NPs vs. MD's.

[W19]

I think they should phase out anesthesia, primary care and psych and leave them for NP/CRNA to do... Lets face it guys, they are not killing patients.

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[deleted407021]

I think they should phase out anesthesia, primary care and psych and leave them for NP/CRNA to do... Lets face it guys, they are not killing a lot of patients.

I've seen a veteran CRNA take 10 minutes to try and start a spinal tap on a difficult back. Brought in the anesthesiologist -- did it in 10 seconds. What happens when there's no anes doc? There are enough bad psychiatrists -- do we want a bunch of bad psych NPs? Don't PCP NPs miss important stuff, sometimes, at a greater rate than docs?

It's not just about killing patients, it's also about maiming them and limiting their care opportunities because their providers don't have the full picture they need to adequately treat them.

 

[el_duderino]

If we want to maintain our ground as physicians, we need to start talking. We need to start making our own infographics. We need to start shouting back at them and putting them in their place.

That's tough, though. You can't attack NPs. They're not attacking doctors. They're promoting themselves.

No one wants to listen to doctors promoting themselves.

 

[chipwhitley]

That's tough, though. You can't attack NPs. They're not attacking doctors. They're promoting themselves.

No one wants to listen to doctors promoting themselves.

They are attacking doctors, though. By promoting themselves as just as good as doctors, they're devaluing our training. They're attacking our bedside manners and our compassion, too. Their propaganda portrays us as greedy uncaring people.

 

[Drrrrrr. Celty]

I think they should phase out anesthesia, primary care and psych and leave them for NP/CRNA to do... Lets face it guys, they are not killing patients.

Except they are killing patients ( I've in just a year seen plenty of nurses either almost kill their patients or kill them), the only reason we aren't talking about this is because for some reason the public has decided that nurses are more trustworthy than doctors. I guess people prefer the person who's changing their iv, telling them they'll get better over the person who's running them through ten tests to make sure they know what's killing them.

 

[chipwhitley]

Except they are killing patients ( I've in just a year seen plenty of nurses either almost kill their patients or kill them), the only reason we aren't talking about this is because for some reason the public has decided that nurses are more trustworthy than doctors. I guess people prefer the person who's changing their iv, telling them they'll get better over the person who's running them through ten tests to make sure they know what's killing them.

So basically we don't do anything about it until some prominent figure dies as a result of NP's mistreatment. That might take a while though, because I'm pretty sure the big shots will never go to an NP.

 

[el_duderino]

They are attacking doctors, though. By promoting themselves as just as good as doctors, they're devaluing our training. They're attacking our bedside manners and our compassion, too. Their propaganda portrays us as greedy uncaring people.

So what do doctors say?

"Just as good as NPs"?

No one wants to hear physician self-promotion. The reputation already is arrogance.

 

[el_duderino]

So basically we don't do anything about it until some prominent figure dies as a result of NP's mistreatment. That might take a while though, because I'm pretty sure the big shots will never go to an NP.

Until there's some solid data showing that they are killing people, or something like you describe happens here.

 

[Drrrrrr. Celty]

So basically we don't do anything about it until some prominent figure dies as a result of NP's mistreatment. That might take a while though, because I'm pretty sure the big shots will never go to an NP.

I have no solution. I think there's a degree of absurdity in just having this conversation. It's like asking a car mechanic to be a plumber.

So what do doctors say?

"Just as good as NPs"?

No one wants to hear physician self-promotion. The reputation already is arrogance.

Except that's the thing, the people in this country perceive any abundance of knowledge that is exceptional as inherently aggressive or arrogant. We're seen as aggressive and arrogant because we know enough to shut people up and shut down the entire slew of nonsense that is swished around in the cocktail we call the public.

In the end no one listens to doctors or scientists. We're like friggin aliens to these people.

 

[Psai]

The reason why people aren't being hurt is because there are a ton of safeguards. You order a med and it is checked by the pharmacist, then the nurse looks at it and you are monitoring for effects. A lot of diseases take many years for bad outcomes to manifest and mortality is not the best way to measure how well patients are being taken care of. Gomers don't die. If someone has 10 comorbidities and they die in 10 years instead of 20 because of mismanagement, how can you measure that? When a crna is actively trying to kill a patient but the anesthesiologist walks in at just the right time to save them, how do you measure that outcome when nothing bad happens?

