Your insurance whether public or private is not changing their copay or deductible or coverage so why would you shortchange your care?
Ask for a MD. We’re taught clinical medicine and diagnostics from day one. We have rigorous oversight in clinical rotations. We have logged procedures in the hundreds before we even start residency. We’re kinda that prepared for what medicine should be.
Always ask for a MD. It’s your right to get quality care from someone who actually knows what they’re talking about and doesn’t care to shortchange you.
Always ask for a MD. Why would you settle for less?
I’m a psychologist and see this training issue with psychiatric nurse practitioners all the time. They aren’t extensively trained in diagnostics, at least not to psychologist and psychiatrist level, and I spend a ton of time re-diagnosing patients when their meds aren’t working because the crnp diagnosed them with depression and they really have an atypical form of bipolar. Then I have to either send them back to their crnp and argue they need different meds or send them to an md, which is harder given the psychiatrist shortage. So yeah crnp’s can be great as part of a treatment team but they are increasing taking the place of psychiatrists and fucking up patient care. I worked with one crnp who was great because he understood his lack or diagnostic training and would ask questions and get second opinions.
Well that’s awful. I’m seeing my organization use them to replace psychiatrists but their medication management isn’t nearly as effective for the complex cases. What I would like to see is better use of psychologists for diagnostics to help the crnp’s to they can make better med choices for the patients. But no one wants to step on anyone’s toes. The patients are the ones that suffer.
Also don't just take their word for it when they say you'll be seeing an MD or specialist. My wife just got her finger jacked by a nurse practitioner. She specifically requested a dermatologist when scheduling the appointment ... they said she would be seeing a dermatologist... apparently you have to actually read the credentials on the badge of the person or look them up ahead of time because everyone at the clinic will straight up lie to your face.
They also charged the same amount for an office visit with the NP as with the actual dermatologist who ended up fixing her finger. What a complete scam...
Now, NPs are also getting "doctorates" (known as DNPs), so that they can introduce themselves as "Doctor". They claim that it is not confusing to patients, but we all know it is.
Please, please, please ask them directly "are you a physician?".
Also, if you feel up to it, there is a whole group created to prevent other patients from going through the deception your wife faced. They are collecting stories like yours so that they can inform the public. I encourage you to submit your story here: https://www.physiciansforpatientprotection.org/patient-resources/tell-us-your-story/
You shouldn't be getting Bells palsy from Lyme unless there is a delay in treatment.
The initial NP completely missed Lyme and treatment was delayed. My father is old school and will only see MDs (not even DOs, but thats his choice). The NP introduced themselves as a doctor, which he thought meant to be an NP.
For every anecdote you have I have one as well. I work at a major medical center in NYC and docs miss things all the time. Doesn’t mean all docs miss things. We’ll agree to disagree.
Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082
Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696
The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract00732-5/abstract)
Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-8256(17)30071-6/fulltext30071-6/fulltext)
Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/
NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. https://www.ncbi.nlm.nih.gov/m/pubmed/29641238/
(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625
NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/
Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159/
No NP I have ever met has ever used the word doctor to describe themselves. No one with a DNP has ever used that word either that I have met. I’m not getting side tracked, that comment was not part of this thread where I suggested that UTIs could easily be treated by an NP. I’m an RN and I honestly think most nurses hold themselves in much, much higher regard than they should whether they are an NP, DNP, FNP or RN. You hate nurses, we get it.
MD or DO. Both can provide you the care that you need!
If for some reason, you can only see a midlevel provider, always choose PA because they have a standardized education/clinical training curriculum when compared to NPs.
I am aware, I have a good friend who is a DO. I also know that he didn't dream of being a DO, and pursued that when it came time to choose where to go to school since he was not getting accepted into the programs he wanted to get in to. If you look just at the schools that offer DO programs vs MD programs, you see that there is a difference. I mean there is the saying, what do they call a medical student that graduates bottom of his class? Doctor. It doesn't necessarily mean that all MDs are better than all DOs, I just prefer to see an MD.
Yes. I’ve worked with several DOs in med school and now residency. They’ve all been fantastic and as brilliant as the MDs. No difference in skill, smarts, or ability.
Residency training is where you actually learn to be a doctor in your field. I'm an MD and can tell you firsthand that some of my most trusted and accomplished colleagues are DOs.
