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

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Why can't you just limit their practice to certain conditions and certain treatments.

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That's not what they are asking for. They want unlimited scope of care, unsupervised.

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Why do you feel threatened -other than and economic threat?

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Good doctors aren't. Shitty doc's may be, but no one else.


Why can't dental hygienist practice as dentist? Same difference. Paralegals become lawyers after working 2 years? Same difference.

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these same clinics are basically designed to practice bad medicine. You walk in, you leave with something. Most of the time, that something is inappropriate. Most people get 3 days of a runny nose and a sore throat, so they've diagnosed themselves with something that needs an antibiotic. So they walk into the retail clinic to get it and feel better in another 2-4 days.

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Or don't get better. Get much worse and end up in our office on inappropriate meds and misdiagnosed. Seen it time and time again.

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the plan is usually just all the orders listed without an explanation as to why they did it.

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I also don't mean it in a negative or demeaning way at all, though it could be taken offensively in black and white from someone who felt like being offended: they're brilliant at word association and algorithms.
They're never taught the thought process of a diagnostic work up from the ground-up (again- has zero to do with intelligence, everything to do with training). But myself, another physician and his NP had a discussion on an antibiotic choice once. She chose one that neither of us would've reached for first. She did it because it was on the little algorithm card for that condition. We agreed that she wasn't wrong. But there's no thought that goes into what's being covered when she chooses it- she just knows "condition A, antibiotic X." There are alternatives for the allergic patient, but I promise she isn't aware of what covers G+/- vs anaerobes or why 2 antibiotics are needed rather than 1 because the patient has a PCN allergy.

And then, of course, something that will likely be lost on most reading it, but you'll get where I'm coming from: algorithms. Algorithms are great. They make it easy. But if you could treat everything by following algorithms, non-proceduralists would be out of jobs. The "art" of medicine starts when you know where to jump off the algorithm and do things differently. It's something you can only do if you've got a broad basic sciences background plus years of clinical experience, particularly those years of clinical experience where you're under the tutelage of the more seasoned docs.

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Why can't you just limit their practice to certain conditions and certain treatments.

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Let's put it this way- you walk in with symptoms and walk out with conditions. It must be diagnosed. Diagnosing is hard. It's better done by those with more experience. Thus, residency exists for physicians.

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Hell, why can't anyone who wants to educate themselves on the law take the BAR and practice it?

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Hey, I'm more than happy to let them take our boards. If an NP can pass Step 1-3 + CS, they've got enough of a fundamental knowledge base to then be trained.



But they don't. And they aren't required to.

Cool, the slippery slope fallacy is always a fun exercise.

Where do you fall on LA's $500,000 medical malpractice awards limit? Because if you're in favor of it, you have no leg to stand on in opposition to opening up the barriers to entry.

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All that to say they hire them because they are cheaper than another MD.

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Well, yes and no. More like "they can do 60% of what another MD could do for 60% of the cost."

It's not just cheaper. They're absolutely less effective and less capable of the full scope of primary care (one more time- not that they're not intelligent enough, compassionate enough, or anything else I may sound like I'm knocking. Simply untrained for the job). If given the choice between a solo practitioner owning his practice and hiring an NP or partnering with another MD, he'd be better off with another MD, strictly prophet-wise.

In a free market there would still be credentialed and trained practitioners of all professions, but the consumer would be able to decide if he wants to pay the premium or not. If it turns out to be a bad deal then the consumers will prefer "real" doctors.

When I was in Central America I broke my leg and a guy who was not a doctor but who had a lot of experience in the field is who took my x-ray, looked at it, showed me the crack, and then also made a cast for me. He had instructions for care that mirrored the industry standard in the US. The whole ordeal cost $150, no insurance, no bullshite. If there were complications I sure as frick would have went to a real doctor but for routine shite I may or may not want to fork out the extra $$ to see an MD.

Also, the customer service of doctors is deplorable. I go all the time due to having 4 kids and being an aging man myself. Every time I go I show up on time, if not 5 or 10 minutes early yet I have to wait in the examination room for 15-30 minutes. The doctor NEVER says "sorry I was late with another patient" and the doctor is NEVER on time. It's basically like the doctors have zero respect for your time. It's crazy to think about it when you apply that mentality to other professions.

Also, doctors make mistakes yet rarely admit to it. I've caught a mistake a doctor made with my mom that I was able to figure out simply by googling it. It would have harmed her greatly had the procedure been needlessly performed. He never apologized although the other doctor was "troubled" by the recommendation. They claim that you need an MD to ensure that nothing will go wrong or be missed and yet when they make a mistake they claim that law suits need to be restricted.

Doctors will restrict freedom of choice, advocate to have the government mandate their monopolies and then shrug it off when there's a shortage of doctors.

What else would it take for doctors to do in order to classify them as a cartel with immense lobbying power to rig the markets in their favor?

Why are you still bringing up this GP thing?

It's simply a colloquialism.