Medicine is a science but also an art. You can follow protocols and deliver adequate care but to really do what's right for the patient you need to be able to think about your patients and their problems, rather than pretending that you are "holistic" which can make up for serious deficiencies in knowledge and experience

With the everyone deserves a prize generation, people don't trust authority anymore. They think that their opinions hold the same weight as facts. There is a growing distrust for education and there exists a belief that years of education and understanding is equivalent to a cursory Google search. This np vs physician nonsense is just a symptom of the greater problem. The two are not comparable, just as paralegals and lawyers are not comparable.

 

[chipwhitley]

So what do doctors say?

"Just as good as NPs"?

No one wants to hear physician self-promotion. The reputation already is arrogance.

I don't think that's true. I've explained the differences between MDs and NPs to many non-medical people and they have been absolutely shocked and wished there was more information out there for patients regarding the exact qualifications of the provider they're seeing. We should also work to clean up our image regarding arrogance.

 

[chipwhitley]

In the end no one listens to doctors or scientists. We're like friggin aliens to these people.

So I guess we just give up and go into ibanking?

 

[Mad Jack]

"It says the initiative is necessary to meet the demands of European limits on working hours, but has concerns that the practitioners are not subject to regulation in the way that either surgeons or nurses are."

Since when did surgeons start heeding to work hour regulations? Surgical residents rarely do that in the U.S. and I could hardly imagine an attending surgeon refusing to perform a life saving procedure due to some arbitrary work hour regulation by handing the procedure over to a "surgical assistant." I have a child who needs an emergency surgery, but I cannot perform it because I have already hit my quota this week sorry guys

Non-consultants are not allowed to work beyond the EU mandated maximum hours. If they do one day, their hours are cut later in the week. As to nurses, they are limited to I believe 40 hours per week under EU directives, while trainee physicians are limited to 45.

 

[W19]

So I guess we just give up and go into ibanking?

I don't think I am smart enough to be an ibanking

 

[Mad Jack]

I think they should phase out anesthesia, primary care and psych and leave them for NP/CRNA to do... Lets face it guys, they are not killing patients.

Lolololol

Psych is probably the last thing you'd want to phase physicians out of- the enormous number of drug interactions and treatment strategies are beyond most nurses. Most psych NPs do wellness checks on your average lightly medicated patient, but psychiatrists are there to deal with for more difficult cases- suicidal patients, those with schizophrenia, bipolar, etc. These people absolutely will die or have poor quality of life with inadequate medical management.

Now, in primary care, even nurses will own up to the fact that there are a lot of patients that are too difficult to manage because they have multiple comorbidities that have to be referred to IM or FM physicians. Most nurses actually don't want to practice without a doctor backing them up, believe it or not- it's a very vocal minority, while the majority likes having someone with greater breadth of training to bump the weird stuff off of.

And anesthesia- there aren't a lot of pediatric, transplant, or cardiothoracic surgeons out there that would be thrilled with your idea. And there's still a good number of surgeons that prefer anesthesiologists. This is entirely apart from the fact that AMCs and hospitals want them around as liability sponges, and that CRNAs can't practice independently in many states, and that many hospitals have anesthesiologists that work in the ICUs, etc...


Don't get why a med student would want to burn three specialties to the ground.

 

[PhillyMed777]

My roommate and I were talking yesterday and we both agreed that if given the chance to pursue another career with some guarantee of success, we would get out of medicine. Problem in the real world is that I really don't have much to offer the world at the moment other than memorizing things. So i'll continue to drag my untalented a** to school everyday.

 

[chipwhitley]

Lolololol

Psych is probably the last thing you'd want to phase physicians out of- the enormous number of drug interactions and treatment strategies are beyond most nurses. Most psych NPs do wellness checks on your average lightly medicated patient, but psychiatrists are there to deal with for more difficult cases- suicidal patients, those with schizophrenia, bipolar, etc. These people absolutely will die or have poor quality of life with inadequate medical management.

Now, in primary care, even nurses will own up to the fact that there are a lot of patients that are too difficult to manage because they have multiple comorbidities that have to be referred to IM or FM physicians. Most nurses actually don't want to practice without a doctor backing them up, believe it or not- it's a very vocal minority, while the majority likes having someone with greater breadth of training to bump the weird stuff off of.

And anesthesia- there aren't a lot of pediatric, transplant, or cardiothoracic surgeons out there that would be thrilled with your idea. And there's still a good number of surgeons that prefer anesthesiologists. This is entirely apart from the fact that AMCs and hospitals want them around as liability sponges, and that CRNAs can't practice independently in many states, and that many hospitals have anesthesiologists that work in the ICUs, etc...


Don't get why a med student would want to burn three specialties to the ground.

