NYT Today: "Nurses are Not Doctors"

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Whevever this topic pops up I can't help but browse http://www.pandabearmd.com/category/the-future-of-medicine/

Your a panda fan after my own heart. Thank you, friend. I needed a shot of this: http://www.pandabearmd.com/2007/05/27/harvard-medical-school-the-not-too-distant-future/

He's a genius. And he is missed. I've been on sdn long enough to have had some exchanges with him--all of which he was right in. I wish he was around I would tell him just that.

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There is often blame for this placed on physicians by physicians (or future physicians, like many of us on this forum).

"Why don't docs unionize?" "How can we fight back, when we are too busy fighting among ourselves?" "Psychiatry not respected by vascular surgeons" "EM docs are basically glorified triage nurses"....etc

It always brings up the thought for me::: the physician fields within "medicine" are largely not the same profession. Huh? Sounds strange, I imagine.

A neurosurgeon and a family med doc are both physicians, they are both at the pinnacle of their field, and both deserve respect... why doesn't the neurosurgeon rally for the family med doc in the face of NP's taking over primary care?

They aren't the same career.

The radiation oncologist and anesthesiologist are both physicians, they are both highly educated, and both deserve respect... why doesn't the radiation oncologist rally for the anesthesiologist facing replacement by CRNA's?

They aren't the same career.

Human nature is to care most about ourselves, our family, and our personal friends. We give most attention to the threats to our own well-being...not so much to what happens to that other antelope being chased by the lion 100 yards away.

While different specialties all practice under the umbrella of medicine with the title "physician", they are no more similar than NFL player is to NBA player playing under the umbrella of sports entertainment with the title "professional athlete".

Aggregated:

NFL players don't strike for NBA players' reimbursements, turf, interests.

Specialists don't strike for PCPs' reimbursement, turf, interests.

There will never be any "union" formed. Different specialties are not the same career.

No one can be blamed. It is nature.
Yes, but the initial schooling is the same for MDs unlike the NFL/NBA which are different sports.

Part of the problem is different specialties have different barriers to entry with respect to class rank, board scores, clinical grades, etc. This is even worse with schools that say only this percentage of students are allowed to get "Honors" in a course/subject. As much as medical schools don't want competition, residency programs clearly do and want stratification. I'm sure they would love it if Dean's letters say Frazier is ranked 5 out of 125 instead of which quartile or what code word you are.

Many of us remember how well were treated by those in FM, IM, Peds, OB-Gyn, Surgery, and Psych and during internship and promise ourselves to be more or less like them when we become attendings. Depending on the specialty, many of us become what we despise.

Different specialties, have different lifestyles so there is almost always is a grass-is-greener field.

Esp. if there is a specialty that reminds you of an attending you hate, you are ecstatic when a certain field's reimbursements get cut in half. Or if you hate that certain doctors have it "easier" than you, you love that their reimbursement got cut: Just look at Radiology.
 
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Esp. if there is a specialty that reminds you of an attending you hate, you are ecstatic when a certain field's reimbursements get cut in half. Or if you hate that certain doctors have it "easier" than you, you love that their reimbursement got cut: Just look at Radiology.
Preach!
 
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Who is PandaMD and why is he no longer on SDN?

Well not to overly speculate...

But several years ago his (now ex- ) wife joined the site, told everyone that he was ruining his life and his marriage with his addiction to the internet, neglecting his family to spend time on SDN and lying about it, and said a lot of generally terrible things.

He hasn't been around much since.
 
When you start making more aggregate annually than surgeons and you're a non-surgical subspecialty, you'll definitely be in their cross-hairs. I'm sure there are tons of surgeons that are salivating at Radiology being cut. Considering many surgeons read their own films, they believe Radiology to be a useless specialty.
 
Well not to overly speculate...

But several years ago his (now ex- ) wife joined the site, told everyone that he was ruining his life and his marriage with his addiction to the internet, neglecting his family to spend time on SDN and lying about it, and said a lot of generally terrible things.

