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(The New York Times)   They make diagnoses, prescribe medications and order and perform diagnostic tests. And since they are reimbursed less than physicians, increasing the number of nurse practitioners could lower health care costs. Who could have a problem with that?   (well.blogs.nytimes.com) divider line 130
    More: Obvious, health care costs, primary care physicians, American Academy of Family Physicians, Robert Wood Johnson Foundation, study design, medications, medical practices, health cares  
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4641 clicks; posted to Main » on 28 Jun 2013 at 11:01 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-06-28 09:55:38 AM
Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.
 
2013-06-28 10:25:49 AM

The Stealth Hippopotamus: Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.


NP and PAs can be a great addition to care in underserved areas if (and this is the part that idiot politicians miss) they work closely with a supervising physician to help them deal with areas outside their expertise. I work closely with many NP and PAs and they themselves admit that they are most comfortable dealing with relatively healthy folks with only one or two chronic illnesses and with regular preventative visits.
 For the older population who have 3-4 problems (like diabetes, hypertension, COPD) and multiple meds they admit these folks are out of their areas of expertise. If they are practicing independently without a Internist or Family Practice doctor to ask for advice they will be referring more folks to specialists and then you will see costs of care for a pt managed by an NP or PA zooming back up to where they are with an MD.
 
2013-06-28 10:31:39 AM
So in other words, this is madness?


/great now I can't get 300 out of my head
 
2013-06-28 10:53:28 AM
I'm a doctor.  I employ NPs and PAs.  They're good, but not anywhere near MD level.  They simply lack the fund of knowledge that MDs have.  They are very good at protocolized specific tasks.
 
2013-06-28 10:54:49 AM
Based on recent experience, hell no. My wife was on medical leave for 2 months, seeing an "in-network recommended" NP and getting no progress. This "close supervision" sounded like BS to me, she never got to see the MD. Finally I emphatically pleaded with her to dump this group and go see a doctor recommended by my own doctor. He was out of network and hellaexpensive, but I didn't care about cost at that point. She went to see him for 1 visit and was back to work the next day and doing fine.

Now that's just one personal anecdote, and I realize it probably doesn't work out that way for everyone. But personal experiences like this are a pretty big influence no matter how objective you try to be.
 
2013-06-28 10:57:16 AM

The Stealth Hippopotamus: Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.


I'm with you, I agree to see the Nurse Practitioner at my doctor's office once.  she was of no use, couldn't give me a useful diagnosis and put me on an anti-biotic I didn't need to be on.  she kept asking my opinion.  "You're the medical professional, you tell me!"
 
2013-06-28 11:00:22 AM
Doctors.

(off to RTFA)
 
2013-06-28 11:04:34 AM
I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.
 
2013-06-28 11:05:35 AM

mysticcat: I'm a doctor.  I employ NPs and PAs.  They're good, but not anywhere near MD level.  They simply lack the fund of knowledge that MDs have.  They are very good at protocolized specific tasks.


But do they offload some of your work?  To put it in tech support terms, they're tier 1 or 2 (maybe tier 1 is the internet/your mom/that person at work that looked at the thing on your arm) which takes care of the really common stuff, leaving you with the things they can't solve at tier 3.
 
2013-06-28 11:05:36 AM
Here in lovely South Dakota, I have to drive 3 hours for the rheumatologist. In a state that has a problem with having an MD in many areas, it blows my mind that I have my pain management doctor at a 5-minute walk from my house.

In re: NPs; they are common out here, as I have learned. For a cold or my annual, I have no issue with seeing her. If there is something more urgent, I prefer the MD/DO/whateverthelettersare. Oh, and for vaccinations. Which reminds me, I have to check in on the flu vaccine soon... wonder if the new one is out yet?
 
2013-06-28 11:05:37 AM
My experience with NPs has been nothing short of fantastic.
 
2013-06-28 11:06:49 AM
It probably depends on the issue, I have a relative who has a chronic autoimmune thing that needs to be monitored and he is a big fan of his NP this person listens to him more than the doctors he has seen. The monitoring consists of bloodwork so there's nothing to interpret. I could see wanting to see a real deal doctor if you have some undiagnosed illness that you are trying to figure out.
 
2013-06-28 11:06:53 AM

mysticcat: I'm a doctor.  I employ NPs and PAs.  They're good, but not anywhere near MD level.  They simply lack the fund of knowledge that MDs have.  They are very good at protocolized specific tasks.


Which brings up the question that is on everyone's mind: Does PA = NP?

Don't look at me that way.
 
2013-06-28 11:07:33 AM

sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.


Same here.  Are pediatrician said to our son, "how's the little girl?"  That was the last straw, now we see a nurse practitioner that actually checks the notes from the previous visit.
 
2013-06-28 11:08:28 AM
The problem we had with the NPs at the urgent care clinic associated with our regular doctor's office is that were getting too creative with their prescriptions and choosing meds that weren't in our formulary. Lots of fun to have to call the doctor's office back when you're standing in the pharmacy to get a script changed so that we could get a drug with an affordable co-pay......

Otherwise, as long as they have a protocol to follow, they work out okay.
 
2013-06-28 11:08:40 AM
As someone who's eventual career goal is CRNA, I fult support my advanced practice nursing brothers and sisters.
 
2013-06-28 11:08:52 AM
same thing at the dentist.  After 20 minutes minutes of cleaning, the tech has seen more of my tooth surfaces than the 15 seconds the dentist took looking.  Sure, he can look at the xrays if he wants.
 
2013-06-28 11:09:00 AM
I'm gonna guess doctors, hospitals, medical schools, and patients.
I currently see a NP to monitor my hypertension, and for regular checkups, but if anything changes dramatically or I get hurt, then I want to see an MD.
 
2013-06-28 11:09:05 AM
Soviet Canuckistan uses nurse practitioners (& triage nurses) in our emergencies wards.
It's great for obvious wounds/ailments (skate-blade slash to the face, 2-4 consumed too quickly, etc.).
 
2013-06-28 11:09:17 AM

The Stealth Hippopotamus: Which I think is madness, but hey I'm in the minority.


I had a MRSA infection once that was treated solely by a NP. I never even saw a doctor. She treated it, prescribed the antibiotics, sent a sample to a lab for culture, and did follow-up visits to make sure it wasn't going to infect my bloodstream and kill me. She was professional, nice, and did an outstanding job.
 
2013-06-28 11:10:35 AM

sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.


I agree. Nurses are generally far better than doctors at communicating with patients and giving care. Plus nurses will admit when they or the system doesn't know something: doctors are trained never, ever to admit that might ever be fallible.

Doctors are basically highly trained technicians with terrible people skills.
 
2013-06-28 11:11:03 AM
I mean, why would you even want to see someone who's had those extra years of training?
 
2013-06-28 11:11:51 AM
According to the article, NPs want to be paid the same, so where would the cost savings come from?
 
2013-06-28 11:12:50 AM

jjorsett: According to the article, NPs want to be paid the same, so where would the cost savings come from?


Volume.
 
2013-06-28 11:13:49 AM

The Stealth Hippopotamus: True they have less training but people are proving again and again that price is more important than quality.


They don't have LESS training, they have DIFFERENT training.  A NP cannot replace a doctor for about 99% of the activities you really need a doctor for.  Surgery, specialist medical consultation, and referrals are largely things that an NP won't or can't touch with a 50-foot pole, and shouldn't.

What they _can_ replace a doctor for is routine medical upkeep stuff.  They can do periodic exams for most things without supervision, can administer low-difficulty medications like the flu vaccine, and can put you through the preliminary stuff that a doctor would otherwise have to do anyhow to get a basic feel for whether you're sick and how, which is checklist stuff that takes whoever's doing it an hour, but only takes five minutes to read off to the doctor.

NPs are very valuable to doctors, they reduce the workload of routine stuff that doesn't need academic or specialist knowledge, just working knowledge, and they're assistance that doesn't need to be supervised or have their hands held once asked to do something.  My family members in medicine absolutely love their NPs, and most of the ones affiliated with the hospital instead of their office as well. Then, most of the doctors in my extended family got into it to do surgery or diagnose interesting cases, not to grind at repetitive tasks 50 hours for every one that really needs them.

So... I'm not sure where they found the dudes described in TFA.  Honestly, I'm betting the author just made up that reaction whole cloth.

//Though it does sound like the NPs on the network/institution in TFA are being asked to do things beyond their job training/description.  Advanced consultation is a no-no.
 
2013-06-28 11:15:06 AM
They're fine for basic things.  If you have something more complex or need surgery or anything like that, you need an actual doctor.  But NPs and PAs are only supposed to work under the direct supervision of a physician, so there's definitely a limit to how much you can farm out to midlevel providers.  You can try to turn medicine into an industry like fast food as much as you want, as long as you're willing to accept the results.
 
2013-06-28 11:15:10 AM
Hah, now my post looks funny below orbister's. Not that I necessarily disagree with him/her btw.
 
2013-06-28 11:16:12 AM
If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.
 
2013-06-28 11:17:44 AM

sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.


Again, this is why most doctors love NPs.  All the things patients do in lieu of just taking your advice and fixing their problem, like demanding you act like you're genuinely pleased to see them and wasting hours of your time in search of empty reassurance... that's stuff that Nurses essentially specialize in, in the same way a thoracic surgeon specializes in heart-related problems.
 