Based on his previous posts, I'm pretty sure he was being sarcastic.

 

[Mad Jack]

Based on his previous posts, I'm pretty sure he was being sarcastic.

I was hoping so, but it's so hard to tell

 

[chipwhitley]

My roommate and I were talking yesterday and we both agreed that if given the chance to pursue another career with some guarantee of success, we would get out of medicine. Problem in the real world is that I really don't have much to offer the world at the moment other than memorizing things. So i'll continue to drag my untalented a** to school everyday.

Well that's why no one gets out. No matter how bad it gets, it's easier to just keep on doing what you're good at doing than start something completely new.

 

[W19]

I was hoping so, but it's so hard to tell

Based on his previous posts, I'm pretty sure he was being sarcastic.

I wasn't...

 

[Mad Jack]

I wasn't...

Okay, then it was just a really dumb idea. You're forgiven.

 

[W19]

Okay, then it was just a really dumb idea. You're forgiven.

thanks

 

[Lord Humongus]

My roommate and I were talking yesterday and we both agreed that if given the chance to pursue another career with some guarantee of success, we would get out of medicine. Problem in the real world is that I really don't have much to offer the world at the moment other than memorizing things. So i'll continue to drag my untalented a** to school everyday.

Ain't that the truth. I'm still in the "accepted not matriculated" category and technically can still walk away no harm no foul, but almost certainly won't even despite the storm clouds I can clearly see gathering on the horizon. Why? Because my only talents are memorizing stuff, taking tests, and logical thinking. These are nearly completely useless in the real world, where at most they will allow you to keep a steady middle tier job with a rare promotion while you watch socially dominant back slappers and glad handers rising to the top of the hierarchy, before being put out to pasture once you start becoming too expensive in your late thirties or early forties. At which point you're SOL and have the choice of eating a bullet or stocking shelves for the remaining ~30 years of your life.

So yeah, I'm gonna gamble and take the only path that lets you fill in the blanks to a super secure job that pays you as if you were the CEO of a medium sized corporation. Even with the midlevel threat. Hey, we'll always have neurosurgery! Right? Right...?

 

[PhillyMed777]

Ain't that the truth. I'm still in the "accepted not matriculated" category and technically can still walk away no harm no foul, but almost certainly won't even despite the storm clouds I can clearly see gathering on the horizon. Why? Because my only talents are memorizing stuff, taking tests, and logical thinking. These are nearly completely useless in the real world, where at most they will allow you to keep a steady middle tier job with a rare promotion while you watch socially dominant back slappers and glad handers rising to the top of the hierarchy, before being put out to pasture once you start becoming too expensive in your late thirties or early forties. At which point you're SOL and have the choice of eating a bullet or stocking shelves for the remaining ~30 years of your life.

So yeah, I'm gonna gamble and take the only path that lets you fill in the blanks to a super secure job that pays you as if you were the CEO of a medium sized corporation. Even with the midlevel threat. Hey, we'll always have neurosurgery! Right? Right...?

Yes, that is, if you are able to part of the 200 people in the entire country that get neurosurgery and have the capability to complete a residency.

Ill add that I asked my roommate and myself the exact same question at the beginning, middle, and end of MS1. All those times we still would stick with medicine. It's only now that our answers have changed.

 

[Mjolner]

Yes, that is, if you are able to part of the 200 people in the entire country that get neurosurgery and have the capability to complete a residency.

That DEFINITELY remains to be seen.
There's a big difference between able to complete Med school vs being able to match/complete a neurosurgery residency.

 

[Lord Humongus]

Yes, that is, if you are able to part of the 200 people in the entire country that get neurosurgery and have the capability to complete a residency.

Ill add that I asked my roommate and myself the exact same question at the beginning, middle, and end of MS1. All those times we still would stick with medicine. It's only now that our answers have changed.

Sure, the neurosurgery comment was tongue in cheek, hence the dramatic double "right?"s at the end.

 

[chipwhitley]

Ain't that the truth. I'm still in the "accepted not matriculated" category and technically can still walk away no harm no foul, but almost certainly won't even despite the storm clouds I can clearly see gathering on the horizon. Why? Because my only talents are memorizing stuff, taking tests, and logical thinking. These are nearly completely useless in the real world, where at most they will allow you to keep a steady middle tier job with a rare promotion while you watch socially dominant back slappers and glad handers rising to the top of the hierarchy, before being put out to pasture once you start becoming too expensive in your late thirties or early forties. At which point you're SOL and have the choice of eating a bullet or stocking shelves for the remaining ~30 years of your life.

