of ER services.