Should physicians let NP/PA take over primary care and anesthesia?

[FNP_Blix]

For the record, I have no bad blood against NPs, I love NPs, except for the very few that want to have a d*ck measuring contests with doctors or even students.


When undiagnosed Bechet's disease (or heaven forbid, a disease that isn't grossly staring you in the face) comes to your office.

Forgot to mention the pathergy test too...

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[bashwell]

Of course you would. Anything where the medical establishment can have their thumb on.

What you say is a double edged sword. It cuts both ways. Many NPs want to be able to and some already do practice independently, as you yourself pointed out earlier. So I could just as easily reply with something like, "Of course that's what you'd say. Anything where NPs can usurp physicians."

 

[FNP_Blix]

What you say is a double edged sword. It cuts both ways. Many NPs want to be able to and some already do practice independently, as you yourself pointed out earlier. So I could just as easily reply with something like, "Of course that's what you'd say. Anything where NPs can usurp physicians."

This is true, but that is not my intention, nor the nursing establishment. Medicine has had a stronghold of the healthcare industry for ages, and for good reason. They have contributed a lot. But nursing has elevated itself, and continues to do so, and not all, but many in the medical establishment are threatened by this, or have fears that are not warranted. NPs, since their introduction, have been doing great, and only the data shows positive things.

 

[Jabbed]

Just realized that @FNP_Blix necroed a 2 year old thread. Coming across as a little thirsty..

 

[Mad Jack]

You don't think ARNP knows how to do that? lol. I just finished rotations at a jail where NPs where running the clinics and infirmary's and we see all kinds of complicated pathologies and patients with multiple comorbidities. Just the other day, we did penicillin challenge on a patient that had gummatous syphillis. For all you braniacs on this forum, have you ever seen this in real life and do you know what level of syphillis this is? How many of you have actually done a pelvic exam? Do you what to look for? Can you tell if what you are looking at is just a cervical polyp, a nabothian cyst, or potentially cancerous? Do you know what p53 tumor supressing gene and it's role in endometiral cancer? Regarding your insult about us not being able to treat knee pain, have you ever actually aspirated a bursa and sent for culture to determine if its gout causing the pain?Do you know how to perform an anterior drawer test? Do you know what clue cells look like under the microscope? How many of you have actually experienced working with a patient that has Steven Johnson's syndrome and the PT ways over 700Ibs and has MDRO? Have you ever done chest compressions to save a life? Do you know how to treat a patient who has critically high K+ levels?...All these thing's I've experienced, have been involved with, and would know what to do to get the above examples/patient the help they need. ARNPs know much more than you think. And if you have such a problem with us, then as physicians, why hire us? But you wont not hire us because you know that you cant. You need us. So all you can do is complain about something you cant control.

All of the examples you states are basic medical knowledge. Omg, p53 guise, we got ourselves a genius over here! They've done pelvic exams, omg! Clue cells! This person deserves a Nobel mother****ing prize in Nursing! Chest compresssssssionnnnns! Lay those hands on and heal thy patients with your arcane nursing magic! TREATING MOTHER****ING POTASSIUM THAT IS CRITICALLY HIGH?! Somebody hand this woman some continuous albuterol, because it's a prize she's gonna love along with...

Look, it just goes to show how misunderstood medical education is that you think this stuff is something we don't have to know or experience. I didn't just sit on my hands when I was putting in 80 hour weeks in Ob/Gyn, nor did I skip the lectures on gynecological pathophysiology and histopathology. Hell, I can tell you what the uterus looks like on the inside too, I've had to assist on enough surgeries. Oh my god, a patient with SJS that weighs over 700 lbs and has a MDRO! Try tackling a patient with Lupus, IgA nephropathy, ARDS, a PE, and thromboses in literally every peripheral vein that's on a ventilator and dialysis with a fungal UTI and MDRO pneumonia that eventually develops ITP and a platelet count of literally zero and then we'll talk. Walk me through the management of systemic scleroderma with 90% cutaneous involvement. Regale me with a tale of how you would manage patient with GVHD with renal failure requiring dialysis and ventilator dependent respiratory failure that has a bowel showing signs of necrosis. Hell, just walk me through how you intubate a patient with a complete cervical spinal fusion that happens to be pregnant, and then the best way to ventilate them once they're tubed and I'll give you a pat on the back and a cookie. You don't even have to give me the drugs you'd use, I'll go easy.

