The Advanced Nurse Practitioner Provider Specialists Experiment

[tdram]

She's already been approached and has declined. There are only two gyn/oncs in the county, so she's pretty committed to giving patients the care she feels they need. We have these discussions almost every time I see her. Like I said, it isn't impossible, just unlikely.

What I could see happening, before her being bought out, is she and the other gyn/onc merging. He is also independent. They already cross-cover each other for w/e and holidays.

I just cross my fingers and hope things stay the same. I don't think I would get the kind of care she delivers if she were bought out by McMedicine.

I also hope it stays the same, but I have a feeling that we are headed to a complete McMedicine takeover faster than any of us ever imagined. Pretty soon we won't be patients of a doctor but customers of massive multinational corporations. On the physician side, they'll start moving us around wherever they can make more money from us at the moment. This is what they do for so many other professions. Their financial people will use an algoirthm to decide that they can make more money with another gyn/onc at a branch in another state more than yours and there goes your trusted physician and the relationship you had built up with that person over time.

---

Members don't see this ad.

 

[masaraksh]

Impossible to know, since NP licensing is a state-by-state thing and many states don't make the data available.

WTH?!

And, I can google "Joe Smith MD NPI" and get a doc's National Provider Identifier.

If NPs want to practice independently, they should AT LEAST have a similar system. Not to mention, this data should clearly be publicly available. I mean, it is reasonable to want the person whose office you go to to actually be licensed.

 

[masaraksh]

How is grandfathering even legal? If the licensing body has determined that a higher level of education is absolutely necessary for whatever reason, how can you allow some people to continue to be licensed without it?

It's like determining that a product is dangerous and banning future production, but letting the ones that were already manufactured stay in the stores and continue to sell.

I guess its kind of like lead paint. We don't use it anymore since its dangerous.... but we're not asking people to rebuilt/repaint the old houses that have lead paint.

 

[DermViser]

How is grandfathering even legal? If the licensing body has determined that a higher level of education is absolutely necessary for whatever reason, how can you allow some people to continue to be licensed without it?

It's like determining that a product is dangerous and banning future production, but letting the ones that were already manufactured stay in the stores and continue to sell.

Bc everytime you increase the requirements, you'd have to go back to school and be out of the workforce. But yes, quite a few of our derm faculty, are "lifetime" certified in their specialty. If you got your board certification before 1990, you're lifetime certified and are not required to participate in MOC.

 

[tdram]

I guess its kind of like lead paint. We don't use it anymore since its dangerous.... but we're not asking people to rebuilt/repaint the old houses that have lead paint.

The lead paint situation is a bit different because it's only affecting the people who live in the home. I wonder if they require people to mention that their home has lead paint when they sell or rent it?

 

[tdram]

Bc everytime you increase the requirements, you'd have to go back to school and be out of the workforce. But yes, quite a few of our derm faculty, are "lifetime" certified in their specialty. If you got your board certification before 1990, you're lifetime certified and are not required to participate in MOC.

Doesn't really apply to the MOC because you don't have to back to school for that. As far as the other professions- tough luck I guess? Why should the public have to accept your lower quality training (as decided by the new requirements) because getting the appropriate training would take you out of the workforce? I'd be OK with it if they required people who were grandfathered to advertise that so that the customers know what they're getting. If the patient's parents from that case knew this woman only had a high school diploma, I'm not so sure they would have gone to her. They probably assumed she had met the same licensing requirements as every recently trained NP.

 

[LiamNeesons]

I also hope it stays the same, but I have a feeling that we are headed to a complete McMedicine takeover faster than any of us ever imagined. Pretty soon we won't be patients of a doctor but customers of massive multinational corporations. On the physician side, they'll start moving us around wherever they can make more money from us at the moment. This is what they do for so many other professions. Their financial people will use an algoirthm to decide that they can make more money with another gyn/onc at a branch in another state more than yours and there goes your trusted physician and the relationship you had built up with that person over time.

If corporations take over the entirety of medicine, they should have to pay some of the damages when their physician employees get sued otherwise CMG's will just continue to recruit the cheapest employees they can--regardless of outcomes.

 

[fab4fan]

I also hope it stays the same, but I have a feeling that we are headed to a complete McMedicine takeover faster than any of us ever imagined. Pretty soon we won't be patients of a doctor but customers of massive multinational corporations. On the physician side, they'll start moving us around wherever they can make more money from us at the moment. This is what they do for so many other professions. Their financial people will use an algoirthm to decide that they can make more money with another gyn/onc at a branch in another state more than yours and there goes your trusted physician and the relationship you had built up with that person over time.

