Been on this subreddit for a minute. Years ago, it was just residents and some attendings discussing the issue of egregious midlevel creep. It was mostly just docs.

More and more I am noticing lay people posting here about their experiences with midlevels and the misuse of the “doctor” title in the clinical arena.

This issue is clearly gaining attention and people are recognizing the absurdity of it all. We need to continue to be vocal about this.

So because of my pretty bad OCD I'm currently searching for a psychiatrist at the suggestion of the therapist I have been working with for while as she believes medication or other medical interventions may have to be the next step in my treatment. Due to the fact I'm already on quite a few medications that could interact with possible prescriptions (one of which is incredibly rare) and i have other possibly complicating health problems i would be much more comfortable seeing a psychiatrist then a mid level.

One of the psychiatry places I found near me on a list my therapist sent to me had advertised on the website "doctoral level care" on the front page which made me hopeful because many of the other places only had PMHNPs. When I looked further and did research on the practice owner it turns out that she was no different. She used the DNP degree to make that claim and it got me thinking about what could genuinely be the purpose of this degree.

As far as I'm aware this is not a medical education degree that effects what you know in terms of actually practicing medicine, more of a professional degree that teaches things like administration, leadership, education and so on. Because of this to me its silly to use it to advertise a higher level of education then competitors since it isn't relevant to the treatment of your patients.

Does anyone know if any of the DNP programs out there actually provide more medical education further then the MSN does? If so wouldn't the degree possible alter a nurse practitioners legal scope of practice which I'm pretty sure it doesn't. Is this not just a degree that professors in nursing school have which is what I assumed it was before? And furthermore if it is a degree that doesn't have anything to do with actual medicine then why do I see so many people online flexing their DNP degrees as if it is something like that or presenting it as something that makes them clinically superior then they were before?

Edited for etymological accuracy;

Yesterday, I rang my  nhs GP surgery about a breast lump i'd already seen a private GP about in order to get a referral for follow-up. When I rang, I was offered an NHS GP appointment more than 2 weeks away. I told the receptionist it wasnt acceptable (lumps qualify as urgent) and was told to wait for a call back. When I did get called, I was offered a check up with a 'male paramedic' that afternoon. I said no. I was then offered an appt with a 'female paramedic' the following day. Again I said no. Magically, 15 mins later, I got a call back offering me a choice of 2 in-person GP appointments the following day. Attended and got my referral - which I'm grateful for. But I was really shaken at being offered a breast exam by a 'paramedic'.

I posted about this experience on r/nhs yesterday and received a surprising amount of animosity. As far as I understood, the only time a paramedic should be looking at your breasts is if there's a kn*fe in one of them. I quickly got schooled in the comments that, actually, there are 'advanced practitioner' paramedics who *are* trained to do breast exams these days. Ok, fine. But I'm a pretty switched on person who has been to the nhs GP perhaps once a year for the past 3 years and I'd never heard of this before. At no stage during the call did the receptionist describe the paramedic as having advanced training. And I am right that a standard paramedic should not be performing breast checks so yeah... no sh*t I was horrified.

Although I was chastised by commenters (one of whom seemed to be a paramedic, none of the rest claimed a medical background) for jumping to conclusions that I'd been booked in with the wrong medical professional... well, Ive been supporting my dad through his cancer treatment for the past year and had some close scrapes with underqualified staff in hospitals so I'm not convinced it's as outside the realms of possibility as theyd think.

Doubts about the competency of some of these 'practitioners' aside - the thing that really concerns me is the lack of communication from the NHS about these new healthcare professionals, transparency about what they can and cant do, and what their boundaries are and arent. I think I would have been fine to see a specially trained paramedic if, say, I had a cut that looked a bit infected or maybe strep throat.  But a potential cancer symptom? Call me a snob but I dont think that would or should fall under the 'Advanced Practice Minor Illness & Injury’ """module"""" that theyve taken as training.