The point is, we see a lot of ****, and the better of us have literally forgotten more than most NPs know. We're essentially beaten every day for 50-80 hours a week for years. The only way the beatings stop is if you remember. And then, just when you're not expecting it, someone asks you about the most likely tumor to arise in the mother****ing Foramen of Luschka. And you know it, but it's not on you right now since you're low on sleep and caffeine, so you receive another beating, and you remember the next time, no matter how damn tired, hungry, or just depressed by the endless grind you are. It's an epyndemoma, by the way. And that's why we don't want nurses taking things over- because they never even had the knowledge to begin with, because they simply didn't get the education that we've got. Not on the preclinical front, not on the clinical front, and sure as hell not at the graduate medical education level.

No other developed country in the world says that their citizens don't deserve a doctor with full medical education and training to provide them with comprehensive primary care services. Only in America do we say second and third rate "providers" are good enough.

 

[bashwell]

This is true, but that is not my intention, nor the nursing establishment. Medicine has had a stronghold of the healthcare industry for ages, and for good reason. They have contributed a lot. But nursing has elevated itself, and continues to do so, and not all, but many in the medical establishment are threatened by this, or have fears that are not warranted. NPs, since their introduction, have been doing great, and only the data shows positive things.

Many doctors are perfectly right to be concerned about many midlevels and physician extenders because many midlevels and physician extenders want goals which undermine physicians. An obvious example is the militant AANA pushing for CRNAs against anesthesiologists, practicing completely independently from physicians, which has already happened in many states, which they recently tried to do with the VA, etc. So it's not like their "fears" are unwarranted but in fact organizations like the AANA are a real and present danger.

 

[FNP_Blix]

Just realized that @FNP_Blix necroed a 2 year old thread. Coming across as a little thirsty..

lol to be honest, I'm enjoying this. This is my first time coming to a forum like this and discussing (or more like yelling at each other) about this hot topic. I came here, and what the OP said just seemed a little ridiculous, so thats why I started.

 

[Jabbed]

All of the examples you states are basic medical knowledge. Omg, p53 guise, we got ourselves a genius over here! They've done pelvic exams, omg! Clue cells! This person deserves a Nobel mother****ing prize in Nursing! Chest compresssssssionnnnns! Lay those hands on and heal thy patients with your arcane nursing magic! TREATING MOTHER****ING POTASSIUM THAT IS CRITICALLY HIGH?! Somebody hand this woman some continuous albuterol, because it's a prize she's gonna love along with...

Reminds me of a post someone made a while back where they saw an NP managing a crashing dialysis patient. NP (supposedly) is fixated on getting stat doses of kayexalate over anything else.

 

[Mad Jack]

Reminds me of a post someone made a while back where they saw an NP managing a crashing dialysis patient. NP (supposedly) is fixated on getting stat doses of kayexalate over anything else.

Did he fall through a rip in time and land in 1958?

 

[FNP_Blix]

All of the examples you states are basic medical knowledge. Omg, p53 guise, we got ourselves a genius over here! They've done pelvic exams, omg! Clue cells! This person deserves a Nobel mother****ing prize in Nursing! Chest compresssssssionnnnns! Lay those hands on and heal thy patients with your arcane nursing magic! TREATING MOTHER****ING POTASSIUM THAT IS CRITICALLY HIGH?! Somebody hand this woman some continuous albuterol, because it's a prize she's gonna love along with...

Look, it just goes to show how misunderstood medical education is that you think this stuff is something we don't have to know or experience. I didn't just sit on my hands when I was putting in 80 hour weeks in Ob/Gyn, nor did I skip the lectures on gynecological pathophysiology and histopathology. Hell, I can tell you what the uterus looks like on the inside too, I've had to assist on enough surgeries. Oh my god, a patient with SJS that weighs over 700 lbs and has a MDRO! Try tackling a patient with Lupus, IgA nephropathy, ARDS, a PE, and thromboses in literally every peripheral vein that's on a ventilator and dialysis with a fungal UTI and MDRO pneumonia that eventually develops ITP and a platelet count of literally zero and then we'll talk. Walk me through the management of systemic scleroderma with 90% cutaneous involvement. Regale me with a tale of how you would manage patient with GVHD with renal failure requiring dialysis and ventilator dependent respiratory failure that has a bowel showing signs of necrosis. Hell, just walk me through how you intubate a patient with a complete cervical spinal fusion that happens to be pregnant, and then the best way to ventilate them once they're tubed and I'll give you a pat on the back and a cookie. You don't even have to give me the drugs you'd use, I'll go easy.