So yeah, I'm gonna gamble and take the only path that lets you fill in the blanks to a super secure job that pays you as if you were the CEO of a medium sized corporation. Even with the midlevel threat. Hey, we'll always have neurosurgery! Right? Right...?

Run away while you still can.

 

[PhillyMed777]

Run away while you still can.

Can't even count the number of pre-meds I've told to stay away from med school for whatever reasons. For most it never crosses their thick skulls that it can really be "that" bad. They think they know a lot about medicine and dream up mystical lands of money and glamour. Problem is, when they realize oh S***, he was right, i need to get outta here... it's far too late. You are stuck now and you have six figure loans. I fit into that category too and now i'll just make the best with what I got. here's to hoping things go well. and that the label of "physician" retains some respect with limited further infiltration from mid-levelers.

 

[chipwhitley]

Can't even count the number of pre-meds I've told to stay away from med school for whatever reasons. For most it never crosses their thick skulls that it can really be "that" bad. They think they know a lot about medicine and dream up mystical lands of money and glamour. Problem is, when they realize oh S***, he was right, i need to get outta here... it's far too late. You are stuck now and you have six figure loans. I fit into that category too and now i'll just make the best with what I got. here's to hoping things go well. and that the label of "physician" retains some respect with limited further infiltration from mid-levelers.

How can it be bad if you end up in the 1%. Isn't money the only thing that matters?

 

[PhillyMed777]

How can it be bad if you end up in the 1%. Isn't money the only thing that matters?

-Haha that's why i continue.BUT Most docs are not top 1 percent.
-fwiw i thought money is the only thing that mattered prior to med school. Now i realize the benefit of lifestyle, people/relationships, hobbies, etc.
-Lastly, i don't really believe in the idea of the 1 percent. People often say the top 1 percent hold x amount of wealth. But the top 1 percent is the most diverse of all the other percentages. The very bottom of the top 1 percent is a world away from the top part of the 1 percent. They are so different it makes no sense to group all those people under one umbrella of "top 1 percent"

 

[chipwhitley]

-Haha that's why i continue.BUT Most docs are not top 1 percent.
-fwiw i thought money is the only thing that mattered prior to med school. Now i realize the benefit of lifestyle, people/relationships, hobbies, etc.
-Lastly, i don't really believe in the idea of the 1 percent. People often say the top 1 percent hold x amount of wealth. But the top 1 percent is the most diverse of all the other percentages. The very bottom of the top 1 percent is a world away from the top part of the 1 percent. They are so different it makes no sense to group all those people under one umbrella of "top 1 percent"

I agree with you. It also depends where you come from. If you grew up in poverty, then any part of the 1%, bottom or top, isn't a whole lot different to you. They're all different degrees of rich. If you grew up in the bottom of the 1%, then yeah, the top is a huge huge difference. You probably don't even consider someone rich unless they're in the 0.1%.

 

[PhillyMed777]

I agree with you. It also depends where you come from. If you grew up in poverty, then any part of the 1%, bottom or top, isn't a whole lot different to you. They're all different degrees of rich. If you grew up in the bottom of the 1%, then yeah, the top is a huge huge difference. You probably don't even consider someone rich unless they're in the 0.1%.

I have an interesting background. Dirt poor for most of my young life until about the time i went to college, when i saw the hard work of my family lead to success. Yes, i didn't understand the differences between the top 1 percent, until my parents achieved success. But there's a big difference between someone finally buying that new Mercedes Benz E class they were eyeing for 30 yrs and someone buying a private jet.

The reason i have the American Flag as my icon for my SDN profile is that I want to believe based on what I've seen in my life that hard work in this country can get you places. Maybe not anywhere, but somewhere reasonable. I look at the medical profession in this light and for long as I live, I'd like to see hard working and generally high achieving people want to go into the field

The idea that someone can sort of go around the hard work (NP) and try to claim themselves as equal doesn't sit with me well.

 

[Bearcat74]

As "National NP Week" comes to a close, let us resolve that MDs are still the top of the food chain in medicine, but NPs, due to the ever increasing high cost of health care in the USA, are going to play a more prominent role. Don't think for one second that if a hospital or agency can save a buck, they will either use an NP over an MD, or send MRIs to Israel or Australia, to be read at a lower cost. Central rule in this world..... "just follow the money!"

 

[PathoTurnUp1865]

What specialties aren't endanger of mid-levels? Neurology? EM?

 

[Mad Jack]

What specialties aren't endanger of mid-levels? Neurology? EM?