2013-06-28 11:17:53 AM

jjorsett: According to the article, NPs want to be paid the same, so where would the cost savings come from?


Because we don't always get what we want?
 
2013-06-28 11:18:55 AM

Jim_Callahan: The Stealth Hippopotamus: True they have less training but people are proving again and again that price is more important than quality.

They don't have LESS training, they have DIFFERENT training.  A NP cannot replace a doctor for about 99% of the activities you really need a doctor for.  Surgery, specialist medical consultation, and referrals are largely things that an NP won't or can't touch with a 50-foot pole, and shouldn't.

What they _can_ replace a doctor for is routine medical upkeep stuff.  They can do periodic exams for most things without supervision, can administer low-difficulty medications like the flu vaccine, and can put you through the preliminary stuff that a doctor would otherwise have to do anyhow to get a basic feel for whether you're sick and how, which is checklist stuff that takes whoever's doing it an hour, but only takes five minutes to read off to the doctor.

NPs are very valuable to doctors, they reduce the workload of routine stuff that doesn't need academic or specialist knowledge, just working knowledge, and they're assistance that doesn't need to be supervised or have their hands held once asked to do something.  My family members in medicine absolutely love their NPs, and most of the ones affiliated with the hospital instead of their office as well. Then, most of the doctors in my extended family got into it to do surgery or diagnose interesting cases, not to grind at repetitive tasks 50 hours for every one that really needs them.

So... I'm not sure where they found the dudes described in TFA.  Honestly, I'm betting the author just made up that reaction whole cloth.

//Though it does sound like the NPs on the network/institution in TFA are being asked to do things beyond their job training/description.  Advanced consultation is a no-no.



Feel I must object to this. Most MDs have had 4 years college (equivalent to RN degree) then Med school (4 years vs 2 years of NP school) then must do at least 3 years of residency in order to be able to practice with certification.
By my math that is 5 years more training.
 
2013-06-28 11:20:22 AM
Why stop there? Why not let the receptionist make the diagnosis and prescribe the medication? Or the guy who cleans up all the medical waste?
 
2013-06-28 11:21:03 AM
I am currently an LPN working on being an RN-BSN(4 yr degree vs 2 yr) my father was a Family Practice doc. I would love to be an NP but starting in 2015 NPs will have to have their PHD instead of just a Master's Degree. I think this is a great idea...more education is key. Puts me out of the running but no biggie.
I work with PAs at "the home" and they do a good job with the docs coming in once a week.
On the lower nursing end the medical assistants are all that you see in doctors offices anymore. They are pushing out Lpns like me from those jobs. Why pay over 15 bucks an hour when you can pay someone less than 10 for the same type of job.
It's all about cost effectiveness.
 
2013-06-28 11:22:15 AM

herdgirl72: I am currently an LPN working on being an RN-BSN(4 yr degree vs 2 yr) my father was a Family Practice doc. I would love to be an NP but starting in 2015 NPs will have to have their PHD instead of just a Master's Degree. I think this is a great idea...more education is key. Puts me out of the running but no biggie.
I work with PAs at "the home" and they do a good job with the docs coming in once a week.
On the lower nursing end the medical assistants are all that you see in doctors offices anymore. They are pushing out Lpns like me from those jobs. Why pay over 15 bucks an hour when you can pay someone less than 10 for the same type of job.
It's all about cost effectiveness.


Jesus Christ, how does any medical professional make less than 20 bucks an hour?  That's 40k/yr!  farking receptionists make 35k+.
 
2013-06-28 11:22:25 AM

mysticcat: I'm a doctor. I employ NPs and PAs. They're good, but not anywhere near MD level. They simply lack the fund of knowledge that MDs have. They are very good at protocolized specific tasks.


No offense, but in this day and age, all of the medical field is getting out of whack. My grandmother's husband was just admit to rehab but then put in the hospital and then BACK in rehab... all because doctors were just writing out Rxs left and right and it took the nurses to figure out that half of them shouldn't have ever been written because of the interactions with the stuff he was already on. Truly fsked the man up ... I'm talking some serious dementia here.
Then again, any nit can go to community college to become an NP or PA. They push them out like a Chinese assembly line. Same kind of quality too. A clinic I go to, you can tell the majority of them went for the money. I don't know how they passed any kind of exam. Most can't even administer a vaccine properly. (Look, use the alcohol wipe, use gloves, administer the needle WHERE YOU SWABBED.)
/nothing personal
 
2013-06-28 11:23:30 AM

enry: mysticcat: I'm a doctor.  I employ NPs and PAs.  They're good, but not anywhere near MD level.  They simply lack the fund of knowledge that MDs have.  They are very good at protocolized specific tasks.

But do they offload some of your work?  To put it in tech support terms, they're tier 1 or 2 (maybe tier 1 is the internet/your mom/that person at work that looked at the thing on your arm) which takes care of the really common stuff, leaving you with the things they can't solve at tier 3.


This is my opinion as well.  For certain things - like a minor burn injury - I don't see why an actual MD needs to get involved (with all the expense).  If it goes beyond their expertise then they can defer to an actual doctor.
 
2013-06-28 11:24:01 AM

Lexx: If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.


THIS.
Everything in healthcare is this. Doctors run everything, and they are very good at taking care of themselves and each other.
 
2013-06-28 11:24:10 AM

Lexx: The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.


Right, just like how Michelin artificially limits its star ratings instead of just assigning them to every fry cook who wants one.

Jim_Callahan: They don't have LESS training, they have DIFFERENT SIGNIFICANTLY LESS training.

 
2013-06-28 11:26:08 AM
Doctors?

*reads article*

Yep, doctors.
 
2013-06-28 11:27:19 AM

Yes please: Lexx: The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

Right, just like how Michelin artificially limits its star ratings instead of just assigning them to every fry cook who wants one.

Jim_Callahan: They don't have LESS training, they have DIFFERENT SIGNIFICANTLY LESS training.


No...it really does happen.  If the medical colleges REALLY cared about patient outcomes and not just limiting the # of doctors entering the workforce, they'd restrict the # of hours/week each doctor in residency works, and lessen the workload for each resident by increasing the number of residents used.  Overworked residents are a huge cause of farkups and bad patient outcomes.
 
2013-06-28 11:28:26 AM
Doctors rage at the idea of someone with less training will take ther jerbs.

I find it amusing that the underlying cause of this rage are their threatened paychecks.
 
2013-06-28 11:29:05 AM

sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.


Becauase they are employees of the doctors or hospitals, don't have to pay overhead, and have no responsibility to the bottom line.
 
2013-06-28 11:29:23 AM
Why isn't she in the kitchen?
 
2013-06-28 11:29:39 AM
Kirzania:Then again, any nit can go to community college to become an NP or PA. They push them out like a Chinese assembly line. Same kind of quality too. A clinic I go to, you can tell the majority of them went for the money. I don't know how they passed any kind of exam. Most can't even administer a vaccine properly. (Look, use the alcohol wipe, use gloves, administer the needle WHERE YOU SWABBED.)
/nothing personal


Uh, what? I wasn't aware that community colleges gave out master's degrees.
 
2013-06-28 11:29:54 AM

Lexx: If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.


Bullshiat conspiracy theory is bullshiat.

Really if you think Doctors control medical school admissions you must be smoking something. They are one of the most valuable resources to a University (ie the tuition is sky high, you get the prestige of med school etc). There is no way Universities would allow a secret cabal of the AMA to tell them they cannot open a med school. If they could there is no way in hell one would have been built in the shiathole that is Mt Pleasant Michigan at CMU
 
2013-06-28 11:30:03 AM

bopis: Everything in healthcare is this. Doctors run everything, and they are very good at taking care of themselves and each other.


It's a shame we don't do this for teachers. :( To me, they should be on a similar kind of education:pay ratio.
 
2013-06-28 11:30:33 AM
Well is the business costs go down, by moving to less expensive employes, will my costs go down?

If the NP costs less than an MD, will the paying healthcare customer be getting the same quality of care as with the MD?
If so could we not instead lower MD compensation to achieve the same effect?

OR if the quality of care from an MD is quantifiable better than that of an NP could that become like the $1 menu option for customers?
In the end if NP and MD are = then MD should get less or NP should get more.
If not the same then customers should not be expected to pay the same for NP as they would for MD.

Oh wait i forgot I'm just a pleb in these matters, please let me get back in my proper position here over the barrel.
Forgive my impertinence and continue to enjoy your time at my backside please.
 
2013-06-28 11:30:36 AM
Whether they have an MD, PA or NP following their name, my experience is that they are all incompetent.
 
2013-06-28 11:31:46 AM
Lexx:Jesus Christ, how does any medical professional make less than 20 bucks an hour?  That's 40k/yr!  farking receptionists make 35k+.

I would have made more flipping burgers at McDonald's than I did at my first job as an EMT-IV in 2005.

The only people who get paid what they are worth are RNs and MDs, if at all. My profession still has a LOT of people who do it for free, for example.
 
2013-06-28 11:33:46 AM
For many years the AMA has been severely limiting the number of new doctors graduated, and thus creating an artificial shortage of doctors.

