Nurse practitioners are better than MDs

[MedicineZ0Z]

http://www.facebook.com/ZDoggMD/posts/10156122333682095

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[762513]

This definitely makes NP's look bad.

 

[MedicineZ0Z]

This definitely makes NP's look bad.

When you read the comments (on Zog's page), you find that there are quite a few who secretly like the post but pretend not to.

 

[762513]

When you read the comments (on Zog's page), you find that there are quite a few who secretly like the post but pretend not to.

I saw, but the top rated comment is from an NP who disagrees with 1.2k likes.

 

[MedicineZ0Z]

I saw, but the top rated comment is from an NP who disagrees with 1.2k likes.

His page is largely people in medicine or premeds along with RNs (who dislike NPs) + PAs (who also dislike NPs). Her comment on her own public page seemed to get nothing but love. So while a (growing) minority - important to proceed cautiously as a profession. This "be collaborative" and nice guy thing backfires hard.

 

[762513]

His page is largely people in medicine or premeds along with RNs (who dislike NPs) + PAs (who also dislike NPs). Her comment on her own public page seemed to get nothing but love. So while a (growing) minority - important to proceed cautiously as a profession. This "be collaborative" and nice guy thing backfires hard.

Physicians have no real competition in the role of expert in the diagnosis and treatment of disease, both sides of the NP debate know this, regardless of if they admit it or not. Most of what I see is serious insecurity on both sides of the fence.

 

[MD2BE92]

What many entering these fields don't understand is the highway robbery that they are complicit in...more school (and $$$) for no greater knowledge or capability. Feel bad for 'em honestly.
Those that do get why programs have done this are required to do it because its the norm.

Same trend with needing a degree for everything nowadays. The education market has far outgrown its practical use

 

[nowaysanjose]

Stop hiring them and stop training them. Stop taking their referrals and you have to work with a mid-level in any capacity just go PA. This crap has to stop.

 

[Mt Kilimanjaro]

“Concierge nurse consulting , advocacy and VIP care management for clients in Manhattan.”

About Gail Ingram - Career Bio

Everything she claims checks out—she was a volunteer in an ICU once.

Also, her Manhattan VIP concierge patients are definitely as complex as low income patients in rural America.

 

[W19]

We have a winner... and her name is Gail Ingram.

 

[RTD]

People who compete where there should be no competition and belittle where there should be collaboration will not have a good time in health care.

 

[MedicineZ0Z]

Stop hiring them and stop training them. Stop taking their referrals and you have to work with a mid-level in any capacity just go PA. This crap has to stop.

Exactly this. Why we continue the self destruction just blows my mind.

Physicians have no real competition in the role of expert in the diagnosis and treatment of disease, both sides of the NP debate know this, regardless of if they admit it or not. Most of what I see is serious insecurity on both sides of the fence.

Physician income is still generated via seeing simple routine cases too. Put 1 Dr in charge of 4 NPs and have the Dr see the 10 complex patients daily and supervise the NP seeing 15 easy ones a day. The supervisory scenario was something a MD/MBA told me is on the horizon and guess what happens? Suddenly the Dr makes 140k and the NP/PA makes 120k. We're actually not far from that scenario in some places (NYC).

 

[MedicineZ0Z]

People who compete where there should be no competition and belittle where there should be collaboration will not have a good time in health care.

It's 2018 and nurses are able to "compete" with doctors in the context of diagnosis and treatment. This is where we're at....

 

[Money Moniker]

People who compete where there should be no competition and belittle where there should be collaboration will not have a good time in health care.

People who roll over without defending their territory will not have a good time on planet Earth. Healthcare is on planet Earth. You might be thinking of the "kumbayah" world of the Lion King, but that is a fictional cartoon populated by talking animals rather than human beings chasing finite money in a zero-sum game.

 

[Money Moniker]

Stop hiring them and stop training them. Stop taking their referrals and you have to work with a mid-level in any capacity just go PA. This crap has to stop.

To the extent I will be forced to work with midlevels by circumstances outside of my control, I will do my damnedest to share as little of my knowledge with them as possible. I doubt the administrative bureaucracy in large hospital systems will allow me to dismiss their requests for explanations with a blunt "because I told you so," but they'll never get anything but the most superficial of thought processes out of me in regards to matters in that realm of medicine that has traditionally been physician territory. I'm not one to spend hundreds of thousands and 7+ years of my life just to train my competition for free.