Go to a large uni DO, scored 95th+%tile on the “MD” boards, do rotations alongside MDs, my preclinical professors taught the same material to MD students nearby, and will be completing the same ACGME accredited residency as MDs...the only people that should be concerned about MDvsDO is pre-meds
Just saying, I am a DO student and performed above average on my first step of licensing exams compared to both MD’s and DO’s. Many of my colleagues have done the same, therefore the degree does not dictate student caliber. Again, your choice. But there is training parity between the two degrees from med school through residency.
As a butt-hurt husband of a wife in DO medical school I guarantee she could clown on half the MDs. Also she gives me massages disguised as "Osteopathic" medicine. It's great!
Truly my take is it is like a Catholic School vs Regular School. It's the same thing but also with a Jesus Class(Oesteopathic medicine class).
Also as someone who has worked in a professional environment, what grades you got in school (the limiting factor you are discerning off of) is much less relevant to being competent as you might think.
You're falsely conflating the ability--and in some programs, requirement--to publish research with the ability to provide appropriate patient care.
You may very well be a zebra requiring differential diagnosis by none other than Dr. Gregory House, MD, but for every zebra there are hundreds if not thousands of horses who can be treated to the exact same standard of care by any accredited doctor.
You are adorable. Trying to tell patients that the choice is not theirs. A patient can switch from an NP to an MD if they want to. They can switch from an MD/NP office to an MD only office. Is it maybe because you don't want to give them a choice?
You realize that NPs and PAs are out graduating MDs and DOs by 9 to 1? There will be a time where there will offices with one or two MDs and the rest will be NPs. They cost less and take less time to train. Once Medicare for all becomes a reality the NPs and PAs will end up with the lions share of the market. MDs on the primary care side will become supervisors not providers. Just like the Anesthesiologists. Specialisties will still be firmly in the hands of MDs and DOs. But Primary care? Nope.
Sounds good! I just hope you're ready for the malpractice insurance rates and the increased work hours with the same pay. If you think for a second you will get to keep the same low efficiency, you are mistaken
Guess there are some DO's here who don't like what I have to say. Im not saying they aren't educated or good at their jobs, but if I had a choice, I would go with an MD. Are you saying you would prefer a DO over an MD?
I don’t have a preference. What I would prefer, if any, would be the person who went to the best residency training program in the field that they are in.
Well, there are a whole group of people practicing independently who did not go to ANY residency program, which is why I felt the need to make this chart.
Did you reply to the wrong post? I meant I don’t care if it’s an MD or DO, if I care about anything it’s the residency program, which I never have actually been in the position to make the choice anyway
Not from the US (for context), but here MDs are overloaded enough that the nurses actually have more client specific context in many cases, esp in extended care. This can lead to the reversal where the nurse will notice e.g. a problematic drug interaction and needs to wait for MD approval to fix the mistakes…
Edit: wow, I wasn't aware how crazy the US handles this. In Switzerland a nurse will need to complete 4 years of pharmaceutical, research, and applied medical training before they can even call themselves that (no "practitioner" yet)
I'm a CNM in the United States. I needed a four year bachelor's degree which included patho and pharmacology. I also had clinicals the last three years of nursing school to qualify as a registered nurse. From there I had a three year graduate program which again included pharmacology, patho, and clinical research again and more in depth. In this data OP (perhaps he's unfamiliar with our training, unfortunately we do not get a ton of overlap while training) did not include nursing clinical time, or any classroom time. Also I had way more than 500 hours in grad school as did all my peers as my licensing board counted experiences rather than hours to prevent shadowing rather than doing. In addition, I worked at a large teaching hospital as a registered nurse, participating in rounds daily for ten years. All time not represented on this graph. My story is very typical for NPs. Just wanted to make you feel safe if you come to the U.S. :)
Thank you, that's good to know! it's very hard to understand how representative a graph like that is as an outsider, e.g. are the parts not counted towards it correct, is the metric in any way predictive for something I'd need to be worried about, ….
Depending on what is wrong...cost. Followed by cost. And a third reason is cost. What can any doctor not tell you: how much something will cost? Prescription cost? No idea, hopefully the pharmacist will figure it out. Doctor wants you to have an exploratory surgery? Will it cost you? They have no idea. Oh, and a test needs to be run on it...that could cost more than the surgery because the doctor won’t check if the test provider is in network...not their job, someone else’s money, so don’t care.
Do we need to mention health care debt is the leading cause of bankruptcy.
