PAs/NPs attempting to "cancel culture" the AMA

[VA Hopeful Dr]

The medical board can step in there maybe. Also if specialties took a stand together, that would ****ing end real quick.

Not really. The medical boards main purpose is making sure we aren't a danger to the public. They don't really involve themselves in contract issues between us and employers.

As for the second part: herding cats.

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[Matthew9Thirtyfive]

Nope. I was arguing that you can’t prove that they do. I think they do, but is it so inferior that they don’t have a place in healthcare?

No, but none of us are saying they don’t. Or at least most of us aren’t. In fact I’ve said a couple times that midlevels have a place in healthcare when they are appropriately supervised and trained. If NP schools were standardized and required education more like PAs, and supervision was required (and done), I would have zero problem. In fact, I don’t have any problems with midlevels on specialty services who are acting within their scope and training because they seem to mostly help.

 

[Matthew9Thirtyfive]

Not really. The medical boards main purpose is making sure we aren't a danger to the public. They don't really involve themselves in contract issues between us and employers.

I know they can go after an individual physician who isn’t supervising properly in a state that requires it. I was hoping they could go after facilities too.

As for the second part: herding cats.

Wishful thinking to be sure.

 

[IsleyOfTheNorth]

They should be a physician, OR they could go the midlevel route and commit to spending many years under close supervision to be able to build up the knowledge to be safe in a solo gig, which is what I and many of the NP’s I know are doing. The SDN lie is that “all” NP’s are loose cannons wanting to practice unsupervised out of the gate with “500 hours of shadowing all online” which is just 100% lies that that’s what ALL NP’s get for education and ALL NP’s want solo practice immediately. That’s the lies you guys are repeating to each other on this and a hundred other threads mostly because you like to hear yourselves speak.

Would you agree that medical school teaches things that are not taught to supervised NPs? How would an NP know when they know enough to be safe?

The SDN lie is that “all” NP’s are loose cannons wanting to practice unsupervised out of the gate ... and ALL NP’s want solo practice immediately.

I don't think the problem is with what they want to do, it with what they can do.

 

[DrNotaDr]

Would you agree that medical school teaches things that are not taught to supervised NPs? How would an NP know when they know enough to be safe?



I don't think the problem is with what they want to do, it with what they can do.

The bigger question is, for arguments sake, if I can do 80% of what a PCP does, and I know when to refer the other 19%, let’s say that leaves a 1% gap ie Swiss cheese theory of system failure, is that 1% critical enough to mean NP’s shouldnt exist. SDN says yes (but they are biased) state governments say no.

 

[Matthew9Thirtyfive]

The bigger question is, for arguments sake, if I can do 80% of what a PCP does, and I know when to refer the other 19%, let’s say that leaves a 1% gap ie Swiss cheese theory of system failure, is that 1% critical enough to mean NP’s shouldnt exist. SDN says yes (but they are biased) state governments say no.

And we all know state governments always make the mo$t re$pon$ible deci$ion$.

Also, where is the data that an NP can do 80% of what a primary care physician can do? The only data I’ve seen showed more like 50-60%, and that was with supervision (edit: and in a subspecialty setting with a narrower scope).

 

[IsleyOfTheNorth]

The bigger question is, for arguments sake, if I can do 80% of what a PCP does, and I know when to refer the other 19%, let’s say that leaves a 1% gap ie Swiss cheese theory of system failure, is that 1% critical enough to mean NP’s shouldnt exist. SDN says yes (but they are biased) state governments say no.

How can you know when to refer that 19%? How could you know to refer someone for signs of cancer that you were never trained to identify? You don't know what you don't know.

 

[Matthew9Thirtyfive]

How can you know when to refer that 19%? How could you know to refer someone for signs of cancer that you were never trained to identify? You don't know what you don't know.

Tbf, with adequate training and close supervision, that could probably be safely accomplished in specialty settings. I really just don’t think the midlevel education appropriately prepares them for primary care. It’s too broad.

 

[Neopolymath]

The bigger question is, for arguments sake, if I can do 80% of what a PCP does, and I know when to refer the other 19%, let’s say that leaves a 1% gap ie Swiss cheese theory of system failure, is that 1% critical enough to mean NP’s shouldnt exist. SDN says yes (but they are biased) state governments say no.

Terrible referrals, imaging, and medications lead to problems that affect real people and cost the system and individual's money.

Let's say you refer X amount more than a physician. That X amount of people are paying a second copay for something. They are paying for an mri they don't need. They are taking drugs they don't need. They are getting care for incidental findings etc. That doesn't even address the possible harm. Surely, you know that nothing is medicine is benign.

You scoffing at the difference here is typical of NPs. You don't care about $ and harm to the system so you can go play doc.

 

[DrNotaDr]

And we all know state governments always make the mo$t re$pon$ible deci$ion$.

Also, where is the data that an NP can do 80% of what a primary care physician can do? The only data I’ve seen showed more like 50-60%, and that was with supervision (edit: and in a subspecialty setting with a narrower scope).

I said for arguments sake. We could spend a year arguing those numbers.

How can you know when to refer that 19%? How could you know to refer someone for signs of cancer that you were never trained to identify? You don't know what you don't know.

You guys talk about how mid levels drive up the cost of medicine with unnecessary referrals. You can’t have your cake and eat it too.

Tbf, with adequate training and close supervision, that could probably be safely accomplished in specialty settings. I really just don’t think the midlevel education appropriately prepares them for primary care. It’s too broad.

I agree. We are better off in subspecialties.

 

[DrNotaDr]

Terrible referrals, imaging, and medications lead to problems that affect real people and cost the system and individual's money.

Let's say you refer X amount more than a physician. That X amount of people are paying a second copay for something. They are paying for an mri they don't need. They are taking drugs they don't need. They are getting care for incidental findings etc. That doesn't even address the possible harm. Surely, you know that nothing is medicine is benign.

You scoffing at the difference here is typical of NPs. You don't care about $ and harm to the system so you can go play doc.

If they are getting MRI’s they don’t need and taking meds they don’t need then it’s the cardiologist, nephrologist, neurologist who’s ordering it, and that’s an MD problem.

 

[Neopolymath]

You guys talk about how mid levels drive up the cost of medicine with unnecessary referrals. You can’t have your cake and eat it too.

The other alternative is one you obviously want to pretend doesn't exist. You guys just don't exist or get severely short leashed to prevent this. Boom no more worry. I don't have to worry about missing cancer as much or referrals for clearly not cancer.

That just doesn't play into the PR speak today. Some of that is also probably people who would agree but know that the system is too broken to put the cat back in the bag.

 

[IsleyOfTheNorth]

You guys talk about how mid levels drive up the cost of medicine with unnecessary referrals. You can’t have your cake and eat it too

You didn't answer my question. It's a pretty important question:

The bigger question is, for arguments sake, if I can do 80% of what a PCP does, and I know when to refer the other 19% ...

How can you know when to refer that 19%? How could you know to refer someone for signs of cancer that you were never trained to identify? You don't know what you don't know.

 

[Neopolymath]

If they are getting MRI’s they don’t need and taking meds they don’t need then it’s the cardiologist, nephrologist, neurologist who’s ordering it, and that’s an MD problem.

So what exactly do you do as an NP if you aren't doing any of these clinical things? You don't treat your patients? You just charge a copay to talk to them?

I hate to break it to you but someone is sending all these unnecessary imaging requests lol.

 

[DrNotaDr]

The other alternative is one you obviously want to pretend doesn't exist. You guys just don't exist or get severely short leashed to prevent this. Boom no more worry. I don't have to worry about missing cancer as much or referrals for clearly not cancer.

That just doesn't play into the PR speak today. Some of that is also probably people who would agree but know that the system is too broken to put the cat bag in the bag.

Unless you can do a water dance and create more residency spots tomorrow it’s better to see an NP than no one.

 

[Matthew9Thirtyfive]

I said for arguments sake. We could spend a year arguing those numbers.

Except we don’t have to because we have data for supervised practice, and no IRB would approve a fully independent study because it’s unethical.

 

[DrNotaDr]

So what exactly do you do as an NP if you aren't doing any of these clinical things? You don't treat your patients? You just charge a copay to talk to them?

I hate to break it to you but someone is sending all these unnecessary imaging requests lol.

If I refer someone to cards, and they order a holter monitor, then it’s the MD ordering the extra test. If I refer someone to cards, and they say nothing needed, I possibly just wasted that persons time and money, but the patient wasn’t harmed.

 

[Neopolymath]

Unless you can do a water dance and create more residency spots tomorrow it’s better to see an NP than no one.

We have now evolved to the next stage of the discussion that always happens.

Let me know how NPs in surgical sub clinics and derm clinics are serving the needs of the rural and suburban community primary care clinics. Biggest myth of them all right here.

 

[Matthew9Thirtyfive]

Unless you can do a water dance and create more residency spots tomorrow it’s better to see an NP than no one.

Another false dichotomy. And I wouldn’t argue that bad care is better than no care.

 

[DrNotaDr]

Another false dichotomy. And I wouldn’t argue that bad care is better than no care.

I would argue it isn’t always bad care, although I’m sure you’d disagree.

 

[Matthew9Thirtyfive]

If I refer someone to cards, and they order a holter monitor, then it’s the MD ordering the extra test. If I refer someone to cards, and they say nothing needed, I possibly just wasted that persons time and money, but the patient wasn’t harmed.

It doesn’t seem like you understand appropriate referrals. Inappropriate referrals that waste time and money isn’t no big deal. And when we have NPs and PAs doing more biopsies, more imaging, and more lab tests, they are absolutely harming patients or exposing them to increased risk.

 

[Neopolymath]

If I refer someone to cards, and they order a holter monitor, then it’s the MD ordering the extra test. If I refer someone to cards, and they say nothing needed, I possibly just wasted that persons time and money, but the patient wasn’t harmed.

That time or money doesn't mean anything to you? It's hard to imagine that it doesn't add up to millions of dollars taken from the average health illiterate $40k per year salary blue collar person/group. Shrugging your shoulders because the ultimate harm didn't happen to the patient all so you can make $100k and play doctor. just wow. The whole problem on display in this thread.

 

[Matthew9Thirtyfive]

I would argue it isn’t always bad care, although I’m sure you’d disagree.

No, but I’d say the chance of getting bad care is significantly higher when you are seeing someone with fewer hands on hours than a petsmart dog groomer. It would be better to spend the money spent on midlevels to open more residency spots or find ways to improve access to physicians, not create a two-tiered elitist system where poor patients have to see undertrained people who don’t know what they don’t know and simply cannot provide the standard of care.

 

[Neopolymath]

No, but I’d say the chance of getting bad care is significantly higher when you are seeing someone with fewer hands on hours than a petsmart dog groomer. It would be better to spend the money spent on midlevels to open more residency spots or find ways to improve access to physicians, not create a two-tiered elitist system where poor patients have to see undertrained people who don’t know what they don’t know and simply cannot provide the standard of care.

In the end game, THEIR families won't have to see other midlevels so they don't gaf. It's all good, man! Same for the admins and congress.

 

[DrNotaDr]

No, but I’d say the chance of getting bad care is significantly higher when you are seeing someone with fewer hands on hours than a petsmart dog groomer. It would be better to spend the money spent on midlevels to open more residency spots or find ways to improve access to physicians, not create a two-tiered elitist system where poor patients have to see undertrained people who don’t know what they don’t know and simply cannot provide the standard of care.

Again, you always sink to the lowest common denominator. They may see a NP with 15 years in practice, as I have proven before that’s about how long the average NP has been in practice. Equating NP education hours to that of a dog groomer is super insulting and intellectually dishonest.

 

[Matthew9Thirtyfive]

In the end game, THEIR families won't have to see other midlevels so they don't gaf. It's all good, man! Same for the admins and congress.

Yeah, it astonishes me that the “woke” culture in medicine is totally okay with making a two-tiered elitist system that disproportionately will affect minorities.

 

[DrNotaDr]

Yeah, it astonishes me that the “woke” culture in medicine is totally okay with making a two-tiered elitist system that disproportionately will affect minorities.

Sounds like you should go practice socialized medicine somewhere. Capitalism doesn’t seem to agree with you.

 

[Neopolymath]

Yeah, it astonishes me that the “woke” culture in medicine is totally okay with making a two-tiered elitist system that disproportionately will affect minorities.

Hey, mod, stay on topic. We aren't gonna talk about why woke culture in medicine actually isn't about helping people but actually looking cool on Twitter. HAAAAAA!

