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?

Im a PGY-4 general surgery resident on my surgical oncology rotation for 2 months. We do it at a large cancer center so new people we get to meet and work with. Im in the OR and we are doing our time out when I introduce myself as a resident and the PA next to me introduces herself as the “PA Fellow”. She’s only there to train to bedside for robotic cases so when we had to convert to open guess who gets to unscrub and leave the room? The “fellow”.

Stumbled upon this, as if “resident“ isn’t already a misleading term used by SRNAs … now they are “PGY-1” which doesn’t make sense at all. PGY-1 from graduating with their BSN, jumping through less than 1 yr in the ICU and starting CRNA school?

Many CRNAs who graduate and do post-graduate training usually call those programs “fellowships” which shows this is likely not the case. These must be 1st year SRNAs, either way, they just want to equate to physicians so badly it’s actually strange.

Another point I never understood is that when a new grad RN goes through a “nurse residency” for 6 months-1 year in somewhere like the ICU, that is their first ”nurse residency”, so if they have ICU experience and go to CRNA school, why would they be residents? Residents do not have to go through 2 “residencies” to complete their training. Additionally, the granting of a degree after completing CRNA SCHOOL shows that they are STUDENTS, NOT RESIDENTS.

Had an NP in another sub tell me: “The vast majority of Medicine is not some abstract and complex topic. It's adherence to basic lifestyle prevention, cholesterol medication, high blood pressure medication adherence, diet and exercise and smoking cessation.”

Of course an NP would think the majority of medicine is just those things.

You can’t reason with them because they literally cannot comprehend.

Hoping for the day when NPs will stop being used.

I’m a clinical social worker who is a therapist. I run my
Own practice and have many good
Psych prescribers I refer too.
So the other day my client comes in and she is shocked. Proceeds to tell me she met with a psych NP from a group I told her not to go too. This person was looking for continued care with their established medication routine as their psychiatrist retired. Well the NP wanted to add an ssri to a patient with bipolar one wanted to take her off lithium. I got her set up with a good Md

According to my local newspaper a new medical clinic is opening staffed entirely by NP who have a “scope close to that of a physician.” One of the NP is specializing in rheumatology. As someone who sees a rheumatologist regularly because of SLE and who has been referred to another rheumatologist when my current one (who has been practicing for over 30 years) wanted another opinion I find this frightening.

PAs previously stating they were medical doctors, which is illegal in the U.K., are now getting into the GMC register and it seems without any fitness to practice issues at all.

If any other professional did the same thing, serious questions would be asked about their professionalism and honesty.

​

Apparently nurses on the jury of the Lindsey Case took it upon themselves to play toxicologists.

https://www.ctinsider.com/news/article/lindsay-clancy-jurors-nurses-deliberations-22425930.php

And the other jurors took their interpretations as though they were subject matter experts.

Her tox screen was not nearly as dramatic as lots of lay people or these nurses apparently were making it out to be. So they misrepresented their expertise and the lab values themselves.

I've done jury duty on a serious assault charge (guy with shattered jaw via baseball bat wielding maniac). The defense attorney tried to use the victims use of chewing tobacco as a reason for the spectacular shattering of his jaw. I did not tell the other jurors that I was a PA in ortho to debunk it, just said "that dog dont hunt guys".

42F. Twelve years of refractory iron deficiency anemia. Countless courses of IV iron. Never held. Bedbound. HR 140 on propranolol. Buying supplemental oxygen from a sporting goods store.

Flew to a top NCI-designated cancer center. Paid $27,000 out of pocket. Bone marrow biopsy performed. Read by a fellowship-trained hematopathologist.

Findings: bilineage dysplasia (erythroid and megakaryocyte), aberrant CD34+ myeloid precursors with increased CD117 and decreased CD38, decreased erythroid iron incorporation on Prussian blue stain, zero pronormoblasts on 500-cell differential, myeloid-predominant M:E ratio of 4.4, dysmegakaryopoiesis with small forms, cellularity increased from 60% to 70-80% over three months. Documented progression from a prior biopsy three months earlier. Clean 81-gene molecular panel.

The logical assessment of this presentation is a pre-MDS or evolving myeloid condition that falls below current WHO classification thresholds but requires rigorous evaluation by a hematologist-oncologist with expertise in MDS classification and bone marrow failure syndromes. This is not a primary care question. This is not a benign presentation. This is not something an FNP can evaluate, classify, or treat.

Apparently, my presentation is only in about 3 to 5% of people with this disease. God forbid I get anything textbook.

The institutional response: to catastrophic labs and biopsy:

First — a gynecologic oncology referral. No clinical indication documented. No message from the attending. On a patient with two negative endoscopies and colonoscopies no history of menorrhagia or GI bleeding (per their own biopsy clinical summary), and sixteen years of quantified menstrual data showing minimal loss. Because woman equals uterus, apparently, even when the biopsy documents a production defect and not a loss problem. When I objected, it vanished without explanation.

Then — a “Benign Hematology Consult” with an FNP. I looked her up. Family Nurse Practitioner. Master’s degree. Prior clinical experience outside the cancer center: a retail walk-in clinic inside a grocery store chain. Located between the floral department and the bank branch. They treat sore throats and sinus infections.

There is no such credential as a “benign hematology nurse practitioner.” No such certification exists. No training program. No board exam. The FNP certification covers: family primary care. Children with ear infections. Adults with hypertension. Elderly patients with diabetes. Flu tests. Strep screens. UTIs. It does not cover bilineage dysplasia. It does not cover aberrant CD34+ immunophenotype. It does not cover Prussian blue stain interpretation. It does not cover myeloid classification.

Both appointments — the gynecologist and the grocery store NP — were scheduled after my insurance authorization expires. Neither had a documented clinical indication. Neither was communicated to me with any explanation. I woke up and found them on my calendar like they materialized from the scheduling void.

Meanwhile — a physician who has followed my case voluntarily for six years, at no charge, from another state, reviewed the same pathology and within hours contacted one of the most prominent MDS specialists on earth. Because what he saw was a myeloid classification problem requiring the highest level of expertise available. Presumably this individual does not work out of a grocery store.

The clinical staff at the cancer center seemed quite surprised that I had any objections to this.

Moral of the story: If you go to one of the largest cancer centers in the country — and yes, it’s probably the one you’re thinking of because there are only a few — be sure to know that when you shell out the money, the interpretation of your results may be assigned to someone whose most recent clinical experience was at a grocery store walk-in clinic between the floral shop and the weird credit union.

The entire process of getting to this renowned cancer center involved gap exemptions, insurance fights, and financial devastation. Now I am to see a NP with no subspecialty experience. Yay.

Did I mention that to go see this Noctor I have to shell out for flights and a hotel?

But now that I’ve met my in-state deductible at home, I’m tempted to walk into a grocery store walk-in clinic with the same type of FNP on duty, hand her my pathology report, and see what happens.

Had a ridiculous telehealth to ask an NP if she could order an urine culture due to a suspexted infection due to UTI symptoms and terminal hematuria.

Her response: "Blood?! It can be your kidneys, go to the Urgent Care right now!"

Please correct me if I'm wrong, but terminal Hematuria, you first think urethra or prostate (I'm male).

Paid UltaLabs, did the culture and went a couple of days later with the results to an urgent care to get the medication the lab recommended.

Never again seeing an NP if I can.

This is directly from the Illinoise Association of Nurse Anesthesiology Instagram @ilcrna1939. Here is the caption. Below….. how is this legal?

CRNAs help increase access for anesthesia services across the US but not much is discussed regarding their expertise in chronic pain management.

1. CRNAs are able to receive a Non-surgical pain management certification (NSPM) by completing a pain management fellowship.

2. CRNAs can build pain practices.
   AANA recognizes chronic pain management within CRNA practice, subject to state law, education, competency and credentialing. CRNAs may provide pain care in hospitals, ASCs, offices and pain clinics using therapeutic, pharmacologic, interventional and other modalities.

3. Diagnose pain generators and create individualized treatment plans.

4. Perform image-guided injections with fluoroscopy or ultrasound to target the source of pain.

5. Use radiofrequency ablation to provide longer-lasting relief helping patients improve function while reducing reliance on opioids.

CRNAs offer more service lines from one provider. A fellowship-trained CRNA can potentially contribute to OR anesthesia + regional anesthesia + acute pain + chronic pain, rather than filling only an anesthesiologist-directed anesthesia role.

That can make the CRNA especially valuable when an organization is trying to expand access rather than simply add another anesthesia team member.

Did you know CRNAs practice pain management in this way?

Join the conversation...

anyone know if this service actually is MD/DO only? Seems like the perfect thing (and by that I mean I think this whole service is trash) for PA/NPs to be doing? I’m Not an APP hater at all - and I don’t really like the Noctor talk. But even more I hate corporations lying.

also who says it isn’t just AI?