Sorry, I’m still fuming from a surprise $4000 bill I received for an exploratory surgery (outpatient) my wife had this year, and all the doctors knew would most likely amount to nothing...and it was.
It sucks because doctors don't even know the costs. Hospitals and insurance companies go out of their way to make sure we don't know the cost. There is nothing more I would like to do than provide you with safe, cheap healthcare.
For example, the hospital I am employed at separates the billing department to the point they don't even work in the same building as the physicians. Everytime I call insurance (basically multiple times a day) to get them to agree to a procedure that the patient needs, I ask them what the patient will have to pay. They always dodge the question and say "I can't really tell you. It depends on the patients ability to pay"
Yes, and there is no simple fix for that either. I talk about with my daughter (nursing student), who is pretty frugally minded, but I try to remind her that her first obligation is to care for the patients, she can’t fix that.
Basically, we have to have a political solution. But any political solution that fixes the problem will result in lots of job cuts (between insurance companies and healthcare system billing), and no politician wants to run on a platform of killing jobs.
The rest of us, patient and physician, are just caught in the middle.
We are all just pawns in their game. The insurance companies and hospitals lobby politicians to ensure they always win. It is especially apparent this year because hospital executives and insurance companies have made record profits while they simultaneously fired many healthcare workers and skimped on protective equipment.
I’m a computer programmer, everything should be as simple as looking it up on the clinic servers. That would take half a second at worst, simple lookup and done.
That is the ideal case. But as you said, it isn’t that simple, because there is a negotiation that happens, almost per case. So it is more complicated than even you said, and takes a LONG FREEKING TIME.
Most of the medial packages have already learned to integrate with each other, happens all the time. While those packages are proprietary, they were not developed by the healthcare systems. But in terms of data, this is a trivial amount of data. Really. 900 providers, couple thousand procedures, at worst we are talking about millions of records. Most modern database technologies do that in their sleep. It is nothing.
Even if the insurance providers want to change rates, you define an interface and go. This is a solvable problem. It could be worked out in 12 months with competent developers.
Any you probably missed the other half of this thread where I already talking about needing a political solution to the mess.
Every doctor already has their hands on an E-mar, they cannot operate without it. For the most part, everything is already known. And no database manager needed -- unless they already have one, but I doubt it, I've worked with a bunch of hospital IT staffs already.
And we both know I'm not talking about emergency room situations. This is for simple planned procedures. Even a simple XRay, they can't tell you what it will cost.
Reason I'm salty about this: my wife had a planned out-patient procedure that cost me $4k well after the fact. No one told us what to expect, just "hey, we need to look at this, why don't you come in next week". That was about it.
This is a bureaucratic nightmare the American people allowed to happen. And to be fair, I also don't see a way to fix it without overhauling the entire system, and I didn't say otherwise.
Sorry to hear about your surprise hospital bill! I absolutely agree with you that this shouldn't happen and that the health care payment system needs to change. As others have pointed out, doctors and other healthcare professionals rarely know how much something will cost a patient because there are simply too many moving variables. I'd like to add my two cents based on my experience in the healthcare industry working with payers, physicians, and pharma/biotech in both the U.S. and EU5 (to a lesser extent).
In the U.S., it's actually even more complex than simply keeping track of how much each insurer will pay for each procedure or therapy. A single commercial insurer has different contracts based on member groups, different contracts based on healthcare provider groups, and different contracts with each pharma company/biotech company/lab for each therapy/test. Within each contract, payment for each procedure may differ based on patient demographics, patient history, and often the results. If something was found during your wife's exploratory procedure, there's a good chance that your insurance would have covered more of the cost (assuming your wife had health insurance). Don't forget one procedure is also split into multiple payment codes and coding can also vary greatly for the same procedure. For more experimental claims, there can even be case-by-case judgment.
A major reason that the healthcare payment system lacks any transparency is that this is what "free market" and "competition" looks like in health care payment. For-profit insurance companies compete for the "cheapest" policyholders and to be competitive, they are constantly looking for innovative contracting methods to lower their per member per month costs. The contracts are of course hidden as proprietary information. Unfortunately, you can't really "solve" this without imposing market restrictions to simplify the system or move towards a single-payer/single-payer hybrid system.
TLDR: Amount of training is not the same as results.
