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Started By
Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 5/12/16 at 12:05 am to ManBearTiger
Posted on 5/12/16 at 12:05 am to ManBearTiger
Why are you anti doctor
1
Posted on 5/12/16 at 12:08 am to LATigerdoc
I'm anti dickheads and pro free market, you just happen to be a overtly monopolistically inclined doctor with a dickheaded attitude
Posted on 5/12/16 at 12:08 am to ManBearTiger
once again. It's principle. The primary care nps are not in my field
This post was edited on 5/12/16 at 12:11 am
Posted on 5/12/16 at 12:10 am to Hopeful Doc
quote:
When doing primary care rotations in school, I often heard patients say something to the effect of "yeah, the doctor wouldn't give me an antibiotic so I went to urgent care and got a z-pack."
That UC provider was just as likely an MD. Many times in triage a patient would tell me their PCP sent them to us (ED) for further eval and treatment, many of them freaking out after being told they needed to immediately go to the ED, and I would have to calm them down and then tell them they were being assigned to our urgent care (to be possibly seen by an NP) because I, as an RN, knew that there was absolutely nothing wrong with them that warranted an ED visit. Most times, that PCP was an MD.
In my 16 years as an RN/APRN, I don't recall ever hearing an MD explain to a patient the why and why nots of not prescribing an antibiotic in cases just like or similar to the one quoted above. On the other hand, I have heard several NPs take the time to explain this to their patients as best they can (with their grossly limited knowledge and experience base). Of course, not all MDs or NPs do what I just stated.
An MD once told me "I could take 30 minutes explaining to them why they do not need an antibiotic, and have them tell me they still want it anyway, or I can just give them what they're asking for and be out of there in about a minute." This practice becomes more frequent as the years pass thanks to Dr. Google and Mr. Press Ganey.
The issue with the collaborative practice bill and whether it should be passed is not black and white in my mind. I've worked in EDs where the MDs are only available for collaboration if the NP asks for it, and I've worked in an ED where the MDs at the very least laid eyes on the patients to performing focus based exams. I did clinicals in and now work in a clinic, as an NP, where the collaborative MD never lays eyes on a single patient and simply signs off on charts.
So this is why I see collaborative practice as a gray area. Some places it is warranted and beneficial for the patients and NPs alike, but in others, it only benefits one person, the MD signing charts and collecting his fee.
In any field of medicine, they're are excellent MDs and NPs, and there are the ones you would rafher
suffer than have them treat you.
This post was edited on 5/12/16 at 12:12 am
Posted on 5/12/16 at 12:10 am to LATigerdoc
Serious question, approximately where between autism and aspergers do you fall on the spectrum?
Posted on 5/12/16 at 12:13 am to ManBearTiger
I am very honored to have met u. It's been a pleasure
Posted on 5/12/16 at 12:15 am to ManBearTiger
quote:
I'm anti dickheads
Damn. I was hoping we could be friends.
Posted on 5/12/16 at 12:17 am to SmackoverHawg
I'll be your friend
Posted on 5/12/16 at 12:18 am to SmackoverHawg
Self deprication is an automatic disqualifier for dickheadism, so there's still hope
This post was edited on 5/12/16 at 12:18 am
Posted on 5/12/16 at 12:18 am to Hopeful Doc
quote:
But here's the thing about being a doctor- your time is absolutely valuable.
Your patients are beneath you. Got it.
Posted on 5/12/16 at 12:19 am to Asgard Device
Usually they are directly anterior to you, often supine on an exam table
Posted on 5/12/16 at 12:21 am to Asgard Device
quote:
Your patients are beneath you. Got it.
I'm a bit more calm, cool, and collected than our friend here when it comes to sniffing out troll attempts.
But it sounds like you should probably change physicians.
Posted on 5/12/16 at 12:24 am to ManBearTiger
quote:
Self deprication
I don't know what that is, but I've done self defecation before. Leftover taco bell, late night of drinking prior, duck hunt in waders faaaar from dry land. Not a good combo.
Posted on 5/12/16 at 12:26 am to LATigerdoc
quote:
I'll be your friend
Now off to poliboard to piss some people the frick off.