I hope I'm dead before that happens.--not to be morbid, but YKWIM.

 

[Instatewaiter]

They make great cardiologists: http://eurheartj.oxfordjournals.org/content/33/21/2692.full.pdf

http://www.mountsinaiheartnp.org/2012-presentations/10_Role_in_Acute_Cardiac_Care.pdf (See slide 13)

In the first, they were following a computer program and were supervised by a cardiologist.

In the second, these teams are staffed by an attending cardiologist. Of course there aren't going to be differences because the leader of the team is the same. The NP is acting as a resident.

 

[DermViser]

In the first, they were following a computer program and were supervised by a cardiologist.

In the second, these teams are staffed by an attending cardiologist. Of course there aren't going to be differences because the leader of the team is the same. The NP is acting as a resident.

I know, I was being facetious. These "studies" are all bunk.

 

[RJGOP]

Dude, Oregon has already cut physician reimbursement to NP levels.

I don't expect NPs to win increased reimbursement. What I expect to happen is MDs will take the haircut.

That's exactly right. Oregon is probably the worst state, reimbursment wise, to be a physician. Not to mention NP's are treated as well as physicians if not better- obviously because they've worked so hard, just as hard as the physicians, to become NP's. I don't understand why physicians work there. It's almost like they're trying to drive them out. However, that not the only reason not to live in Oregon.

 

[DermViser]

That's exactly right. Oregon is probably the worst state, reimbursment wise, to be a physician. Not to mention NP's are treated as well as physicians if not better- obviously because they've worked so hard, just as hard as the physicians, to become NP's. I don't understand why physicians work there. It's almost like they're trying to drive them out. However, that not the only reason not to live in Oregon.

Yup, being a complete ****hole is another reason not to live in Oregon. Definitely not surprised based on how it's run. The weather is also terrible.

 

[masaraksh]

Yup, being a complete ****hole is another reason not to live in Oregon. Definitely not surprised based on how it's run. The weather is also terrible.

c'mon. Don't $hit on a place just because its rural.

I will be going to a somewhat rural area for medical school and am very happy. In fact, I probably wouldn't mind practicing there or somewhere else non-urban. Not everyone needs an urban center ... and not everyone cares much for sunny Cali or Florida.

 

[DermViser]

c'mon. Don't $hit on a place just because its rural.

I will be going to a somewhat rural area for medical school and am very happy. In fact, I probably wouldn't mind practicing there or somewhere else non-urban. Not everyone needs an urban center ... and not everyone cares much for sunny Cali or Florida.

I was talking about Portland, which isn't rural. Cities can be ****holes too.

 

[RJGOP]

c'mon. Don't $hit on a place just because its rural.

I will be going to a somewhat rural area for medical school and am very happy. In fact, I probably wouldn't mind practicing there or somewhere else non-urban. Not everyone needs an urban center ... and not everyone cares much for sunny Cali or Florida.

The fact that Oregon pays physicians like crap has nothing to do with the fact that its rural. Personally, I would prefer to live in a rural area anyway- being from the Midwest.

 

[masaraksh]

I was talking about Portland, which isn't rural. Cities can be ****holes too.

Really? I've never been there. Or anywhere near there for that matter. But from the looks of it seems like a nice place to live. Just googled it and looking under 'tourism', 'shopping' 'breweries' 'cuisine', 'sports' etc. it seems like a fine city and definitely a place you may choose over some other cities in the US.


Again, I havn't been there. But have you? Also, there are medical schools in cities that are even further up on the ****hole scale, no?

 

[BurghStudent]

No specialty is safe outside of Surgery (and surgical specialties and subspecialties), Pathology, and Radiology. Any field with a better lifestyle, low malpractice risk, etc is prone to having NPs enter them.

The only question is whether patients will be willing to see them or not. For primary care specialties, I believe they will, bc it will be harder to correlate a death with NP misdiagnosis, unless it's quite obvious. You can bet the politicians foisting midlevels on the public will never see a midlevel for the care for themselves and their families.

One thing that scares me about radiology and dermatology etc is outsourcing. Teledermatology and teleradiology are already growing fields in the U.S. How long will it take Congress to devise a way to pay physicians oversees to diagnose en masse for a low fee?

 

[masaraksh]

The fact that Oregon pays physicians like crap has nothing to do with the fact that its rural. Personally, I would prefer to live in a rural area anyway- being from the Midwest.

Physician compensation is a separate issue. I was addressing DermViser's remark about Oregon being a ****hole and terrible weather.

 

[DermViser]

One thing that scares me about radiology and dermatology etc is outsourcing. Teledermatology and teleradiology are already growing fields in the U.S. How long will it take Congress to devise a way to pay physicians oversees to diagnose en masse for a low fee?