The point is, we see a lot of ****, and the better of us have literally forgotten more than most NPs know. We're essentially beaten every day for 50-80 hours a week for years. The only way the beatings stop is if you remember. And then, just when you're not expecting it, someone asks you about the most likely tumor to arise in the mother****ing Foramen of Luschka. And you know it, but it's not on you right now since you're low on sleep and caffeine, so you receive another beating, and you remember the next time, no matter how damn tired, hungry, or just depressed by the endless grind you are. It's an epyndemoma, by the way. And that's why we don't want nurses taking things over- because they never even had the knowledge to begin with, because they simply didn't get the education that we've got. Not on the preclinical front, not on the clinical front, and sure as hell not at the graduate medical education level.

No other developed country in the world says that their citizens don't deserve a doctor with full medical education and training to provide them with comprehensive primary care services. Only in America do we say second and third rate "providers" are good enough.

You're right, I don't know a lot of the things you just mentioned. I won't pretend like I do. But again, is that knowledge necessary in the primary care setting where this level of medical care isn't required? I would argue that ARNP training is sufficient and has proven useful to perform PRIMARY CARE. Please read my other comments. And in other countries, they are finding that they benefit from NPs. It's not 2nd or 3rd tier medicine as you claim.

 

[FNP_Blix]

Anyway folks, it's been fun! lol

 

[Jabbed]

You're right, I don't know a lot of the things you just mentioned. I won't pretend like I do. But again, is that knowledge necessary in the primary care setting where this level of medical care isn't required? I would argue that ARNP training is sufficient and has proven useful to perform PRIMARY CARE. Please read my other comments.

lol where do you think they go after we discharge them from the hospital?

 

[Staphylococcus Aureus]

A fundamental misunderstanding of primary care would be to presume your patients come in only with primary care issues. That and somehow thinking you can refer (correctly and timely) something admittedly you don't know.

 

[FNP_Blix]

lol where do you think they go after we discharge them from the hospital?

lol where do you think they go after we discharge them from the hospital?

They go to primary care where intubation doesn't occur and all the things that mad jack described are not managed. In the primary care setting you are not medically managing at that level.

 

[bashwell]

You're right, I don't know a lot of the things you just mentioned. I won't pretend like I do. But again, is that knowledge necessary in the primary care setting where this level of medical care isn't required? I would argue that ARNP training is sufficient and has proven useful to perform PRIMARY CARE. Please read my other comments.

They go to primary care where intubation doesn't occur and all the things that mad jack described are not managed. In the primary care setting you are not medically managing at that level.

That's a potentially dangerous (for patients) attitude to have!

 

[FNP_Blix]

A fundamental misunderstanding of primary care would be to presume your patients come in only with primary care issues. That and somehow thinking you can refer (correctly and timely) something admittedly you don't know.

That's right. If someone comes in that is in critical condition, you think I'm going to try and manage them and be a cow boy in the office? I know what standards of care are and scope of practice.

 

[FNP_Blix]

That's a potentially dangerous (for patients) attitude to have!

Yea and how? What is incorrect about that statement? Are you yourself going to intubate or do surgery in the office? The pediatrician I just followed doesnt even do Rocephin shots in his office. If he suspects someone has even uncomplicated pyelo, or someone is septic they go to the ER according to him. That is not dangerous. That's called elevation of care, and knowing one's limits. You guys act like NPs want to be surgeons or internists when I'm talking about office setting. I realize there are "zebras" to look out for and that's what we are trained to recognize as well.

 

[Jabbed]

They go to primary care where intubation doesn't occur and all the things that mad jack described are not managed. In the primary care setting you are not medically managing at that level.