He hasn't been around much since.
Is he an attending? If so, in what field? What terrible things?
 
Well not to overly speculate...

But several years ago his (now ex- ) wife joined the site, told everyone that he was ruining his life and his marriage with his addiction to the internet, neglecting his family to spend time on SDN and lying about it, and said a lot of generally terrible things.

He hasn't been around much since.

Sounds like the future me.
 
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Pandabear:

I lol'ed

The Great Lawsuit Rush of 2049
“No, I don’t have a spleen, Jimmy. Hardly anybody from my generation does. Or a second kidney, a gall bladder or any other of those useless organs that nobody knows the purpose of. In fact, the Nurse Practitioner Assistant over at Bowel, Bile, and Beyond said that he probably only sees three or four gallbladders a year. He’s not even sure what the gallbladder is for although he thinks it’s part of the immune system or something. He’s the manager, you understand. They send them to a pretty intensive six-week course so he knows what he’s talking about. “
 
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Is he an attending? If so, in what field? What terrible things?

Let us not allow a scorned woman to besmirch him. He is the Mark Twain of medical satire. A first rate humorist. And the most original voice in medical writing I've ever seen. He in fact transcends the genre of medical writing--most of which is tepid boredom at best.

He's an ED attending now. But was active throughout his training as a brilliant poster and blogger.
 
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Well not to overly speculate...

But several years ago his (now ex- ) wife joined the site, told everyone that he was ruining his life and his marriage with his addiction to the internet, neglecting his family to spend time on SDN and lying about it, and said a lot of generally terrible things.

He hasn't been around much since.
I've already started reading some of his blog. Terrible? Not really (so far). Realistic, yes: http://www.pandabearmd.com/2008/04/13/medical-school-pre-clinical-years-twenty-questions-part-3/. So far I'm loving it!
 
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I think the ex-wife said terrible things about him, not that he said terrible things on his blog.

Yes that was what I meant .

I think he was a very witty and insightful writer.

And maybe I'm totally wrong and his wife was blatantly lying.

But after that incident, I always remember him as a sad and cautionary tale about the dangers of internet addiction.
 
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You know that moment when you bumped a glass of wine off the table and it's just beginning to tip? You know it's going to fall on the flawless white carpet below and there's nothing you can do.

That's this moment in medicine.

The rocket has been ignited, the first domino has been toppled, shots have been fired.

I don't think there's much we can do. Physicians would be smart to have single voice and work together. It's obvious that nurses will continue to expand their scope of practice with no increase in training, standards, or quality. They will sell everyone that "what we're doing is enough". And I don't think research papers will stop them, nor the higher quality of physicians. The only thing that will stop them are patients dying or medical errors.

There is a role for NPs and midlevels, but if they want to have equal rights they need to be prosecuted equally, and pay equal malpractice. And they shouldn't been helped by physicians when the patients are difficult.

A collaborative environment is great, but it doesn't work when the midlevels want physicians to do all the hard work while they handle the easier work - then complain and say they are just as effective.

I don't see this ending well for American healthcare. The only thing that will turn this around is tragedy and death. Get ready to clean up the carpet.

2255472-44259-wine-collection-red-wine-in-falling-glass-isolated-on-white-background.jpg
 
Yes that was what I meant .

I think he was a very witty and insightful writer.

And maybe I'm totally wrong and his wife was blatantly lying.

But after that incident, I always remember him as a sad and cautionary tale about the dangers of internet addiction.
Or that she made his life so miserable and he just didn't have the heart to tell her that was the reason he was ignoring her.
 
Wow, it's been so long since I've read Panda's posts. They're recast in a completely different - and abso-frickin-lutely hilarious - light after some time on the wards. I think I know what I'm doing the rest of the night...
 
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Wow, it's been so long since I've read Panda's posts. They're recast in a completely different - and abso-frickin-lutely hilarious - light after some time on the wards. I think I know what I'm doing the rest of the night...
Love his effervescent realism esp. with regards to certain third year rotations.
 
