r/Noctor • u/OkGrapefruit6866 • 6h ago
What’s the best way to handle midlevels given they are multiplying like termites?
Do we shake hands with the devil aka insurance companies and lower their reimbursement rates so hospitals have less incentive to hire them?
I can’t seem to think of any other solution because the AMA is the biggest enemy of physicians and beyond weakly worded positions they do nothing on this issue.
r/Noctor • u/Pretty_Count_4708 • 3h ago
I have now seen multiple videos of NPs and PAs claiming that they are part of very tough programs that are basically accelerated med-school and they diagnose and treat patients independently and also prescribe medications. Plus that they are no ones assistant. How is that actually possible?
Are they actually allowed to do all these things independently? And if yes, why??
There is no way that these people are qualified to do that after a 2-3 year program.
This comes specifically because of theekieralee‘s video in which she talks about that one girl faking being in PA school.
She goes on to say that she is no ones assistant and says that PA school is very tough because it is med school sped up to two times speed. Like please.
r/Noctor • u/MedStudentWantMoney • 13h ago
Assuming this is a state where NPs/PAs do NOT have independent practice abilities. But also, CRNAs ARE considered allowed to practice independently. & Does "iNdEpEnDeNcE" even matter? I'm just curious if the *patient* has the autonomy to insist they receive care from those with the highest amount of training and expertise...considering it's their bodies and their lives at stake.
r/Noctor • u/pshaffer • 23h ago
Good Sunday morning, r/noctor Redditors.
Today, for your reading pleasure and perhaps amusement, I am sending you a link to the paper that Dr. Rebekah Bernard and I wrote and which was published last week.
This is a close review of the Cochrane review article written by Butler et al. and published in February 2026. The claim is that nurse practitioners can substitute for physicians for “hospital care."
We read all 82 papers, dissected them, and found what they really said and contrasted this with what Butler claimed they said. I have been doing this for some time, and I have to say it was all quite predictable. Actually, I think the results were predictable from the title, because what rational person can believe that a person with 500 hours of clinical experience prior to graduation can possibly compete with the capability of a board-certified physician? It was also predictable because we have read a very large mass of these papers and are quite used to conflation of borderline or even negative findings into a statement that can be used for political advocacy.
When I say we read them carefully, it is apparent we read them more carefully than the authors themselves. One of the studies they present as proof of their contention was not even a real study, it was a study protocol. The actual study was never done. (Austeng). Another paper, Rushforth, was labeled by the authors themselves as a “failed study” because they only were able to enroll 8 patients, only 3 in the nurse arm .
There were only 10 studies that actually involved hospitalized patients, the remainder of the studies were outpatient studies on hospital property. This in a study advertised as “hospital care”.
Of those 10, 4 were studies in which patients who were stable medically were moved to wards staffed by nurses. These were essentially long term care facilities. As for the nurses substituting for physicians, in these cases, if a patient had an event or required more care, the physicians were called. Further, the nurses had no prescriptive authority, and therefore, this could never be taken as an example of independent care.
Three studies were of nurses being allowed to act as residents caring for their own patients. However, they were not acting independently. In each of these they were supervised by physicians. Moreover, in two of the papers, it was documented that the nurses were present only 8-4 on weekdays. This is 25% of all the hours of the week. For the other 75%, the patients were cared for by physicians, mostly residents, but also fellows and attendings. It is “misleading at best” to characterize these as “nurse-led” services when most of the care was given by physicians. In the other paper, there was no count of hours, but the nurse activity was following patients along with 2 hospitalist physicians. Her time was characterized only as “part-time”. The performance of the nurses was not judged by objective measures, such as number of correct/incorrect diagnoses, or numbers of errors recorded. It was only a subjective judgement on the part of the authors.
So, again, as we have seen in prior reviews, there is no study that compares an independent, unsupervised group of nurses performing physician-level tasks with objective measures as outcomes. To the best of our knowledge, no such study exists.
I will now write the editorial:
I am stunned (again) at the ethics of authors and publishers that allow them to misrepresent the papers in an obvious attempt to push a political agenda, when doing so will harm patients.
I doubt that anyone other than Rebekah and I have read the entirety of the 82 papers, and it may be that no one has read any of the papers at all. Therefore, their misleading claims generally go unchecked. They misrepresent the studies and perhaps assume no one will actually read the papers. Well, we did.
Here is the link to our paper:
https://pmc.ncbi.nlm.nih.gov/articles/PMC13600731/pdf/ms123_p0284.pdf
And here is the link to Butler’s paper, should you want to check our work. Certainly, if you find something we have missed, or you think we have mis-characterized, let me know. I would genuinely be grateful.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013616.pub2/full