But you think that going forward all that you have to worry about is making sure that they get their annual flu vaccine?

 

[FNP_Blix]

But you think that going forward all that you have to worry about is making sure that they get their annual flu vaccine?

No, you're putting words in my mouth. What I'm saying is that I don't need to know what the most likely tumor is that arises in the Foramen of Luschka to provide good primary care! lol Jesus Christmas. What do you think we do exactly in primary care? Majority of unusual cases is a matter of recognition and referral. NPs and physicians in this setting need to know their limits. A lot of management is involved too, which AGAIN, we are trained to do.

 

[bashwell]

When I was a med student I was at a family physician's office and saw a patient suddenly collapse. No one else there at the time but the family physician (and me). Given you're in PRIMARY CARE (all caps like you did), are you just going to say . . .

you think I'm going to try and manage them and be a cow boy in the office? I know what standards of care are and scope of practice.

If you did, then the poor soul might've died!

 

[FNP_Blix]

When I was a med student I was at a family physician's office and saw a patient suddenly collapse. No one else there at the time but the family physician (and me). Given you're in PRIMARY CARE (all caps like you did), are you just going to say . . .

Well what did you do in that case? I manage patients that collapse every day. I know ACLS and what is needed in those instance. You seriously underestimate our training man.

 

[FNP_Blix]

Well what did you do in that case? I manage patients that collapse every day. I know ACLS and what is needed in those instance. Not much else you can do in the office besides try and save their life. You seriously underestimate our training man.

 

[IlDestriero]

You don't think ARNP knows how to do that? lol. I just finished rotations at a jail where NPs where running the clinics and infirmary's and we see all kinds of complicated pathologies and patients with multiple comorbidities. Just the other day, we did penicillin challenge on a patient that had gummatous syphillis. For all you braniacs on this forum, have you ever seen this in real life and do you know what level of syphillis this is? How many of you have actually done a pelvic exam? Do you what to look for? Can you tell if what you are looking at is just a cervical polyp, a nabothian cyst, or potentially cancerous? Do you know what p53 tumor supressing gene and it's role in endometiral cancer? Regarding your insult about us not being able to treat knee pain, have you ever actually aspirated a bursa and sent for culture to determine if its gout causing the pain?Do you know how to perform an anterior drawer test? Do you know what clue cells look like under the microscope? How many of you have actually experienced working with a patient that has Steven Johnson's syndrome and the PT ways over 700Ibs and has MDRO? Have you ever done chest compressions to save a life? Do you know how to treat a patient who has critically high K+ levels?...All these thing's I've experienced, have been involved with, and would know what to do to get the above examples/patient the help they need. ARNPs know much more than you think. And if you have such a problem with us, then as physicians, why hire us? But you wont not hire us because you know that you cant. You need us. So all you can do is complain about something you cant control.

Medical students have done all of those things.


--
Il Destriero

 

[FNP_Blix]

Medical students have done all of those things.


--
Il Destriero

Good

 

[bashwell]

Well what did you do in that case? I manage patients that collapse every day. I know ACLS and what is needed in those instance. You seriously underestimate our training man.

Nope, I'm only going off of what you said. Just follow the logic of your own words. Stop jumping from one thing to another. See, now you're actually agreeing there's more that needs to be done, that it's fine to be a "cow boy" at least sometimes. Not just a bunch of flu shots or whatever.

 

[Mad Jack]

You're right, I don't know a lot of the things you just mentioned. I won't pretend like I do. But again, is that knowledge necessary in the primary care setting where this level of medical care isn't required? I would argue that ARNP training is sufficient and has proven useful to perform PRIMARY CARE. Please read my other comments. And in other countries, they are finding that they benefit from NPs. It's not 2nd or 3rd tier medicine as you claim.

Best as I can tell the only country that gives NPs full, unrestricted practice authority is the United States.

You'd be surprised how much of that "other stuff" is actually incredibly useful in primary care. Hell, I'm going to be a damn psychiatrist. I still need to know it all, because I've got to rule out any of the many many organic causes of mental illness first. Can't even count the number of close calls I've seen dodged by a bit of knowledge picked up on the wards- what makes doctors the gold standard is that we're trained to pick up on the few percent of cases that fall outside of the norm. As more and more motivated and highly qualified physicians enter primary care, we'll have family physicians that are actually trained and care to use that experience to its fullest. If we were doing things right, we'd train enough physicians that we didn't need NPs at all, because they are second class providers, plain and simple.