I can't speak for Telerads, but Telederm is mainly used in rural areas, in which primary docs don't have dermatologists for miles. It's an excellent way for derms and FM docs to collaborate on cases.

 

[DermViser]

Really? I've never been there. Or anywhere near there for that matter. But from the looks of it seems like a nice place to live. Just googled it and looking under 'tourism', 'shopping' 'breweries' 'cuisine', 'sports' etc. it seems like a fine city and definitely a place you may choose over some other cities in the US.


Again, I havn't been there. But have you? Also, there are medical schools in cities that are even further up on the ****hole scale, no?

Yes, bc tourism photos are always valid.

 

[sinombre]

Portland is a pretty fun city. The weather really does suck though, relative to California.

Actually the weather everywhere sucks relative to California.

 

[RJGOP]

Physician compensation is a separate issue. I was addressing DermViser's remark about Oregon being a ****hole and terrible weather.

Alright, my bad, I guess I just misunderstood you. He was right about the bad weather though.

 

[masaraksh]

Alright, my bad, I guess I just misunderstood you. He was right about the bad weather though.

Weather is so subjective though.

I highly doubt Portland can be that bad. I've lived in Montreal (which has insanely long an painful winters) and Boston (which has bad winters and humid summers) but they're still great cities.

 

[RJGOP]

Weather is so subjective though.

I highly doubt Portland can be that bad. I've lived in Montreal (which has insanely long an painful winters) and Boston (which has bad winters and humid summers) but they're still great cities.

The bold is so true. That reminds me of the Minnesotans whose favorite seasons were the -25 degree winters. They thought that was beautiful weather. I though that weather was miserable on the other hand, and in turn, they thought I was crazy.

 

[masaraksh]

Yep, and personally, I like living somewhere that has all 4 seasons and I enjoy winter (even though it can be miserable sometimes). I love winter sports.

Thats why I was so put off by DermVisers comment about Oregon being a ***hoel with bad weather.

 

[WhippleWhileWeWork]

The only reason I'm glad I went to med school is at least I'll be able to manage my own health in the midst of this jungle.

This.
And your family's. Maybe your friends' too.

 

[WhippleWhileWeWork]

Thats why I was so put off by DermVisers comment about Oregon being a ***hoel with bad weather.

Haha of all the things said in this thread, his opinion of Oregon got your goat?

 

[DermViser]

Yep, and personally, I like living somewhere that has all 4 seasons and I enjoy winter (even though it can be miserable sometimes). I love winter sports.

Thats why I was so put off by DermVisers comment about Oregon being a ***hoel with bad weather.

Well if you like gray skies, with constantly rainy weather, then Portland is perfect.

 

[sinombre]

Oregon might have a lot of cloudy skies and rain, but at least it's not Cleveland, which at least is not Detroit.

 

[EsotericAlchemy]

Oregon might have a lot of cloudy skies and rain, but at least it's not Cleveland, which at least is not Detroit.

As a native Oregonian, I'd like to take this opportunity to remind everyone that Oregon is a state not a city. There's more to the state than just Portland.

 

[sinombre]

As a native Oregonian, I'd like to take this opportunity to remind everyone that Oregon is a state not a city. There's more to the state than just Portland.

I actually love Oregon, especially the coast. I used to drive up the coast and go camping every year. It is a beautiful state.

The whole not being able to pump your own gas thing is kind of dumb though.

 

[masaraksh]

I actually love Oregon, especially the coast. I used to drive up the coast and go camping every year. It is a beautiful state.

The whole not being able to pump your own gas thing is kind of dumb though.

wat?

 

[RJGOP]

I actually love Oregon, especially the coast. I used to drive up the coast and go camping every year. It is a beautiful state.

The whole not being able to pump your own gas thing is kind of dumb though.

You can't pump you're own gas?

 

[RJGOP]

Oregon might have a lot of cloudy skies and rain, but at least it's not Cleveland, which at least is not Detroit.

I believe this video is at least partly responsible for Lebron's return to Cleveland.

 

[tdram]

You can't pump you're own gas?

You can't pump your own gas in Oregon or New Jersey because these states think gas pumping is too dangerous to be done by anyone other than a licensed and certified teenager.

 

[maxxor]

You can't pump your own gas in Oregon or New Jersey because these states think gas pumping is too dangerous to be done by anyone other than a licensed and certified teenager.

Supposedly the gas stations get cheaper insurance rates.

