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Started By
Message
re: LA legislature denies Independent nurse practice
Posted on 6/22/21 at 1:12 pm to lsucoonass
Posted on 6/22/21 at 1:12 pm to lsucoonass
quote:
They are a doctor just not an MD
Yeah , and So is “Dr. Josh”
Posted on 6/22/21 at 1:14 pm to CajunDoc
So again what are the current oversight regulations???
Posted on 6/22/21 at 1:23 pm to BeepNode
quote:That's because the doctor's union (American Medical Association) artificially keeps the supply of doctors low.
Doctors today seem like they're completely slammed.
Posted on 6/22/21 at 2:03 pm to SM6
Your sense is wrong, but thanks for playing.
"Only handling the simple things" is all well and good until they continue to call issues these simple things and miss something important.
The saying in medicine is that "you don't know what you don't know." Ignorance in medicine is a very scary thing
"Only handling the simple things" is all well and good until they continue to call issues these simple things and miss something important.
The saying in medicine is that "you don't know what you don't know." Ignorance in medicine is a very scary thing
Posted on 6/22/21 at 7:01 pm to lsucoonass
quote:
Well I can tell you this, I’m a practicing Occupational Therapists and had to take the same anatomy course as the med school students (that included the cadaver lab) at LSU health in Shreveport
No you did not, you took an A&P course developed for allied health students in the summer taught in the gross anatomy lab (6 th floor) taught by some of the same professors as med school ( Dr clausen?, Dr penny?) but it was not the same course taught to med school students in fall and spring
That being said I would put my money on a good PT or OT for musculoskeletal anatomy over a MD (other than an orthopedic or similar) any day
Posted on 6/22/21 at 7:14 pm to Tigerpaw123
Y’all are burying the lead- James Gill is still alive?? And still being paid to write his crap? Good lord.
Posted on 6/22/21 at 7:21 pm to CajunDoc
quote:
CajunDoc
You are more concerned with your market share than you are patient health. The rest of the country has NP and PAs delivering primary care at a range of facilities. Louisiana took the brave stance not to allow that, interesting decision in a state that struggles with 1) a lot of terribly unhealthy people 2) many people unable/unwilling to pay for their own health care.
How much are your association dues? I have to admit, they are paying dividends.
Posted on 6/22/21 at 11:24 pm to SM6
quote:
You are more concerned with your market share than you are patient health
his 'market share' will not likely be impacted lmao. patient health will likely be impacted.
quote:
The rest of the country has NP and PAs delivering primary care at a range of facilities. Louisiana took the brave stance not to allow that,
actually the majority of states do not allow independent midlevel practice. most states do require collaborative/supervision contracts.
quote:
1) a lot of terribly unhealthy people 2) many people unable/unwilling to pay for their own health care.
1) is a great reason to not allow midlevel independence as managing a patient population with many and complex medical problems is much more likely outside the scope of midlevel practice and training.
2) if they can't/won't pay for health care your point is moot.
Posted on 6/23/21 at 5:24 am to CajunDoc
To clarify:
1. No one (in healthcare) has the same level of “book smart” or “academic rigor” as medical students.
Wife and I are physicians and our oldest child just got done with the MCAT. She studied 300 hours for the test (while keeping a 4.0 GPA in college). I repeat, she studied 300 hours for the test to APPLY to medical school. Her friends did similar levels of preparation.
No other medical discipline studies like that. The number of hours she will study in her 1st year alone of medical school will surpass any mid levels total training for their career.
2. I supervise and lecture mid levels as well as primary care medical residents.
The difference between the two groups (in lecture and clinic) is in stark contrast.
The types of questions I get during a lecture, the way they process information, and the clinical questions I get throughout the day.
We utilize NP’s to see routine complaints in our offices, but we have MD’s in the same clinic with protected time to be available for questions which always arise. We also have several specialists (I am one of those) available by computer message. We can review the patients chart and give advice.
I have never had a medical resident make a “What were you thinking?” type of mistake in diagnosing or dosing a medication. I probably get 1-2 of those mistakes per week with my mid levels.
NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.
1. No one (in healthcare) has the same level of “book smart” or “academic rigor” as medical students.
Wife and I are physicians and our oldest child just got done with the MCAT. She studied 300 hours for the test (while keeping a 4.0 GPA in college). I repeat, she studied 300 hours for the test to APPLY to medical school. Her friends did similar levels of preparation.
No other medical discipline studies like that. The number of hours she will study in her 1st year alone of medical school will surpass any mid levels total training for their career.
2. I supervise and lecture mid levels as well as primary care medical residents.
The difference between the two groups (in lecture and clinic) is in stark contrast.
The types of questions I get during a lecture, the way they process information, and the clinical questions I get throughout the day.
We utilize NP’s to see routine complaints in our offices, but we have MD’s in the same clinic with protected time to be available for questions which always arise. We also have several specialists (I am one of those) available by computer message. We can review the patients chart and give advice.
I have never had a medical resident make a “What were you thinking?” type of mistake in diagnosing or dosing a medication. I probably get 1-2 of those mistakes per week with my mid levels.
NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.
This post was edited on 6/23/21 at 6:29 am
Posted on 6/23/21 at 7:28 am to SECdragonmaster
quote:
NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.
I agree, so again what is the current oversight regulations in LA regarding NP and physician? what is a collaborative agreement?
Is what we currently have worth a shite? is it worth fighting over ? Or should we be looking into adding more structure to it?
Posted on 6/23/21 at 8:38 am to Ronaldo Burgundiaz
quote:
That's because the doctor's union (American Medical Association) artificially keeps the supply of doctors low.
Tha AMA is a professional organization, it functions nothing like a union. Physicians don’t have a union. The AMA also has zero control over how many new schools open up and how many residency spots get approved/funded.
