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Posted on 4/4/18 at 9:10 pm to WaWaWeeWa
quote:
But this bill will eventually pass because of the money and persistence of the NP lobby to expand their scope of practice through legislation
And that's why I think that we, as physicians, should go on the offensive and argue for independent practice so long as they're held to the same high standard that we are.
Posted on 4/4/18 at 9:22 pm to Hopeful Doc
quote:
they're held to the same high standard that we are.
I agree
Posted on 4/4/18 at 9:23 pm to Rock the Casbah
quote:
Doctors have all become overpaid government workers - no better than lower paid government workers. Bring on the NPs...
So a NP at 85% salary isn’t overpaid? Why not just reduce doctor’s reimbursement 15%?
Posted on 4/4/18 at 9:26 pm to Hopeful Doc
quote:This... all of this
edical school requires a bachelor's degree (or damn near it with very very rare exception) followed by 4 years followed by a minimum of a year of residency to be independently licensed. The State Medical Board is actually about to increase the requirements for US grads from 1 year of post-grad training (and 3 for IMG) to the completion of a residency for everyone.
So you've got a self-regulating board increasing the requirement. They also will require, in general, that basically anything you choose to do with your license is fine, but you will be held to the standard of a board-certified physician in that field. What does that mean? If I have x-ray in my office and bill the patient for it and see a pneumonia but miss a lung cancer that the average radiologist would see, then I'm not practicing up to the standard required to use x-ray in my office. I am, of course, trying to keep this simple.
On the other hand, the state nursing board is pushing to allow people with a bachelor's degree in nursing who have completed a curriculum which is frequently done online and part-time while working full-time as a nurse with very little clinical training (sometimes as short as about 3 months, not structured as a formal residency program or med school rotation would be) to be able to practice medicine independent of the state medical board and held to a standard to be decided by the board of nursing.
Posted on 4/4/18 at 9:30 pm to saderade
Would you let a paralegal defend you if you might go to jail?
Yeah, just think about that.
Yeah, just think about that.
Posted on 4/4/18 at 9:59 pm to BearsFan
is It legal for paralegals to defend clients in a courtroom setting? You’re not comparing apples to apples. NP’s are certified, through education and passage of national boards to treat patients in a clinical setting.
Posted on 4/4/18 at 10:09 pm to saderade
I’m in my first semester of NP school. I think there are very few NP jobs that should not have some sort of collaborative agreement with a physician. And like stated above, if they don’t have an agreement they should be held to the same standards.
Posted on 4/4/18 at 10:27 pm to tke_swamprat
MD IQ = 130+
RN IQ = 100ish
Ditch insurance and regulation and let the market decide.
RN IQ = 100ish
Ditch insurance and regulation and let the market decide.
Posted on 4/4/18 at 10:28 pm to pensacola
What about NP’s IQ?
Posted on 4/4/18 at 10:56 pm to toosleaux
I went straight through college, medical school, and residency and didn’t have independent prescriptive authority until age 30. A nurse I work with just finished becoming a nurse practitioner at age 24 and has full prescriptive authority and can practice independently after 3 years. Absolute insanity.
NPs also can “specialize” and change fields (from general surgery to dermatology to neurology to primary care, etc) without any further training. If I wanted to specialize in a different field I would have to complete a minimum of a 3 year residency. Again, insanity.
NPs also can “specialize” and change fields (from general surgery to dermatology to neurology to primary care, etc) without any further training. If I wanted to specialize in a different field I would have to complete a minimum of a 3 year residency. Again, insanity.
Posted on 4/4/18 at 10:58 pm to pleading the fifth
Also the nursing boards are shooting themselves in the foot pushing independent practice of NPs. The compromise will be for NPs to be removed from the oversight of the state boards of nursing and fall under the state boards of medicine like their PA counterparts. It’s already a push in many states with many having hybrid boards.
Posted on 4/4/18 at 11:03 pm to guttata
NP is a nurse who went to school online
Should not be able to practice independent of doctors
Should not be able to practice independent of doctors
Posted on 4/4/18 at 11:03 pm to toosleaux
I've worked with dozens of NP's and PA's through residency and my career thus far. There are probably only 2 that I would not mind having myself or a family member see if we were truly sick, and that is because they both have the intelligence to spot that a common complaint has an uncommon reason as well as the humility to come to me to ask for my help. They are both the only 2 mid-level providers that I've ever asked, "did you ever think about going to medical school?"
