re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187

I might not know the difference, but I do know they are all RN's. Again, it is my belief that those who push for this are dangerous.

CRNA's should not be included in the APRN group. That is completely different, but they should also be required to be supervised by an MD, Anesthesiologist.

Have you ever worked with RN's who do things without consulting the MD, they are the know it alls and they are dangerous.

quote:

---

Absolutely, part time schooling, online classes (in many cases), and less than 1000 clinical hours should not result in independent practice.

---

I want to expand on this - while I do not know the specifics for APRN training, I do know that it is miniscule in comparison to MDs or CRNAs.

To give the board some perspective and shed light on the issue of training/experience: I graduated medical school four years ago and am in year 4 of 8 of my training. We have to log all of our duty hours for accreditation purposes. I've spent 13,688 hours in residency/fellowship thus far. This is AFTER medical school.

For comparison, I have linked the Family NP curriculum at Vanderbilt. LINK. It's an 18 month curriculum.

quote:

---

I beg to differ. I saw an NP in December for a sinus infection. Bill was in excess of $300

---

This is basically true across the board. The charges and reimbursements are sort of modeled after CMS and don't change much if the same service is being provided. Cash for service payments are virtually non existent nowadays, payments are almost all tied to insurance industry.

The key point is that the advent of independently practicing advanced nurse practitioners is to save the HOSPITAL SYSTEM money, not you, the patient. And trust they won't pass that savings (and it's arguable if savings truly exist) on to you.

quote:

---

Sorry doc, I'd rather pay a NP $30 to write me a antibiotic prescription for my strep-throat than pay you a $100. May have to sell that summer home in Mankato bay. Will send prayers.

---

Your underlying belief that doctors are overpaid is obvious

Did you stop to think that maybe he isn't thinking about his bottom line?

Maybe he realizes all the incredibly hard cases he sees all day and how doctors with years of experience can miss diagnoses. How humbling the practice of Medicine can be.

It's not arrogance ("no one can do this but me"). But rather a realization that if experienced doctors can miss things why would you turn the reigns over to someone with far less training.

Why is it always the doctors who are just out for money?

You don't think the NPs are doing this for more money? You are very naive my friend

And how much do you think this will reduce health care costs? A family practice doc makes like $200,000 at most. How much do you plan to save when you add in the cost of extra visits and unnecessary tests because the NP is unsure of themselves. And if you think your doc orders unnecessary stuff now... Just wait

Almost half the country has granted this extended scope of practice....and things haven't gone to hell yet. The NPs I know in AZ (AZ has extended scope for NPs).....still work in environments where they work under a doctor fwiw. And they all have their DNP now.

quote:

---

Why not let NPs do the easy stuff?

---

They do. That's not what this is. It's for basically unlimited scope of practice. It means you can go to a much easier, much much much less intense school. In fact, so easy that most work and go to NP school. Then no residency so in about two years of reading a few remedial, and I mean remedial, med related books...you are a doctor. At least under current rules they have to be supervised. This would allow them unlimited scope of practice after working a certain number of hours under a doc. With no standardized testing, no licensing exam.

How bout if they can pass step I, II, III of our medical training and complete an accredited residency then they could.

I mean...how many hours does a paralegal have to work to become a lawyer? Seriously, same difference. With no bar exam and no law school.

Tell you what doc, if you write some letters, with the same veracity as this post, to the med schools, AMA, and congress demanding funding and infrastruce support for more residency positions overall, and better incentives to enter primary care, then you might find the support you need.

Until then, your support of this measure just further erodes access to care for, likely, millions of people in La. And for what? Quality of care? That's a damn cop out when the existing demand for primary care services is such that physicians have NO CHANCE of meeting it.

So your solution is to just not address the supply shortage at all? They wait the 8 weeks for their NP appointment, or don't be seen? And I wonder why I have to constantly defend the motivations of my physicians.

Offer a realistic solution. Doc! When Medicaid expansion goes through in La., tell me how those people will receive primary care services, and in what time frame.

Also amazing is how inferior you perceive mid levels to be, yet theyou lead care teams at most of the large health systems in TX. MD Anderson is the leading employer for PA's in the entire country. Those mid levels evaluate and determine care plans just as the docs do. They run the clinics, not the docs. They make the care decisions in 75% of cases. Yet you feel them incapable of managing primary care? The brightest mid levels are plenty capable of being a better provider than most physicians. I"ve seen it on many ovcasions and have hired and fired both

You realize rectal temps are only usually done on babies?

quote:

---

Not necessarily my GP sends all of his emergency patients to see the Nurse Practitioner for patients that he is too busy to see. She writes up the scripts and send us on our way. No issues with this from me.

---

This is physician oversight though. The physician essentially triaged lower acuity patients to the NPs. I don't have a problem with this, but I wouldn't want an NP to be the sole provider for a potentially life threatening, emergent issue.