The plan is to turn doctors into executives where their main role is to supervise lower trained and paid NPs and PAs. A doctor as owner of his practice can continue to make a large profit while actually seeing very few of his patients.
 
2013-06-28 11:34:31 AM

mesmer242: Uh, what? I wasn't aware that community colleges gave out master's degrees.


Uh, that's my bad. I'm thinking RN and LVN.
 
2013-06-28 11:37:39 AM

orbister: sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.

I agree. Nurses are generally far better than doctors at communicating with patients and giving care. Plus nurses will admit when they or the system doesn't know something: doctors are trained never, ever to admit that might ever be fallible.

Doctors are basically highly trained technicians with terrible people skills.


Someone's been watching Doc Martin.
 
2013-06-28 11:40:32 AM

Kirzania: mesmer242: Uh, what? I wasn't aware that community colleges gave out master's degrees.

Uh, that's my bad. I'm thinking RN and LVN.


An NP or PA is nothing close to an entry level LPN or Graduate Nurse. The entire approach to even something as basic as patient assessment is completely different.
 
2013-06-28 11:41:21 AM
NPs are great in certain medical situations. But if the shiat hits the fan or if the case is complex, you can be damn sure you want an MD there.
 
2013-06-28 11:42:04 AM

WhippingBoy: Why stop there? Why not let the receptionist make the diagnosis and prescribe the medication? Or the guy who cleans up all the medical waste?


Considering the vast majority of office visits are entirely routine, commonsense things, we probably could and there really wouldn't be all that big a difference in treatment outcomes.

I don't know about you, but 90% of the times I'm going to the doctor, I know what's wrong, and what is going to be prescribed. Because, after a few decades on earth, you sort of know what your own personal health issues are, and that those issues tend to reoccur.

/Now, if I suddenly start bleeding from my eyes, then...yeah, please don't stick me with a Physician Assistant. They are only going to get antagonized when I pointedly keep referring to them as "nurse."
 
2013-06-28 11:42:58 AM
It's not the initials behind the name, but the name in front of the initials, that matter the most.  A person of integrity, with good training and clinical experience, will know his or her limits and act accordingly, and in the best interest of patients, the large majority of the time.
 
2013-06-28 11:44:33 AM
I am a retired x-ray/cat scan tech and have worked in the medical field for 18 years...those are my credentials for my comment.  I believe that the nurse practitioners demand equal pay for equal work is a bit bogus.  Part of the rationale for the pay rates of all medical professionals is based upon the amount of training they had to go thru to be qualified to do their job.  When a nurse practitioner goes to pre-med for 4 years, 3 years or so of med school, spends time as an intern (12-16 hrs/day)...then I will support their request of equal pay but until they have the skills, knowledge, and training that a doctor has accumulated, I am forced to say that they do not deserve equal pay.  This is like saying that a chief petty officer in the navy deserves officer's pay because he does some things that an officer does.  Nope, not going to happen.
 
2013-06-28 11:44:34 AM

fiddlehead: NPs are great in certain medical situations. But if the shiat hits the fan or if the case is complex, you can be damn sure you want an MD there.


NPs specialize in what field they work in.
A family practice anp is not going to b e trained the same as a Neonatal NP, or an acute/emergency care np.
 
2013-06-28 11:44:47 AM
I would often take the A-student NP with a lot of experience and knowing their limitations over an MD who doesn't. The general population has little understanding how specific all medical practice is now. If I am hit by a car crossing the street I would take the Trauma RN or ICU NP over a Ph.D/M.D Family Practice MD any day of the week. Even better, I would take a E-4 army corpsman making 20k a year if I got shot over the Top-of-the-class Dermatologist (the hardest specialty to get into...have to be brilliant), M.D./Ph.D making 750k/year. Also, in 14 states NPs and PAs can practice without MD supervision, and that number is growing. Most of the time, that is going to be a good thing, but remember, there are C students in any profession, and you need to have some accounting of that. In the medical field, if you don't do your job right, people can die.
 
2013-06-28 11:46:49 AM

mysticcat: I'm a doctor.  I employ NPs and PAs.  They're good, but not anywhere near MD level.  They simply lack the fund of knowledge that MDs have.  They are very good at protocolized specific tasks.


Well I'm not a doctor. But I did stay at a Holiday Inn Express last night.
 
2013-06-28 11:54:55 AM

bopis: Lexx: If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

THIS.
Everything in healthcare is this. Doctors run everything, and they are very good at taking care of themselves and each other.


I'd take a doctor over a politican any day.
 
2013-06-28 11:56:58 AM
So... NPs should do more stuff than RNs but less stuff than MDs?
 
2013-06-28 12:01:50 PM

HairBolus: For many years the AMA has been severely limiting the number of new doctors graduated, and thus creating an artificial shortage of doctors.

The plan is to turn doctors into executives where their main role is to supervise lower trained and paid NPs and PAs. A doctor as owner of his practice can continue to make a large profit while actually seeing very few of his patients.


Hooray again for the credentialing racket.

Same thing happens with nursing homes and the various affordable alternatives - if your elderly relative just needs here-and-there assistance and somebody keeping an eye on her, and not skilled nursing, you're farked in states where nursing home owners have bought themselves enough legislators. You get to choose between the savings-destroying nursing home, the marginally-less-savings-destroying high-dollar assisted living facility owned by the nursing home operator...or grandma living in your extra bedroom.
 
2013-06-28 12:04:05 PM
As someone who worked as a CNA in a nursing home while going to EMT school, I'm very happy there are license and credentiling standards for them.

They would be complete and total hell without them.
 
2013-06-28 12:08:06 PM

bopis: Lexx: If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

THIS.
Everything in healthcare is this. Doctors run everything, and they are very good at taking care of themselves and each other.



I've heard/read that before, and it would be hard to prove that there isn'tan artificial shortage, to some extent.  But historically, one of the factors that limited the available slots in medical schools was the availability of cadavers.  Everyone has to take anatomy, and there simply weren't enough cadavers to allow for enormous class sizes.  Sorry if a citation is needed -- I don't have one.
 
2013-06-28 12:10:08 PM
I love these medical threads about as much as attorneys love reading all of the legal threads.  It's amusing how many people are medical experts.
 
2013-06-28 12:11:00 PM

Lexx: Yes please: Lexx: The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

Right, just like how Michelin artificially limits its star ratings instead of just assigning them to every fry cook who wants one.

Jim_Callahan: They don't have LESS training, they have DIFFERENT SIGNIFICANTLY LESS training.

No...it really does happen.  If the medical colleges REALLY cared about patient outcomes and not just limiting the # of doctors entering the workforce, they'd restrict the # of hours/week each doctor in residency works, and lessen the workload for each resident by increasing the number of residents used.  Overworked residents are a huge cause of farkups and bad patient outcomes.


It's less of problem than most people think. But the answer isn't to fill some of those hours with less competent people.  And if you want to expand the number of people in residency, you'll also need to increase the length of residency accordingly, and decrease pay proportionately.  What would you suggest, 25 percent?  So instead of a four year residency paying $50k a year for 80 hours a week, it's a five year residency paying $32k a year for 64 hours a week.  Who's going to take that job?
 
2013-06-28 12:15:44 PM

basemetal: I love these medical threads about as much as attorneys love reading all of the legal threads.  It's amusing how many people are medical experts.


You should spend time in a thread on CPR sometime. Fark has a large number of highly qualified resuscitation efforts who assure me of things like CPR is useless, and that you kill people doing it.
 
2013-06-28 12:16:24 PM
experts, not efforts.
 
2013-06-28 12:17:35 PM

The Stealth Hippopotamus: Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.


There is not much correlation between price and quality in health care.  There are many studies that demonstrate this.

What are you getting when you pay more to have a doctor treat a condition, instead of a cheaper NP?  Presumably, better training.  It may be worth it for a complex condition that requires a higher level of expertise and training.  For a simple condition - the common cold, a simple laceration, a lumbar strain - the extra cost may not be worth it.

On the other hand, a doctor may be more likely to recognize that the low back pain is unrelated to the lumbar arthritis seen on the x-ray, and instead is due to a life-threatening aortic aneurysm.  But such instances are rare, and there are many docs who will not bother to explore differential diagnoses if the criteria for an obvious and common diagnosis are met.  (On the third hand... how do you know when to look for zebras when you hear hoofbeats?  You can't do it for everybody - takes too much time and energy, and costs too much. I guess that's what the "art of medicine" is about.)
 
2013-06-28 12:22:12 PM

HairBolus: For many years the AMA has been severely limiting the number of new doctors graduated, and thus creating an artificial shortage of doctors.

The plan is to turn doctors into executives where their main role is to supervise lower trained and paid NPs and PAs. A doctor as owner of his practice can continue to make a large profit while actually seeing very few of his patients.


This. I have absolutely no sympathy for MDs. They've controlled the AMA for years and through accreditation and state board requirements have severely limited the number of people who can become MDs. I have as much sympathy for a doctor complaining about this as I do lawyers complaining about paralegals. There are more than enough talented people with a bachelors that new medical schools could be opened and train enough new people that our medical system could be healthy and not cost prohibitive. While I respect MDs, I do not think we need to limit Med School admittance to the top 10% of college graduates. I am sure it would be possible to double that rate and still have very competent doctors.
 