 

[DubbiDoctor]

To the extent I will be forced to work with midlevels by circumstances outside of my control, I will do my damnedest to share as little of my knowledge with them as possible. I doubt the administrative bureaucracy in large hospital systems will allow me to dismiss their requests for explanations with a blunt "because I told you so," but they'll never get anything but the most superficial of thought processes out of me in regards to matters in that realm of medicine that has traditionally been physician territory. I'm not one to spend hundreds of thousands and 7+ years of my life just to train my competition for free.

I agree with your perspective. Some midlevels are very nice people, but their professional interests run counter to those of physicians. Even the best, kindest, most supportive PAs want to earn similarly to MD/DOs, and will most likely support policies that increase their compensation, such as autonomy.

 

[drdeliz]

Why would anyone make such a ridiculous statement? Most MD's are very capable and extremely good at their profession. I believe that it is possible that some NP's are excellent at what they do... Not everyone in every profession is excellent at their job. The fact that we as physicians have more education than Nurse Practitioners and that the system makes us go through more "red-tape" than NP's is an understatement. I have been seen by NP's at the VA Hospital and I must say that I was NOT impressed. Was seen by a PA and she impressed me. Have been seen by many doctors and some have impressed me while others have NOT. So to say something like this post, is unnecessary and unprofessional.

 

[TypeADissection]

 

[flightnurse2MD]

Nurse: I'm in school getting my DNP right now.
Me: Good for you.
Nurse: Yea, I thought about medical school, but getting a DNP is basically the same thing.
Me: Ah....
Nurse: What are you in school for?
Me: I'm a 4th year medical student.
Nurse: Oh really? Why?!
Me: Oh, I thought about getting my DNP, but getting a MD is basically the same thing...

 

[Lnsean]

Nurse: I'm in school getting my DNP right now.
Me: Good for you.
Nurse: Yea, I thought about medical school, but getting a DNP is basically the same thing.
Me: Ah....
Nurse: What are you in school for?
Me: I'm a 4th year medical student.
Nurse: Oh really? Why?!
Me: Oh, I thought about getting my DNP, but getting a MD is basically the same thing...

So she had you convinced that MD is same as DNP at the end of this conversation. That's what it sounds to me.

wtf is this weak sht.

 

[nowaysanjose]

So she had you convinced that MD is same as DNP at the end of this conversation. That's what it sounds to me.

wtf is this weak sht.

Anyone ever notice how all nurses are just GOING to NP school as opposed to "trying to get into" NP school? There's something to be said for the weed-out process that is pre-med being lost as well. NP schools accept everybody and fail nobody--there's absolutely no barrier based on intellectual capacity.

 

[NYCdude]

I thought I wanted to be a hospitalist at first but after seeing all this **** lately I think I'm better off specializing.

 

[popopopop]

So she had you convinced that MD is same as DNP at the end of this conversation. That's what it sounds to me.

wtf is this weak sht.

He was being sarcastic.

 

[studentdoct4281]

really weird trend that i saw somewhere was a study was done showing that the amount of Male nurses has sky rocketed in the past 15 years and the amount of Female medical students/doctors has gone up respectively as well. it was showing that the number of females in medical school now exceeds that of males for the first time ever

 

[Rekt]

This definitely makes NP's look bad.

You're assuming most of them don't feel the same way, which they do.

 

[MedicineZ0Z]

You're assuming most of them don't feel the same way, which they do.

All you need is 10% of NPs agreeing with her and that's destructive to our profession. Why? Because of the # of NPs graduating in the next 10 years. Their strength is in numbers and unity for legislation.

Why would anyone make such a ridiculous statement? Most MD's are very capable and extremely good at their profession. I believe that it is possible that some NP's are excellent at what they do... Not everyone in every profession is excellent at their job. The fact that we as physicians have more education than Nurse Practitioners and that the system makes us go through more "red-tape" than NP's is an understatement. I have been seen by NP's at the VA Hospital and I must say that I was NOT impressed. Was seen by a PA and she impressed me. Have been seen by many doctors and some have impressed me while others have NOT. So to say something like this post, is unnecessary and unprofessional.

Lets be real here. Most midlevels have no idea what to do in any remotely complex situation. They rely very heavily on looking things up then ultimately ask the physician what to do or do something to buy time. This does not mean that all doctors know everything. It simply means that it's very uncommon to find a midlevel that actually knows how to work up, diagnose and treat anything complex.