Wow, it's been so long since I've read Panda's posts. They're recast in a completely different - and abso-frickin-lutely hilarious - light after some time on the wards. I think I know what I'm doing the rest of the night...

Here's a good one on clinical evals:

Clinical Evaluations
January 25, 2007 | Leave a Comment

Actual Evaluation by My Residents and Attendings

(Just for old time’s sake I reviewed my Dean’s letter. Man, those were the days! -PB)

OB/Gyn: Student is on time and does everything asked of him willingly and with good humor but seemed uninterested in assisting in any more vaginal deliveries than were required to pass the rotation. Actually winced, yes winced, when he was sprayed with urine and feces during one particularly rapid delivery. Commented to me that it was “Nothing like the Discovery Channel.”

OB/Gyn: Student Doctor Bear is on time and cheerful but does not fight hard enough to be the first to see patients complaining of vaginal discharge. I don’t think he should fail the rotation but I am giving him low marks for referring to our weekly STD clinic as “Kooter Patrol.” I also caught him rolling his eyes as I lectured a young, single, G5P4004 on the need for greater personal responsibility. I didn’t quite understand what he meant when he invited me to “repeat my advice to the wall and see if there was any difference” but I think he was making fun of me. Student Doctor Bear also showed no interest in standing around doing nothing while I performed a particularly difficult colposcopy.

General Surgery: Student Doctor Bear did everything asked of him but was singularly unenthusiastic about holding a retractor for six hours. He does not seem to enjoy call and never seems to either know or care about the answers to the random trivia question I ask him just to keep him on his toes.

Medicine: Does not seem enthusiastic. Once actually sat down (!) during rounds…and the attending and all of the residents were still standing! Had an insolent, “you people keep talking while I rest my feet,” expression on his face and ignored every frantic hand gesture to stand up before he made the attending mad. When the attending asked, with admirable sarcasm, “Are you tired, Student Doctor Bear?” he said, “Yes,” and persisted in his sitting position until we had moved to the next patient. And then, oh weep thou heavens and hide thine eyes in shame, when the attending suggested that maybe he wasn’t cut out for internal medicine he replied, “You’re probably right about that.”

Medicine: For reasons unknown to me, Student Doctor Bear is uninterested in electrolytes. Even after spending a brief forty-five minutes discussing a patient’s Potassium (Peace Be Upon Its Holy Name) level his only comment was, “So, do you think we need to supplement it?” Supplement it? Is the wind’s name Mariah? Can we began to explore the intricacies of Potassium (PBUIHN) in the brief time we had between five PM and eight PM when the silly rules require us to let our medical students go home to study?

Pediatrics: A good medical student but he has kids of his own so I don’t think he believes us when we say how great working with kids is. Changes diapers like a pro and is not awkward at all when handling the babies.

Heme-Onc: Did not directly observe the medical student. If you tell me he was on the rotation I’ll believe you and I do seem to remember catching a brief glimpse of him hanging way, way back in the team but when I blinked he was gone. I could probably review the hospital surveillance tapes if you really need an evaluation but I suspect finding more than a few seconds of footage will be more difficult than locating Big Foot.

Surgery: Not a good medical student at all. Despite never having been in an operating room, rotated on a surgery team, observed any operations, or completed a surgery residency, Student Doctor Bear displays absolutely no knowledge of how we do things in the OR, where to stand, and what my favorite music is. And this was his his second day of third year, for crying out loud. And he is woefully ignorant of the collateral circulation supplying the anterior two-thirds of the left adrenal gland even though he should have learned this in first year anatomy.

Family Medicine: I detected a lot of resistance from Student Doctor Bear. He seems reluctant to hug the patients and his sympathetic nodding skills are woefully inadequate. His empathy skills also need work. For example, when a patient complains about knee pain Student Doctor Bear needs to refer her to physical therapy, not comment that it is “No wonder because every time you stand up you squat-press a small German car.”