2013-06-28 12:27:18 PM
It surprises me that people have yet to fully grasp that the doctors have deliberately created this 'shortage' by limiting how many doctors can graduate per year.

How else can they demand 6 figure incomes for so little work?
 
2013-06-28 12:27:55 PM
A good NP is just about as good as a GP physician insofar as the most common ailments such as a minor infection, blood pressure, cholesterol, diabetes management and such. As long as they are wise enough to refer problem patients to a physician, I see no overall problems to this approach to stemming healthcare costs. On average, they do make more errors on prescriptions than physicians, but that's why I have to check over them I suppose.

The real problem with healthcare costs is the drug companies who spend on average 3 times as much on marketing as they do on R and D, and the fact that the government is insistent on incorporating private insurance firms into the new healthcare system. Why? The government can't provide enough bureaucracy? The pharmacy benefit managers make on average $10 per prescription, as much as pharmacies do, just for telling me, via a computer algorithm, that they will pay x amount for your script or they won't pay at all. They get money from pharmacies every time they sent an electronic request for payment, they get money from physicians who have to sign up for the privilege of prescribing for their own patients. They get money from the drug companies in the form of kickbacks for preferring one drug over another. They get money from your employer for claiming to review your drugs for safety and efficacy, when that has always been the pharmacists job, and it's just a smokescreen for more kickbacks anyway. Thats how these guys are able to claim to save businesses money. No one sees where the other monies go.

Now the government wants to give them tax money, constantly, with annual increases I'd bet, just like the military contractors get, ad nauseum, ad infinitum. It is unfeasible, untenable and foolish.
 
2013-06-28 12:33:34 PM

Yes please: Lexx: Yes please: Lexx: The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

Right, just like how Michelin artificially limits its star ratings instead of just assigning them to every fry cook who wants one.

Jim_Callahan: They don't have LESS training, they have DIFFERENT SIGNIFICANTLY LESS training.

No...it really does happen.  If the medical colleges REALLY cared about patient outcomes and not just limiting the # of doctors entering the workforce, they'd restrict the # of hours/week each doctor in residency works, and lessen the workload for each resident by increasing the number of residents used.  Overworked residents are a huge cause of farkups and bad patient outcomes.

It's less of problem than most people think. But the answer isn't to fill some of those hours with less competent people.  And if you want to expand the number of people in residency, you'll also need to increase the length of residency accordingly, and decrease pay proportionately.  What would you suggest, 25 percent?  So instead of a four year residency paying $50k a year for 80 hours a week, it's a five year residency paying $32k a year for 64 hours a week.  Who's going to take that job?


I am not aware of any study that demonstrates a significant improvement in patient safety or clinical outcomes in teaching hospitals after the 80 hour work week restrictions were adopted.  But the jury's still out on that.

You know what would significantly reduce the incidence of resident errors?  Require attendings to take in-house call, and be available to the house staff on demand.  Yeah, I know you can page them or call the attending, but it's not the same as being at the bedside.  But this will hamstring physician training.

Residents need autonomy to develop their clinical acumen.  Autonomy means they will screw up from time to time.  If they always kick difficult decisions up the chain of command, it will be harder to develop the skills, temperament, and mindset needed to manage their own cases when they're attendings.  If you're going to hold their hand the whole time and turn residency into a short-leash apprenticeship, then residencies will have to be longer, so that residents can acquire enough experience before being kicked out of the nest.

/adjusts onion belt and big shiny forehead mirror
 
2013-06-28 12:42:47 PM

The Stealth Hippopotamus: Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.


We warned them. High-pay professionals sat on their asses while manual and service labor got boned over the last 3 decades by corporate-friendly policy changes, and now it's their turn. HMOs, outsourced back-office staff, the erosion of tort, regulatory, and consumer protection law, the move away from adversarial court cases to stacked-deck arbitration, the explosion of para-legals and nurses; all of this has been part of the corporations reducing "skilled labor" to the level they spent the 80s and 90s reducing "unskilled" to. These guys really should have been paying attention instead of shrugging it all off and saying "got mine".
 
2013-06-28 12:46:44 PM

pdieten: The problem we had with the NPs at the urgent care clinic associated with our regular doctor's office is that were getting too creative with their prescriptions and choosing meds that weren't in our formulary. Lots of fun to have to call the doctor's office back when you're standing in the pharmacy to get a script changed so that we could get a drug with an affordable co-pay......

Otherwise, as long as they have a protocol to follow, they work out okay.


There is a phone app called apocrates where you can look up drug prices.
 
2013-06-28 12:50:33 PM

hardinparamedic: basemetal: I love these medical threads about as much as attorneys love reading all of the legal threads.  It's amusing how many people are medical experts.

You should spend time in a thread on CPR sometime. Fark has a large number of highly qualified resuscitation efforts who assure me of things like CPR is useless, and that you kill people doing it.


Meh...if you have expert knowledge about something, non-experts debating your subject matter shouldn't bother you in the slightest. If you can't persuade others to your point of view, then the problem is probably with you, not your audience.

/besides, even an expert can screw up his facts every once in a while, and get called on it by a non-expert.
 
2013-06-28 12:54:28 PM
DNRTFA, but this sounds insurance-driven.  Why wouldn't your HMO want to pay 80% of the doctor's fee schedule for the same procedure to have a PA or NP provide the service, when they are still charging the beneficiary 100% of the premiums and copays?  That's an extra $10-20 of free margin on a standard office visit for the HMO.
 
2013-06-28 12:55:04 PM
I went to my family doctor in 6th grade because I was feeling sick every morning. He told my mom that it was a pychological thing that I didn't want to go to school so I was making it up. Well I ended up puking in a NP office(unrelated allergy thing) and she made the suggestion that I go and get tested for GERD. Sure enough that's what I had and have been treated since....in my opinion doctors don't give you the time because they don't give a shiat
 
2013-06-28 12:55:57 PM

NuttierThanEver: The Stealth Hippopotamus: Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.

NP and PAs can be a great addition to care in underserved areas if (and this is the part that idiot politicians miss) they work closely with a supervising physician to help them deal with areas outside their expertise. I work closely with many NP and PAs and they themselves admit that they are most comfortable dealing with relatively healthy folks with only one or two chronic illnesses and with regular preventative visits.
 For the older population who have 3-4 problems (like diabetes, hypertension, COPD) and multiple meds they admit these folks are out of their areas of expertise. If they are practicing independently without a Internist or Family Practice doctor to ask for advice they will be referring more folks to specialists and then you will see costs of care for a pt managed by an NP or PA zooming back up to where they are with an MD.


bearsbearsbearsbears
 
2013-06-28 12:57:14 PM

Scipio: HairBolus: For many years the AMA has been severely limiting the number of new doctors graduated, and thus creating an artificial shortage of doctors.

The plan is to turn doctors into executives where their main role is to supervise lower trained and paid NPs and PAs. A doctor as owner of his practice can continue to make a large profit while actually seeing very few of his patients.

This. I have absolutely no sympathy for MDs. They've controlled the AMA for years and through accreditation and state board requirements have severely limited the number of people who can become MDs. I have as much sympathy for a doctor complaining about this as I do lawyers complaining about paralegals. There are more than enough talented people with a bachelors that new medical schools could be opened and train enough new people that our medical system could be healthy and not cost prohibitive. While I respect MDs, I do not think we need to limit Med School admittance to the top 10% of college graduates. I am sure it would be possible to double that rate and still have very competent doctors.


Do a quick search of the AMA and find out what percent of docs actually belong to the AMA and feel that the AMA represents their view, then decide if that's a fair assessment of doctors as a whole.

/med student - have not met one doc that supports what the AMA does
 
2013-06-28 12:59:48 PM
Bumblefark:
Meh...if you have expert knowledge about something, non-experts debating your subject matter shouldn't bother you in the slightest. If you can't persuade others to your point of view, then the problem is probably with you, not your audience.

/besides, even an expert can screw up his facts every once in a while, and get called on it by a non-expert.


People pontificating on a topic they have no idea about, and trying to scare laypeople from doing CPR when it is not only indicated, but the only hope for someone to have a quality life and good outcome by telling them that "doctors don't want CPR and you'll kill them anyway so why try" is not debating.

There is a difference between having an honest discussion and being a flagrant shiat that gives advice that harms people.
 
2013-06-28 01:03:56 PM

Mtrotter12: I went to my family doctor in 6th grade because I was feeling sick every morning. He told my mom that it was a pychological thing that I didn't want to go to school so I was making it up. Well I ended up puking in a NP office(unrelated allergy thing) and she made the suggestion that I go and get tested for GERD. Sure enough that's what I had and have been treated since....in my opinion doctors don't give you the time because they don't give a shiat


Well that personal anecdote convinced me.
 
2013-06-28 01:04:07 PM

Lexx: Yes please: Lexx: The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

Right, just like how Michelin artificially limits its star ratings instead of just assigning them to every fry cook who wants one.

Jim_Callahan: They don't have LESS training, they have DIFFERENT SIGNIFICANTLY LESS training.

No...it really does happen.  If the medical colleges REALLY cared about patient outcomes and not just limiting the # of doctors entering the workforce, they'd restrict the # of hours/week each doctor in residency works, and lessen the workload for each resident by increasing the number of residents used.  Overworked residents are a huge cause of farkups and bad patient outcomes.


