When a nurse is your health-care provider, you’re at risk

[KnuxNole]

That's not right either. Why should nps get all the easy cases and leave physicians to deal with complex cases all the time? It's hard enough to be a doc seeing 40 patients a day without someone taking all the low lying fruit.

This is an issue at a hospital I was at where the midwives want to have all the easy patients and turf all the difficult ones to the obgyns. Also if they run into problems they wanted to send those cases to the doctors as well. So they absolve themselves of responsibility if something goes wrong. That ain't right

A lot of docs hate east cases, and they are glad to let the NP handle them while they take care of more complex issues, clinic flows faster, etc. NPs are useful for urgent care regards. Especially in busy clinics, and gets a higher $$.

I like easy cases, it helps to break the day up.

I don't see a problem with midwives handling uncomplicated pregnancies. There is always OB in house. Same with NPs in ED doing fast track, low acuity ED cases.yes, the ED MD can still see them, but while the MD is handling that one critical patient who needs a central line and intubated, the NP/PA can see 3-4 low acuity patients, making flow so much faster.

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[KnuxNole]

As soon as the novelty of being a doctor wears off (and/or once you're out practicing after residency and you still have hospital admins breathing down your neck with patient quotas to meet), you may begin to appreciate the occasional runny nose or viral gastroenteritis. There's a reason ED docs are always at the forefront of the "burnout" discussion.

No one is saying they prefer all easy/routine cases (well, no one who isnt that NP poster), but most people will need those softballs to catch up or to keep things otherwise sane.

I feel terrible for PCPs. They have so little time to deal with an insurmountable quantity of mostly bull****. And they're required to handle it all while the EMRs become more bloated and slowed down by extra clicks, extra forms, and extra headaches in addition to all the other mindnumbing "meaningful use" criteria.

Don't get me started on meaningless use.....

 

[KnuxNole]

The trainwrecks at least are sick and need interventions. I'd rather spend 20 minutes putting a line in a septic shock pt than trying to explain to some uri pt why they don't need antibiotics.

You can generate more RVUs from seeing a handful of level 5s than a ton of URI patients.

I think he meant easy inpatients, mixed with harder cases. I know currently, I love the simple COPD exac, leg cellulitis patient mixed with more complex peeps.

 

[studentp0x]

Way back when I was in Paramedic School, I had to do 40 hours in the OR to practice Intubations. I never once saw the anesthesiologist. The entirety of the anesthesia were done by CRNA's. If they didn't have confidence in their colleagues to perform on them if they needed it, it didn't show. It may be the same situation as a commenter mentioned above concerning NP's -great for the routine (if there is such a thing), non-complicated procedures. Let the residency trained docs handle the rest


Wow, just wow. I think I lost a couple of IQ points...

Crooked Line hit the nail on the head. Let the NP/PA's handle the low acuity, relatively routine patients: The URI's, med refills, strains/sprains, etc.

The biggest issue for me is competency. Don't take a freshly minted RN with little to no experience into an NP program, graduate them and boot them out to practice independently. They may have the book smarts, but not the street smarts. (Similar problem in EMS with "zero to hero" Paramedic programs). And for the love of all that is holy don't stick them in an isolated, rural ED with no support. Only 1 night out of 3 has an MD, the other 2 have NP's. I'd spend the majority of a 24 hour shift running up and down the road with every lump, bump, laceration and headache 75 miles to the major academic medical center.

Having said that, a good, competent, experienced nurse that becomes an NP- worth their weight in gold. I've worked with a couple that I'd put up against a doc any day.

I think anyone who argues that NPs can be equal should also be arguing that medical education is largely a waste of time. Clearly some fluff studies can make you competent to practice medicine (notsrs).

 

[FIREitUP]

Way back when I was in Paramedic School, I had to do 40 hours in the OR to practice Intubations. I never once saw the anesthesiologist. The entirety of the anesthesia were done by CRNA's. If they didn't have confidence in their colleagues to perform on them if they needed it, it didn't show. It may be the same situation as a commenter mentioned above concerning NP's -great for the routine (if there is such a thing), non-complicated procedures. Let the residency trained docs handle the rest


Wow, just wow. I think I lost a couple of IQ points...

Crooked Line hit the nail on the head. Let the NP/PA's handle the low acuity, relatively routine patients: The URI's, med refills, strains/sprains, etc.