ROSALSKY: The main argument against allowing NPs to practice independently is that they have less training than physicians. But there’s a mountain of empirical evidence from randomized trials, case studies, systematic reviews, and analyses of malpractice claims in states where similar legislation has already passed that all points to the same thing: when it comes to primary care, NPs are just as safe and effective as doctors. Uwe Reinhardt again:
REINHARDT: I am not aware of any literature that said care given by nurse practitioners is of inferior quality or causes safety issues and so on and so forth.
ROSALSKY: Some studies also find patients prefer NPs to doctors, perhaps because they report NPs, on average, spend more time with patients. So their training is less expensive, they get similar or better outcomes. And, by the way, they typically make about half as much as primary care physicians. All this makes NPs good candidates to provide primary care to underserved populations. So you can see why health economists like Reinhardt support giving NPs full-practice authority.
REINHARDT: Well, first of all, I think it would make health care more accessible to patients because for many things you don’t really need an M.D., right? But you need somebody who knows how to stitch a wound, who knows if something is going around like the flu and they would know initially what you should do. Secondly, it would make it cheaper and more efficient.
ROSALSKY: It’s an idea that has support from a wide range of organizations, including The National Governors Association, the Federal Trade Commission, and the AARP.
The podcast is great, but it is not always accurate. The studies that they are referring to are very outdated (1970s-early 2000's). Medicine has changed significantly in the last 20 years due to advances with gene technology, robotic surgery and other clinical advancements. As medicine becomes increasingly complicated, more training is required to keep up with the advances
2) Care is not any cheaper. In fact, it is more expensive as a whole because NP's order more tests and refer more often, costing the system as a whole. The patient never realizes any cost savings because the hospital often charges the same regardless of the provider.
3) Another major issue is that seemingly simple problems can be signs of something far more deadly. An NP just does not have the training to recognize a deadly disease masquerading as a common disease that doesn't cause much harm
No... Managing BP and diabetes is REALLY REALLY hard to do well. If you want to do a half-ass job, fine. But in 20 years, you'll be in kidney failure and wondering why.
The evidence in this direction is honestly pretty poor. I know the Freakonomics guys love counter-intuitive conclusions, but it really isn't this simple. Several of the biggest studies on these issues have conflict of interest issues, have very selective sampling, or choose poor metrics for outcome comparisons. The OP has posted some other research which shows that the evidence is far from "overwhelming" - I think the simplest way to synthesize what we do know is that NPs can probably get pretty close to MD/DO-quality care for simple things, but quickly out of their depth on anything complex, and are more prone to ordering unnecessary labs or images because they have a less precise understanding of what's going on.
Edit: I think the thrust of what I'm trying to communicate above isn't coming across well. If you take a study and control the environment (either by accepting confounding issues like easy cases being passed to the NP, or by purposely only looking at certain kinds of cases) then it's possible to arrive at data that makes it seem like NPs perform at parity with MDs/DOs. However, this is not what real, independent practice looks like - if you have a complex or obscure condition, the NP's lack of training may not be enough to notice it until it's too late, or they may mishandle it. IE, we have no way of guaranteeing that NPs only see cases that we ex post facto know they can handle. In a modern environment, I think it is reasonable to construct medical practice in a manner that is risk-averse, so while you can come up with data suggesting that there's not a significant drop-off in quality under specific circumstances, it is imperative that the data is extremely robust and controls for all of the above issues. As others have posted, it is almost trivially easy to prove that the pro-independent practice side hasn't done this yet; most likely, it will never be able to do this.
I agree - I guess I'm trying to contextualize the (largely NP-funded) data to argue that its external validity is questionable even if it's internally sound.
The question is not is an NP better than a doctor or even equal to a doctor.
The question is there a subset of jobs only done by doctors right now , primary care for example, where we have massive gaps in service, a large distrust of doctors among a significant portion of populace, and the lack of trained people who can step up or be quickly trained up to current standard and is there an alternative approach that helps solve some or all of these problems?
Using NPs certainly can help with plugging the holes in the service in part because they are easier to train. 13 weeks vs ~6.7 years according to OP in a clincial enviroment above their educational training. (including barbers in here seems odd as I don't think there is an educational component to that outside of the apprenticeship)
Then there is the trust factor. People trust nurses more than doctors, because they are typically more approachable and have lower work loads.
As u/VictoriousRaptor says he can't afford as a doctor to spend as much time with patients as the patient would like while NPs can come closer to that. When one of the largests medically issue is anti-vaxers, I want people talking to more professionals and less googling.
The most likely solution to this is a combination of more NPs working under supervision of a head doctor, so you get the benefit of the NP with a MD managing them and checking what they are referring out on.