My wife's work week is 80 hours this week as a fresh second year resident.  And this is how more weeks go than don't.  She makes less than $8/hour while making 25% more than me at $22/hr or so.
 
2013-06-28 01:05:11 PM

basemetal: I love these medical threads about as much as attorneys love reading all of the legal threads.  It's amusing how many people are medical experts.


seconded
 
2013-06-28 01:05:52 PM

NuttierThanEver: 5 years more training.


5 years less doing.
 
2013-06-28 01:11:25 PM

Cavemankiwi: NuttierThanEver: 5 years more training.

5 years less doing.


www.themovies.co.za
 
2013-06-28 01:12:35 PM

Anastacya: Here in lovely South Dakota, I have to drive 3 hours for the rheumatologist. In a state that has a problem with having an MD in many areas, it blows my mind that I have my pain management doctor at a 5-minute walk from my house.

In re: NPs; they are common out here, as I have learned. For a cold or my annual, I have no issue with seeing her. If there is something more urgent, I prefer the MD/DO/whateverthelettersare. Oh, and for vaccinations. Which reminds me, I have to check in on the flu vaccine soon... wonder if the new one is out yet?


August
 
2013-06-28 01:17:37 PM

Lexx: If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.


Came here to say this.
 
2013-06-28 01:18:25 PM

LiberalEastCoastElitist: There is a phone app called apocrates where you can look up drug prices.


Epocrates doesn't tell you how much you'll pay though.  That's entirely dependent on your insurance plan.  Although I guess it can be fun to see that you're getting a $6000 medicine for a $5 copay.  Or if you know that your prescription is ten pills that cost $0.12 each, you could offer to pay cash instead of your $15 copay.  Why did the copay increase?  Because the first medicine is Tier 1 and the second is Tier 3.  Why?  God question.  Ask your insurance company.
 
2013-06-28 01:22:57 PM

Wangiss: Lexx: If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

Came here to say this.


And after reading the rest of the thread you're still admitting it?  If you own up medical school (or more accurately, residency) spots, you won't have an artificial shortage of doctors any more.  You'll have an actual shortage, and those that you do have will be less competent on the whole.  And perhaps marginally less expensive.
 
2013-06-28 01:26:07 PM

CWeinerWV: Scipio: HairBolus: For many years the AMA has been severely limiting the number of new doctors graduated, and thus creating an artificial shortage of doctors.

The plan is to turn doctors into executives where their main role is to supervise lower trained and paid NPs and PAs. A doctor as owner of his practice can continue to make a large profit while actually seeing very few of his patients.

This. I have absolutely no sympathy for MDs. They've controlled the AMA for years and through accreditation and state board requirements have severely limited the number of people who can become MDs. I have as much sympathy for a doctor complaining about this as I do lawyers complaining about paralegals. There are more than enough talented people with a bachelors that new medical schools could be opened and train enough new people that our medical system could be healthy and not cost prohibitive. While I respect MDs, I do not think we need to limit Med School admittance to the top 10% of college graduates. I am sure it would be possible to double that rate and still have very competent doctors.

Do a quick search of the AMA and find out what percent of docs actually belong to the AMA and feel that the AMA represents their view, then decide if that's a fair assessment of doctors as a whole.

/med student - have not met one doc that supports what the AMA does


Whether or not they do support the AMA is besides the point. The same can be said for the legal profession as well or any professional org. The AMA is the de facto representative for MDs in the political process. They have a monopoly on everything. They inflate the credentials necessary to open a medical school so the number of new schools that open are limited. You cannot tell me that MDs do not benefit as an extension of this practice.
Furthermore, I personally know many great and wonderful MDs, DOs, DDSs, etc. and I know on an individual level they are often good people. I just have little sympathy that they let the AMA run amok and for 30 years the AMA has successfully managed to prevent any significant increase in MDs being graduated. Only in the past few years under congressional pressure have they again started to let schools increase student class size and open new schools. Residency is also a joke for the average PCP as upwards of 80hrs/wk for 3 years is not really necessary for that position (other specialties I cannot comment on) and is simply another excuse to not allow more people to get into the field (AMA often complains they cannot graduate more students b/c the government hasn't funded enough residency programs). It is a big joke and anyone can see through the reasons why the requirements are so onerous. I find it humorous that the UK can graduate competent doctors in 4-6yrs, but the US takes 8+ (emphasis on the plus).
I believe the U.S. has probably the highest quality professionals in their fields in the entire world, but the medical field is different from other professions. There is no possible way that an individual can serve themselves and their own healthcare issues even if they wanted to take the risk to do so poorly. They cannot provide the drugs they need for themselves by law being a biggie. Therefore, unlike onerous requirements we can place on other professions, the medical field needs to be vastly more accessible and therefore a vibrant, competitive medical market is needed.
If we cannot have new MDs to serve a PCP role in the amount that's needed, then new roles will be created to fill that gap. Our society can barely keep up with the doctor shortage we currently have and with the huge increase in the next 10yrs. there is no way it won't get worse. Doctors are smart people, they should realize this. Hence why when the AMAs policies the profession was largely silent and profiting on is coming back to bite them as lower trained professionals can step on their coattails, I cannot help but to feel largely indifferent and somewhat glad to see happen (as it will hopefully save me a few dollars in the end).
 
2013-06-28 01:38:15 PM

orbister: sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.

I agree. Nurses are generally far better than doctors at communicating with patients and giving care. Plus nurses will admit when they or the system doesn't know something: doctors are trained never, ever to admit that might ever be fallible.

Doctors are basically highly trained technicians with terrible people skills.


I tend to think that has more to do with understanding that, no matter what school or subject of study, you are always going to have somene that graduated last in their class; or in the bottom 25%.

In my experience:  The better the Doctor, the better the bedside manner.
 
2013-06-28 01:40:09 PM
I think there will come a time when a doctor becomes less of a hands on player and more of a management role. There is just no reason why an MD needs to do physicals or interpret routine tests. For every brilliant doctor who notices some minute detail and makes a rare diagnosis, there are 5 more who sleepwalk through their day just like everyone else.
 
2013-06-28 01:42:40 PM

Outtaphase: Based on recent experience, hell no. My wife was on medical leave for 2 months, seeing an "in-network recommended" NP and getting no progress. This "close supervision" sounded like BS to me, she never got to see the MD. Finally I emphatically pleaded with her to dump this group and go see a doctor recommended by my own doctor. He was out of network and hellaexpensive, but I didn't care about cost at that point. She went to see him for 1 visit and was back to work the next day and doing fine.

Now that's just one personal anecdote, and I realize it probably doesn't work out that way for everyone. But personal experiences like this are a pretty big influence no matter how objective you try to be.


I agree with you. 2 more anecdotes:

I went to the ER with severe throat pain. I ended up seeing a Nurse Practitioner. Checked me out for 20 minutes, said I had Strep. That misdiagnosis almost cost me my life when my throat closed a few days later, and when an MD saw me, they thought it was absolutely insane that I was diagnosed with Strep when what I had was obviously a Peritonsillar abscess that should never have reached the level of danger it did.

My friend was admitted to St. Vincent's Staten Island (The worst hospital in NYC) with respiratory distress and what we were calling Simpson's Disease (his skin was yellow). It was five days of NP's without seeing a doctor once. When myself and his sister started screaming at people, we finally got to see a doctor, who diagnosed him with an iron deficiency and something else that was fairly simple and had him out two hours later.

I know many NP's and they are perfectly good at their jobs, but they are absolutely no substitute for an MD.
 
2013-06-28 01:43:05 PM

The Stealth Hippopotamus: So in other words, this is madness?


No. This is Med-Express!


/kicks tSH into MRI machine
 
2013-06-28 01:54:53 PM
Future Nurse Practitioners are being forced to go terminal just to be an NP, that is, after 2014 all RN's wishing to specialize as a NP must become a DNP. Most of the programs I looked at directed the DNP education towards administrating other health care providers, setting health care policy, and actually not doing much hands-on at all. This is a primary reason why I jumped ship to pre-med, then med school.

Further, if you visit placed such as Allnurses.com, the huge community for Nurses and nursing students (the nursing equivalent of Student Doctor Network), you can see this topic is as old as the forums have been around. You'll also find interesting tid bits from current NP's: many, so they state, do want to do everything a physician can do. They do not want all the responsibility. They admit they do not have the same training. But they do, rightly, point out that they can ease the burden on physicians, and thus on our whole health care system in the U.S., by doing what they're already doing: handling patients that fall within their range of knowledge and training.

You can also find some lovely data floating around Allnurses showing that when NP's and DNP's were given the same licensing exams at a physician, just under 50% pass. This should be a no brainer.

Personally, I love the idea of a DNP, or some other nurse specialist, not being in administration, but handling cases that would otherwise clutter up my clinic. Hell. Yes. Please.

All of this said, though, I would like to note that Nurses get paid out of the door, physicians do not (that is, less than $40K/year).

Right now, with no training, and only having to pass a quick exam that any slope-browed mongoloid could get through with flying colors, I can be a CNA down the street, work 3 nights a week/end, and make $38,000 a year. The need is great, and for the work, the pay is very high.