SB 435 is a horrible idea. A lot of medicine is about pattern recognition, which I think is why mid-level providers have been able to take off the way they have. However, something learned in residency is how to spot the "zebras" and how to think outside the box. A common saying is in my profession is that if you don't think about something, you're not going to find it. With residency, you end up seeing just about one of everything, and for those really rare things, you never forget it. This is an experience and training aspect that the mid-levels do not have. It's not their fault, just how the game is played. If this passes, there will be many life-changing conditions missed because a mid-level has never seen it and tries to fit it in one of the other "boxes" that they know. Physicians are not perfect and we end up hurting patients sometimes just like a mid-level can. The reason for this should never be "I didn't know that could happen," but unfortunately, that is what will be said a lot more if this passes.
SB 435 is a horrible idea. A lot of medicine is about pattern recognition, which I think is why mid-level providers have been able to take off the way they have. However, something learned in residency is how to spot the "zebras" and how to think outside the box. A common saying is in my profession is that if you don't think about something, you're not going to find it. With residency, you end up seeing just about one of everything, and for those really rare things, you never forget it. This is an experience and training aspect that the mid-levels do not have. It's not their fault, just how the game is played. If this passes, there will be many life-changing conditions missed because a mid-level has never seen it and tries to fit it in one of the other "boxes" that they know. Physicians are not perfect and we end up hurting patients sometimes just like a mid-level can. The reason for this should never be "I didn't know that could happen," but unfortunately, that is what will be said a lot more if this passes.
Posted on 4/4/18 at 11:16 pm to MDTiger 13
NPs, especially those that are hospital based, are notorious for ordering significantly more lab tests and studies, as well as consulting more specialty services. This shotgun approach to medicine is not cost or time effective.
Posted on 4/4/18 at 11:22 pm to cajuncarguy
quote:
Texas CRNAs, who put you under for surgery, have been able to practice without doctor supervision. And they make a lot more than those in Louisiana while helping keep the overall costs under control
CRNAs are able to practice independently in some states while many others require physician supervision. Truthfully the CRNA probably started this whole “mid level provider encroachment into medicine” ball rolling. Anesthesiologists of old traded their profession for convenience and the rest of us have suffered for it. I love working with many of my CRNA colleagues but in my opinion independent practice is not the ideal model for optimal patient safety in anesthesia.
Posted on 4/4/18 at 11:25 pm to Lithium
quote:
The quality of Midlevels greatly. Some are really good and really really bad.
The same can be said for physicians. I've worked in healthcare for 23 years, I've had numerous interactions with all types of physicians. Trust me, there are some great physicians out there, and there are some that should never have been given a license. That's a fact!!!
Posted on 4/4/18 at 11:30 pm to djangochained
quote:
NP is a nurse who went to school online
Attempt at trolling? The LSU Heath Sciences Center in New Orleans has a on-campus NP program, as does Baylor, Texas A&M, University of Houston, UT, Auburn, Alabama, and most major allied health/ medical schools.
LINK
Posted on 4/4/18 at 11:40 pm to EA6B
NP schools do require minimum clinical training hours though obviously no where near as rigorous as a 3-5 year medical residency program. For example, CRNA trainees usually accrue around 3000-4000 hours of clinical training while anesthesiology residents usually accrue between 13000 and 15000 hours of clinical training.
What is alarming, however, is the proliferation of DNP (doctorate in nursing practice) degree programs that are almost exclusively online-based and require no formal clinical training.
What is alarming, however, is the proliferation of DNP (doctorate in nursing practice) degree programs that are almost exclusively online-based and require no formal clinical training.
Posted on 4/4/18 at 11:59 pm to Scruffy
quote:
Scruffy works daily with NPs.
This is an awful idea.
I do too. And I agree it's a terrible idea. They don't have the training to recognize all the dangerous pathologies they should understand to practice independently. Do you really want someone operating "on the level of a doctor" without having completed 4 years of school plus a residency?
Part of that training is learning what you don't know. NPs... They don't know what they don't know. And that is why they are dangerous without oversight.
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