 

[FNP_Blix]

Nope, I'm only going off of what you said. Just follow the logic of your own words. Stop jumping from one thing to another. See, now you're actually agreeing there's more that needs to be done, that it's fine to be a "cow boy" at least sometimes. Not just a bunch of flu shots or whatever.

No you're misunderstanding me. If it is a matter of urgency, a life and death situation, then of course, you have to intervene. I'm talking about more ambiguous cases where there may be question if management should be done in the office. Are you going to administer IV antibiotics in the office, or manage a septic patient in the office? NO.

 

[FNP_Blix]

Best as I can tell the only country that gives NPs full, unrestricted practice authority is the United States.

You'd be surprised how much of that "other stuff" is actually incredibly useful in primary care. Hell, I'm going to be a damn psychiatrist. I still need to know it all, because I've got to rule out any of the many many organic causes of mental illness first. Can't even count the number of close calls I've seen dodged by a bit of knowledge picked up on the wards- what makes doctors the gold standard is that we're trained to pick up on the few percent of cases that fall outside of the norm. As more and more motivated and highly qualified physicians enter primary care, we'll have family physicians that are actually trained and care to use that experience to its fullest. If we were doing things right, we'd train enough physicians that we didn't need NPs at all, because they are second class providers, plain and simple.

In England, Canada, Isreal, Indonesia, Australia, etc., NPs are being utilized more and more and with great degree of autonomy. Let's take your example, and lets pretend we eliminate all NPs tomorrow...all I can say is good luck, you're going to need help managing your patients in all areas of medicine and you are going to wish that we came back to help.

 

[Mad Jack]

In England, Canada, Isreal, Indonesia, Australia, etc., NPs are being utilized more and more and with great degree of autonomy. Let's take your example, and lets pretend we eliminate all NPs tomorrow...all I can say is good luck, you're going to need help managing your patients in all areas of medicine and you are going to wish that we came back to help.

It's an easily solved problem, if we'd just start taking physicians from other countries with adequate GME and maybe providing them with a simple internship to learn the US system. They'd certainly be more qualified than most NPs, and we've got literally tens of thousands of them knocking down our door at any given time that we simply can't train, so just change the training and bring back the GP.

 

[FNP_Blix]

Best as I can tell the only country that gives NPs full, unrestricted practice authority is the United States.

You'd be surprised how much of that "other stuff" is actually incredibly useful in primary care. Hell, I'm going to be a damn psychiatrist. I still need to know it all, because I've got to rule out any of the many many organic causes of mental illness first. Can't even count the number of close calls I've seen dodged by a bit of knowledge picked up on the wards- what makes doctors the gold standard is that we're trained to pick up on the few percent of cases that fall outside of the norm. As more and more motivated and highly qualified physicians enter primary care, we'll have family physicians that are actually trained and care to use that experience to its fullest. If we were doing things right, we'd train enough physicians that we didn't need NPs at all, because they are second class providers, plain and simple.

Physicians need to fix their own house before they start trying to fix other professions. Nursing is expanding taking on more roles out of necessity, and in other countries, they are realizing the same truth. While physicians are greatly needed, NPs are helping buffer the impending crisis, not making it worse as you think.

 

[bashwell]

No you're misunderstanding me. If it is a matter of urgency, a life and death situation, then of course, you have to intervene. I'm talking about more ambiguous cases where there may be question if management should be done in the office. Are you going to administer IV antibiotics in the office, or manage a septic patient in the office? NO.

I can't "misunderstand" you if I'm directly quoting you and going off of your own words. Yes, I agree what you said earlier is in tension with what you now say, since you have to clarify now, but that's my exact point. You say something, then you have to clarify what you say, or add to it, or whatever, but then you pretend like it wasn't a correction when it was. Welp!

 

[FNP_Blix]

It's an easily solved problem, if we'd just start taking physicians from other countries with adequate GME and maybe providing them with a simple internship to learn the US system. They'd certainly be more qualified than most NPs, and we've got literally tens of thousands of them knocking down our door at any given time that we simply can't train, so just change the training and bring back the GP.

