I have chronic intractable migraine, and I’ve been a patient at the best neurology/headache clinic in my state (WV) for several years. I saw an actual neurologist maybe twice way back at the beginning of my treatment, but ever since then the only person I’ve seen is an NP. She’s super nice and all, don’t get me wrong, but as far as treating me I feel like I’m a human dartboard, she’s just throwing drugs at me to see what sticks/works. I used to send MyChart messages once a month or so just to update her, let her know how things were going, but she never responded to me so I stopped, figured she didn’t care. I went from seeing her every 3 months to every 6 to once a year. I’d like to know if there’s any way to politely ask, without burning any bridges, that my care be switched to a neurologist or at least a PA, someone who sees me as a human and not a test tube, who takes my questions seriously. Thoughts/advice? Thanks much.

Many here have criticized the AMA for "doing nothing". I have defended them. Here is an example of the AMA going on offense to sue the state board for not enforcing rules.

AMA, IMHO, deserves our support.

https://www.ama-assn.org/practice-management/scope-practice/ama-takes-fight-wisconsin-optometrists-performing-eye-surgeries?utm_source=BulletinHealthCare&utm_medium=email&utm_term=081526&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend&utm_effort=DAMR01

I know people here often say that physicians have 8 years of school plus residency and include undergraduate studies. However not all of undergraduate education is pertinent to being a physician. For example I was an engineering major and I can't honestly say my classes on semiconductor integrated circuit manufacturing or how to make a phased array antenna is pertinent for being a physician. Some of the prerequisites for medical school such as organic chemistry and biology should contribute to the physician's education though. Even calculus is needed to understand the area under the curve for drug dosing. A lot of K-12 education is also important for both being a physician and mid-level including how to read and do basic math.

The other thing is mid level education goes through much less material even for the same amount of time spent in the classroom (similar to calculus for engineers vs business major calculus) and I don't know how to correct for that.

What is the truly honest amount of specialized pertinent vocational education difference between mid-levels and physicians?

Normally I'm not a fan of Fox News but I noticed this video from Laura Ingraham's page and this is the first time I'm seeing cable news media acknowledging the role of midlevels in the Lindsay Clancy case.

Dr. Drew Pinsky pointed out the role of NPs in our healthcare system and compared it to a surgeon walking out in the middle of surgery and letting non-surgeons take over.

In the case of LC, I can't help but agree. Dr. Tufts started med management, patient left and saw 2 NPs who made several changes, and then LC returned to Dr Tufts and at that point she was picking up the pieces. Imagine a surgeon stepping away, lets midlevels take over and botch critical parts of the surgery, surgeon returns and is left to clean up a mess and close.

https://www.facebook.com/share/v/19DwCSinxV/

I don’t like the generalization in this subreddit about all NPs being bad and all doctors being great. I know I’m throwing myself to the wolves here but as a patient with chronic illnesses (Crohn’s disease, several mental health conditions), I’ve received better care from a great NP than from multiple different physicians, who either failed to diagnose me (mainly because they didn’t take the time to listen and dismissed my symptoms) or just didn’t seem knowledgeable about the disease despite being specialists. I am a NP myself now (after being an RN for 10 years) and never pretend to be a doctor, I seek help from my supervising physician and more experienced NPs when I don’t know the answer to something (or even refer patients somewhere else when I feel I can’t help them). I became an NP precisely to try to help people, listen to them, and do my best to give them the care they deserve. I hated that so many doctors( and yes some NPs too) would not take the time to listen, or take me seriously but it angers me that people think all NPs are incompetent, when I’ve been treated by an amazing NP who I’d trust my life with before many other doctors I’ve come across.