That's more than some of us are looking at during residency, and barely as much as some of us are looking at right after licensing. Physicians don't make a lot for awhile. It takes time. The money issue is a non-issue.

Too, and the other big reason why I chose to jump ship from nursing, many (many) nurses decide to become nurses for the same reason late-in-life-teachers become teachers: they perceive it as easy, and the leniency given in their courses is insane. Scary insane. These are the dregs of society in many cases, hoping for something better. They'll reach it, but they'll deliver subpar performance which will result in conflict in the future, or a lowering of standards in this country. Mark my words. I simply thought better of myself, and my abilities.

That's not to say all nurses, or future DNPs are like this. Verily, I've tried to convert two of my good friends from undergrad that went on to become nurses to the physician side. Their reasons were strong. These are good, decent, honest human beings. The sort you hope you see if you need care, and the type which form the schema of a hardworking, highly skilled, nurse. This sort make up maybe 5% of nursing students.

I understand most American's place a low (loooow) value on health care until they actually need it, and then only want the best possible but at a rate cheaper than a Tijuana donkey show. I know. I've been there. But you can't have everything: not giving a single dime for STEM education, forcing science majors to trudge through a high price, complex, medical education, then telling them that they can't make any money for years- it's pretty no win. You want, want, want, but as a country, you're not willing to give, give, give.

Buck the fark up, America, decide what you want and let us know. If you want well trained, professional health care providers, physicians, specialists, then support us rather than take away our education, rather than raise the prices on our education, and rather than steal money from STEM everywhere. And too, realize, that nurses and physicians can work to alleviate a lot of problems, possibly even lower health care costs, but you're not (repeat: NOT) going to get a physician making as little as a nurse, or wanting to, until you/we as a country decide that helping physicians is a priority. Making STEM education as a priority. Your health and your future as a priority. I would gladly take a nurses pay, with a big farking smile and a thank you, if my whole education was paid for by you. If you promised not to sue me for every little mistake. And if you decide to respect what I tell you rather than contradicting me with your WebMD garbage.

It's give and take, again, and everyone just wants to take, take, take, and they believe, wrongly, that physicians are the greedy ones when many give, give, give much of their lives to helping others.
 
2013-06-28 01:55:06 PM

Yes please: Lexx: Yes please: Lexx: The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

Right, just like how Michelin artificially limits its star ratings instead of just assigning them to every fry cook who wants one.

Jim_Callahan: They don't have LESS training, they have DIFFERENT SIGNIFICANTLY LESS training.

No...it really does happen.  If the medical colleges REALLY cared about patient outcomes and not just limiting the # of doctors entering the workforce, they'd restrict the # of hours/week each doctor in residency works, and lessen the workload for each resident by increasing the number of residents used.  Overworked residents are a huge cause of farkups and bad patient outcomes.

It's less of problem than most people think. But the answer isn't to fill some of those hours with less competent people.  And if you want to expand the number of people in residency, you'll also need to increase the length of residency accordingly, and decrease pay proportionately.  What would you suggest, 25 percent?  So instead of a four year residency paying $50k a year for 80 hours a week, it's a five year residency paying $32k a year for 64 hours a week.  Who's going to take that job?


So you think residency is a job people take because they feel like it?  That's original, at least.
 
2013-06-28 01:56:25 PM
Or... OR... we could just force the AMA to allow more students to enter domestic medical schools, thus increasing the number of competent doctors.  Little known fact: they intentionally keep the number artificially low, which results in increasing amounts of foreign-imported doctors--especially at county hospitals.

/...or we could just keep importing them from overseas and suffer the consequences.
 
2013-06-28 01:57:22 PM
While I've had some great NP's and received plenty of help and information from them, they simply cannot substitute the total care, knowledge and treatment for all of my labs, scopes and ultrasounds that my hepatologist provides for my cirrhosis.

/just my experience
//ymmv
 
2013-06-28 02:02:45 PM

Meesterjojo: CNA down the street, work 3 nights a week/end, and make $38,000 a year.


This is where I throw up the bullshiat flag. No CNA I've EVER met makes $38k, let alone working three days a week. I've looked at the average wages for CNA's, as I wanted to get my foot in the door of the med field at the lowest level, and it was barely minimum wage. In my state, average CNA pay is just under ten bucks an hour and that's pay that's ten percent above average when it comes to CNA pay.
 
2013-06-28 02:03:56 PM

Yes please: Wangiss: Lexx: If nurses wanted to act like doctors and get paid like doctors, they should become doctors - in a perfect world.

The problem with this, is that medical school are largely controlled by doctors and deliberately limit their capacity to create an artificial shortage of doctors, and thus inflate the demand & wages for existing doctors.

Came here to say this.

And after reading the rest of the thread you're still admitting it?  If you own up medical school (or more accurately, residency) spots, you won't have an artificial shortage of doctors any more.  You'll have an actual shortage, and those that you do have will be less competent on the whole.  And perhaps marginally less expensive.


Please write grammatically correct sentences in the future.  It will help me understand your point.

Sincerely,

Wangiss
 
2013-06-28 02:11:42 PM

darthaegis: orbister: sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.

I agree. Nurses are generally far better than doctors at communicating with patients and giving care. Plus nurses will admit when they or the system doesn't know something: doctors are trained never, ever to admit that might ever be fallible.

Doctors are basically highly trained technicians with terrible people skills.

I tend to think that has more to do with understanding that, no matter what school or subject of study, you are always going to have somene that graduated last in their class; or in the bottom 25%.

In my experience:  The better the Doctor, the better the bedside manner.


My personal experience doesn't reflect this statement. The worst beside manner I have ever received from a doctor was from a graduate who was in the top 10%. Complete dick who for some unknown reason thought he knew my history and symptoms better than me. It was pure arrogance (guess how I know he graduated in the top 10%? Here's a hint, I didn't ask). As for the shiatty doctors, who knows where in their class they graduated, but the doctors that were just incompetent that I have dealt with tended to have pretty decent to awesome bedside manner, but were unable to have any insight to medical issues. The outstanding doctors that I have known were largely middle of the class physicians. The absolute worst doctors I have had were by and large foreign doctors. There are exceptions to this, but personally, it has been such a huge discrepancy that I only go to U.S. trained doctors now.
All my frustration with the medical field aside, we do a very good job of training our doctors to have some training in bedside manner which is why I will never rail on the requirement that MDs get a BA/BS first. The doctors that I know and personally enjoy talking with (usually not my treating physicians) have all had education outside the medical field which lends them intellect and perception outside of the medical field which translates into better communication and patient empathy. The best treating physician I ever had was a humanities major  (forget which specific field), he could explain things extremely well, took time to listen, and did what I expected him to do.
 
2013-06-28 02:25:53 PM

NuttierThanEver: The Stealth Hippopotamus: Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.

NP and PAs can be a great addition to care in underserved areas if (and this is the part that idiot politicians miss) they work closely with a supervising physician to help them deal with areas outside their expertise. I work closely with many NP and PAs and they themselves admit that they are most comfortable dealing with relatively healthy folks with only one or two chronic illnesses and with regular preventative visits.
 For the older population who have 3-4 problems (like diabetes, hypertension, COPD) and multiple meds they admit these folks are out of their areas of expertise. If they are practicing independently without a Internist or Family Practice doctor to ask for advice they will be referring more folks to specialists and then you will see costs of care for a pt managed by an NP or PA zooming back up to where they are with an MD.


As a new PA, i agree.

I started in medicine as an LPN, went on to RN, then BSN, and now PA.
 
2013-06-28 02:27:21 PM

Cletusostomy: I would often take the A-student NP with a lot of experience and knowing their limitations over an MD who doesn't. The general population has little understanding how specific all medical practice is now. If I am hit by a car crossing the street I would take the Trauma RN or ICU NP over a Ph.D/M.D Family Practice MD any day of the week. Even better, I would take a E-4 army corpsman making 20k a year if I got shot over the Top-of-the-class Dermatologist (the hardest specialty to get into...have to be brilliant), M.D./Ph.D making 750k/year. Also, in 14 states NPs and PAs can practice without MD supervision, and that number is growing. Most of the time, that is going to be a good thing, but remember, there are C students in any profession, and you need to have some accounting of that. In the medical field, if you don't do your job right, people can die.


I'm curious.  How did you get shot over the dermatologist?  Catapult, or circus-style cannon, or some kind of railgun?
 
2013-06-28 02:27:41 PM

sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.


Thats bc ppl with nursing backgrounds (such as myself) are more interested in the whole big picture, not just what problem needs fixing at the moment.
 
2013-06-28 02:30:00 PM

WhippingBoy: Why stop there? Why not let the receptionist make the diagnosis and prescribe the medication? Or the guy who cleans up all the medical waste?


That's a strawman argument.  NPs, by definition are RNs who are prepared to provide primary and preventative health care services.  It would be expected that they'd have at least a master's in nursing (MSN).
 
2013-06-28 02:34:22 PM
Since when do we hold RN's and MD's at the same level?  Oh right since the corporations and insurance companies started raping the medical profession.
 
2013-06-28 02:35:17 PM

Galileo's Daughter: WhippingBoy: Why stop there? Why not let the receptionist make the diagnosis and prescribe the medication? Or the guy who cleans up all the medical waste?