Family Medicine: He’s not buying it. Student Doctor Bear is not ready to board the Primary Care Mother Ship. Maybe we could have tried sleep deprivation and a low protein diet but he we didn’t have the time.


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Oh, the memories of internship.
A Letter to an Attending
April 9, 2007 | Leave a Comment

Who do You Think You Are?

Dear Sir or Madame,

I am exceedingly glad to be done with the rotation. I have been a resident for almost two years and that month was perhaps the worst experience of my medical career. You made what should have been a moderately unpleasant experience which is what we expect on rotations in your specialty into an almost unendurable ordeal which no one in any other career except ours would tolerate with as much good humor as I did.

I have most certainly quit jobs for less, and it is only the iron grip on my gonads enjoyed by the hospital that kept me from telling you to “admit your own goddamn patients.”

Now, the fact that you had it harder when you were a resident, something you pointed out on every possible occasion, is completely irrelevant to me. I don’t care. Let’s just assume I am a ***** and leave it at that. I’m not about to change my ways now just to please you. You’re not my mother. You’re not my father. Hell, you’re not even in my chain of command and your bad evaluation is going to sit in my file doing nothing until, one day, some alien archeologist sifting through the sterile rubble of our planet deciphers it and comments to his collegues that you were a real horse’s ass.

You accused me of being unenthusiastic and on this charge I am completely guilty. I am interested in most aspects of medicine including your specialty but if you expected me to clap my hands and squeal for joy at 4AM when confronted with the twelfth admission of the night it is no wonder you were disappointed. As even you grudingly admitted that I did my job and everything asked of me, I don’t know what else you expected except for me to kiss your ass and pretend I live for every-third-night call

I was also less than thrilled to be pimped over the phone in the early morning hours when all I was trying to do was admit an uncomplicated patient. If you want something other than what I ordered for the patient have the goodness to tell me as I am not a mind-reader. And as I am usually physically ill at that time in the morning from fatigue, dehydration, caffeine, and lack of sleep, just tell me which of many formulas you would prefer for me to use to calculate creatinine clearance and I will use it. Don’t make me decide and then ask me to justify my decision.

Did I mention it was 4AM? I don’t care. We weren’t even talking about a renal patient. On every occasion when we spent an hour on the phone picking the nits off of nits I had a board full of admissions from the other services I was covering and a couple of pagers that that would not stop beeping. If I am to sit under a tree in the agora soaking in your wisdom in the socratic manner than call off the dogs from the other services. We don’t have time. I would have also liked to have layed down for an hour or two after I cleared the board and you were seriously slowing me down.

Additionally, if you were reading the lab values off of your computer at home, why did you have me repeat them to you over the phone? This is just sadism on your part and why, after I found out, I refused to do it. Who do you think you are, anyways? You don’t pay my measly salary, I have sworn no oath to be your little scut *****, I’m about ten years older than you, and there is absolutely nothing in it for me to repeat numbers to you over the phone. And your weasel-like excuse that it was good practice make no sense. Practice for what? My eight-year-old can read numbers over the phone. I reviewed the lab values and the fact that you seemed to think I had not belies the trust you purported to have in me as a fellow physician.

I also didn’t appreciate your patronizing attitude and how you called me “Doctor” in an ironic and insulting manner. On one hand you insisted that you expected a lot out of me (“doctor”) and that you expected me to think independently (“doctor). On the other hand you micromanaged every single decision to the point that when I asked you why you didn’t just come in yourself and eliminate the middleman, I was being completely serious. The premise that you were treating me like a fellow physician was ridiculous. If you treated your colleagues like that I’d be surprised. And as I am working for about a tenth of what you make on an hourly basis, well, the reality is that you treated me and every other resident who has worked with you as low-wage sweat shop labor.

Not to mention that If I was a valued colleague you wouldn’t have been so snotty when I gave you my opinion.