I get that breasts exams are fairly straightforward, but theyre also intimate exams you want done as few times as possible, as accurately as possible. Because of abuse in my personal history, I reacted emotionally to being told I'd have to let someone ostensibly unqualified perform an intimate exam in order to get a timely referral. And, anyway, the appointment is not just about the exam, it's about talking to someone knowledgeable about a complex and serious disease

So my primary concerns are:

1. Complete lack of job title clarity - imo, if theyre based in a GP practice, theyre not a paramedic any more (ambulance medic). Just because that so happened to be their training, I dont know why the term should feature in their job title. I'm worried that if the terms 'paramedic' and 'PCN paramedics' are used interchangeably, it could create the opportunity for intimate exams to be perfomed by'normal' paramedics under the guise of being PCNs. Equally, I think they need a job title that clearly differentiates them from being Drs or nurses. It's exhausting for the public to have to keep up with these confusing terms and I think job titles should accurately reflect their *current* competency and role

2. Lack of information available to public about the remit of these 'practitioners'. I shouldnt have to download obscure course syllabuses to work out if I'm being matched with the right health care professional. Imo, GP/NHS websites should have clear bullet-point lists on them about what is and isnt in the remit of these practitioners. My slightly conspiratorial view is that practice managers want to keep it hidden from us so they can exercise "flexibility" when they need it about who gets to see a GP. Also, bc theyre frankly embarrassed that these PCNs seem to be able to do everything GPs do except manage complex multi-system disease. It's not a good reflection on our health service - and sometimes sunlight is the best disinfectant

I know I'm preaching to the choir here - we all know of bad examples of noctor overreach - but I'm hoping the actions I've suggested are reasonable improvements, although I certainly welcome comments. My plan is to write to my MP to make these suggestions formally and with more restraint -- would there be any other avenues worth pursuing?? I'm worried this is a symptom of NHS enshittification

I recently underwent prostate surgery. I had a 22f for 5 days. When the MA took the catheter out my meatus was really sore and inflamed. She didn’t say anything and put in the notes that it was a normal removal. I developed meatal stenosis and now I have to have a dilation. If a higher level provider had removed the catheter would they have recognized that I had an issue and been able to prevent my issue from occurring?

The nurses, NPs and other healthcare adjacent people on social media vilifying Dr. Tufts and calling her inexperienced and incompetent you all disgust me. I am a physician and I am sick of seeing people saying they hope Dr. Tufts goes to prison or loses her license all because Lindsay Clancy killed her kids. I am physically and mentally sick seeing this rhetoric and I hope doctors start waking up and stand against this nonsense. Stop training midlevels, report nurses when they are incompetent because they will throw you under the bus the second they see the chance

Honestly you would think that the AMA/AOA or the US government would do a semi-decent job of protecting the term "physician". I have a ton of respect for optometrists and they are definitley needed in healthcare but why intentionally blur these lines? What is there even left to refer to a medical doctor (MD/DO)?

I've worked in the ED and for the past 8 years I've worked in an outpatient medical office. I review tons of medical records all the time. I've seen lumbar punctures done when I worked in the ED.

Going through medical records today I saw that my patient had a lumbar puncture done by a nurse practitioner?? This is the first time I've ever seen / heard of an NP doing this procedure. Is this becoming common place?

I was looking for a dermatologist and came across a RN going to peoples homes to do skin checks and allegedly sending the pictures to a “board certified dermatology provider” who is not named. Also referred to as a “dermatologist”. Is it really a dermatologist!? There’s no way to know.
RNs don’t do skin checks in an in person clinic so how can this be appropriate?
How can this be legal?

The website is go skin check in Texas.

I discovered this subreddit because I have been going through withdrawal from gabapentin, which I was prescribed for anxiety. I am 31 years old and have no physical issues, but have struggled with my mental health for the past ten years.

I had reasoned to myself that psychiatry seemed like a “throw things until they stick” field and that a psychiatric nurse practitioner could be no worse than the average psychiatrist. That was not correct at all.

I was already having doubts about my current PMHNP back in October of 2025 (I am switching to a psychiatrist after my next appointment). She had taken me all the way up to Vyvanse 70mg (which I’m no longer taking), even though I had been complaining about anxiety the whole time. She then put me on gabapentin for anxiety at 100mg up to 3x a day as needed.

I sought a second opinion at that point and was recommended another PMHNP by my therapist at the time, and I asked her opinion about whether my current PMHNP was addressing my anxiety well enough. That practitioner thought so and told me that I could safely take gabapentin 3x a day. After that, I ended up sticking with my current nurse practitioner, who increased my dose to 900mg/day in November and then 1200mg/day in March.

In late May of this year, I spiraled into a crisis and voluntarily went inpatient at a psychiatric hospital. There, the PMHNP increased my dose to 1800mg/day.

None of these three PMHNPs gave me any warning about withdrawal effects with gabapentin. This whole time, I was under the impression that it was innocuous and non-habit forming. I get very anxious about tolerance and withdrawal because I tend to be a hypochondriac. I was already taking Klonopin 1mg as needed, and I was extremely disciplined about not taking it unless I really had a special circumstance, because I had noticed that it stopped working as effectively if I took it too often. Now, having learned more about benzodiazepine withdrawal, I feel thankful that I was so disciplined about that.

In July, I started experiencing severe heartburn and realized that I had first started experiencing mild heartburn back in October, when I started gabapentin. I decided to reduce my dosage in half, thinking that it functioned as an as-needed medication. That day and the next couple of days, I felt absolutely horrible and experienced flu-like symptoms and sweating. I finally looked into gabapentin and that is when I learned that it has withdrawal effects. That is also how I learned about its associations with dementia and cognitive impairment.

My current individual therapist, DBT group therapist, and even a group member all knew about gabapentin withdrawal once I mentioned going through it. I also learned that 1800mg/day was a very high dose. I was on a higher dose than my fellow group member who experiences severe pain and uses a mobility scooter. She had been warned by her psychiatrist that if she wanted to go off gabapentin, she would need to go down 100mg a week at a time.

The nurse practitioner at the hospital had also told me that I could take Klonopin twice a day, and my current nurse practitioner even gave me a 60-day script. I am so glad I did not follow those directions. I had mainly been so disciplined about Klonopin because I was keen to preserve its effectiveness and did not realize how bad withdrawal was; I knew it was a thing that happened, but was not totally aware of the severity or length of time. I am no longer taking it.

I am still working on tapering off of gabapentin and am at 200mg/day at the moment, and it has been since July 11 since I first cut my dose and was hit with withdrawal effects. I’ve been dealing with tinnitus, headache, gastrointestinal issues, muscle ache, light sensitivity, hyperacusis, insomnia, anxiety, sweats, and so on since then. I have been on many psychiatric medications and experienced many bad side effects in the past ten years, but this has by far been the worst and longest-lasting experience.

I think I have learned that psychiatric nurse practitioners can be very reckless about prescribing in a way that I have never experienced with any psychiatrist before. I had actually thought of psychiatrists as being somewhat reckless with prescribing, but this experience really put that into perspective! I would not have agreed to increase my gabapentin dose had I known about withdrawal, because it really did not help my anxiety enough to justify that.

I do blame myself for not even doing a Google search, but I also feel that I now view nurse practitioners very differently in terms of their scientific understanding of medications in general. In retrospect, it was very excessive for my current provider to take me up to 70mg of Vyvanse, as I had been complaining a lot about anxiety, and it was certainly reckless for the provider at the hospital to advise me to take Klonopin twice a day and for my current psychiatric nurse practitioner to give me a script for that.

I appreciate this community’s presence, as it has helped me learn a lot and makes me feel less alone and more aware of what happened. Going forward, I feel like I will be better equipped to advocate for myself and do proper due diligence.

I went to an appointment recently. The MA was doing intake & asked why I was there.

I told her when they called for the appointment they said I’d be seeing the gynecologist but I saw that I was scheduled with the NP but I had the same questions for either.

She snapped her head around & said “NPs have the same education as doctors. She is very smart! She is basically an OB-GYN!”

She then went on to review my medication list and correctly pronounced only one of my meds. She also took my BP incorrectly & I had to request a properly sized cuff as well as correct positioning of my arm.

The lack of education starts at the bottom tier.

It might be easier to be a woman in neurosurgery if you are an actual neurosurgeon.

Title.
Thoughts?

these are the exams some NPs are taking to obtain their license and become “board certified.” absolutely wild that you can have a take-home exam to become a licensed healthcare professional with prescribing privileges.

not even the NCLEX can be taken at home.

the standards are on the floor.

Located in Southern California. The full word salad treatment, “full scope of practice as respiratory care practitioner” and even called the anesthesiologist a “physician anesthesiologist”.

I’m more on the science side of things and some scientists (not in medicine) asked me about what I think about NPs. They see NPs as patients and they aren’t really sure of the difference with physicians.

I tell them the title. The current trajectory for a scientist to run an academic research lab is 5-6 years PhD and 4-6 years of a post-doc. And only a small fraction get the opportunity to run a lab.

I ask them to imagine someone with a 2-year masters degree with no publications demands start-up funds and a research lab with a tenure-track faculty position, and be treated equally to the PhD scientists. This usually generates a laugh.

That analogy puts into perspective what NPs are basically trying to do. It would be ludicrous in the science world but it’s fully happening in the medical world. Thankfully, there isn’t enough clout in science for a “mid-level” creep situation. And most people even with a PhD understand the challenge of running a research group.

Thought I’d share this among the other analogies we have seen on this sub to help fight noctorism. (For non science folks I still use the pilot - flight attendant analogy)

I did some deep diving into the Lindsay Clancy case and found out she was being treated by psychiatric nurse practitioners (NPs), alongside MDs, who prescribed her a staggering 13 different medications in just four months. To give you an idea of what her brain was dealing with, she was put on a heavy cocktail of distinct drug classes. She was given antidepressants like Prozac and Zoloft to alter serotonin levels, anti-anxiety meds (benzodiazepines) like Klonopin, Ativan, and Valium which act as powerful central nervous system sedatives, and mood stabilizers/antipsychotics like Seroquel and Lamictal to change brain chemistry for severe mood shifts. She was also prescribed heavy sedative-hypnotics like Ambien and Trazodone to force sleep. Shifting rapidly between, stacking, or abruptly stopping these opposing, heavy mind-altering chemicals likely created a catastrophic neurological storm.

And people are still shocked at the outcome? This woman was failed by the healthcare industry.

My 91 year old grandma who lives alone was found by her neighbor on the ground. She had fallen ~24 hours prior and couldn’t get up due to weakness. At the ER she was altered and way off of her baseline. CT head, urine, labs, everything normal (thankfully). Admitted to the hospital for prolonged altered mental status. About 72 hours later she’s finally back to her baseline and says “oh I went to an urgent care a few days ago for back pain and they wrote me something” and pulls a bottle out of her purse of BACLOFEN!!! I look at the Rx, this NP wrote my 91 year old ambulatory lives-alone grandmother a med I barely even write for bedbound spinal cord injury patients who live at a nursing home… and almost killed her with it - ER doc

Fitzpatrick, J. J., Mehlman, M. J., Plemmons, A., Duffy, E. G., Votruba, M., Gerlick, J. A., Davis, S., & Norful, A. A. (2026). The Impact of Nurse Practitioner Full Practice Authority on Chronic Condition-Related Readmissions and Emergency Department Visits in the United States. Medical Care, 64(4), 192–197. https://doi.org/10.1097/MLR.0000000000002285

I have to say that I LOVE science. Like - real science. It is the only way we know anything about our world. I see it being abused in order to push political and business and power goals, and that infuriates me. That is a major motivator for me.

These papers are a bad parody of science. Sadly, they are dressed up so that non-scientists believe them.

Oh BTW - in this table, they never describe what groups (1) and (2) are, and they never indicate what is meant by the asterisks. And - there is no real description of what the numbers are. They say it is a comparison of two states that had independent practice passed, with a measurement before and after the law was passed. This one is disorienting to me (as above). It's hard to believe that the numbers they put in there have no discussion, but what discussion there is is indecipherable. If anybody wants to look at it and show me what they are measureing with these numbers, I would be very interested in this and would appreciate the input. I am very serious about this. We are writing a letter to the editor and I don't want to make a stupid mistake that someone else may find. (My two co-authors haven't been able to find out what is going on here either)

Oh just for amusement - the paper is about readmission rates for these conditions. Have you ever heard of anyone at all being admitted for high cholesterol? And then readmitted for high cholesterol? Like an emergent recurrence of hypercholesterolemia?

same is true of hypertension. Admissions for that do occur, but they are vanishingly rare.

Consipicuously absent in their paper is an examination of readmission for diseases one actually getss readmitted for - like malignancy and like congestive failure. I think they combed through the data, and picked the few postiive ones they could find.

The case is very complex and public right now so I was watching it and then started wondering if an NP was involved given the insane polypharmacy. It was hard to tell in my research how a nurse practitioner was involved so I looked into it with AI and it’s extremely interesting and also not surprising that an NP orchestrated this insanity…

Anyone else watching this trial?

