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

You nailed why this is scary. People want to just be able to prescribe themselves anti-biotics these days. They know NPs are an easier way to get them.

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Sam4LSU

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I agree with everything you said 100%

Thank you for your honesty

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FNP checking in... I am not a doctor and I don't deserve to be called a doctor even with a Doctorate degree in nursing. I do not believe that NPs were created to practice with complete independence. I do believe that online schooling for this degree should be phased out. My program was 75% classroom/skills lab and 15% online. It was a 2.5 year program. I graduated from LSU HSC. This is not the "norm" for NP programs, but should be. We also had to complete more clinical hours when compared to other programs, which is why I went to LSU. I also feel that more clinical hours would be beneficial. Unfortunately, there are idiots in every field of work that somehow managed to make it through schooling, but should not be in practice and these are the people who frighten me the most if this bill passes. NPs like myself, will never want complete autonomy. If we did, we would have went to medical school to begin with. With that said, I do believe that NPs should be able to practice to the full extend of their Scope of Practice as defined by the LSBN.

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Well said. And I know I may come across as anti-NP at times, but I most certainly am not. I have two and am training a third. The program was created to serve a purpose and it has. I apologize if some of my posts were derogatory towards NP's in general. I think the vast majority feel the same way you do and understand the dangers and motives behind this.

LINK

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This has nothing to do with my paycheck as a primary care physician -- zero. It has everything to do with the inadequate training NP's receive.

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This. It amazes me how our only motive seems to be profit according to our opposition. However, the NP's wanting to freelance have only humanitarian goals. Are they not doing this for profit? If not, then why? Better more accessible care? Nope, we've already shot that down. More efficient care? Nope.
Why? Money. They and the big hospital groups they work for want to cut doctors out of the loop for profit and profit alone. How else does it make sense?

If anything, more oversight should be mandated. There are plenty that do essentially practice independently and get some shady arse doc to sign off on their charts for a nominal fee. Like I've said before, I review 100% of my NP's charts. It doesn't have to be that strict, but that's my standard. ANYTHING but routine med checks and the simplest of complaints is to be run past me. And my rule is that I see the pt every third visit minimum. Many of these collaborating physicians never see the pt or even step foot in the office they are "supervising". And that is what needs to end. We need more oversight, not less.

You obviously have way too much free time on your hands if you've got the time to review 100% of both of your NPs charts. I'm sure your NPs are thrilled to be working for someone who respects them so much that their doc doesn't trust them to do anything. I commend you that you are obviously not a MD who is motivated by money.

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You say the market will adjust if NPs don't provide adequate care, but do you really want it to adjust because your grandma died due to an autonomous NP with much less training than a doctor missing a critical diagnosis? Because in this case the only way the market adjusts is if people get hurt. I'm not ok with that.

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i get what you are laying down, i really do, but let's not act as if physicians are perfect and never miss shite either... there are some dumb arse physicians out there, that i wouldn't trust with chemistry notes, much less my healthcare...

bascially, there is a need for more midlevel practitioners, a need that will only grow with time as people live longer due to advancements in healthcare, and it's a need that the thought of "physicians only" can fix is not the right answer... autonomy for a midlevel, IMO, would only come at the cost of much, much more training and education...

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there are some dumb arse physicians out there, that i wouldn't trust with chemistry notes, much less my healthcare...

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Very true.

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autonomy for a midlevel, IMO, would only come at the cost of much, much more training and education...

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Yeah...it's called med school. And pharmacists don't need to be care providers either. Sorry, but y'all get NO training in treatment or diagnosis. My wife is a PharmD btw.

And once again, how exactly will give NP's autonomy increase access and improve care?

I think primary care training needs to be intensified personally. Newer grad's are just glorified NP's so I can see how the line gets blurred. It's almost like there's been an intentional effort to dumb down family practice to promote mid-levels. But even their training far far FAR exceeds that of mid-levels. Please read the post from the NP earlier.

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You obviously have way too much free time on your hands if you've got the time to review 100% of both of your NPs charts. I'm sure your NPs are thrilled to be working for someone who respects them so much that their doc doesn't trust them to do anything. I commend you that you are obviously not a MD who is motivated by money.

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I told them going in how things would work. Their first few years would be just like residency and I was willing to sacrifice some volume and profit in exchange for ensuring they were well trained. I play the long game. We still see about 30-40 pt's/day more than I did solo. So it's a win-win situation. I understand that doing things the right way can take time and patience. They do as well. Like Coach John Wooden said, "If you don't have time to do things right the first time, when will you have time to do them again."

So I have increased access to care, can offer lower prices for those seeing the NP, give exceptional oversight, and increased my profits which helps ensure I can continue these services and expand them. This is how is should and can be done. Legislation such as the one proposed here does none of the above. All it does is allow rogue mid-levels to run wild.

And once AGAIN, how does letting them practice with zero oversight increase access? Do you not think they will be motivated by profit to give care they are not qualified to give?



And I want to re-emphasize that I'm not anti-NP. I just think it's ridiculous to ever allow them complete autonomy. And in fact, I'm for more oversight and training for both them and FP's. I think overall healthcare has declined in the past 20-30 years because of our touchy-feely bullshite training programs. And arguing that there are bad doctors is no excuse for allowing even less skilled and more poorly trained "providers" to run amok.

I think it's all a conspiracy towards single payer.

Seriously.

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And pharmacists don't need to be care providers either.

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trust me, we don't want to, asshat... nor did i insinuate that's what i, as a pharmacist, am promoting....

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y'all get NO training in treatment

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yeah, this is bullshite... there are many times where we know more about the treatment of an ailment more than the physicians that are ordering the treatment.... again, there are some dumb arse physicians out there....

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or diagnosis

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that's not our bag... that's a physician's...

you need to calm the frick down over there, chief... not all other healthcare professionals outside the realm of "physician" are trying to encroach on your precious prescriptive authority.... like i've said before, not everyone wanted to be a physician and then went and did something else.... i've never wanted to be a physician, nor do i envy any of you... i see my physician friends and they are miserable...

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My wife is a PharmD btw.

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you've said this a million times and i don't give a frick what your wife does...