 

[lazers]

Maybe not today, but I wouldn't be surprised if in 10 years the NP is actually doing rad onc. Why not? I mean.. guys.. they have better patient satisfaction scores!!

This won't happen because the NRC (nuclear regulatory commission) will never let NPs become radiation providers. The only field where other physicians cannot legally practice once they have a medical license is radiation therapy. This is due to the regulations of handling radiation sources established by the federal government.

 

[tdram]

Supposedly the gas stations get cheaper insurance rates.

I wouldn't doubt that. I don't really understand what the logic is to continue a ban on self-pumping when 48 other states allow it. I mean, I get that it adds jobs, but creating a law that restricts what people can do in order to create jobs doesn't make a lot of sense. That's like banning cooking at home, so everyone will be forced to eat at a restaurant.. that'll create more jobs too.

 

[lazers]

That's bc it was a lie. They don't like primary care - it was a way to elbow their way into specialties like GI, Derm, etc.

NPs and PAs are getting the H&Ps and following up the patient once their done with treatment. I actually like that model for NPs and PAs, but no one would be ok (from patients to hospitals) with NPs actually directing the treatment plan.

 

[RJGOP]

I wouldn't doubt that. I don't really understand what the logic is to continue a ban on self-pumping when 48 other states allow it. I mean, I get that it adds jobs, but creating a law that restricts what people can do in order to create jobs doesn't make a lot of sense. That's like banning cooking at home, so everyone will be forced to eat at a restaurant.. that'll create more jobs too.

That's actually a really good point.

 

[lazers]

That's actually a really good point.

Lol, why are we talking about pumping gas?

 

[WhippleWhileWeWork]

I wouldn't doubt that. I don't really understand what the logic is to continue a ban on self-pumping when 48 other states allow it. I mean, I get that it adds jobs, but creating a law that restricts what people can do in order to create jobs doesn't make a lot of sense. That's like banning cooking at home, so everyone will be forced to eat at a restaurant.. that'll create more jobs too.

The "broken window fallacy". So many "job creation" strategies are just a rehashing of this.

 

[RJGOP]

Lol, why are we talking about pumping gas?

Because we were discussing the ridiculousness of not being able to pump your own gas in Oregon and New Jersey. I think Sinombre brought that point up.

 

[RJGOP]

The "broken window fallacy". So many "job creation" strategies are just a rehashing of this.

The problem is these strategies are stupid. However, Oregon and New Jersey are Liberal states, so they opposed great and useful job creators like the Keystone Pipeline. The pipeline also would have driven down oil prices, so gas would be cheaper.

 

[tdram]

This won't happen because the NRC (nuclear regulatory commission) will never let NPs become radiation providers. The only field where other physicians cannot legally practice once they have a medical license is radiation therapy. This is due to the regulations of handling radiation sources established by the federal government.

The NP lobby is pretty powerful. I wouldn't be surprised if they ended up getting themselves radiation therapy licenses too.

 

[lazers]

The NP lobby is pretty powerful. I wouldn't be surprised if they ended up getting themselves radiation therapy licenses too.

It's a pretty far stretch as radiation oncologists are on the committee deciding who gets licenses. In addition they heavily lobby through ASTRO preventing anyone getting into their turf.

 

[tdram]

It's a pretty far stretch as radiation oncologists are on the committee deciding who gets licenses. In addition they heavily lobby through ASTRO preventing anyone getting into their turf.

Well that's good to know. At least one part of medicine is somewhat safe.

 

[Winged Scapula]

It's a pretty far stretch as radiation oncologists are on the committee deciding who gets licenses. In addition they heavily lobby through ASTRO preventing anyone getting into their turf.

Agreed. Between ASTRO and the NRC, it's hard to imagine. I had to jump through a lot of hoops to handle radioisotopes and be put on the institutional license, it's hard to imagine what would be required for a non physician/physicist/NM tech to handle the isotopes for a therapeutic goal.

 

[tarheel1408]

Y'all are talking like it's a matter of safety that determines where and how nurses get to practice. Thus far (and to my understanding), scope of practice has increased in states because of battles won in the courtroom that are based on antitrust lawsuits. I could be wrong, but I think nurses are winning territory by arguing that physicians (Board of Medicine) shouldn't have a monopoly on the practice of medicine. If this logic can trump patient safety, then I would imagine no specialty is really immune.

 

[DermViser]

^ So, should I expect the majority of my med school class to be like the people in that video... or more like DermViser?

I realize that is your (failed) attempt to jab at me, but I'll answer you anyway. Your class will be filed with a variety of students. Some will be reality based in their thinking, some won't be. Some will have no idea what debt means, others will. See the 12 types of Medical Students cartoon.