The biggest issue for me is competency. Don't take a freshly minted RN with little to no experience into an NP program, graduate them and boot them out to practice independently. They may have the book smarts, but not the street smarts. (Similar problem in EMS with "zero to hero" Paramedic programs). And for the love of all that is holy don't stick them in an isolated, rural ED with no support. Only 1 night out of 3 has an MD, the other 2 have NP's. I'd spend the majority of a 24 hour shift running up and down the road with every lump, bump, laceration and headache 75 miles to the major academic medical center.

Having said that, a good, competent, experienced nurse that becomes an NP- worth their weight in gold. I've worked with a couple that I'd put up against a doc any day.

Of course this is anecdotal (as your experience has been), but I've seen CRNA's that have absolutely no clue and put a whole 10CC syringe of propofol in for a 10 minute procedure. I am okay with CRNA's in very limited scenarios and if there is a physician anesthesiologist seconds away. Otherwise, I personally don't think it's worth the risk, especially since there are better ways this country can save money on health care.

 

[Psai]

Of course this is anecdotal (as your experience has been), but I've seen CRNA's that have absolutely no clue and put a whole 10CC syringe of propofol in for a 10 minute procedure. I am okay with CRNA's in very limited scenarios and if there is a physician anesthesiologist seconds away. Otherwise, I personally don't think it's worth the risk, especially since there are better ways this country can save money on health care.

Oh that's just anecdote. All of the high quality studies with rock solid methodologies for sufficient time frames with appropriate end points by experienced, well respected researchers published in rigorously peer reviewed, unbiased journals financed by independent third parties say that nps have equivalent outcomes to doctors

 

[Sirach38]

Oh that's just anecdote. All of the high quality studies with rock solid methodologies for sufficient time frames with appropriate end points by experienced, well respected researchers published in rigorously peer reviewed, unbiased journals financed by independent third parties say that nps have equivalent outcomes to doctors

Yeah, you know what, I say we just stop all this bs and give NPs MD degrees. After all, they are just the same as us. Let's just require a weekend course on what it takes to be a doctor, a background check, a small fee, and bam! Every NP is now an MD. This should solve everything.

 

[slopes23]

Soo.... There appears to be some funny or clever sarcasm in this thread and then there is the super lame sarcasm (technical term). Can we try and avoid the latter?

 

[Sirach38]

Soo.... There appears to be some funny or clever sarcasm in this thread and then there is the super lame sarcasm (technical term). Can we try and avoid the latter?

I have a hard time differentiating between the latter and the former...so to answer your question, probably not

 

[link2swim06]

You also deal with a lot more risk and probability of litigation. What about cases like the johns hopkins 55 million dollar verdict where the hospital was held liable for a bad outcome to a newborn? It was the parents decision to have a nurse midwife assist the delivery but they decided to just show up at the hospital when it was too late and blamed the doctors there. The role of the midwife was barely even brought up

I don't really think medical mal is a good enough reason avoid a field. Additionally, that 55 million will probably be settled for much less on appeal.

A lot of med mal in EM can be from failure to diagnose which could just as easily occur in a low acuity patient.

 

[jl lin]

Wait, how in the world can a nurse practitioner refer to herself as a nurse-physician? If for example, a nurse wanted to be thought of as nurse-physicist, he or she would still have to go through the required educational processes and laboratory practice to be a physicist.


Nurse practitioners may obtain some kind of doctorate, but it does NOT make them physicians, in that physicians, at least here in the US pretty much, are MDs or DOs.

Insanity!

 

[jl lin]

I think anyone who argues that NPs can be equal should also be arguing that medical education is largely a waste of time. Clearly some fluff studies can make you competent to practice medicine (notsrs).

"Dr." Gregory House: "Why bother with medical school when you have Wifi?"

 

[Psai]

Soo.... There appears to be some funny or clever sarcasm in this thread and then there is the super lame sarcasm (technical term). Can we try and avoid the latter?

ok mr (accepted) medical student

 

[slopes23]

ok mr (accepted) medical student

Lol. Cool story bro.

 

[FIREitUP]

Lol. Cool story bro.

dude, at least use that phrase correctly. he didn't even tell a story, ffs.

 

[slopes23]

dude, at least use that phrase correctly. he didn't even tell a story, ffs.

I think we'll be alright.

 

[PhysMatMan]

I love how in the comments the one nurse keeps complaining that residencies are only open to medical students. The corrupt establishment pays physicians to undergo training while shutting out accomplished NP's.

 

[W19]

I love how in the comments the one nurse keeps complaining that residencies are only open to medical students. The corrupt establishment pays physicians to undergo training while shutting out accomplished NP's.

I could not see a comment section...

 

[PhysMatMan]

http://humanevents.com/2015/01/07/the-nurse-will-see-you-now/

enjoy!