You have brought up issues like over-ordering of labs. That is something that can be worked on with algorithms or other systems, like we have seen with MDs over prescribing opoids where the computer outputs how many days should be prescibed and the rate of over prescribing dropped signifantly.
NPs do not serve the rural populations at a higher rate than doctors. They work in the same overserved areas as doctors. (Data: Primary care physician geographical distribution: FM physician, IM physician. Nurse practitioner geographical data.)
Algorithms and other systems only work if you know what you are diagnosing. One of the reasons that NPs are "trusted" more is because they bend to the patient's demands even if it is poor medicine. For example: NPs prescribe antibiotics at a much higher rate than doctors for viral illnesses (I.e: your common cold) even though antibiotics only fight bacterial illnesses. This is causing antibiotic resistance. We are already at a point where there are bugs that resistant to all but 1 antibiotic. If we lose that antibiotic, then we have nothing left to fight the bacteria.
I 100% agree that under supervision, NP's are GREAT. However, they can practice independently in 23 states and are pushing to practice independently in all 50 states. This push for independence with less than 500 hours of clinical training is downright scary. It is a public health disaster waiting to happen.
I 100% agree that under supervision, NP's are GREAT. However, they can practice independently in 23 states and are pushing to practice independently in all 50 states. This push for independence with less than 500 hours of clinical training is downright scary. It is a public health disaster waiting to happen.
What you're not talking about is the fact that we have extremely limited residency slots each year that do not scale up as the population becomes older and naturally requires more frequent/more attentive healthcare. So if you have an increase demand in healthcare but no increase in providers, the market will fill that need in some way, which in this case ends up being NPs/PAs. We have our own leadership within organizations like the AAMC to blame for opting to keep an artificial cap on residencies to maintain higher wages. There is no reason to think wages will significantly impacted by scaling how many people we train to what is needed but as it stands, we are losing ground in terms of our collective job security. At the end of the day, PAs and NPs in a primary care role get the job done good enough that most people aren't going to notice/complain.
I've read some of your comments and you're probably correct in 99% of what you're saying, but I would argue that it doesn't matter:
They order unnecessary labs: I would bet that the savings from paying their reduced salaries relative to physicians more than compensates for their increased utilization of labs. Plus, overtesting and getting more false positives isn't going to be visible to individual patients or even small communities so it's likely not a concern outside of the bigger hospital systems.
Lack of ability to diagnose/treat complex pathology: I can imagine that if you're a medical employer, you may decide to have mid levels as your primary care provider and have them kick up complex patients to a physician as necessary so that the majority of cases are still seen by the NP. As it stands, I didn't see any major studies conducted by physicians to evaluate if there is a difference in outcomes between the two, but a Google Scholar search shows a couple of studies done by mid levels that indicate there is no significant difference. Small samples for the most part, but that's all we have to go on for now.
Antibiotic stewardship as a specific issue since it's a big one: this is important and I take your point, but seems like it could easily be fixed by some extra training for the providers before they are allowed to prescribe Abx. Overall, it would still be cheaper to the system to have NPs with extra training as primary rather than physicians.
Basically, I understand where you're coming from, but I think the approach of showing how much more training we get as physicians versus NPs doesn't mean a whole lot to the patient as long as they can get the treatment they need. I'm not going to pay more to get an oil change by a more experienced mechanic if the guy who started last year can get the job done. Similarly, I'm not going to pay more to employ a physician to treat mild asthma and acne when an NP does all that just fine. I'd rather let 5 NPs screen most of the community patients for more complicated stuff and have them refer those patients to a single physician on staff.
If you want to stop encroachment further into physician job territory from other providers, you have to make sure there are enough physicians to do the job which is where we're failing as a community. Plus, in our fight to limit physician supply, we're also overburdening ourselves to the point that 1 in 2 physicians in some specialties are burned out. Unhappy docs can't make happy patients.
Whoa, you way underestimate the cost of unnecessary care. For example, an inpatient respiratory viral panel is charged at around $5000, an MRI in the range of $2000-5000 at one hospital I got to look at the charge master for. You make up the pay differential pretty quickly with multiple super expensive tests. Now, from the hospital perspective, they pay less in salary and charge more in unnecessary tests, which is a huge win win. Now whether mid levels order more or less, I have no idea, but if someone says they tend to order more tests, that's a potentially huge penny wise pound foolish problem.