That’s another thing, if you don’t want my opinion, don’t ask for it and don’t get all bent out of shape when I give it to you. In my opinion, my job on the rotation was to provide cheap clerical labor for which you otherwise would have had to pay somebody a decent salary. I think I’m on the money with that opinion, at least from my point of view. If you don’t agree, well, you don’t agree and the fact that I didn’t apologize for my opinion should tell you something.

In the end, I think that’s what really pissed you off. When you called me on the phone at the end of the rotation to express your displeasure with me and my attitude you were probably expecting the usual obseqiousness to which you are accustomed and some sort of apology with a promise to do better.

But you don’t own me. I did my job even though I don’t like you and I’ll be damned if I’ll apologize to make you feel better about your personal control issues. You do your thing, I’ll do mine, and I will never have to work for you or with you again.

Sincerely,

P. Bear, MD
 
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This thread is tl;dr, or I'm just lazy.

The name of the game has become doctor-bashing. The problems with the health care system cannot possibly be the insurance companies who laughed all the way to the bank when America's community organizer signed PPACA into law. The problems can't be the drug companies that charge ridiculous amounts of money for recycled compounds. It has to be the ass-hole in the white coat that yelled at the poor little nurse.

We, as physicians (yeah I know I'm a med student), will continue to get effed from every side until we prioritize our profession. How many classmates do you have that are the 'screw you, I take care of myself only' types. We strive by competition, but that doesn't mean we leave each other in the dirt. We need to stop bickering among ourselves, stop drawing more lines where they needn't be. Oh, and, we need to take the AMA back into our own hands.
 
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This thread is tl;dr, or I'm just lazy.

The name of the game has become doctor-bashing. The problems with the health care system cannot possibly be the insurance companies who laughed all the way to the bank when America's community organizer signed PPACA into law. The problems can't be the drug companies that charge ridiculous amounts of money for recycled compounds. It has to be the ass-hole in the white coat that yelled at the poor little nurse.

We, as physicians (yeah I know I'm a med student), will continue to get effed from every side until we prioritize our profession. How many classmates do you have that are the 'screw you, I take care of myself only' types. We strive by competition, but that doesn't mean we leave each other in the dirt. We need to stop bickering among ourselves, stop drawing more lines where they needn't be. Oh, and, we need to take the AMA back into our own hands.
That will happen when medical schools stop ranking, board scores are Pass/Fail (like Dentistry), and clerkships are P/F (like at Stanford), until then, there is no way different specialties will get along, esp. with turf battles on certain procedures. Or when specialists say, "Talk to your PCP about that" (regarding a form that needs to be filled out, followup, etc.)
 
That will happen when medical schools stop ranking, board scores are Pass/Fail (like Dentistry), and clerkships are P/F (like at Stanford), until then, there is no way different specialties will get along, esp. with turf battles on certain procedures. Or when specialists say, "Talk to your PCP about that" (regarding a form that needs to be filled out, followup, etc.)

I guess it's just the kind of people medical school attracts. We need validation, and if that will be at a fellow MD's expense, so be it.
 
what specialties are safe? The nurse lady said oncology or surgery, though those are probably on her 25 year plan. Her first goal is to establish a beachhead on the coast of primary care.
Surgery and perhaps anything which requires an extensive understanding and manipulation of basic sciences?

So many people use "begging the question" incorrectly these days that I usually just assume they mean "raising the question", haha.

Yes, it's actually quite silly when people substitute colorful expressions incorrectly, rendering them a bit pointless.
 
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is there no way to boycott referrals from NPs and physician's who hire NPs? Oregon may have already been lost, but other states still have a chance at seeing how physicians view nurses with master degrees.

hahaha, this would be funny...
I'm sorry sir but in order to make an appt you'll need a referral from a doctor....
but I see a nurse
then go see a doctor
but my nurse is as good as any doctor
then ask your nurse to do your cataract surgery
 
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is there no way to boycott referrals from NPs and physician's who hire NPs? Oregon may have already been lost, but other states still have a chance at seeing how physicians view nurses with master degrees.

quoting myself until somebody tells me why this idea would not work.

am i wrong for saying that a giant portion of the blame should be placed on physicians who continue hiring masters of nursing into their practices?
 
quoting myself until somebody tells me why this idea would not work.

am i wrong for saying that a giant portion of the blame should be placed on physicians who continue hiring masters of nursing into their practices?

