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Started By
Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 4/9/16 at 12:08 pm to KarlMalonesFlipPhone
Posted on 4/9/16 at 12:08 pm to KarlMalonesFlipPhone
That's pretty much how it works.
0
Posted on 4/9/16 at 12:09 pm to guttata
quote:
How do you address the need of more primary care providers? Med schools have pretty much tried everything to pursuade students to go into primary care.
The ultimate answer, imo, is you have to make medical school tuition free. How and if that is actually feasible, I have no clue. I'm graduating med school with 305k dollars in debt. My hand was forced from the start, I simply can't afford to go into something where you will only make 150-200k dollars. Until they can help curb student loan debt for future doctors, you will see people continuing to subspecialize.
Posted on 4/9/16 at 12:13 pm to guttata
quote:
making pcps see 10 more patients a day does nothing but comprise the standard of care as well.
It compromises their quality of life more than the quality of their care.
The expansion of mid levels into the PCP office is a great option. The addition of a payer source to essentially every Anerican was supposed to help but didn't seem to do so much.
Alaska is doing it right. They have a PCP shortage and a strong state economy, so they're offering $300-350K salaries (employed, 5wk vacation) for IM/Peds/FM (with OB playing a little more). It's a cyclical thing. More people are going into subspecialties now. Another 5-10y, and folks will swing back the other way.
Posted on 4/9/16 at 12:14 pm to jennBN
quote:
I am not an NP and have no desire to be one. It pays less than bedside nursing and requires more education/responsibility. However, this thread could benefit from a healthy dose of humility. Maybe the reason some prefer the NP is the difference in bedside manner. Docs, some of you sound condescending and arrogant. Maybe your patients agree...
Yeah but you work in an area that pays bedside RNs 100k plus. Most other parts of the country....NPs DO make more than a bedside RN.
The NPs I've personally seen as a patient....I noticed had more time to spend with me in the appointment to address any concerns I had. They had time to talk with me and I didn't feel as rushed as I have sometimes with MDs. My gyno has an NP in her office. If I need to get an appt not 3 months in advance and it's not a serious issue....I'll opt to see the NP cause I can usually get an appt with her that week vs a month later.
This post was edited on 4/9/16 at 12:15 pm
Posted on 4/9/16 at 12:16 pm to KarlMalonesFlipPhone
quote:
is you have to make medical school tuition free.
That's a standing offer on the table in New Orleans. It usually draws 1-3 spots per class.
quote:
305k dollars in debt. My hand was forced from the start, I simply can't afford to go into something where you will only make 150-200k dollars.
Sure you can. There's plenty of loan repayment options and people looking to pay off your loans to go work for them. And primary care can make plenty more than 150-200k if you know what you're doing. But salaried jobs for a PCP in LA are in the 200-220 range right now from what I'm hearing from some friends.
Posted on 4/9/16 at 12:17 pm to Mudge87
quote:
Seems like these jobs are becoming much more in demand with most stuff being outpatient treatment these days. I have no big issue with this fwiw.
"Demand" isn't what is driving this, it's the steady decline of reimbursement that's doing it. I work in the hospital field, we'd love to be able to hire physicians for most things, but sometimes you have to make do with a PA or NP. It wouldn't be that way if reimbursement were more fair.
Posted on 4/9/16 at 12:18 pm to KarlMalonesFlipPhone
A federally funded scholarship that will pay off your medical school debt when you match into a family practice residency?
Is the issue really that there isn't enough primary care physicians? Or is it that they aren't in the right rural/impoverished areas?
Maybe the question should be how do you get a professional to live next to a cornfield in Iowa or the ninth ward?
Is the issue really that there isn't enough primary care physicians? Or is it that they aren't in the right rural/impoverished areas?
Maybe the question should be how do you get a professional to live next to a cornfield in Iowa or the ninth ward?
Posted on 4/9/16 at 12:18 pm to guttata
Improved reimbursement for primary care. Cut all the bullshite that swamps us with administrative costs. Improve primary care training to teach docs how to make a good living...it's possible.
And how does giving NP's autonomy help this? Is care in name only really care? I can go on, but I'm at the track and gotta watch my horses.
And how does giving NP's autonomy help this? Is care in name only really care? I can go on, but I'm at the track and gotta watch my horses.
Posted on 4/9/16 at 12:19 pm to Hopeful Doc
quote:
Another 5-10y, and folks will swing back the other way.
not necessarily.... if the cost of getting the education continues to rise, and if salaries for family practices/"general practitioner" doesn't increase to make it worthwhile, i could very much see it being where it doesn't swing back...
the only course of action, at that point is to have other allied healthcare fields fill in the gap for, with expanded training/schooling, of course.... not that i necessarily want it, but i could definitely see a point in my career where we (pharmacists) will have prescriptive authority with a collaborative agreement with a physician's group... it's just a matter of time really...
Posted on 4/9/16 at 12:20 pm to Hopeful Doc
quote:
That's a standing offer on the table in New Orleans. It usually draws 1-3 spots per class.
But you have to do rural track to qualify for that. There are people that want to do primary care, but not necessarily be limited to living in a rural area.
Posted on 4/9/16 at 12:23 pm to KarlMalonesFlipPhone
quote:
I'm graduating med school with 305k dollars in debt.
Wanna hear a heartbreaking story about school debt?
Friend of mine went to dental school. A very expensive dental program at USC. Graduated and it wasn't until after when she was in her residency that she developed a severe allergic reaction to acrylic. So bad she couldn't even be in the same room as it. Was in the hospital with severe respiratory issues from it. So bye, bye dental career. Alllllllll those student loans(she told me she could be living in a really nice home in Scottsdale the amount of loans she has)...nothing to show for it but severe health issues.
She is now going back to school online to get her masters in health administration. She said it took her months to just process the fact that her lifelong dream had been forever snatched away from her.
Posted on 4/9/16 at 12:24 pm to LATigerdoc
Half the nurses I know think they know as much as a doctor. None of them could have gotten into med school much less made it through.
Posted on 4/9/16 at 12:24 pm to Hopeful Doc
quote:
That's a standing offer on the table in New Orleans. It usually draws 1-3 spots per class.
Are you referring to the "Rural scholar track".
That requires that you practice in a rural area for atleast 5 years after residency. (Not positive on the length of time)
Posted on 4/9/16 at 12:26 pm to KarlMalonesFlipPhone
quote:
but not necessarily be limited to living in a rural area.
You don't have to live in a rural area. You have to work in one. And there are also qualifying urban under served populations that count, too. You can go to school for free by living in NOLA and driving to Mandeville everyday for 5 years, then opening up shop closer to home.
Posted on 4/9/16 at 12:26 pm to Crimson
quote:
Crimson
My point was becoming a NP is not as easy as 18 months of online courses. It's a 3 year program. I agree it's not the same level as med school. But it is enough to let them struggle with the sniffles and coughs that I'm sure are the majority of pediatric clinic. Let them lift the burden of the simple stuff, and let them defer to a doctor on anything more complex. There is a reason they are called mid-levels and not more. Also, experience is key. I like a NP with 15 years and 3 kids at home than a fresh Doctor that doesn't understand how to raise a kid.
The mechanic (Doctor) can change the oil on my Honda, but I will have to drop it off for a couple hours and it will cost a bit. However, I trust 5 minute oil change (NP) to do it when all I need is an oil change. They are less trained, but fully capable to handle a simple issue. Sometimes, I even feel daring enough to let them top off my fluids.
This post was edited on 4/9/16 at 12:30 pm
Posted on 4/9/16 at 12:27 pm to lsunurse
quote:
Friend of mine went to dental school. A very expensive dental program at USC. Graduated and it wasn't until after when she was in her residency that she developed a severe allergic reaction to acrylic. So bad she couldn't even be in the same room as it. Was in the hospital with severe respiratory issues from it. So bye, bye dental career. Alllllllll those student loans(she told me she could be living in a really nice home in Scottsdale the amount of loans she has)...nothing to show for it but severe health issues
That's terrifying and heartbreaking at the same time. I think I would mentally crack at that point. Posted on 4/9/16 at 12:28 pm to KarlMalonesFlipPhone
Had a child present to the OR for me to anesthetize that was seen and "cleared" for surgery by a nurse practitioner. When I did my pre op exam I discovered a significant heart murmur in the child. The NP recorded a normal heart exam. Cancelled the case to have the murmer worked up. Patient went back to NP for referral who again stated the heart exam was normal without a murmer.
This person is either incompetent or arrogant.
Thing is I've discovered quite a few clinical errors such as this on the part of NP's over the years. I don't get upset because I know they do not have the education and training of a MD. Supervision is necessary.
Giving them autonomy may help access to care but at the expense of quality of care.
This person is either incompetent or arrogant.
Thing is I've discovered quite a few clinical errors such as this on the part of NP's over the years. I don't get upset because I know they do not have the education and training of a MD. Supervision is necessary.
Giving them autonomy may help access to care but at the expense of quality of care.
Posted on 4/9/16 at 12:30 pm to nolatiger711
quote:
However, I trust 5 minute oil change (NP) to do it when all I need is an oil change.
Are you certain that you know the difference in what you need?
Posted on 4/9/16 at 12:30 pm to double d
quote:
Half the nurses I know think they know as much as a doctor
I know that type, work with some of them
Working in a teaching hospital though...there have been times that us RNs had to stand our ground on crazy orders an intern may try to write. I hate going over them and calling the senior, but sometimes we don't have a choice. Even after asking the intern "you really wanted order this? You sure?" I mean...I'm not gonna let a 2 year old that is still awake and alert, having wet diapers, and able to tolerate po intake(with a mother willing to encourage po) be subjected to an IO being placed in them because the child is slightly dehydrated and we can't get an iv in right away (an intern actually wanted us to do this...didn't see anything wrong with it either).
Posted on 4/9/16 at 12:33 pm to Hopeful Doc
quote:
You can go to school for free by living in NOLA and driving to Mandeville everyday for 5 years, then opening up shop closer to home.
That's alot of if and buts. Mandeville is the only example you can give where that would seem desirable, and I don't think that area qualifies any longer. Last I heard Slidell was the best option. Still, why make those kind of sacrifices when you can just match into a specialty.
The fact that 1-3 people went that route should say less about the people and more about the incentive. Want a better result, make a better incentive.
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