This link has the comments

 

[KnuxNole]

A lot of the comments seems to be defending the nurses, which is expected. I wonder if a physician can make counter-arguments to all those people.

 

[Paul Delle]

Where's the evidence? .. Right,..because there is none, this is basically an editorial with a very misleading title. No mention of the current and growing Doctor shortage.

 

[KnuxNole]

Where's the evidence? .. Right,..because there is none, this is basically an editorial with a very misleading title. No mention of the current and growing Doctor shortage.

So you made an account to support NPs? Why waste precious time.

 

[fancymylotus]

Where's the evidence? .. Right,..because there is none, this is basically an editorial with a very misleading title. No mention of the current and growing Doctor shortage.

You do realize that making troll accounts is against TOS right

 

[Baller MD]

New http://www.opb.org/radio/programs/thinkoutloud/segment/naturopaths-fight-for-equal-status-in-oregon/
Naturopaths Fight For Equal Status In Oregon
OPB | Jan. 15, 2015 12:20 p.m.


.

Naturopathic doctors are fighting to be considered primary care physicians in Oregon. One of the provisions of the Affordable Care Act says health insurance consumers will have access to providers of their choosing and that insurers will not discriminate against a particular provider. Now, naturopaths in Oregon want that non-discrimination language added to state legislation, arguing they are still being shut out of some insurance plans despite their patients’ wishes.

GUESTS:

• Jeff Clark: Naturopathic physician at True Health Medicine
• Ralph Prows: President and CEO of Oregon’s Health Co-Op

shoutout to 101N for the source

 

[fancymylotus]

New http://www.opb.org/radio/programs/thinkoutloud/segment/naturopaths-fight-for-equal-status-in-oregon/
Naturopaths Fight For Equal Status In Oregon
OPB | Jan. 15, 2015 12:20 p.m.


.

Naturopathic doctors are fighting to be considered primary care physicians in Oregon. One of the provisions of the Affordable Care Act says health insurance consumers will have access to providers of their choosing and that insurers will not discriminate against a particular provider. Now, naturopaths in Oregon want that non-discrimination language added to state legislation, arguing they are still being shut out of some insurance plans despite their patients’ wishes.

GUESTS:

• Jeff Clark: Naturopathic physician at True Health Medicine
• Ralph Prows: President and CEO of Oregon’s Health Co-Op

shoutout to 101N for the source

What?!

 

[Baller MD]

http://www.oregonrn.org/?670

With the passage of HB 2902, Oregon becomes the first state in the nation to require insurance companies to follow ‘equal pay for equal work’ rules on insurance reimbursements for Nurse Practitioners, Physician Assistants and Physicians in primary care and mental health.

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Oregon is a ****hole to practice real medicine.

 

[fancymylotus]

http://www.oregonrn.org/?670

With the passage of HB 2902, Oregon becomes the first state in the nation to require insurance companies to follow ‘equal pay for equal work’ rules on insurance reimbursements for Nurse Practitioners, Physician Assistants and Physicians in primary care and mental health.

---

Oregon is a ****hole to practice real medicine.

No one move to Oregon, I guess.

 

[PhysMatMan]

Dream of the 90's is alive in Portland, Portland, Portland.....

 

[fancymylotus]

Dream of the 90's is alive in Portland, Portland, Portland.....

What's the allure of Oregon, seriously? What comes from there? Apples? Rainy weather? The Twilight series?

 

[Krahis]

Sigh. Sad state of affairs.

 

[KnuxNole]

Boo....and I was considering Portland in one of the places to live after residency.

I is disappoint.

 

[fancymylotus]

Boo....and I was considering Portland in one of the places to live after residency.

I is disappoint.

Nooooo come to NY

 

[PhysMatMan]

Portlandia is filmed there. That's about it.

 

[Kahreek]

I wont have any problem with a nurse being my sole care provider, because at least there will be a doc in the room.

 

[67552931811]

http://www.oregonrn.org/?670

With the passage of HB 2902, Oregon becomes the first state in the nation to require insurance companies to follow ‘equal pay for equal work’ rules on insurance reimbursements for Nurse Practitioners, Physician Assistants and Physicians in primary care and mental health.

---

Oregon is a ****hole to practice real medicine.

What a joke.

 

[oldanddone]

http://www.oregonrn.org/?670

With the passage of HB 2902, Oregon becomes the first state in the nation to require insurance companies to follow ‘equal pay for equal work’ rules on insurance reimbursements for Nurse Practitioners, Physician Assistants and Physicians in primary care and mental health.