They take their time chitchatting with patients and are cheerleaders for the patient's medication compliance. The first part drives up "patient satisfaction" surveys. The second part drives up outcomes in so called "studies" when looking at NPs vs. Drs. But how does any of it correlate to better outcomes in real medicine? It doesn't.

 

[762513]

People who roll over without defending their territory will not have a good time on planet Earth. Healthcare is on planet Earth. You might be thinking of the "kumbayah" world of the Lion King, but that is a fictional cartoon populated by talking animals rather than human beings chasing finite money in a zero-sum game.

If there was no physician shortage there would be no need for NP’s or PA’s.

 

[762513]

All you need is 10% of NPs agreeing with her and that's destructive to our profession. Why? Because of the # of NPs graduating in the next 10 years. Their strength is in numbers and unity for legislation.


Lets be real here. Most midlevels have no idea what to do in any remotely complex situation. They rely very heavily on looking things up then ultimately ask the physician what to do or do something to buy time. This does not mean that all doctors know everything. It simply means that it's very uncommon to find a midlevel that actually knows how to work up, diagnose and treat anything complex.

They take their time chitchatting with patients and are cheerleaders for the patient's medication compliance. The first part drives up "patient satisfaction" surveys. The second part drives up outcomes in so called "studies" when looking at NPs vs. Drs. But how does any of it correlate to better outcomes in real medicine? It doesn't.

Are you saying medication education and increase compliance doesn’t improve outcomes? Are you insane?

 

[deleted480308]

If there was no physician shortage there would be no need for NP’s or PA’s.

By all means, exist with supervision then

 

[MedicineZ0Z]

If there was no physician shortage there would be no need for NP’s or PA’s.

A big number of them push for specialized jobs in urban areas though.

Are you saying medication education and increase compliance doesn’t improve outcomes? Are you insane?

I didn't argue that. I said that is their absolute limit. The second the patient is actually sick, they have no idea what to do. And to be in a primary care role, you need to have both equally.

 

[762513]

By all means, exist with supervision then

We’ve had this discussion, we don’t need to have it again.

 

[762513]

A big number of them push for specialized jobs in urban areas though.

I didn't argue that. I said that is their absolute limit. The second the patient is actually sick, they have no idea what to do. And to be in a primary care role, you need to have both equally.

That’s a pretty broad brush you’re painting with.

 

[deleted480308]

We’ve had this discussion, we don’t need to have it again.

Any time I see you implying that Independance for midlevels is somehow necessary we’ll go through it again...

 

[762513]

Any time I see you implying that Independance for midlevels is somehow necessary we’ll go through it again...

Anytime I see you post any evidence of your own we can start the discussion over again. Your preference is to sit on a throne and snipe.

 

[deleted480308]

Anytime I see you post any evidence of your own we can start the discussion over again. Your preference is to sit on a throne and snipe.

My preference is to point to the huge disparity in training

 

[762513]

My preference is to point to the huge disparity in training

We both know you don’t post evidence because you can’t.

 

[deleted480308]

We both know you don’t post evidence because you can’t.

Res ipsa loquitur

 

[762513]

Res ipsa loquitur

If that were true, proving it would be easy, and NP practice could be stopped dead in its tracks.

 

[deleted480308]

If that were true, proving it would be easy, and NP practice could be stopped dead in its tracks.

Np Independance doesn’t have anything to do with scientific facts or equivalent training, it is a function of lobbying efforts. In America votes move laws, not facts

 

[MedicineZ0Z]

If that were true, proving it would be easy, and NP practice could be stopped dead in its tracks.

Well first step is professional organizations taking a broad stance against them. Second, stop training them! This is already happening at a growing rate but needs to widen. Third, focus lobbying efforts on this and not random nonsense. And four, don't be a sellout.

 

[atomheart]

I have seen a kid be hospitalized after an NP failed to detect an emergent and unstable problem in the office...

...just to have someone else say something like "there's bad nurses just as there's bad physicians", and let the physician take the liability fall.

This is the future of medicine unfolding and there is nothing anyone can do about it.

 

[762513]

I have seen a kid be hospitalized after an NP failed to detect an emergent and unstable problem in the office...

...just to have someone else say something like "there's bad nurses just as there's bad physicians", and let the physician take the liability fall.

This is the future of medicine unfolding and there is nothing anyone can do about it.

Anecdotes don’t help us answer this question, research does.

