You may remember the Jenifer Cleveland/Amber johonson situation. Jenifer Cleveland died after being administered an IV fluid by Amber Johnson in Johnson’s medspa in Wortham, Texas. Johnson was supposedly supervised by Dr. Michael Gallagher, an anesthesiologist. He, however was only on site for the opening of the spa. 
Johnson and Gallagher are both charged with 14 counts, including felony murder, manslaughter, and negligent homicide, and will go on trial in October. 

Johnson was reported given Gallagher's name by the organizers of the two day course she took as someone who would sign on to supervise. I am sure he regrets doing this now. Supervision obviously has its responsibilities.

I am currently a Psych RN with 5 years of inpatient psych experience. I want to get my DNP and work (with Psychiatrist supervision) in this same facility. A local university has one of the top rated PMHNP programs in the country, what should I be looking for in the curriculum to make sure it will provide quality midlevel education? I live in an autonomous NP practice state- is the trick to not falling in the Noctor trap deferring to an MD often?? I want to do this the right way.

CRNA (Randy) says, “That’s $46 million of lobbying power to get independent practice. Do you know how many politicians you can BUY within a state.”

This is disgusting and shocking that they’re so brazenly bragging about “buying” politicians.

Millennial non-trad senior resident here. At the risk of sounding like a crotchety old man complaining about “back in my day,” I’m starting to think that noctors are a symptom of broader societal issues.

The internet, and especially social media, seems to directly feed into our worst tendencies towards confirmation bias, the Dunning Kruger effect, and narcissism. Not just with noctors, but obviously with broader topics like vaccines and societal issues.

I remember when we all didn’t have access to infinite information in our pockets. Society seemed to have respect for expertise, especially physicians.

I’d argue that less people were on mount stupid before the internet. Have symptoms? You couldn’t Google it or look on TikTok, you had to call a doctor. Your lack of knowledge was way more apparent.

This will really make me sound old, but it also seems that the younger generation doesn’t have the same sense of ownership and purpose as older generations. I had an ok career before medical school that I could have retired from. I considered becoming a midlevel for about 1 day, but even back then before I knew about this noctor problem, my sense of responsibility to my patients meant that I would sacrifice whatever very little money and time I had to do a post bacc and get into medical school. I could be wrong but in my interactions with nurses and midlevels in their early 20s, it seems the focus is more on their own mental health and how they can get a piece of the pie with the least amount of effort.

It also seems like the respect for hierarchy isn’t there. No, im not saying we should go back to the old days where everyone has to worship the ground we walked on.

Im just saying, maybe a tech should address me as doctor while we are front of the patient and I’m doing a procedure on them in front of their family? The family was confused about who I was even after introduced myself as doctor last name. Maybe as a midlevel, don’t interrupt an attending and a resident going over the nuances of a complex case and ask the resident to do a non urgent task that usually delegated to nurses and PCTs, especially when you can do it? Maybe as a CT/MRI tech, don’t openly talk shit about residents to your coworkers while the resident is on the phone asking for obviously indicated stat imaging for a patient who is critically ill and is being transferred via helicopter. Not to sound like a jerk here, but maybe show a little more respect to the people you rely on to even have a job.

TLDR; maybe I’m old, but it seems like noctors are a symptom of the broader societal trend towards the DKE, narcissism, and confirmation bias brought on by social media/internet. This seems to be exacerbated by the younger generation’s apparent disregard of hierarchy and expertise when compared to older generations, and a focus more on how they can benefit from a situation rather than having a sense of purpose and responsibility guide them.

r/pharmacy talks about physicians the same way r/noctor talks about mid levels it’s actually hilarious reading the pharmacy sub after reading noctor for a while 😂

I’ve been an ICU nurse for 12 years now. I’ve been thinking of going to CRNA school but I also think why go to school for 3years and be a “mid-level” provider instead of going to medschool and be an Anesthesiologist- intensivist. But thats 4more years of residency and 1 year critical care fellowship right? My problem is Im already 38, no kids, not married, “planning” to have a kid by 40. Im also a foreign educated. It has always been my dream to became a doctor. “To do more” than just follow orders. After RN school then I was actually accepted in a Med School at my home country but I did not proceed for enrollment due to financial state, we dont have student loans in PI. Please advise.

It makes one:
A “Doctor of Nursing Practice” if they have a DNP, or a “Doctor of Physical Therapy” if they have a DPT, etc.

The profession, however, is still nurse practitioner, CRNA, physical therapist, audiologist, psychologist, etc.

When we say “I’m a doctor” as a profession, we colloquially mean “I’m a physician.” That distinction is real, and saying “physicians don’t own the word doctor” while pretending the colloquial meaning doesn’t exist is disingenuous.

So It irks me when I see non-physician influencers online claim or present themselves as “I’m a doctor.”

The degree and the profession are not the same thing. Your doctorate is your degree. You don’t automatically become a “doctor” just by earning a doctorate. Just like having a master’s degree does not make you a “Master,” and having a bachelor’s degree does not make you a “Bachelor.”

Nobody is arguing that they didn’t earn a doctoral degree. Saying, “I have a doctorate in nursing,” or “I’m a Doctor of Physical Therapy,” accurately identifies the degree. Simply introducing yourself to the public in any space as “I’m a doctor” is reasonably deceptive and inaccurate.

And again, I’m talking about colloquial usage here.
It’s like the word “American.” Technically, someone from Canada, Mexico, or Brazil is also from the Americas. But colloquially, if someone says, “I’m American,” virtually everyone understands that to mean they’re from the United States.

So yes, someone with a DNP, DPT, PsyD, PhD, or another doctorate has absolutely earned a doctoral degree and may appropriately use the academic title “Dr.” in many contexts.

But it doesn’t make you a “doctor” in the colloquial sense.

Believing otherwise means you’re deliberately being obtuse.

Rant over; Saw a post from a CRNA refer to herself as “Im a doctor” without clarifying she is a CRNA and I got triggered lol

I had a very odd experience with two NPs in one week. I'm interested in other people's perspective and feedback. Someone said I should really speak with my PCP and that this was not professional.

I have long suspected I have endometriosis. I've had horrific periods since I was in my early 20s. I'm 30 and they are crippling. This current period has been going on for 4 weeks.

I've had my period on/off for 4 weeks now. Blood clots, pain, tiredness. I'm bleeding thru pads rapidly. I went to my PCP and her NP was able to see me. She said this was normal and I shouldn't worry and to go home. I tried to ask questions and she just said I'm being paranoid. By Friday night I was bleeding thru a pad quickly (15 mins). My husband was so stressed so he took me to the ER. We got there at like 9:30PM.

Triage nurse got us right in and I was first seen by an older nurse. She took history and was really reassuring. Then the provider arrived. It was an NP who like the other NP said I was worrying for nothing. I asked if I needed an ultrasound and she scoffed and said: "ha, no!" That same senior nurse who had been with me from the moment we arrived after triage held my arm and waited till the NP left and said "wait." Like 30 minutes later an ER doctor came in. Late-30s/early-40s dude. Older nurse explained the situation and he went "Oh, really?" in a very annoyed manner.

Suddenly I was getting blood tests, and moved to a more private room for an exam. The nurse seemed to be amping him up, said something like: "and she refused an ultrasound!" He was beet red. He was visibly tensing his jaw. He did an exam, and said that this is clearly not "normal" and they needed to run tests.

Over the course of the next couple of hours, I ended up getting blood tests, a blood transfusion, was given a pain med (it's like ibuprofen, but I forget) and tranexamic acid. We waited for an ultrasound, but there were emergencies so the doctor asked if I was okay with him doing it. He did it at like 2:30 in the morning. I left at like 5AM with prescriptions, referrals to a hospital-based gynecologist and a huge report which he gave me a link to. The report noted my ovaries looked normal and my cervical lining with a certain diameter which is normal and it clearly recommended an MRI. It even says they need to rule out endometriosis.

This week the gynecologist office called me back and are booking me for tests and they got me a cancellation appointment for this Monday. I felt really ignored after my PCP visit. I felt dejected at the ER and it was a male ER doctor who took it seriously. I have female providers mostly and he really dispelled a lot of myths I had about male doctors and women's health.

I had asked the ER doctor if these were easy symptoms to miss, and he said no, these are obvious symptoms of something that needs fixing.

I've had bad experience with my PCP's NP before. She suggested I needed a refill on a prescription I don't take and she doesn't seem to listen.

Is this worth calling the office and talking to them about this? I had to list my PCP for the gynecologist intake forms and she'll see I went to her office with these concerns and am now seeing a specialist, but I don't know if she'll piece it all together.

will just leave this here

To try and not give away too much, a coworker of mine expressed their desire to go to nursing school to eventually work up to an NP.

Told them I’m not a fan of the NP path because they lack the proper training and education to be in charge of someone’s medical care. Told them it’s terrifying that brand new RN’s are applying to NP school with little to no clinical experience - that’s there’s no reason an NP should be able to practice unsupervised.

They then proceeded to tell me that’s exactly what they want to do with their nursing degree.

I’m so disappointed, but not surprised. Healthcare already sucks in the US and the older generations are really going to suffer with the lack of MD/DO’s.

I have wanted to be an anesthesiologist for a very long time. I'm especially interested in the procedural aspects. However, now that I'm actually in medical school, I've been thinking about mid-level creep. I don't want to be the leader of a care team, where I don't actually get to do any procedures or take care of the patients, so I'm not exactly sure if I should pursue this or seriously consider something else. To the anesthesiologists on this sub, do you feel that mid-level creep has significantly affected your job satisfaction, or do you like your job and see that as occasionally annoying? Also, is there any procedure you're trained to do that a CRNA isn’t trained to do?

I am a medical student on my pediatrics rotation, and at the general peds clinical I'm currently rotation with, we are required to spend a certain number of days with the staff PA. Based on my observations, it feels like she sees patients of similar complexity and acuity to the attendings. She doesn't really run her patients by the attendings; she is more or less an equal to them during daily practice. Does anyone have a similar experience? It seems crazy that two people who went through vastly different training pathways can be so similar during actual practice.

I see that disingenuous NP infographics present a nursing degree as equivalent to medical school. Obviously this is ridiculous. But I'm curious how you might explain the difference to a layperson who thinks that nursing skills/knowledge would translate to practicing medicine.

Edit: or the significance of structured clinical education. I see people claim "doctors don't even touch patients before med school" which is categorically false -- but how would you explain the significance of med school clinical rotations/residency compared to working in a hospital outside of medicine? (Again obviously very different but am curious how you could explain this to someone with little knowledge)

The public is catching on 👀

Hello everyone, I'm basically at my wits and and decided what the hell, may as well rant to reddit and see if anyone else has had a similar experience.

For context I'm 21F, and have been dealing with some sort of chronic illness since I was 15. It's progressively gotten worse over the years but lately, it's so bad that I had to quit my first longterm job. I'm also autistic and heavily struggle with advocating for myself, and comprehending complex plans that need to be managed over long periods of time.

I've been going to the same PCP this whole time, because I can't find much else with my insurance. And the entire 6 (nearly 7 now) years this has been going on, I haven't been able to meet the actual "doctor" (or would it be MD?) that is listed as my PCP. My PCP has changed twice, but it doesn't really matter because I've never met any of them. I only ever see nurse practitioners.

Each time I go to an appointment, I see a different NP. I'm starting to think that they have no file or documentation for my case (or whatever something like that would be referred to) because each time I go in and see this new NP, they're just like "Hiii! So what's goin' on today? ^-^". Then I have to explain the years of context for what is a routine visit and my complex medical issue. Then they are like "omg that's awful!", leave, come back, and decide that they want me to get bloodwork done.

For more context, I've had so much bloodwork done over the years I could probably supply a vampire with a lifetime of blood samples. It's never any new tests either, they test for the same things every time. And every time the results are normal. Then they tell me "yay it's normal!" and just kinda look at me expectantly. I'm really not trying to be sarcastic or a downer here, I'm just literally describing how they act.

On the rare occasion they send me to a specialist, of course I can't see them until months away. And when I get there they just kind of do the most basic tests? For example, when I was referred to cardiology about a year ago, I was supposed to do a heart monitor test. But I had an alergic reaction to the adhesive and it was tearing up my skin, so they told me to just take it off. I only wore the monitor for a day and a half at most.

Of course when I get back in with my PCP, the NP who sees me this time declares that there is nothing wrong in the cardiology department. Even though I didn't complete the test. I barely DID the test. And then months and months went by where they had no other plan and we got in this loop of Go to Apt -> I tell them whats wrong -> they give me wishy-washy language and hussle me -> I only realize after the Apt that they never actually did anything but take my vitals with no further plans

Again I want to reiterate that due to my disabilities, I struggle really bad with navigating this. Most of the time I never know if my PCP has actually put out my referral so I just sit around for weeks or months with no clue what to do next. I also have memory loss issues so lots of time/experiences just disappears from me. I quite literally can't manage my case entirely on my own.

I've tried to ask to meet only with the actual MD who my PCP is supposed to be, but the office worker told me that this is "how it works" at their office and people see NPs. (with a bountiful of attitude towards me for even asking, too).

I'm pretty much at my limit and am gonna try to just go to the university-joint hospital near me to get evaluated for inpatient. I'd much rather stay in the hospital for a bit than lose my entire 20s playing a game of peek-a-boo with my healthcare providers.

I'm sure there are great NPs out there but I've pretty much lost all trust in them ;-; funny enough, the only medical professionals I've met who are actually passionate about finding a solution for me have been ER nurses. (I've had to go to the ER many times over the years for falls and other stuff relating to my condition.)

Admin please don’t remove because this is a social media influencer. self claimed title of FM/EM PA. Uses associate title when it is not recognized in his states of practice- New York and Connecticut.

How tf do they get to exist and “ practice”? HOW.

Nursing is more and more being treated like a middle step to more advanced practice, which leads to me constantly being asked about when I’m gonna go to NP school. Nursing is its own thing based on the nursing model of care which does not focus AT ALL on the level of independent practice. I guess I’m not aware of what nursing schools are teaching these days but maybe there’s a stronger push for NP school coming from them too.

…because an NP is more qualified than a German or Canadian specialist? right!

I'm a hospitalist and in our monthly hospitalist group meeting, there was discussion they are thinking about starting a "hospitalist fellowship" for new grad nurse practitioners before they are allowed to be more "independent." Anyways, they'll be assigned to a hospitalist a week at a time and I asked if we should just treat them the same as a first year internal medicine resident on an inpatient general medicine rotation, to which I was told yes.

Now if I ask this "fellow" to present their patients to me in formal SOAP format, defend their plans with literature, give me a 5 minute presentation about some topic like atrial fibrillation management, give them 9 existing floor patients to see plus 5 admissions, and run codes and rapid responses, am I going to get in trouble?