This won't work because it's become harder to be self employed. Most physicians eventually will be employed by larger groups.

Plus, in general physicians are against NPs as much as their idea they can practice on their own or have equal rights. NPs are going to be needed by American healthcare.
 
quoting myself until somebody tells me why this idea would not work.

am i wrong for saying that a giant portion of the blame should be placed on physicians who continue hiring masters of nursing into their practices?

It's a business advantage. If I can see double the patients and pay a well-trained PA $100k - half of what I would have to pay another physician - why WOULDN'T you hire a PA? The secret in medicine in terms of earnings is productivity, and the more patients you shove through the door, the more money you get. It's a simple economic decision.
 
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It's a business advantage. If I can see double the patients and pay a well-trained PA $100k - half of what I would have to pay another physician - why WOULDN'T you hire a PA? The secret in medicine in terms of earnings is productivity, and the more patients you shove through the door, the more money you get. It's a simple economic decision.

i understand that hiring NPs is a business advantage, but you are ****ing over your colleagues by doing so. i feel like physicians are constantly bitching about NPs while simultaneously hiring them on the side.

the number of unemployed NPs will skyrocket when physicians stop hiring them in the states where NPs require physician oversight. this concept seems too simple, so i must not be understanding something correctly.
 
It's a business advantage. If I can see double the patients and pay a well-trained PA $100k - half of what I would have to pay another physician - why WOULDN'T you hire a PA? The secret in medicine in terms of earnings is productivity, and the more patients you shove through the door, the more money you get. It's a simple economic decision.

So why not only hire PA's then? At least they are somewhat regulated by the medical profession.
 
No, but I would be interested in that figure. I don't care what people say - this does beg the question...what specialties are safe? The nurse lady said oncology or surgery, though those are probably on her 25 year plan. Her first goal is to establish a beachhead on the coast of primary care. They have successfully invaded and are moving inward.
OMM
DO>DNP=MD
:ninja:
 
i understand that hiring NPs is a business advantage, but you are ******* over your colleagues by doing so. i feel like physicians are constantly bitching about NPs while simultaneously hiring them on the side.

the number of unemployed NPs will skyrocket when physicians stop hiring them in the states where NPs require physician oversight. this concept seems too simple, so i must not be understanding something correctly.
The days of the private practice run by doctors is almost completely gone. Physicians aren't deciding to buy PAs and NPs, it's administrators (both for hospitals and for practices). I worked on the operations side and physicians have very little control over these kind of decisions. They get told see more patients or you will need to use an extender to meet your "goals." That's the reality. Physicians are shooting themselves in the foot for not having a voice, but unlike other professional groups, we have very little involvement on the business end of our profession so we have little to no control...

And these administrators have absolutely no clinical experience and don't really care about outcomes, they care about bottom lines. It's a different world.
 
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So why not only hire PA's then? At least they are somewhat regulated by the medical profession.

Yeah that's the question isn't it? Even though some PAs have aspirations of practicing independently, in the end they're still regulated by the medical board. I think it mostly has to do with the availability of PAs in some areas...believe there are a lot less PA schools than NP schools. Plus it's a little harder to convince people that you can be out there on your own when your very degree is to be a "physician assistant".

Yeah 187 PA schools vs 350 NP schools (and I don't think that's even counting the intermediate "APN" designation).
 
The days of the private practice run by doctors is almost completely gone. Physicians aren't deciding to buy PAs and NPs, it's administrators (both for hospitals and for practices). I worked on the operations side and physicians have very little control over these kind of decisions. They get told see more patients or you will need to use an extender to meet your "goals." That's the reality. Physicians are shooting themselves in the foot for not having a voice, but unlike other professional groups, we have very little involvement on the business end of our profession so we have little to no control...