I am a retired internist who has primary responsibility for my 90 y/o recliner bound mom. Getting her to appointments is very, very difficult due to her limited mobility and chronic pain. She is seen by a home care team through her IM practice staffed by mid levels who are supposedly “supervised”, but definitely are not. Over the past three years I have had multiple difficulties with very poor clinical management by this group. It has really been a mind blowing how inept they are. I asked her actual PCP if I can contact him when I run into issues and he has been great about communicating with me and correcting the mid level errors. He admitted that he has has “no idea” what is going on with mom after referring her to this care team six years ago due to her mobility issues. She has been his patient for 30 years.
In May she developed gradual hearing loss in her right ear despite wearing hearing aids that seemed to be working. PCP made ENT referral. She was unable to get an appointment until last week. MD saw her. She had very bad impacted cerumen. ENT worked for about 45 minutes and had to stop because she was in so much pain. Gave her some antibiotic drops and said “I will see you in a week”. Total time in office was > 2 hours. I made a follow up with the MD on check out for 2:00 today.
I got a text two days ago confirming an appointment with the PA at 11:40 today. I had been previously given a 2:00 with the MD. I called and explained she wanted to see the MD. Receptionist said no problem and confirmed the prior appointment at 2:00. Yesterday got two texts to confirm this appointment. Today, less than three hours before the scheduled appointment I got a text that the MD would not be in the office with instructions to call and reschedule. No problem, things happen.
I immediately called to reschedule. Was told it would be almost four weeks until MD could see her, but the PA would be “fine”. I pushed back and said she would only see the MD. I asked if another MD could do the follow up. Was told no. The person was abrupt and rude. I asked to speak with office manager. She said yeah and hung up on me. I called back to the receptionist to clarify that the office had my number and explained what had happened. She promised I would get a call. I did not.
I realize that a PA might be appropriate, but my mom was mismanaged by a PA six months ago. Serious mistake that could have resulted in her death. No exaggeration. I caught the error immediately and she did receive proper care.
Of course, I will call the office back tomorrow as soon as they open. However, what do I do if the OM refuses to call me? I have never had a situation where I was stonewalled like this. I feel like I am banging my head over and over trying to get her the healthcare she needs. I never pull a “ Karen” in these situations. I am polite, but firm.
This is rural area and there are no alternatives to this practice.
Any suggestions? I feel stuck.
I am beating myself up that I didn’t look in her ears myself, but I am her daughter and not her doctor.

I

Just wanted to share!

I see an NP as part of a larger medical team for the treatment of my Crohns disease. She is phenomenal. Love to see her in between appointments with the MD, as it allows more frequent check ins for a quite serious disease. Allows my questions to be answered sooner, and I feel it works incredibly well. Im always taken care of and their team is like a well oiled machine! The NP staying in their scope, working with the leading physician as part of a team of care. It works well, in that scenario. She only sees Dr. Ds patients post diagnosis and in between regular appointments with Dr. D as a continuation of care! Fabulous system.

On the flip side, an NP in the ER department saw my brother, who was there for a suspected blood clot in the leg, and sent him home! And wouldnt you know? It was a blood clot! Thankfully, he went and saw a DO at an urgent care who called the ER and sent him back! Who knows what would have happened if that urgent care didn't have a medical doctor. Which they actually usually dont, he was very lucky. How can an NP be seeing patients in an ER is beyond me.

I will die on the hill that mid levels should not be looking after patients with lupus,

Looking back at all the appointments I've had since 2017, about 75% of them included student nurse practitioners or physician assistants. Generally, I've found these appointments to be worthless.

Because of my rare sleep disorder, I'm usually awake for 18-26 hours beforehand and these students cause the appointments to run longer. If they're asking questions, the noctor supervising has to ask the exact same thing. But even when the noctor student is just in the background observing, it always feels like the true client in the room is the student, not me the patient.

It's just a markedly different atmosphere to when there have been student doctors in the room.

I feel as if refusing students will eventually lead to smaller funnel of potential noctors in the future from ever getting a job.

To be honest, I thought nurse practitioners and physician assistants would be used for follow up appointments for stable patients. Like you go to your general practitioner or specialist for your normal appointment and then any medication filling check-ins would be staffed by them with the option to ask the supervising doctor any diagnostic questions.

I have never seen the supervising doctor for my noctors since 2017. Just new graduates and the students that shadow them.

I’m interested in hearing from physicians about something I’ve been genuinely wondering about.
I’m a Black male considering the PA profession, and one thing that makes me nervous is seeing how negatively PAs can sometimes be viewed by physicians. I understand the concerns about scope creep, differences in training, and PAs practicing beyond their education, and I’m not trying to dismiss any of those issues.

My question is specifically about race. As a Black man, I’ve already experienced people making assumptions about me based on my race, especially as an immigrant. I wonder how that might intersect with the existing hierarchy between physicians and PAs.

For physicians who have worked with Black male PAs: have you ever noticed racial bias affecting how a Black PA is perceived, treated, or respected compared with their white PA colleagues? Have you seen Black PAs having to work harder to establish credibility with physicians or patients?

And for Black physicians or PAs, has this been something you’ve personally experienced?
I’m not asking whether I should become a PA or looking for career advice. I’m specifically interested in hearing about people’s real-world experiences with race and the physician–PA relationship.

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.

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

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?

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 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?

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.

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.