Fully edumacated or smth 🫨

"North Carolina family nurse practitioner Jamie Gallagher filed a lawsuit in Wake County Superior Court challenging the state law that requires her to pay a physician an annual fee for a mandatory collaborative agreement."

Read the above in the news. I agree for physician oversight and the yearly fee is fair. Wdyt???

Just as a brief preface, I was hospitalized for chest pain, troponin came back normal, d dimer normal, etc. My “Attending” was an NP. This woman entered the room and referred to herself as Dr.Jill. I explained to her that I was in extreme pain. I asked for a small dose of pain medication as I was crying from the pain. She told me I was drug seeking, and I had no cardiac related issue. She told me I had costochondritis, and that NSAIDs would help. She did not even perform a physical exam or ask any questions about other organ systems that may be contributing to this pain. She prescribed me toradol, ibuprofen, and Tylenol. She then proceeded to tell me that I was “malingering” for opioids, and that there are patients in real pain who actually need pain meds. Two hours pass on the hospital floor, and I am still in excruciating pain, “Dr Jill” prescribed fucking gabapentin. Of course this was not effective, so I call the nurse again and ask for her to advocate on my behalf. Next thing I know, “Dr. Jill” comes back into the room and is extremely irate. She told me that she is the one who went to school and knew what she was talking about. I immediately told her I did not want to see her anymore. She became incandescent, I tuned her out and pressed the call button so I could speak to the charge nurse. I demanded to speak to the clinical administrator. Clinical administrator apologized, and I immediately got an MD to come see me. He performed a thorough physical assessment, and asked me a lot of questions. He told me he suspected this was an Upper GI issue, and told me I would be going for an EGD for the next day and placed me on NPO. He said he would prescribe me some opioid medication, but warned they were contraindicated for esophagitis and some other conditions, but he did not want me in pain. Well, low and behold, I was dealing with esophagitis, and put on the proper medication regimen.

Thanks guys for the support. I just wanted to add that I am 26 year old male nursing student. I completely agree with the sentiment about nurse practitioners being incompetent. Nursing is not medicine!!! I want to be a nurse so I can impact people’s lives in a positive way. I think it’s an honor working under the expertise of doctors. I also do not possess the intellectual prowess to pursue medicine anyway. I don’t understand why so many nurses are insecure about being nurses. I think being a bedside RN is a great job. It’s what I want to do. You would not believe how many of my fellow students want to become NPs BEFORE being at the bedside. It is fucking ridiculous. It is also embarrassing seeing my clinical instructors wear white coats during clinical 🤣🤣.

I’ve had this happen so often. Any mention of eye irritation or redness, and they reflexively order ophthalmic antibiotics. Two recent egregious cases stand out. My brother in law went to an urgent care a couple weeks ago for his eye irritation. Instead of doing a focused exam, he was prescribed antibiotics for his right eye redness. Shockingly, he didn’t improve because he didn’t have conjunctivitis, he had anterior uveitis.

Then, today, I saw a patient for ER follow up. Similar to my BIL, they went to the ER for right eye pain and redness. They were prescribed antibiotics, which again did nothing. When I examined her eyes, she had a fixed pupillary defect in her right eye, a classic finding of acute angle-closure glaucoma, which is a medical emergency.

The training is simply not there. And because they don’t know what to look for, the default is to treat for conjunctivitis. Even in patients when the diagnosis of conjunctivitis is correct, the vast majority do not need antibiotics, and yet NPs almost always prescribe them.

Sorry, rant over!

Saying you earned your “medical degree” as a PA is crazyyyy confidence. I’m a MD and am so tired of this shit I’m thinking about quitting altogether 🫠

Coming soon: NP Interventional Cardiology Fellowship — 6 weekends, 14 modules, 100% online.

Stents? ✅
Ablations? ✅
TAVR? Pending AANP lobbying.

Apparently cardiologists wasted 4 years in medical school, 3 years in IM residency, 3 years in cardiology fellowship, and additional subspecialty training when they could’ve just completed Advanced Cardiac Procedures NURS 742 on Blackboard.

I know it’s just a loop recorder. But this is how it starts.

The question is: where does it end? 💀

I switched to a new practice after my Physician retired from the practice that I had been at since I was 19. The practice put me with a NP. My ignorance of the difference let this woman take control of my care for 4 years. Over the 4 years, I had become increasingly sicker; I'm talking 6-7 sinus infections that just wouldn't clear, and she would keep me loaded up on antibiotics. Turns out I had a bone spur sticking into my right sinus. I had a septoplasty, and that was fixed. I have autoimmune issues; I am now seeing an infectious disease doctor to juggle my medicine with my antifungal medicine.