And these administrators have absolutely no clinical experience and don't really care about outcomes, they care about bottom lines. It's a different world.

Exactly what I was trying to explain to him.
 
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Yeah that's the question isn't it? Even though some PAs have aspirations of practicing independently, in the end they're still regulated by the medical board. I think it mostly has to do with the availability of PAs in some areas...believe there are a lot less PA schools than NP schools. Plus it's a little harder to convince people that you can be out there on your own when your very degree is to be a "physician assistant".

Yeah 187 PA schools vs 350 NP schools (and I don't think that's even counting the intermediate "APN" designation).

Given the choice I would hire a PA. I can't trust someone who's ambition exceeds their ability by miles. A little bit might be necessary to learn, but independence before some gross approximation of competence as an agenda deserves our cold shoulder wherever possible.

The problem is as said above. Who has the choice. Most of us are going to be working for big groups or networks with HR departments and whole divisions of deciders we've never met.
 
The days of the private practice run by doctors is almost completely gone. Physicians aren't deciding to buy PAs and NPs, it's administrators (both for hospitals and for practices). I worked on the operations side and physicians have very little control over these kind of decisions. They get told see more patients or you will need to use an extender to meet your "goals." That's the reality. Physicians are shooting themselves in the foot for not having a voice, but unlike other professional groups, we have very little involvement on the business end of our profession so we have little to no control...

And these administrators have absolutely no clinical experience and don't really care about outcomes, they care about bottom lines. It's a different world.

i appreciate the explanation.
 
just keep reinforcing the notion that NPs are a threat to MDs

you can be nice to individual NPs, but don't forget that on a healthcare policy level NPs are the greatest threat to MDs

people keep confusing the two
 
i understand that hiring NPs is a business advantage, but you are ******* over your colleagues by doing so. i feel like physicians are constantly bitching about NPs while simultaneously hiring them on the side.

the number of unemployed NPs will skyrocket when physicians stop hiring them in the states where NPs require physician oversight. this concept seems too simple, so i must not be understanding something correctly.
There's a difference btw hiring a PA (under medical board) and hiring a NP (nursing board).
 
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My god the future is so bleak for us just entering residency, especially for those going into fields that are IMHO easy targets for further NP encroachment.

Here I was thinking that EM would be a somewhat safe bet, but given that our consultant colleagues view us as "glorified triage nurses," well I can't see that attitude boding well for the future of EM. The way I see it going is jobs in EM will become scarce as EPs are forced to play the anesthesia MLP manager game (basically managing a bunch of NPs/PAs who are grinding out the work in the ED)

I had a 260 step 1 too... should have put more thought into doing derm. Oh well, what's done is done. At least I enjoy the field and I suppose I can be happy on $120k/year or whatever it is an EM PA/NP makes.

As others have said, the snowball has already been pushed off the summit and it's only a matter of time before our worst fears come to fruition. This is going to happen and no longer speculation.
 
No, but I would be interested in that figure. I don't care what people say - this does beg the question...what specialties are safe? The nurse lady said oncology or surgery, though those are probably on her 25 year plan. Her first goal is to establish a beachhead on the coast of primary care. They have successfully invaded and are moving inward.
If your specialties are not involved cutting flesh, you are not safe. However, I think radiology and pathology are safe because of the level of expertise they require...
 
If your specialties are not involved cutting flesh, you are not safe. However, I think radiology and pathology are safe because of the level of expertise they require...

Not exactly.

Several of my relatives had to go to a dermatology center to get some suspicious moles removed. The NP/PA (or w/e degree) actually did the cutting each time. And the suturing. And the bandaging.

This isn't a rip on dermatology.

This is just saying "cutting flesh" doesn't make one safe from eventual encroachment.

Perhaps removing organs and getting knuckle-deep in brains is another story.