Neurology moreso than EM, but EM is fairly safe.

 

[PathoTurnUp1865]

Neurology moreso than EM, but EM is fairly safe.

Really? I've always felt like neurology would be one of those specialties that would be harder for a mid-level to encroach on. I still have a long ways before 4th year but I want to have a strong list for elective rotations.

 

[Mad Jack]

Really? I've always felt like neurology would be one of those specialties that would be harder for a mid-level to encroach on. I still have a long ways before 4th year but I want to have a strong list for elective rotations.

You really shouldn't base your specialty of choice on fear of midlevel encroachment. Unless that field is anesthesia, I suppose.

 

[gmbz]

I love this thread because everyone thinks the world is burning.

 

[PhillyMed777]

@gmbz Nothing is burning, it just sucks some bit. And i'd prefer if it didn't suck at all personally.

@Bearcat74 we didn't need to "resolve" that physicians are at the top of the food chain. We already knew that. I picked to be a doc (out of the other various choices in the healthcare industry) because my academic credentials would be a waste otherwise.

No matter how much I am forced to pretend that I am an equal in my medical school group activities with nurses, pharmacists, etc, I know it is untrue.

@Mad Jack I agree, mid-level encroachment isn't as big an issue outside of a few considerations. If you've been working in some specialty clinics, you have probably seen that without the doc there, it's nothing. The only one with a strong command of that specialty is always the doc.

Becoming a specialist of some kind as a US MD is also not too hard, as long as you play your cards right.

 

[W19]

Really? I've always felt like neurology would be one of those specialties that would be harder for a mid-level to encroach on. I still have a long ways before 4th year but I want to have a strong list for elective rotations.

If you took neuroanatomy, you would understand that neurology is not a specialty that mid level would be comfortable in...

 

[chipwhitley]

If you took neuroanatomy, you would understand that neurology is not a specialty that mid level would be comfortable in...

Our hospital's neurology consult service has an NP who pretty much does her own thing and apparently does fine?

 

[Psai]

Our hospital's neurology consult service has an NP who pretty much does her own thing and apparently does fine?

We had a consult by a "neuro np" who couldn't read the eeg or offer anything beyond what we already had. Wtf is the point of sending in a mid level when the team is asking for a specialist? Biggest waste of time ever

 

[scootad.]

What % of NPs are able to recite all the cranial nerves by name?

 

[WedgeDawg]

What % of NPs are able to recite all the cranial nerves by name?

Pretty sure even NPs can count to 12

 

[PhillyMed777]

Pretty sure even NPs can count to 12

I'm not...

 

[W19]

Our hospital's neurology consult service has an NP who pretty much does her own thing and apparently does fine?

That hospital is really shortchanging its patients.

 

[scootad.]

Notice how I didn't even get into what % of NPs know each cranial nerve's function...

 

[Wordead]

Neurology moreso than EM, but EM is fairly safe.

? There already are EM PAs and NPs everywhere

They are a ****ing nightmare because they consult all the time .

I would argue that EM has a lot more potential to be taken over by midlevels because it's pretty algorithmic to rule out **** that will kill a patient immediately, order a **** ton of tests, and then turf it to medicine or whatever team that needs to take care of the problem.

 

[Mad Jack]

? There already are EM PAs and NPs everywhere

They are a ****ing nightmare because they consult all the time .

I would argue that EM has a lot more potential to be taken over by midlevels because it's pretty algorithmic to rule out **** that will kill a patient immediately, order a **** ton of tests, and then turf it to medicine or whatever team that needs to take care of the problem.

Yeah, but most hospitals don't want the liability that comes with having midlevels operate under their protocols. That's the thing people frequently forget. A doctor misses something, his ass is on the line. A PA follows hospital protocol and misses something, the hospital is taking the hit, guaranteed.

 

[Psai]

? There already are EM PAs and NPs everywhere

They are a ****ing nightmare because they consult all the time .

I would argue that EM has a lot more potential to be taken over by midlevels because it's pretty algorithmic to rule out **** that will kill a patient immediately, order a **** ton of tests, and then turf it to medicine or whatever team that needs to take care of the problem.

No way. Em has such potential for things to go bad quickly that there is always a role for em physicians. The knowledge base that you need is so broad that mid levels don't come close to being sufficient. We had a guy who came in with abdominal pain and flank pain and the np thought he had pyelonephritis despite no fever, no n/v, clean ua. Then he started hemorrhaging out his rear, turned out he had an aortoenteric fistula.