 

[762513]

Well first step is professional organizations taking a broad stance against them. Second, stop training them! This is already happening at a growing rate but needs to widen. Third, focus lobbying efforts on this and not random nonsense. And four, don't be a sellout.

If the physician lobby was worried about patient safety they would be fighting the naturopathic “physicians” tooth and nail. The lobby is worried about money not people, because treating and educating patients who would rather go to a naturopath would take time and effort. They would prefer that the patients who use turmeric to treat cancer stay out of their waiting rooms. Don’t give me the “patient safety” argument. It’s disengenious and everyone out of medical school knows it.

 

[deleted480308]

If the physician lobby was worried about patient safety they would be fighting the naturopathic “physicians” tooth and nail. The lobby is worried about money not people, because treating and educating patients who would rather go to a naturopath would take time and effort. They would prefer that the patients who use turmeric to treat cancer stay out of their waiting rooms. Don’t give me the “patient safety” argument. It’s disengenious and everyone out of medical school knows it.

You honeslty propose my mother would be just as safe treated by only those with an NP level of knowledge as compared to those with a physician level of knowledge?

 

[762513]

You honeslty propose my mother would be just as safe treated by only those with an NP level of knowledge as compared to those with a physician level of knowledge?

What does the research say?

 

[deleted480308]

What does the research say?

That NPs aren’t at all educated to the same standards as physicians.

But we can do another journal club if you want to pick your favorite research trial to propose equivancy, I haven’t seen you post a good one yet.

 

[atomheart]

Anecdotes don’t help us answer this question, research does.

There's no research that exists that can prove the equivalency of NPs to Primary Care Physicians. Both NPs and physicians know that...the research that NPs poop out unilaterally and uncritically supports their agenda and every single person in medicine knows it. It's the public that doesn't know any better and that's why physicians shake their heads when they see NPs telling their patients they can do anything.

 

[MedicineZ0Z]

You honeslty propose my mother would be just as safe treated by only those with an NP level of knowledge as compared to those with a physician level of knowledge?

Lets be serious, I'd rather be seen by an MS-4 or even Ms-III end of the year than by an NP.

What does the research say?

The "research" doesn't mean anything when NPs don't see complex patients. Not to mention the ridiculous parameters used to measure outcomes.
Fact remains, I've yet to meet a single NP/PA who anyone would consider competent to see a truly sick person. Most simply follows steps they've memorized for very routine basic cases.

 

[762513]

That NPs aren’t at all educated to the same standards as physicians.

But we can do another journal club if you want to pick your favorite research trial to propose equivancy, I haven’t seen you post a good one yet.

Nothing I could ever post could overcome your confirmation bias, I've tried.

 

[deleted103644]

By all means, exist with supervision then

I thought you were a libertarian? Shouldn’t you be against licensure? Shouldn’t these individuals be allowed to practice freely as long as they don’t misrepresent their credentials?

If physicians are better than NPs, PAs, and uncredentialed weirdos peddling crystals, shouldn’t that be decided in the marketplace?

Quotes from Friedman’s “Capitalism and Freedom”:

Licensure therefore frequently establishes essentially the medieval guild kind of regulation in which the state assigns power to members of the profession.…The most obvious social cost is that any one of these measures, whether it be registration, certification or licensure, almost inevitably becomes a tool in the hands of a special producer group to obtain a monopoly position at the expense of the rest of the public. There is no way to avoid this result.…The members [of the profession] look solely at technical standards of performance, and argue that we must have only first-rate physicians even if this means that some people get no medical service – though of course they never put it that way. Nonetheless, the view that people should get only the “optimum” medical service always leads to a restrictive policy.

...

I myself am persuaded that licensure has reduced both the quantity and quality of medical practice; that it has reduced the opportunities available to people who would like to be physicians, forcing them to pursue occupations they regard as less attractive; that it has forced the public to pay more for less satisfactory medical service, and that it has ******ed technological development both in medicine itself and in the organization of medical practice. I conclude that licensure should be eliminated as a requirement for the practice of medicine.

He has no objections to certifications or laws against misrepresentation.

Please note I am not advocating his arguments (although I do see some merit in them), but your rather diehard libertarian positions elsewhere make this position somewhat of an outlier.

Following video clip, not just about medical licensure (first minute against FDA drug approval, last minutes about negative income tax). I am not advocating Friedman’s positions, but I do find them well reasoned and interesting, even if I do not agree with the solutions he proposes: