Why you should become a nurse or physicians assistant instead of a doctor

[el_duderino]

I'll take someone with a PhD in physics who looks at the logistics of things. This isn't medical information we're talking about here.

Author doesn't have a PhD

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[PL198]

Wait so in all of those states, after the period with a physician ( assuming there even is one in all of the states, not sure about that), the NP has the exact same scope as a physician?

 

[Mad Jack]

I really want to see a good quality study on the overall efficiency and cost of NPs and PAs versus physicians in a primary care setting. If NPs are charging at base 85% of what physicians are charging but they make even 10% more specialist referrals, there'd be absolutely no cost benefit. If there's no cost benefit, why would the government even bother with them?

 

[Mad Jack]

Wait so in all of those states, after the period with a physician ( assuming there even is one in all of the states, not sure about that), the NP has the exact same scope as a physician?

Not the exact same. Usually it only applies only to certain practice settings like primary care clinics. Each practice act is pretty particular about what is allowed and what isn't, so it varies greatly by state.

 

[DermViser]

Holy f*ck I thought the ones they were just trying to pass said they were like the 2nd and 3rd or something? This is complete autonomy? With scripts?

Yes. Seeing patients and writing prescriptions.

Hence this:
http://nurse-practitioners-and-phys...r-Center/Should-Patients-Call-You-Doctor.aspx
If we are to be literal, the term "doctor" originates from the Latin word doctoris, which means "teacher." So "doctor" is Latin for "to teach." And isn't that what NPs do? If you have a DNP and can use the title "doctor" legally - and want to - use it proudly.

 

[Mad Jack]

If we are to be literal, the term "doctor" originates from the Latin word doctoris, which means "teacher." So "doctor" is Latin for "to teach." And isn't that what NPs do? If you have a DNP and can use the title "doctor" legally - and want to - use it proudly.

So should we just start calling our high school teachers "doctors" while we're at it?

 

[DermViser]

Wait so in all of those states, after the period with a physician ( assuming there even is one in all of the states, not sure about that), the NP has the exact same scope as a physician?

Well that was specific to Connecticut. The rest may have the same or allow autonomous practice from the beginning.

 

[yappy]

Money is worth way more when you're younger than when you're older. You have more expenses and more responsibilities. When you're old, you will own your house, no student loans, be winding down your career etc. You should enjoy yourself while your body is still strong and you are relatively attractive. You aren't going to be skydiving in Hawaii or backpacking in Europe when you're 60.

I agree that the poorer you are the marginal utility of money is greater; however, I don't agree with the second statement you've made. It's so overstated it's hardly worth addressing; assuming that the opportunity cost of medical school was a trip to Europe the flip side of that is that you got to experience medical school! moving to a new town, growing professionally in a way that you desired, meeting new interesting people, is grander than Europe. You also have the opportunity to travel after or during the summers of medical school. Most people don't do any of this stuff once they get a real job - 22 years old for most people.

 

[DermViser]

So should we just start calling our high school teachers "doctors" while we're at it?

My favorite:
All professionals, including NPs, should wear a name tag that is in full view of the patient at all times. All healthcare professionals should use the word "physician" when describing someone who has a medical degree. Too many healthcare professionals continue to substitute the word "doctor" when they mean physician, even though they realize that many healthcare professionals have clinical doctorates.

 

[PL198]

Ok so apples to apples, if a NP and an MD are in the same state, which allows the highest scope possibly for NPs, and both the NP and MD are PCP, the only difference is that the NP charges less? So effectively, medical school for new PCPs in those 18 states is pointless.

 

[PL198]

My favorite:
All professionals, including NPs, should wear a name tag that is in full view of the patient at all times. All healthcare professionals should use the word "physician" when describing someone who has a medical degree. Too many healthcare professionals continue to substitute the word "doctor" when they mean physician, even though they realize that many healthcare professionals have clinical doctorates.

Anyone with a doctoral degree is a doctor. Hence why our professors in undergrad we're all Dr. XYZ and etc. MDs and DOs are physicians. NPs and PAs are not.

 

[DermViser]

I really want to see a good quality study on the overall efficiency and cost of NPs and PAs versus physicians in a primary care setting. If NPs are charging at base 85% of what physicians are charging but they make even 10% more specialist referrals, there'd be absolutely no cost benefit. If there's no cost benefit, why would the government even bother with them?

Bc right now they're fighting to increased scope of practice, advertising themselves as a cheaper option. Once they get that, they've already tried to fight for equal reimbursement.
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.

 

[Mad Jack]

My favorite:
All professionals, including NPs, should wear a name tag that is in full view of the patient at all times. All healthcare professionals should use the word "physician" when describing someone who has a medical degree. Too many healthcare professionals continue to substitute the word "doctor" when they mean physician, even though they realize that many healthcare professionals have clinical doctorates.

I seriously wish I could meet this person in their office for a little chat about how effing wrong they are.

 

[maxxor]

Ok so apples to apples, if a NP and an MD are in the same state, which allows the highest scope possibly for NPs, and both the NP and MD are PCP, the only difference is that the NP charges less? So effectively, medical school for new PCPs in those 18 states is pointless.

...This has been @DermViser's shtick for a few months now.

 

[DermViser]

Anyone with a doctoral degree is a doctor. Hence why our professors in undergrad we're all Dr. XYZ and etc. MDs and DOs are physicians. NPs and PAs are not.

Except the degree for NPs is now the Doctor of Nursing Practice (DNP) degree.

 

[PL198]

...This has been @DermViser's shtick for a few months now.

Yes I just didn't know it was so widespread (18 states). I thought this was much more rare.

 

[Mad Jack]

Bc right now they're fighting to increased scope of practice, advertising themselves as a cheaper option. Once they get that, they've already tried to fight for equal reimbursement.
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.

I'm aware of both regulatory battles, which still leaves me stumped- why the hell would the government want to replace physicians with a more expensive, lesser qualified, and lesser quality group of providers?

 

[PL198]

Except the degree for NPs is now the Doctor of Nursing Practice (DNP) degree.

Still not a physician. If they're not under the medical board, how can they be a physician?

 

[DermViser]

Ok so apples to apples, if a NP and an MD are in the same state, which allows the highest scope possibly for NPs, and both the NP and MD are PCP, the only difference is that the NP charges less? So effectively, medical school for new PCPs in those 18 states is pointless.

Assuming, of course, they haven't also fought at the state level to have equal reimbursement to physicians (right now it is 85% of what a physician gets) like in Oregon, which in that case there would be no difference at all.

 

[DermViser]

I'm aware of both regulatory battles, which still leaves me stumped- why the hell would the government want to replace physicians with a more expensive, lesser qualified, and lesser quality group of providers?

They don't fight for equal reimbursement first. They fight for scope of practice first.

 

[DermViser]

Still not a physician. If they're not under the medical board, how can they be a physician?

Never said they were. They do however would want to be called "Doctor", since they have a doctorate.

 

[PL198]

So long primary care. Physicians are going to lose it nation-wide. Stuff like this really doesn't get undone. Once you give a group those capabilities, it's not going to be plausible to ever take them away, unless the outcomes are horrific. The stats will be skewed so they aren't horrific no matter how bad they actually are, unless we got the most neo-conservative administration as possible in.

 

[DermViser]

Yes I just didn't know it was so widespread (18 states). I thought this was much more rare.

Not esp. when you have millions of people added onto the rolls due to Obamacare. Grassroots lobbying is very effective.

 

[circulus vitios]

I really want to see a good quality study on the overall efficiency and cost of NPs and PAs versus physicians in a primary care setting. If NPs are charging at base 85% of what physicians are charging but they make even 10% more specialist referrals, there'd be absolutely no cost benefit. If there's no cost benefit, why would the government even bother with them?

Because their lobbyists pay more.

 

[DermViser]

So long primary care. Physicians are going to lose it nation-wide. Stuff like this really doesn't get undone. Once you give a group those capabilities, it's not going to be plausible to ever take them away, unless the outcomes are horrific. The stats will be skewed so they aren't horrific no matter how bad they actually are, unless we got the most neo-conservative administration as possible in.

Hence why I can't imagine why anyone who wishes to do primary care (Gen IM, Gen Peds, FM) would do med school? Financially it doesn't make sense, but more importantly, the govt. is more than happy to throw you under the bus. But I guess someone has to be the administrators of the PCMH even though NPs have said that they should be able to lead them too

http://www.medscape.com/viewarticle/772300_2
Kathleen Potempa, PhD, RN, Dean and Professor at the University of Michigan School of Nursing, points to "a strong body of evidence showing that nurse practitioners are sufficiently qualified, skilled, and otherwise capable of leading a primary care medical home. The concept is wonderfully matched to the skill set of the nurse practitioner. The role of the PCMH is to enable true care coordination in a healthcare landscape where care is episodic and patchworked. The NP can effectively treat, and if necessary, ably guide patients to a physician or specialist."

 

[fancymylotus]

Never said they were. They do however would want to be called "Doctor", since they have a doctorate.

oh you mean like the pharmacist who demanded i call her doctor? THAT was a fun interaction.

 

[DermViser]

Because their lobbyists pay more.

And nurses are a union constituency. Guess who that benefits?

 

[DermViser]

oh you mean like the pharmacist who demanded i call her doctor? THAT was a fun interaction.

Just like PTs, Audiologists, etc. as they all have doctorates too.

 

[fancymylotus]

Just like PTs, Audiologists, etc. as they all have doctorates too.

i cant rn.

just cant.

her exact question to me was as follows: "since when can dentists prescribe controlled substances like vicodin?!"

okay there DOCTOR PHARMACIST, do your goddamn job and fill my patients prescription and stop being obstructive.

><

 

[DermViser]

i cant rn.

just cant.

her exact question to me was as follows: "since when can dentists prescribe controlled substances like vicodin?!"

okay there DOCTOR PHARMACIST, do your goddamn job and fill my patients prescription and stop being obstructive.

><

Yeah, bc it's not like dentistry has patients who are in pain.
Pharmacists are also able to automatically replace your Rx with generic unless you sign the line otherwise for no substitutions.

 

[PL198]

Hence why I can't imagine why anyone who wishes to do primary care (Gen IM, Gen Peds, FM) would do med school? Financially it doesn't make sense, but more importantly, the govt. is more than happy to throw you under the bus. But I guess someone has to be the administrators of the PCMH even though NPs have said that they should be able to lead them too

http://www.medscape.com/viewarticle/772300_2
Kathleen Potempa, PhD, RN, Dean and Professor at the University of Michigan School of Nursing, points to "a strong body of evidence showing that nurse practitioners are sufficiently qualified, skilled, and otherwise capable of leading a primary care medical home. The concept is wonderfully matched to the skill set of the nurse practitioner. The role of the PCMH is to enable true care coordination in a healthcare landscape where care is episodic and patchworked. The NP can effectively treat, and if necessary, ably guide patients to a physician or specialist."

Even though so many schools preach primary care for their students which is so lolzy. I swear the goal of med school is to ruin student's lives. Literally everything in the modern world tells people that primary care isn't the way to go for MD students. So I have no idea why the schools seem to think it is and that people aren't going to see through it.

GO USA #IBelieveThatWeWillWin

 

[WhippleWhileWeWork]

This is why we don't help those who don't want it. Saves my sanity at least. Also probably why I am going into Radiology.
.

Why is that?

 

[DermViser]

Even though so many schools preach primary care for their students which is so lolzy. I swear the goal of med school is to ruin student's lives. Literally everything in the modern world tells people that primary care isn't the way to go for MD students. So I have no idea why the schools seem to think it is and that people aren't going to see through it.

GO USA #IBelieveThatWeWillWin

It's bc they can't afford to do that (esp. if they're taxpayer funded and thus accountable to the state) or their Family Medicine dept. will run out on them. Hence why in MS-4 you have to do PCP stuff like an ambulatory month or an IM-sub I, etc. Someone else was saying he wonders if med schools purposefully don't teach to Step 1 so that students don't do as well, and thus match into primary care.

 

[DermViser]

Why is that?

You really can't understand why he's pursuing Radiology?

 

[fancymylotus]

can this be our version of the thread that whomever that was, got closed?

coz i miss that thread

 

[circulus vitios]

Even though so many schools preach primary care for their students which is so lolzy. I swear the goal of med school is to ruin student's lives. Literally everything in the modern world tells people that primary care isn't the way to go for MD students. So I have no idea why the schools seem to think it is and that people aren't going to see through it.

GO USA #IBelieveThatWeWillWin

I think outpatient primary care is good if you you don't mind putting up with bull**** and just want a 9-5 job for $200k/yr.

 

[DermViser]

can this be our version of the thread that whomever that was, got closed?

coz i miss that thread

And I saw WS's Derm Emergency crack after that thread closed. lol.

 

[DermViser]

I think outpatient primary care is good if you you don't mind putting up with bull**** and just want a 9-5 job for $200k/yr.

Except your ROI is better for NP for that same job. If you want 200K for 9-5 outpt. you'll be cranking thru a lot of patients.

 

[WhippleWhileWeWork]

You really can't understand why he's pursuing Radiology?

You really want to do this?

 

[fancymylotus]

god my assistant is aggravating

 

[fancymylotus]

You really want to do this?

same reason he's doing derm.

 

[WhippleWhileWeWork]

god my assistant is aggravating

?

 

[fancymylotus]

me: take off the excess cement in three minutes

ten minutes later

assistant: uhhhh i uhhh tried and uhhh like theres some left on there i cant get off.