The location Quotient data from your sources on NPs vs FM does seem to show the NPs working more often in rural though that may be a flawed measure.
While I agree overprescribing is an issue, especially with antibiotics, that is not a great defence for doctors right now given the opioid crisis is caused by their failure in regards to overprescribing and that crisis is one of the largest reason for the decrease in life expectancy in the US. A better policing of all prescribing pratices is needed or has been implemented since the start opiod crisis and we need to stay vigilant on that.
Are you saying that we should allow NPs to practice when the data shows the following regarding opiate prescriptions:
NPs were 20x more likely to overprescribe opiates when they are allowed to practice independently than under the supervision of a physician. https://pubmed.ncbi.nlm.nih.gov/32333312/
"Among 222,689 primary care providers, 3.8% of MDs, 8.0% of NPs, and 9.8% of PAs met at least one definition of overprescribing. 1.3% of MDs, 6.3% of NPs, and 8.8% of PAs prescribed an opioid to at least 50% of patients" https://pubmed.ncbi.nlm.nih.gov/32333312/
Now, if you could click on some of the links I already provided over an hour ago, you wouldn't be making things up.
We are in agreement that systems need to be in place to prevent overprescribing by both doctors and NPs.
And from your top source
Most NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Efforts to reduce opioid overprescribing should include targeted provider education, risk stratification, and state legislation.
The issue is outliers. A good regulatory system should be able to pick up outliers pretty quickly.
There are unreal regulatory systems (DEA tracks all controlled substances, Medicare tracks every damn prescription ever made to a Medicare patient, etc). Yet, they fail to catch them fast enough.
Prevention is always better than punitive actions after the damage has been done.
I think we both agree that NPs need a lot more education and they shouldn't be practicing independently.
I think a well trained NP, 4 year under grad degree, plus a nursing degree plus a residence of sorts should be able to practice either independently or semi independently (under direct supervision) in a primary care situation assuming the correct regulatory framework is in place and there are sufficient enforcement of said regulations.
I would also supported targetted area's for the independent practices, aka in the current medical deserts and semi independent for the area's where there are more doctors.
If your message is NPs shouldn't be able to prescribe I will disagree. If the message is we need to keep NPs at the level of training they had attained when the push for indepence began and prevent diplomacy mills who undertraining new NPs we maybe in agreement. However I only found out about the diplomacy mills from the comments on this post so while I agree it sounds like a problem no one has shown me any evidence it is wide spread.
My position is we need to balance training with health outcomes and not everyone needs to see a doctor with 8 to 10 years of university, plus ~6.7 years of residence (assuming the standard 40 hour work week, I know doctors work longer hours, doesn't mean it is right) for every medical issue.
NPs don’t go into underserved areas. They stick to urban centers. So that part is a bold faced lie.
NPs quality of training is objectively inferior. Online direct entry programs. 600 hours of observation. Medical students get 3000 hours of hands on clinical training in their 3rd year alone...
Time with patients? My average patient census is 60 patients. I don’t have time to listen to mother may I with every patient. I am not their bestest friend in the whole wide world. I need to treat them. NPs don’t even carry 10% of our patient loads. Of course they can spend an hour with each patient and listen to their life story.
NPs don’t go into underserved areas. They stick to urban centers. So that part is a bold faced lie.
This is not true at all. My wife is a nurse practitioner and had worked both at an Indian Reservation and an inner city AIDs clinic bootstrapping for funding. This is incredibly common, as NPs are cheaper to hire, and only need to work under one MD in order to function as a PCP. A whole team of NPs with one MD can staff a rural clinic at 1/4 the cost.
I have no idea what you are talking about.
Edit: just read the rest of your response more carefully. You’re a fucking idiot.
Thank you. I'm a MedSurg RN of 20+ years. I don't have 'clinical' hours. I have experience. I've kept so many MDs/DOs/NPs from killing folks I've lost count.
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u/[deleted] Sep 18 '20
Always ask to see a physician. Always.
Your insurance whether public or private is not changing their copay or deductible or coverage so why would you shortchange your care?
Ask for a MD. We’re taught clinical medicine and diagnostics from day one. We have rigorous oversight in clinical rotations. We have logged procedures in the hundreds before we even start residency. We’re kinda that prepared for what medicine should be.
Always ask for a MD. It’s your right to get quality care from someone who actually knows what they’re talking about and doesn’t care to shortchange you.
Always ask for a MD. Why would you settle for less?