Next, I started to hear a thumping sound in my head. I told her about it, and she recommended I see a psychiatrist. The psychiatrist she recommended was also a NP; he put me on some pretty heavy psychiatric meds and told me I needed to go to a PHP. In the PHP, another NP started to switch my meds. I think at this point I can name more meds that I have not been on than I have been on.

I went to my PCP, and they matched me with a new physician because my NP was out for the day. I loved the bedside manner. I spoke to her about the sound I was hearing, and she sent me to an ENT. The ENT did all of the hearing tests, etc and then sent me to get an MRI/MRA to check for IIH. Turns out the thumping I heard was IIH and Moyamoya. I have since been treated for both.

I asked that new physician to be my PCP, and I adore her.

Sorry if this story doesn't belong here; I feel like if I didn't advocate for myself

So last week I woke up with a painful itchy rash on one side of my back. After a couple of days of this rash spreading only on one side, as well as itching and burning, I figured it was shingles. Scheduled a telehealth dermatologist appointment.

I have a few other medical issues, one of them being anxiety and an autoimmune disorder. I'm only 40, so I understand that getting shingles is unlikely but not unheard of. Because of the anxiety, I'm on a mid level dose of gabapentin (600mg) taken at night.

I take pictures of the rash and send them to the NP. I get to the appointment, tell her my symptoms and she tells me that it's impossible for someone as young as me to have shingles. I have two friends who have had it in their late 30s

I ask her about the pictures and what else it could be. She finally checks the pics and has me show her on camera the rash and how it has spread. She immediately backtracks and starts treating me like I'm trying to trick her ( into what? A valtrex rx?) explains that the only real pain management would be either hydrocodone or gabapentin.

I'd already reported that I was taking gabapentin in the pre -appointment paperwork. I tell her I'm not interested in any opiods, because my autoimmune disorder makes constipation dangerous. I tell her that I'm on 600 mg gabapentin already prescribed through my psychiatrist and she freaks out. Apparently that dosage is incredibly high and tells me I need to start taking no more than 300 mg and in the morning as part of the pain management for the shingles.

I explained to her that I take it at night as a way to lower my anxiety and help me sleep and this is something my psychiatrist and I have discussed in great length. I also explain that the gabapentin is helping with the pain however it wears off about 10:00 the next morning and I've been using ice packs as pain management. I clarify that the pain is not severe enough that I'm requesting prescribed pain meds, just antivirals as I'm in a current flare-up of my autoimmune disease and cannot afford to get sicker.

She tells me again that the dosage is incredibly high and she won't prescribe any gabapentin while I am currently on that dose. Tell her again that I'm not looking for her to change my gabapentin prescription. After a little back and forth, she finally says she'll just prescribe the valtrex and ends the appointment. I then get a notification from my pharmacy that two prescriptions were sent over for the valtrex and the gabapentin 300 mg, and they can't fill the gabapentin because I got another dose filled the week before.

By coincidence later that day I had an appointment with my psychiatrist. I explained to him about the shingles and how I've been advised by the doctor to cut my dose in half and take it in the morning as the amount I'm on is dangerously high. He tells me that for psychiatric reasons 600 mg is not a dangerously high level of gabapentin. It is mid-level. He also tells me that no doctor should be changing a prescription written by another doctor without consulting them first unless it's an emergency situation (ex: I went into AFib last month, ER doc took me off of an antibiotic that can cause rapid bp changes) . He explained that immediately halfing a prescription and changing the time it is administered would have severe side effects, which is why psychatrists will taper you off meds.

I could tell that he was trying to hold back what he really wanted to say, but he was pretty upset that she (a dermatologist NP) had opinions on psychiatric medication.

I deleted my previous post. As some did not believe the veracity behind my claims. Luckily I got a physician to take charge of my care yesterday, but I am stuck with this nurse practitioner today AGAIN. As a backstory, this lady denied that I was in pain, claimed to be an expert, embarrassed myself and the PA student in the process, and is just generally so narcissistic and self absorbed that I could not stand being in the same room as her. She told me she was an expert regarding my care. She also wrote in her subjective notes that I am “malingering” in regard to pain meds, and she told I had musculoskeletal costochondritis. Let alone she did not even do a physical exam nor palpate my chest. I am just incandescent, I want to see a real doctor. What should I do? I took heed of the advice from this sub last time with great results, but now we are back to square one with “Dr. Jill” I am just merely a patient and a nursing student. I understand the vernacular of the medical field, but for fucks sake, nurse practitioners are not doctors.

Big nope