That's a strawman argument.  NPs, by definition are RNs who are prepared to provide primary and preventative health care services.  It would be expected that they'd have at least a master's in nursing (MSN).


Np and PA are master's degrees.

There are DNSc and DNp which are nurses who ARE doctors.

A DNSc is a research-based degree.


DNP= 4 year bachelor's, 2 years ER experience, Master's degree with 2 years clinicals, then 3 more years school +2 year residency. Every bit the equal of an MD, just focused on different areas.
 
2013-06-28 02:38:29 PM
A PA is a master's degree in medicine, and requires residency training (clinical experience) while in school.


Soooo much poor info in this thread.
 
drp
2013-06-28 02:39:37 PM

sandi_fish: I prefer Nurse Practitioners.  I found they are more personable, more willing to have open discussion should there be any questions, and spend more time with you.


And this neatly encapsulates the entirety of the problem:  When the "consumers" of a service lack the knowledge or ability to tell the difference between "excellent" or "good" or "adequate" or "substandard" services, they resort to irrelevant superficial observations.

"My NP is more personable"
"My NP is more willing to talk"
"My NP spends more time with me"

 NOT
 

"My NP prescribed the correct antibiotic" (I have no way of knowing)
"My NP is managing my kid's asthma optimally" (My kid seems to be doing OK, I guess)
"My NP is held to high educational standards (I have no idea what those standards are or how they differ from physician standards)
"My NP correctly assessed my chest pain as being benignly GI in origin and correctly sent me home with some Zantac instead of referring me for costly, painful, invasive testing with nonzero risk" (All I really know is my chest hurt and someone in a white coat did some stuff and said some things)

It's a hell of a coup.  Insurance companies have convinced an awful lot of Americans that not only are their clients getting equal care from cheaper NPs, that they're actually better off with the less educated professional.  Think about that for a moment.  Your insurance company is saving money by sending you to a person with at best 1/4 the training of a doctor, and you're cool with it, because your NP is nice.

As a nation, we sure seem to get the government we deserve, and it appears we're well on our way to getting the "doctors" we deserve, too.

Caveat emptor.
 
2013-06-28 02:49:35 PM
DRP:

All np programs in my state require 3.25gpa's, and practically no one with less than a 3.5 will get in.

Throughout their training, nothing less than 3.0 is passing.
 
2013-06-28 02:59:25 PM
drp:

It's a hell of a coup.  Insurance companies have convinced an awful lot of Americans that not only are their clients getting equal care from cheaper NPs, that they're actually better off with the less educated professional.  Think about that for a moment.  Your insurance company is saving money by sending you to a person with at best 1/4 the training of a doctor, and you're cool with it, because your NP is nice.

As a nation, we sure seem to get the government we deserve, and it appears we're well on our way to getting the "doctors" we deserve, too.

Caveat emptor.


I do not think that is true. I know I certainly hope it is not true. I have not seen any studies, but most Americans realize NPs are of lower quality, but are competent for most basic primary care problems. Do you think a MD is really necessary for diagnosing and treating flu symptoms in 90% of cases? I certainly do not. Nor do I think a MD is necessary for continuing most asthma treatments that have already been diagnosed and started. There are situations where most MDs are vastly over qualified and its a waste of their time and patients money to see them.
Now some of the stuff I have seen NPs do does worry me. I have heard stories of them increasing anti-depressant medication and other high end meds. I agree with MDs that should be out of bounds, but basic triage of common ailments and continuing treatment should be carried over to a NP. Additionally, NPs can also act as gatekeepers and safeguard doctors from over reacting patients by assuaging common concerns which would normally be expected. This all should fall to an NP.
Going beyond what I mentioned above does worry me. I ask you though, if there aren't enough doctors what is the next step? We have limited capacity to make new doctors (and we are already producing at max capacity under current law). I do not know. There are only two realistic options which are to increase doctors or create new professionals to alleviate their demand. As it stands we cannot create new doctors, and therefore the economy is going the only option left open which is new professionals (NPs).
 
2013-06-28 03:00:18 PM
drp:

"My NP prescribed the correct antibiotic" (I have no way of knowing)
"My NP is managing my kid's asthma optimally" (My kid seems to be doing OK, I guess)
"My NP is held to high educational standards (I have no idea what those standards are or how they differ from physician standards)
"My NP correctly assessed my chest pain as being benignly GI in origin and correctly sent me home with some Zantac instead of referring me for costly, painful, invasive testing with nonzero risk" (All I really know is my chest hurt and someone in a white coat did some stuff and said some things)


"My Doctor prescribed the correct antibiotic" (I have no way of knowing)
"My Doctor is managing my kid's asthma optimally" (My kid seems to be doing OK, I guess)
"My Doctor is held to high educational standards (I have no idea what those standards are or how they differ from physician standards)
"My Doctor correctly assessed my chest pain as being benignly GI in origin and correctly sent me home with some Zantac instead of referring me for costly, painful, invasive testing with nonzero risk" (All I really know is my chest hurt and someone in a white coat did some stuff and said some things) 

Perhaps the problem is that doctors have no way of letting us know why their voodoo is better.  Perhaps the fact that when they mess up we will never know until we die or successfully sue them is part of the problem.
 
2013-06-28 03:14:11 PM

Kirzania: Uh, that's my bad. I'm thinking RN and LVN.


well that is completely irrelevant to the subject matter at hand, since they aren't NPs.  next!
 
2013-06-28 03:34:13 PM
The best diabetes care my husband has ever found has been a NP that specializes in diabetes management.  Having them take care of general appointments and relatively stable patients frees the physicians up to treat patients with more chronic conditions.  America needs to invest in getting more students through medical school and nursing school.  There is a glut of nursing student applicants here in California, and many of them end up on waiting lists for years because there aren't enough spots available in the schools.
 
2013-06-28 03:46:00 PM

The Stealth Hippopotamus: Doesn't matter if you have a problem or not. This is how it has to play out. Why go though all the trouble and expense of becoming a doctor when the job market is looking for RN and Nurse Practitioners? True they have less training but people are proving again and again that price is more important than quality.

Which I think is madness, but hey I'm in the minority.


Why do I need to see a doctor to get a vaccination or get some antibiotics or for a routine physical? If I need open heart surgery or someone to design a cancer treatment regimen then I need to see a doctor but so much healthcare is simple and routine, why can't a nurse practitioner handle those things?
 
drp
2013-06-28 03:49:42 PM

The more you eat the more you fart: DRP:

All np programs in my state require 3.25gpa's, and practically no one with less than a 3.5 will get in.

Throughout their training, nothing less than 3.0 is passing.


The fact that the programs are competitive has precisely zero bearing on the depth or breadth of the training.


Scipio: Do you think a MD is really necessary for diagnosing and treating flu symptoms in 90% of cases? I certainly do not.


I absolutely agree.  NPs can probably handle more than 90% of cases.  How about 95%, just to pull a number out of thin air, just for the sake of conversation?  Small consolation to the 5% left over.

The honest truth is that well over 90% of common complaints don't require any medical treatment at all.  The difficulty is in determining which ones do, and which ones don't.  The cases at the margins are where the aforementioned depth and breadth of physician training catch small problems before they become big problems.

It's a silly argument to say that NPs are good enough for most patients, because most patients are healthy.  Of course the NPs are good enough for them; those patients don't really need medical care at all!  And everyone's healthy ... until they aren't.

NPs can also act as gatekeepers

This is precisely where the risk is, though:  NPs assessing patients without physician input and deciding who the doctor really needs to see.  It should be the other way around:  physicians assessing patients, and deciding which ones can be safely delegated to a closely supervised NP.

I ask you though, if there aren't enough doctors what is the next step?

Expanded use of NPs and other midlevels.  But in closely supervised and directed roles, not the independent practice the insurance companies and nurse PACs are lobbying for.  Insurance companies want to cut costs above all other considerations; nurse PACs want expanded practice rights and independence for their members, because that translates to direct billing and higher wages for their members.  Neither has patient care as a real metric, though both pay lip service to it.  Follow the money.

NPs and other advanced practice nurses have an important place.  They are dedicated, good people.  That place is supervised and directed practice.  More and more of what we're seeing though are advanced practice nurses like NPs and CRNAs acting independently.  The beancounters love it because they cost less.  (Superficially, at least - there are hidden costs from inappropriate referrals, unnecessary testing, missed or delayed diagnosis.)


Wangiss: Perhaps the problem is that doctors have no way of letting us know why their voodoo is better. Perhaps the fact that when they mess up we will never know until we die or successfully sue them is part of the problem.


If you think modern western medicine is voodoo, there is little I can say to convince you.

You are correct that malpractice is a problem, and a big part of the problem is that medicine is very complex, and it's hard for a layperson to know when they're getting good care, or not.  This is why systemic protection in the form of extensive training, careful licensing, and ongoing peer review / credentialing are critical for patient safety.  On the physician side these processes are actually quite rigorous, despite what if-it-bleeds-it-leads news coverage implies.

On the advanced practice nurse side, there is just no comparison.

There are no free lunches.  You get what you (or the insurance company) pay for.  Physicians receive more and better training and are held to higher standards than advanced practice nurses - this is simple objective reality.