It is a really nice dovetail though.

 

[DrNotaDr]

That time or money doesn't mean anything to you? It's hard to imagine that it doesn't add up to millions of dollars taken from the average health illiterate $40k per year salary blue collar person/group. Shrugging your shoulders because the ultimate harm didn't happen to the patient all so you can make $100k and play doctor. just wow. The whole problem on display in this thread.

You were taking about all the “harm” NP’s are doing to their patients. I soundly refuted that so you move the goal posts, as usual.

 

[Matthew9Thirtyfive]

Again, you always sink to the lowest common denominator. They may see a NP with 15 years in practice, as I have proven before that’s about how long the average NP has been in practice. Equating NP education to that of a dog groomer is super insulting and intellectually dishonest.

It’s not actually. An NP with 15 years in practice as an NP is not going to be equivalent to a physician. And even if it were, your one off example of “well they might get a good one” is atrocious. Talk about intellectually dishonest.

The petsmart thing is not intellectually dishonest. We are talking about minimum training requirements because anyone can say well maybe I’ll see an NP who happens to be amazing or maybe I’ll see the one attending who happens to be an anti-vax idiot. Those anecdotal one off arguments are worthless, so you have to go with data. Something you seem extremely reluctant to do (can’t imagine why).

The only people who should feel insulted are patients who are being subjected to inferior care by people who don’t have enough training to style their poodle’s fur.

 

[Matthew9Thirtyfive]

You were taking about all the “harm” NP’s are doing to their patients. I soundly refuted that so you move the goal posts, as usual.

When did you refute that?

 

[DrNotaDr]

It’s not actually. An NP with 15 years in practice as an NP is not going to be equivalent to a physician. And even if it were, your one off example of “well they might get a good one” is atrocious. Talk about intellectually dishonest.

The petsmart thing is not intellectually dishonest. We are talking about minimum training requirements because anyone can say well maybe I’ll see an NP who happens to be amazing or maybe I’ll see the one attending who happens to be an anti-vax idiot. Those anecdotal one off arguments are worthless, so you have to go with data. Something you seem extremely reluctant to do (can’t imagine why).

The only people who should feel insulted are patients who are being subjected to inferior care by people who don’t have enough training to style their poodle’s fur.

Yeah. Again. I don’t know how you get away with comments like these as a moderator.

 

[Matthew9Thirtyfive]

Yeah. Again. I don’t know how you get away with comments like these as a moderator.

I mean, they are just facts. I’m not saying anything that is wrong, and just because you don’t like people to see them doesn’t mean they are inappropriate.

 

[Neopolymath]

You were taking about all the “harm” NP’s are doing to their patients. I soundly refuted that so you move the goal posts, as usual.

I think we have different definitions of "prove" and "refute".

I'll call them the medical and the nursing definitions. Seems appropriate.

Edit: wait are you really pretending we don't have data showing excess prescribing and imaging???

 

[DrNotaDr]

I mean, they are just facts. I’m not saying anything that is wrong, and just because you don’t like people to see them doesn’t mean they are inappropriate.

It’s very inappropriate, but you do you.

 

[Matthew9Thirtyfive]

It’s very inappropriate, but you do you.

Sorry, but gaslighting tactics don’t work on me. It’s not “very inappropriate” to correctly point out differences in training.

 

[Matthew9Thirtyfive]

Let’s try not to let this turn into just a nurse bashing session. As I’ve said, midlevels have a place and can be used safely in specific situations, so we don’t need to be hyperbolic and act like they are all awful and shouldn’t exist.

I also don’t want to let this thread get derailed and closed, so try to keep it factual and on topic and avoiding bashing entire professions. To be clear, pointing out training differences and actual data doesn’t count as bashing.

 

[Lawpy]

Sounds like you should go practice socialized medicine somewhere. Capitalism doesn’t seem to agree with you.

When capitalism endangers patient care, reforms become necessary

 

[RangerBob]

When capitalism endangers patient care, reforms become necessary

Agree.

We already see care being rationed to the poor. Most VA patients (most of whom are poor enough they go to the VA) have NPs as their primary. And if they have an actual doctor they tend to come and go in the span of a few months.