Radiology and pathology are safe because there aren't even enough jobs/services for new docs, let alone midlevels. Only half-joking.
 
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Not exactly.

Several of my relatives had to go to a dermatology center to get some suspicious moles removed. The NP/PA (or w/e degree) actually did the cutting each time. And the suturing. And the bandaging.

This isn't a rip on dermatology.

This is just saying "cutting flesh" doesn't make one safe from eventual encroachment.

Perhaps removing organs and getting knuckle-deep in brains is another story.

Radiology and pathology are safe because there aren't even enough jobs/services for new docs, let alone midlevels. Only half-joking.
The future seems to be bleak... Do you think psych will be safe since most people might not be interested in doing it?
 
The future seems to be bleak... Do you think psych will be safe since most people might not be interested in doing it?

It is one of my interests also.

Encroachment exists already, but, as you allude to, the nature of the job and patient population do act as gatekeepers of sorts.

I'd venture to say that most student nurses don't fantasize about graduating with a NP degree to work up close and personal with schizophrenics et al.

But midlevels have certainly entered the field.

That said, if you are one of the psych patients that is able and willing to pay cash for your treatment (already a characteristic differentiating from average joe layman), who are you going to be more willing to pay that cash to: a nurse or a psychiatrist?

Bring quality to the table and things will be alright.
 
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The future seems to be bleak... Do you think psych will be safe since most people might not be interested in doing it?

I'd argue that psychiatry is actually one of the fields most easily taken over by other providers. Look at all the different types of clinical psychologists, therapists, and related psych-associated professions. There are so many of them. If any of them get prescribing rights (imagine a clinical psychologist with prescribing rights) the game is over for psychiatrists.

Sure, as stated above, there will be the select few one-percenters that can afford to demand MD-level treatment. However, setting up this kind of practice will require the perfect location (desirable) and payor mix (rich), and there's likely going to be INTENSE competition to get those patients in your office. Competition for desirable practice set ups such as a cushy cash-only MD child psych in beverly hills are going to go to a very very very small lucky select few.

I wouldn't bank on psychiatry as a specialty that's immune to the discussion in this thread. However, as always, if you love the subject matter, and can see yourself accepting whatever practice environment you get, then sure go ahead and do psych.
 
I'd argue that psychiatry is actually one of the fields most easily taken over by other providers. Look at all the different types of clinical psychologists, therapists, and related psych-associated professions. There are so many of them. If any of them get prescribing rights (imagine a clinical psychologist with prescribing rights) the game is over for psychiatrists.

Sure, as stated above, there will be the select few one-percenters that can afford to demand MD-level treatment. However, setting up this kind of practice will require the perfect location (desirable) and payor mix (rich), and there's likely going to be INTENSE competition to get those patients in your office. Competition for desirable practice set ups such as a cushy cash-only MD child psych in beverly hills are going to go to a very very very small lucky select few.

I wouldn't bank on psychiatry as a specialty that's immune to the discussion in this thread. However, as always, if you love the subject matter, and can see yourself accepting whatever practice environment you get, then sure go ahead and do psych.

They already have prescribing rights in some states (New mexico, Louisiana)...for years now... 2002 actually.

Hasn't really killed off the field in those locations.
 
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They already have prescribing rights in some states (New mexico, Louisiana)...for years now.

Hasn't really killed off the field in those locations.

Perhaps I shouldn't have used the word "kill." I basically meant reimbursement might suffer compared to states where only psychiatrists can dole out drugs.
 
Sure, I agree that reimbursements might decrease.

But who knows... the VA recently (2012) passed a motion to boost psychiatrist salary cap upward by 50k. On the other hand, they also have taken more interest in opening the door to NP's from what I hear.

As you know, unfortunately, much of everything is just up to uncle sam and our good friends the politicians.
 
As you know, unfortunately, much of everything is just up to uncle sam and our good friends the politicians.

Ha, indeed brother, indeed.

And we all know how sympathetic they are to the physician's "plight"
 
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