Well I'd get started on that then. Get to work and make it happen! Good luck with that. But in the mean time, you need our help.

 

[bashwell]

In England, Canada, Isreal, Indonesia, Australia, etc., NPs are being utilized more and more and with great degree of autonomy. Let's take your example, and lets pretend we eliminate all NPs tomorrow...all I can say is good luck, you're going to need help managing your patients in all areas of medicine and you are going to wish that we came back to help.

So wrong. I'm Australian (and American). I did med school in Australia and also did a brief stint in the U.K. and the US too. I know lots of Canadians as well. From all I have seen, certainly in Australia and NZ, NPs in Australia and NZ are not like NPs in the US!

 

[FNP_Blix]

I can't "misunderstand" you if I'm directly quoting you and going off of your own words. Yes, I agree what you said earlier is in tension with what you now say, since you have to clarify now, but that's my exact point. You say something, then you have to clarify what you say, or add to it, or whatever, but then you pretend like it wasn't a correction when it was. Welp!

No those were not my words. You only stated what you think I was saying, but you're to thick to read between the lines.

 

[Mad Jack]

Physicians need to fix their own house before they start trying to fix other professions. Nursing is expanding taking on more roles out of necessity, and in other countries, they are realizing the same truth. While physicians are greatly needed, NPs are helping buffer the impending crisis, not making it worse as you think.

Actually they're expanding at a rate that is unsustainable and putting them in competition with each other and physicians. The number of NPs I've known that can't find full time work is astounding. They preach about wanting to end this or that primary care crisis, but the truth is it's about the cash. They want more money, and they want to work in the fields that pay, for themselves, to make as much money as possible. Let's not even pretend this is about patients or altruism.

 

[FNP_Blix]

So wrong. I'm Australian (and American). I did med school in Australia and also did a brief stint in the U.K. and the US too. I know lots of Canadians as well. From all I have seen, certainly in Australia and NZ, NPs in Australia and NZ are not like NPs in the US!

And when where you last in those countries? You are right, they are not as advanced as the nursing profession in the U.S. But that is where they are headed. Each year, they are becoming more autonomous.

 

[Mad Jack]

Well I'd get started on that then. Get to work and make it happen! Good luck with that. But in the mean time, you need our help.

"Need" is quite the overstatement. We "need" nurses. NPs are nice here and there, but in most environments just make life easier rather than being truly necessary.

 

[FNP_Blix]

Actually they're expanding at a rate that is unsustainable and putting them in competition with each other and physicians. The number of NPs I've known that can't find full time work is astounding. They preach about wanting to end this or that primary care crisis, but the truth is it's about the cash. They want more money, and they want to work in the fields that pay, for themselves, to make as much money as possible. Let's not even pretend this is about patients or altruism.

Wow, okay so you switched gears fast. Is that what we where even talking about - the money? Well I can say the same about physicians. Why do most physicians specialize? NPs are okay with making lower salaries and basically performing the same work (in some settings). At least I am. And in regards to not finding work - thats far from the truth. Just look at websites like Indeed. Look at the BLS. Growth in this profession is astounding. 31% through 2025. You honestly believe that there is no work. And NPs are by far, much more likely to work in rural areas. Fact check yourself.

 

[bashwell]

And when where you last in those countries? You are right, they are not as advanced as the nursing profession in the U.S. But that is where they are headed. Each year, they are becoming more autonomous.

Um, yeah . . . I'm in Australia right now!

No, I never said they're not "advanced"! You keep putting words in my mouth. And nurses here are "advanced" -- no need to denigrate other nurses in other nations just because I called you out in your point.

And no they're not headed to where they are headed in the US. It's not really even comparable except in broad fashion.

 

[FNP_Blix]

"Need" is quite the overstatement. We "need" nurses. NPs are nice here and there, but in most environments just make life easier rather than being truly necessary.

As a psychiatrist, I can see why you would say that. But in other areas, you're wrong.

 

[Staphylococcus Aureus]

@FNP_Blix you're making it sound like anything that is not routine primary care management must be some acute case bursting through the doors on a stretcher, and keep referencing rarer pathology you "don't need to know." That's the problem. The complicated underlying pathology that walks into a PCP office is complicated for a reason, it doesn't present themselves grossly or classically, so why are you so confident you will refer out something you never needed to know?