---

Oregon is a ****hole to practice real medicine.

This actually could reverse the trend, insurance companies/etc will be less likely to hire NP/PA over MD, because there won't be a dollar savings. However, they are more likely to fight for an erosion of MD remuneration to match the NP/PA remuneration...that is the next logical step to opening up the door to different remuneration for the same activity, if the idea is a third party trying to maximize profit by dividing and conquering the labour force. So....what will be the MD/NP/PA move in all of this? defend the higher wage? as a group? or some be a pawn to the third party folks wanting to erode fees/wages/whatever and undermine the higher wage and also the autonomy of a profession? this legislation could be a good thing - it rips out the cheap factor for a third-party profit-maker, which was what props up the power to blur scopes of practice between MD/NP/PA.

 

[Pacna]

ok mr (accepted) medical student

This is a great example of what people mean when they say physicians treat those under them poorly, and that is a huge part of the reason M3-4 + residency is so filled with negativity.

Yes, we're all very impressed with you being farther along in your training than the other person. You don't need to put them in their place (PIMP). In fact, it's rude.

We can make medical education better. It starts with treating each other with respect, especially when you don't have to. Flex that empathy.

 

[Psai]

It's rude for some random preclinical student to try to call me out with an opinion that I don't care about. You don't know the first thing about m3-4 + residency. By the way, put them in their place would actually be PTITP

 

[giantswing]

This is a great example of what people mean when they say physicians treat those under them poorly, and that is a huge part of the reason M3-4 + residency is so filled with negativity.

Yes, we're all very impressed with you being farther along in your training than the other person. You don't need to put them in their place (PIMP). In fact, it's rude.

We can make medical education better. It starts with treating each other with respect, especially when you don't have to. Flex that empathy.

Medicine is a heirarchy. Deal with it.

 

[Baller MD]

I wont have any problem with a nurse being my sole care provider, because at least there will be a doc in the room.

Ever heard of states that allow independent NPs?

 

[DocVapor]

Ever heard of states that allow independent NPs?

I think you missed his point.

HE would be the MD.

 

[W19]

Both the West Coast and the Northeast of the US are liberal bastions; therefore, it does not shock me that NPs are gaining some ground in these regions...

 

[Pacna]

Medicine is a heirarchy. Deal with it.

Hierarchies are fine. Being a dick to people under you is not fine.

 

[Psai]

Time to put on your big boy pants kid

 

[giantswing]

Hierarchies are fine. Being a dick to people under you is not fine.

The two, while different, are not inseparable.

There will be so many times when someone will be a dick and the best thing you can do is shut your trap and take it. The earlier you learn this, the better off you'll be.

 

[Sirach38]

Hierarchies are fine. Being a dick to people under you is not fine.

Tell this to cardiac surgeons on your 3rd year surgery clerkship and see where it gets you rofl

 

[fancymylotus]

Tell this to cardiac surgeons on your 3rd year surgery clerkship and see where it gets you rofl

They are meaniepants, there is one in particular who likes to ask me if I missed the exit to Bloomingdales and ended up in the wrong place(not joking and it's super annoying)

 

[giantswing]

They are meaniepants, there is one in particular who likes to ask me if I missed the exit to Bloomingdales and ended up in the wrong place(not joking and it's super annoying)

Lol. Showed in an ortho or and was asked very bluntly what i thought i was doing there. Turned out ok, guy was super chill and a great teacher.

 

[fancymylotus]

Lol. Showed in an ortho or and was asked very bluntly what i thought i was doing there. Turned out ok, guy was super chill and a great teacher.

Weeeelllll I may or may not wear incredibly obnoxious outfits on purpose.

Mostly on the "may" side but hospital fashion is lacking(for obvious practical reasons) so why not?

 

[Pacna]

The two, while different, are not inseparable.

There will be so many times when someone will be a dick and the best thing you can do is shut your trap and take it. The earlier you learn this, the better off you'll be.

I don't disagree with anything you said there. That's why it falls on the person in the position of power to be kind.

Tell this to cardiac surgeons on your 3rd year surgery clerkship and see where it gets you rofl

If the mob "asks" you for "protection money," the smart thing to do is to give them the money. If you told me that what they were doing was wrong, how would you react if someone told you "LOL just try to give them the finger and keep your moneyrofl"?

I did tell an interviewer she was being rude, because she was. Like you'd expect, the outcome wasn't in my favor; I didn't get into that school. I wouldn't change a thing. Of course, I'd be singing a different tune if I didn't get in anywhere.