It’s unfortunate we’ll see the same thing elsewhere. Those with means (educated and wealthy enough) and choice will pursue care from physicians. Those without means/choice will be stuck with midlevel care.

It is unfortunate what has happened with the dilution of the degree. An NP used to mean something-typically only nurses with significant nursing experience went to get NPs. So they at least had that in-depth experience. I think this helped them recognize when they needed help.

Now there are so many NP programs, and to be frank I just don’t see many NPs deliver quality care. The few NPs our local hospital used to have on service did such a poor job that the hospitalists would need to manage both their census and the NP’s census. I believe the group realized the NPs created far more work and they were better off just increasing their census size or just spending more for another doc. Why pay someone that creates more work for you?

Personally I tell my entire family to wait for an appointment with the MD/DO unless it’s just a simple case of the sniffles. There are much better ways to save healthcare dollars than by decreasing the quality of care-if Japan and Germany (both countries we literally rebuilt) can do it, we certainly can to—if our politicians actually tried and put some preconceived notions behind them.

 

[jw3600]

Yeah. Again. I don’t know how you get away with comments like these as a moderator.

Lol this is the most NP SDN comment of all time. Basically what all these midlevels are screeching on Twitter.

 

[Lawpy]

Lol this is the most NP SDN comment of all time. Basically what all these midlevels are screeching on Twitter.

We really should form a Twitter group to fight an information war against midlevels and covid deniers/conspiracy theorists. It's a serious public health disaster to sit back and allow being overrun by fake news and disinformation. The arguments made by midlevels follow the similar line of reasoning as antivaxxers, antimaskers and covid hoax believers. We need to fight back against the disinformation spreaders

 

[Matthew9Thirtyfive]

We really should form a Twitter group to fight an information war against midlevels and covid deniers/conspiracy theorists. It's a serious public health disaster to sit back and allow being overrun by fake news and disinformation. The arguments made by midlevels follow the similar line of reasoning as antivaxxers, antimaskers and covid hoax believers. We need to fight back against the disinformation spreaders

You’ll get brigaded by all the midlevels and virtue signaling MS1s and academic attendings.

 

[Steve_Zissou]

You’ll get brigaded by all the midlevels and virtue signaling MS1s and academic attendings.

Saw a “future neurosurgeon” MS1 doing exactly this. **** is pathetic.

 

[Matthew9Thirtyfive]

Saw a “future neurosurgeon” MS1 doing exactly this. **** is pathetic.

I saw that. So self serving.

 

[jw3600]

We really should form a Twitter group to fight an information war against midlevels and covid deniers/conspiracy theorists. It's a serious public health disaster to sit back and allow being overrun by fake news and disinformation. The arguments made by midlevels follow the similar line of reasoning as antivaxxers, antimaskers and covid hoax believers. We need to fight back against the disinformation spreaders

In addition to what other posters replied, there are too many “F you, I got mine” boomer academic physicians making a killing on midlevels knowing it won’t affect them when the chickens come home to roost.

 

[Lawpy]

You’ll get brigaded by all the midlevels and virtue signaling MS1s and academic attendings.

Saw a “future neurosurgeon” MS1 doing exactly this. **** is pathetic.

In addition to what other posters replied, there are too many “F you, I got mine” boomer academic physicians making a killing on midlevels knowing it won’t affect them when the chickens come home to roost.

What about counterbrigading with pseudonym accounts and posting a lot of opeds and perspectives at places like NEJM?

 

[Matthew9Thirtyfive]

What about counterbrigading with pseudonym accounts and posting a lot of opeds and perspectives at places like NEJM?

We really need some people in secure positions to be willing to stand up against them and then a lot of anonymous people to support them.

 

[underthesun]

I want a link to the MS1 neurosurgeon post. That sounds WAY too good to miss

 

[Matthew9Thirtyfive]

I want a link to the MS1 neurosurgeon post. That sounds WAY too good to miss

It’s super cringy. He’s very clearly trying to virtue signal in hopes that he’ll get noticed by some neurosurgery PDs and get an interview (he’s said in other posts that he’s worried about not matching). His handle also is like dr something, and he’s an MS1. Kind of fitting that he supports midlevels.

 

[0ncogene]

What I don't get is, why not just go to medical school if they want to play doctor so bad? It's never too late.