I manage patients that collapse every day.

You work in outpatient primary care?

 

[FNP_Blix]

Um, yeah . . . I'm in Australia right now!

No, I never said they're not "advanced"! You keep putting words in my mouth. And nurses here are "advanced" -- no need to denigrate other nurses in other nations just because I called you out in your point.

And no they're not headed to where they are headed in the US. It's not really even comparable except in broad fashion.

I wasn't denigrating anyone. However, as a NP I've studied my profession pretty well, okay. And what I mean by "advanced" is that the nurse practitioner, specifically is a relatively new concept in other nations. Here, it has been around since 1965. And as a reminder, it was a PHYSICIAN that helped pioneer our profession.

 

[bashwell]

No those were not my words. You only stated what you think I was saying, but you're to thick to read between the lines.

And you're "too thick" to learn how to correctly spell simple words (including in your original post)?

 

[bashwell]

I wasn't denigrating anyone. However, as a NP I've studied my profession pretty well, okay. And what I mean by "advanced" is that the nurse practitioner, specifically is a relatively new concept in other nations. Here, it has been around since 1965. And as a reminder, it was a PHYSICIAN that helped pioneer our profession.

Nice equivocation of "advanced."

Also, your last sentence commits the genetic fallacy.

 

[FNP_Blix]

@FNP_Blix you're making it sound like anything that is not routine primary care management must be some acute case bursting through the doors on a stretcher, and keep referencing rarer pathology you "don't need to know." That's the problem. The complicated underlying pathology that walks into a PCP office is complicated for a reason, it doesn't present themselves grossly or classically, so why are you so confident you will refer out something you never needed to know?


You work in outpatient primary care?

I work in multiple areas. ICU as an RN and Urgent Care as an NP. I agree, you need to know when something is not right, and understanding pathophysiology and various pathologies is clearly important. We are trained to recognize a large amount of pathologies, and when things aren't so clear, we refer to someone that may know. I don't claim to know everything. I know my limits and when it is necessary to refer out. Usually it is pretty clear if a patient is knocking on deaths door or has an issue that is unusual or complicated that is beyond our scope of practice.

 

[W19]

I will never hire a NP and I think most physicians shouldn't...

 

[Mad Jack]

Wow, okay so you switched gears fast. Is that what we where even talking about - the money? Well I can say the same about physicians. Why do most physicians specialize? NPs are okay with making lower salaries and basically performing the same work (in some settings). At least I am. And in regards to not finding work - thats far from the truth. Just look at websites like Indeed. Look at the BLS. Growth in this profession is astounding. 31% through 2025. You honestly believe that there is no work. And NPs are by far, much more likely to work in rural areas. Fact check yourself.

In my state, at least, the job market is awful. And I didn't switch gears, I was refuting the idea that this is about anything other than increased income- which it mostly isn't- or else most NPs would have remained nurses. What you don't realize is that I was an allied health practitioner that worked alongside nurses for yeeeears before going to medical school, I've got a lot of nurse and NP friends. The ones that did it did it for the cash and to get away from direct patient care, plain and simple. And the payoff wasn't nearly as good as they'd hoped, due to the job market (the Northeast is highly saturated unless you're willing to work in a PCP office, which most don't).

 

[FNP_Blix]

And you're "too thick" to learn how to correctly spell simple words (including in your original post)?

Okay, my first priority right now is just to have a conversation. So excuse me Mr. Spelling King. I dont give a s*** about grammar right now lol. Maybe you should work on having neater hand writing. We all know physicians lack in that area.

 

[bashwell]

I will never hire a NP and I think most physicians shouldn't...

I won't if NPs are anything like @FNP_Blix.

 

[Mad Jack]

As a psychiatrist, I can see why you would say that. But in other areas, you're wrong.

What other areas? In the hospital they do resident work for more money and less efficiently. In the outpatient environment, they do things that doctors could do but would rather not because it's annoying. They basically take the scut work that we don't want, not that we can't do. In certain areas, there is a demand for more providers, but those areas are small compared to the whole of medicine.