There are certainly people to blame, but you have no idea what you are talking about.
Posted on 6/23/21 at 8:41 am to Privateer 2007
quote:
No problem here.
Nurses aren't Drs
And this is why access to health care is extremely out of high and out of control
FIFY
Posted on 6/23/21 at 9:31 am to CajunDoc
I don't think anyone should confuse a NP/PA with a MD.
I believe there are things that are so basic that an NP/PA should be allowed to deal with by themselves with proper regulation.
This has been asked several times, but no clear answer given... what do other states do? What is the national standard here?
I'm often of the opinion that if LA is going against national model, we are probably wrong...
I believe there are things that are so basic that an NP/PA should be allowed to deal with by themselves with proper regulation.
This has been asked several times, but no clear answer given... what do other states do? What is the national standard here?
I'm often of the opinion that if LA is going against national model, we are probably wrong...
Posted on 6/23/21 at 12:24 pm to LSUFanHouston
quote:
I'm often of the opinion that if LA is going against national model, we are probably wrong...
LA is actually more in line with the majority of states, but the balance will flip within 4 years is my guess. mostly because the midlevel lobbying is robust and has business interests of large medical management and hospitals.
quote:
This has been asked several times, but no clear answer given... what do other states do? What is the national standard here?
for midlevels there is no clear answer or national standard, it depends on the state. basically main categories are full (independent), reduced (collaborative), or restricted practice (supervision or designated team roles). LA is reduced practice. the majority of states are reduced/restricted practice for midlevels. the rigors of those reduced/restricted agreements change per state. but essentially it means the physician may be vicariously liable for midlevels as they are 'practicing under' a physician.
collaboration generally entails chart auditing/sign off, general management outlines, and consultation availability.
restricted is more limiting on the scope, how/what midlevels can prescribe, treatments, exams, order, perform procedures, and are more closely tied to a physician.
independent practice is allowed in some states after x time of supervision/collaboration, as soon as they are licensed, or with DEA registration.
an intern year physician 1 year out of medical school is much more trained than a midlevel will ever be, but cannot practice independently. In many of the independent practice states you might as well start letting 4th year medical students open up their own practice as they have more training than recently minted midlevels who are practicing independently.
Posted on 6/23/21 at 12:26 pm to Tigerpaw123
quote:
I agree, so again what is the current oversight regulations in LA regarding NP and physician? what is a collaborative agreement?
I have no idea the laws in LA but in Alabama:
1. I have to review 10% of the charts (chosen at random) from a NP’s caseload.
2. I can supervise up to 9 NP’s at a time.
That is the main supervision. So, if they are making mistakes on the other 90%, I won’t know until it’s too late.
That is why I only agree to supervise a mid level when I am working in the clinic with them.
Posted on 6/23/21 at 12:49 pm to AMS
quote:
an intern year physician 1 year out of medical school is much more trained than a midlevel will ever be,
Trained, or classically educated?
I would think an NP with 20 years exp has "seen" more things in the field... but the physician 1 year out of medical school has probably learned more things from books/lectures/labs.
Or is there really no distinction?
Posted on 6/23/21 at 1:04 pm to LSUFanHouston
Source: Beckers Hospital Review
quote:
Full practice authority
Alaska
Arizona
Colorado
Connecticut
Hawaii
Idaho
Iowa
Maine
Maryland
Massachusetts
Minnesota
Montana
Nebraska
Nevada
New Hampshire
New Mexico
North Dakota
Oregon
Rhode Island
South Dakota
Vermont
Washington
Wyoming
Reduced practice authority
Alabama
Arkansas
Delaware
Illinois
Indiana
Kansas
Kentucky
Louisiana
Mississippi
New Jersey
New York
Ohio
Pennsylvania
Utah
West Virginia
Wisconsin
Restricted practice authority
California
Florida
Georgia
Michigan
Missouri
North Carolina
Oklahoma
South Carolina
Tennessee
Texas
Virginia
Posted on 6/23/21 at 2:57 pm to SECdragonmaster
quote:
I have no idea the laws in LA but in Alabama:
1. I have to review 10% of the charts (chosen at random) from a NP’s caseload.
2. I can supervise up to 9 NP’s at a time
and that is what i am getting at, not sure what the law is in LA, so was trying to get a clear answer but no one is offering......
my vague understanding is that our law is similar, retro chart review on a small % of patients and be available by phone...... and if that is the case, it is bull crap and is doing very little, likewise if that is what this fight is about ....keeping this as law or eliminating it, why fight it? as it is doing nothing anyway, and it also confirms this is a turf battle.
if this fight is about strengthening the regulations then lets hear it
Posted on 6/23/21 at 3:22 pm to CajunDoc
Yeah I don't have a problem with this one.
States that have a rural medicine shortage need to lobby for more residency slots and expand their medical school programs. Then have NP's and PA's practice in these clinics under supervision of an MD or DO.
Giving more responsibility to people that may not be prepared for it isn't a solution - although I'm sure there are some NP's out there that are more than capable.
States that have a rural medicine shortage need to lobby for more residency slots and expand their medical school programs. Then have NP's and PA's practice in these clinics under supervision of an MD or DO.
Giving more responsibility to people that may not be prepared for it isn't a solution - although I'm sure there are some NP's out there that are more than capable.
This post was edited on 6/23/21 at 3:25 pm
Posted on 6/23/21 at 3:27 pm to SECdragonmaster
quote:
No one (in healthcare) has the same level of “book smart” or “academic rigor” as medical students.
And there's actually just as much of a shortage of mid levels in some states too.
quote:
NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.
100% agree. Which means Louisiana is doing the right thing at the moment. Which surprises me.
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