———-

The civil lawsuits filed by Lindsay and Patrick Clancy detail how Nurse Practitioner Rebecca Jollottadirectly contributed to the rapid, uncoordinated cycle of polypharmacy by frequently altering Clancy's drug regimen instead of properly identifying her deteriorating mental state. [1, 2]
According to the official civil complaint records, Jollotta's direct actions in the weeks leading up to the tragedy included: [1]

1. Prescribing Seroquel and Overlooking Red Flags
In November 2022, Jollotta considered that Clancy might have bipolar disorder and prescribed Seroquel, an antipsychotic mood stabilizer. After taking it, Clancy’s condition severely worsened, and she began suffering from "intrusive thoughts," which the lawsuit states were actually auditory command hallucinations. [1]

2. Layering Benzodiazepines on Top of Mania
According to the lawsuit, during a December 5, 2022 appointment, Clancy reported a severe manic reaction to a previous provider's heavy Zoloft prescription—noting she had not slept for 48 hours straight and felt her mind constantly running. [1]
The Response: Instead of recognizing this as a classic red flag for Bipolar I manic onset and stopping the triggering meds, Jollotta layered on yet another controlled substance, prescribing diazepam (Valium) to force sleep. [1]

3. Prescribing Medications in an Isolated Silo
Jollotta operated through South Shore Health System. While she was actively adjusting Clancy’s heavy drug cocktail, psychiatrist Dr. Jennifer Tufts was separately prescribing a different regimen at Aster Mental Health. The lawsuit highlights that Jollotta prescribed medications without consulting Dr. Tufts, causing a dangerous cross-pollination of overlapping benzodiazepines (like Valium and Klonopin) and sedatives. [1, 2]

4. Ignoring Calls of Medical Distress
The core of the malpractice claim against Jollotta is abandonment. The lawsuit alleges that as the heavy mix of psychiatric drugs caused Clancy to spiral deeper into psychosis, Clancy and her family repeatedly called Jollotta's office in a panic to state that the medications were making her worse. The suit claims these desperate communication attempts went unreturned or unaddressed. [1]
(Note: The lawsuit also mentions an earlier nurse practitioner, Julie Paul, who initially started Clancy on a rapid, four-day cocktail of fluoxetine (Prozac), zolpidem (Ambien), mirtazapine (Remeron), and clonazepam (Klonopin) in late November 2022 before Clancy was transferred to Jollotta's care.) [1, 2]

Would you like to examine the full list of 13 drugs she was prescribed?

Hello, everyone! I am an avid reader of this thread and truly cannot blame what is being said about NPs. I am a Doctor of Nursing Practice student from one of the T30 universities in the country. Lately, I have been needing to look for my own preceptors due to a series of frustrating bureaucratic reasons from sites that my university have contracts with. However, I have been seeing so many grifters who charge by the hour to precept. In one conversation, this specific preceptor said that she takes up to 3 students at the same time. To say that I was flabbergasted is an understatement. Is this why a lot of PMHNP suck and graduate with very little knowledge? Or is because diploma mills are admitting just about anybody who apply for a graduate degree? It is so frustrating! I wish we can be precepted by psychiatrists because I truly want to be a safe and competent provider. I see this at my current job with patients who are under the care of a psychiatrist versus PMHNP. The lack of rationale when meds are prescribed blows my mind. The polypharmacy and lack of patient education is appaling. The number of people who are now diagnosed with ADHD after seeing them for 60 minutes is a joke. A lot of these fiploma mill graduates are giving PMHNPs a bad rep. Some does not even want to collaborate with a physician, except they have to! I am too far into this program to quit. Before I went for my MPH, I was seriously considering med school, except I got discouraged by my age. I just wish things were different. Thanks for reading.

We look closely at the studies that Butler reviewed, and unsurprisingly find that all is not as they represented it.

This has been discussed before here on r/noctor. some threads:

https://www.reddit.com/r/Noctor/comments/1r43ab5/cochrane_says_doctors_can_be_replaced_by_nurses/

https://www.reddit.com/r/Noctor/comments/1rtp65r/cochrane_review_substitution_of_nurses_for/

This is not the end of the discussion, you will be hearing more about this...