If you choose to pay less for care from a NP, because you assess their care to be "good enough" and worth the excess risk over physician care - more power to you.  But you would be well served by carefully considering that
(1) you really aren't qualified to judge the level of their care
(2) NP vs physician care is not equivalent
(3) if it's not you choosing, but an ins co employee ... what motivates that person?
 
2013-06-28 03:55:52 PM

Wangiss: So you think residency is a job people take because they feel like it?  That's original, at least.


No, and I said nothing suggesting that.  People do residency because they have to in order to be a practicing physician.  No one feels like going to the DMV, but they do it because they have to in order to reach the endpoint of getting a driver's license.  Residency isn't much different.  It's pretty much designed to be right at the cusp of tolerability.  If you make it a little better, there still wouldn't be many people who would really want to do it.  If you make it worse, many people would refuse.
 
2013-06-28 04:19:07 PM

Lexx: Jesus Christ, how does any medical professional make less than 20 bucks an hour?  That's 40k/yr!  farking receptionists make 35k+.


Well for starters, you could live in Alabama or one of the other fine, southern states where people think getting paid $9/hr is a goldmine.  But unless you have relatives or know someone outside the state, you can't really escape.  Man I hate Alabama.
 
2013-06-28 04:22:36 PM

Yes please: Wangiss: So you think residency is a job people take because they feel like it?  That's original, at least.

No, and I said nothing suggesting that.   People do residency because they have to in order to be a practicing physician.  No one feels like going to the DMV, but they do it because they have to in order to reach the endpoint of getting a driver's license.  Residency isn't much different. It's pretty much designed to be right at the cusp of tolerability.  If you make it a little better, there still wouldn't be many people who would really want to do it.  If you make it worse, many people would refuse.


Residency is not just another hoop you have to jump through to become a practicing physician - it IS the process of becoming a practicing physician, under the tutelage of more experienced physicians.

People are under the impression that it's some sort of hazing process which the medical fraternity imposes on its junior members, who are already perfectly competent by dint of their extensive medical school training.  After all, anybody can become an instant medical expert just by reading textbooks, a few journal articles, Wikipedia, and WebMD, right?  Just like those lazy-ass doctors are all PGA-level golfers from watching videos of Tiger Woods and reading golf magazines.
 
2013-06-28 04:55:16 PM
I'd rather watch paint dry than read through all the previous comments but--it seems that much of this discussion centers on pay.  Popular fields of medicine for Physicians these days involve medical procedures.  Colonoscopy, surgury, cardiac cath, radiology, pathology studies, etc.  The areas generally open to Nurse Practitioners don't typically involve procedures but are more restricted to medical diagnosis, prescription, and follow-up.  These are the non-procedural areas that Internal Medicine and General Medicine specialties are having a very hard time recruiting physicians to practice.  Reason:  Procedure heavy specialties make hella more money.  Last I checked (citation lacking) there was a huge nationwide shortage of Internal Medicine Physicians.  If physicians want to abandon a necessary specialty like Internal Medicine, they should not be at all surprised when NP's rise to fill the need.  NP's are asking for level reimbursement for functions like office visits, physical exam, patient teaching, follow-up, medical treatment, etc.  Enough NP's filling all the empty primary care slots will save much health care money even if reimbursement levels are equal.  Physicians are all pissy because they believe NP's can't practice medicine as well as they can or more importantly, shouldn't be paid the same for same work.  NP outcome measurements in many areas of chronic disease are as good or better than Physician care.  (Citation needed) Diabetes, Hypertension, and well-woman Gyn are areas I am aware of that NP's have better average outcomes than Physicans.  Personally, I've know and practiced with a thousand physicans and a few hundred NP's.  I'd happily place myself in the care of any of these people.  A few of the physicians would worry me some but I've never met an NP who wasn't very thorough, bright, and professional.  And, importantly, knew when to seek more information or another opinion.
 
2013-06-28 05:13:24 PM

Wangiss: drp:

"My NP prescribed the correct antibiotic" (I have no way of knowing)
"My NP is managing my kid's asthma optimally" (My kid seems to be doing OK, I guess)
"My NP is held to high educational standards (I have no idea what those standards are or how they differ from physician standards)
"My NP correctly assessed my chest pain as being benignly GI in origin and correctly sent me home with some Zantac instead of referring me for costly, painful, invasive testing with nonzero risk" (All I really know is my chest hurt and someone in a white coat did some stuff and said some things)

"My Doctor prescribed the correct antibiotic" (I have no way of knowing)
"My Doctor is managing my kid's asthma optimally" (My kid seems to be doing OK, I guess)
"My Doctor is held to high educational standards (I have no idea what those standards are or how they differ from physician standards)
"My Doctor correctly assessed my chest pain as being benignly GI in origin and correctly sent me home with some Zantac instead of referring me for costly, painful, invasive testing with nonzero risk" (All I really know is my chest hurt and someone in a white coat did some stuff and said some things) 

Perhaps the problem is that doctors have no way of letting us know why their voodoo is better.  Perhaps the fact that when they mess up we will never know until we die or successfully sue them is part of the problem.


This. The NP at least does referrals if its outside their expertise. But if the Doctor is unsure, they just try random things. The worst are imported Doctors, who either treat conditions that don't even exist or blame you for not responding to treatment for the wrong diagnosis.
 
2013-06-28 05:29:42 PM

Parthenogenetic: Yes please: Wangiss: So you think residency is a job people take because they feel like it?  That's original, at least.

No, and I said nothing suggesting that.   People do residency because they have to in order to be a practicing physician.  No one feels like going to the DMV, but they do it because they have to in order to reach the endpoint of getting a driver's license.  Residency isn't much different. It's pretty much designed to be right at the cusp of tolerability.  If you make it a little better, there still wouldn't be many people who would really want to do it.  If you make it worse, many people would refuse.

Residency is not just another hoop you have to jump through to become a practicing physician - it IS the process of becoming a practicing physician, under the tutelage of more experienced physicians.

People are under the impression that it's some sort of hazing process which the medical fraternity imposes on its junior members, who are already perfectly competent by dint of their extensive medical school training.  After all, anybody can become an instant medical expert just by reading textbooks, a few journal articles, Wikipedia, and WebMD, right?  Just like those lazy-ass doctors are all PGA-level golfers from watching videos of Tiger Woods and reading golf magazines.


I agree completely.  I wasn't arguing anything other than the point that people don't do residency because it's fun or something they want to do.  It's a step in the process, not a hoop to jump through.  There certainly arehhoops to jump through for no reason other than jumping through hoops, but that's not one of them.  Butif you make anything sufficiently unpleasant people will stop doing them despite their benefits.
 
2013-06-28 05:34:36 PM
The patients who don't speak Urdu or Hmong, that's who.
 
2013-06-28 05:52:54 PM
Asking a group known for their God Complexes to accept lessors into their ranks, and someone thought this could ever work out well? Nurses aren't any better, either, when they control patient destiny. Medical professionals protect their turf more than Alaskan politicians.
 
2013-06-28 07:31:27 PM

oldfarthenry: Soviet Canuckistan uses nurse practitioners (& triage nurses) in our emergencies wards.
It's great for obvious wounds/ailments (skate-blade slash to the face, 2-4 consumed too quickly, etc.).


Is 2-4 kinda like meth, but made out of maple syrup and WD-40?
 
2013-06-28 07:38:21 PM
I have terrible health insurance.  It reimburses at Medicare rates, so doctors aren't exactly lining up to enroll me as a new patient. I've nearly died a couple of times in the last few years due to waiting times (months) to get to see a doctor.  I use the ER as my primary care facility, because my insurance has to cover that.  It's a terrible waste of money, but once I am past the $2500 deductible, it's mainly the insurer's money.

I would be so happy to find a highly-qualified nurse who could see me within a week.  I think they could handle most of the small stuff, prescribe antibiotics, and might have the contacts to connect me with a doctor if they recognize that they are dealing with big stuff.

I don't know how people w/o medical insurance even begin to cope. From what I've read of the anecdotal evidence, most do not.
 
2013-06-28 10:09:52 PM

hardinparamedic: Bumblefark:
Meh...if you have expert knowledge about something, non-experts debating your subject matter shouldn't bother you in the slightest. If you can't persuade others to your point of view, then the problem is probably with you, not your audience.

/besides, even an expert can screw up his facts every once in a while, and get called on it by a non-expert.

People pontificating on a topic they have no idea about, and trying to scare laypeople from doing CPR when it is not only indicated, but the only hope for someone to have a quality life and good outcome by telling them that "doctors don't want CPR and you'll kill them anyway so why try" is not debating.

There is a difference between having an honest discussion and being a flagrant shiat that gives advice that harms people.


Well, it was more a shot at the sort of person that swings by a thread just to pat themselves on the back for being more knowledgeable than the average lay person on a subject (i.e., the original poster). But, for what it's worth: you might be taking the trolls a little too seriously. The average reader isn't a complete idiot -- they can usually distinguish who actually knows what they're talking about.

And, again, if they can't? That's a failure on the part of the (ostensible) expert, not the audience.
 
2013-06-29 10:03:34 PM
I'd rather see a doctor. Thank you.
 
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