NO ****, THE SET TIME FOR THIS CEMENT IS THREE MINUTES

 

[maxxor]

Why is that?

Internal medicine / primary care clinic at my school fundamentally left me like "why am I helping these people who don't want to be helped?" I would leave clinic burnt to a crisp every single day wondering why I was even bothering with patients who don't want to hear what I have to say, only to be told to cave and fill out whatever disability form, refill their narcotic/benzo scripts, and refer for whatever imaging modality they thought they needed.

In the specialties, you can turf problems that aren't yours to deal with to primary care. "If it's not skin/eyes/penis, don't talk to me about it" says the Dermatologist/Ophthalmologist/Urologist.

In Radiology, my "clients" are referring physicians, not patients. They need my expertise in providing knowledge or reading a study they can't or don't want the liability of interpreting.

 

[WhippleWhileWeWork]

Internal medicine / primary care clinic at my school fundamentally left me like "why am I helping these people who don't want to be helped?" I would leave clinic burnt to a crisp every single day wondering why I was even bothering with patients who don't want to hear what I have to say, only to be told to cave and fill out whatever disability form, refill their narcotic/benzo scripts, and refer for whatever imaging modality they thought they needed.

In the specialties, you can turf problems that aren't yours to deal with to primary care. "If it's not skin/eyes/penis, don't talk to me about it" says the Dermatologist/Ophthalmologist/Urologist.

In Radiology, my "clients" are referring physicians, not patients. They need my expertise in providing knowledge or reading a study they can't or don't want the liability of interpreting.

Interesting, thank you for your perspective. Where would you say something like gen surg would fit on that continuum?

 

[DermViser]

Internal medicine / primary care clinic at my school fundamentally left me like "why am I helping these people who don't want to be helped?" I would leave clinic burnt to a crisp every single day wondering why I was even bothering with patients who don't want to hear what I have to say, only to be told to cave and fill out whatever disability form, refill their narcotic/benzo scripts, and refer for whatever imaging modality they thought they needed.

In the specialties, you can turf problems that aren't yours to deal with to primary care. "If it's not skin/eyes/penis, don't talk to me about it" says the Dermatologist/Ophthalmologist/Urologist.

In Radiology, my "clients" are referring physicians, not patients. They need my expertise in providing knowledge or reading a study they can't or don't want the liability of interpreting.

 

[Mad Jack]

i cant rn.

just cant.

her exact question to me was as follows: "since when can dentists prescribe controlled substances like vicodin?!"

okay there DOCTOR PHARMACIST, do your goddamn job and fill my patients prescription and stop being obstructive.

><

Wut. Where does she think people get their scripts from after extractions, root canals, and fillings? The effing tooth fairy?

 

[fancymylotus]

Wut. Where does she think people get their scripts from after extractions, root canals, and fillings? The effing tooth fairy?

I have so many obstructive pharmacist stories.

I wrote a prescription for a patient/family friend of mine who I had just seen. We were going somewhere afterwards so I went to the pharmacy w them to fill the rx. The pharmacist started to give my patient a hard time bc it was for T3 or something like that. So I told her I was the prescriber.....

She asked me for my drivers license AND NYS dental license. So when I told her my professional license was framed and hanging in my parents study or at work or somewhere, she was like "you mean you don't carry around a pocket sized version of you license like I do?!??"


:cue blank fancy stare:

 

[Arkangeloid]

Hence why I can't imagine why anyone who wishes to do primary care (Gen IM, Gen Peds, FM) would do med school? Financially it doesn't make sense, but more importantly, the govt. is more than happy to throw you under the bus. But I guess someone has to be the administrators of the PCMH even though NPs have said that they should be able to lead them too

http://www.medscape.com/viewarticle/772300_2
Kathleen Potempa, PhD, RN, Dean and Professor at the University of Michigan School of Nursing, points to "a strong body of evidence showing that nurse practitioners are sufficiently qualified, skilled, and otherwise capable of leading a primary care medical home. The concept is wonderfully matched to the skill set of the nurse practitioner. The role of the PCMH is to enable true care coordination in a healthcare landscape where care is episodic and patchworked. The NP can effectively treat, and if necessary, ably guide patients to a physician or specialist."

Primary Care won't be too bad as a concierge gig, but yeah, I feel worried about the future.

 

[DermViser]

Primary Care won't be too bad as a concierge gig, but yeah, I feel worried about the future.

Concierge only works in few circumstances and in few zip codes, and that's just so you don't feel like you're running thru patients a mile a minute.