Posted on 5/12/16 at 12:30 am to ManBearTiger
quote:
Why not indeed? Why can't I ask a dental hygienist to fill a cavity? Hell, why can't anyone who wants to educate themselves on the law take the BAR and practice it? If I feel I get the best value going that route, why am I barred from making that decision as a prospective patient or client?
In Australia there are dental practitioners they do three years of training beyond high school, Thye do fillings, simple extractions, cleanings, other basic care. Apparently in some areas of Alaska dentists are scarce with no amount of financial incentives offered being enough to attract dentist. In a effort to provide care they sought to allow dental practitioners from other countries to be permitted to practice in the state. Of course the ADA fought it at every turn, but offered no other solution to the lack of dental care.
Once upon a time you could clerk or apprentice for a lawyer and eventually take the bar exam, my grandfather had a 6th grade education and did this. There are currently 6 or 7 states where this is still allowed.
Posted on 5/12/16 at 12:35 am to ManBearTiger
quote:
Wrong. In a free market any meds would be available for purchase to anybody for any reason.
That is fudged up I do not even know where to start.
Posted on 5/12/16 at 12:41 am to Asgard Device
quote:
What about the patient who cannot make decisions due to age or mental status
Somebody is making a decision or else they wouldn't be in your office.
Yeah you obviously have no idea how any of this works
Posted on 5/12/16 at 1:03 am to Hopeful Doc
90% of people have no idea what the training to become a physician consists of. So ill share my experience. This is going to be long, but it may give you a glimpse as to why some of us have the opinions that we have on this subject.
Im in my early-mid 30s and am 2 years away from finishing my training and becoming an attending physician. I busted my arse for 4 years of college. Then I busted my arse to get a good score on that shitty mcat and get accepted to medical school.
Then I busted my arse for 4 years of medical school. The first two years of med school I studied my arse off night and day for 2 years, going to class all day and studying all night, learning basic and medical sciences (anatomy, physiology, histology, biochemistry, microbiology, pathology, etc...).
After finishing the first two years of med school, I spent over a month studying for what we call "Step 1" of the USMLE boards. I would wake up at 6, eat breakfast, take a shite, take a shower, and study from 7am-10pm, only stopping to take a lunch break for 30min-1hr. At 9pm I rewarded myself with a beer (douple ipa at that time) and did practice questions until i fell asleep. Did that every day for 4-6 weeks without a day off so i would do well on that "test." There were several periods of time during my first two years of med school where I didn't even walk outisde my house for 3-4 days at a time, and im not even joking. Didnt even walk outside bc i had so much to study.
Then I started the second 2 years of med school, which was spent in the hospital. Our clinical rotations 3rd year included 8 weeks surgery, 4 weeks psychiatry, 4 weeks neurology, 8 weeks pediatrics, 12 weeks internal medicine, 6 weeks family medicine, 6 weeks ob/gyn (maybe i forgot one?). 4th year I did 4 weeks neurosurgery, 4 weeks burn surgery, 4 weeks pathology, 4 weeks radiology, 4 weeks interventional radiology, 4 weeks anesthesiology, 8 weeks ER, 4 weeks psychiatry, and cant remember at the moment the last couple rotations of 4 th year.
Then I studied for and passed "Step 2" of the usmle boards.
Then i graduated med school, which was the easy part come to find out, and completed a 1 year internship. Then I studied for and passed "Step 3" of the usmle boards.
After that I started my residency in the specialty ive been working towards this whole time. And Ive worked my arse off in residency. Over a two year period during residency, I have worked nearly 100 24-hour call shifts. And by 24-hour call shift, I mean I worked for 24 hours straight. Did that 100 times over 2 years. Never slept a wink during any single one of those shifts. Each one was stressful as frick, trying to do my best for evry single one of my patients. Im in year 3 of a 4 year residency, and am doing a one year fellowship after that.
At this point, I feel like Im getting close to the point of having the knowledge, skills, and experience to safely and effectively practice on my own. But Im not there yet. Ive seen and learned a lot of shite about medicine and patients, and i learn something new from every patient. And everything I learn, I also am reminded of how much I still do not know, which is scary. But I know that all of this knowledge and experience that i have gained over these years and all of the sleepless nights Ive been through will help me be able to handle anything that comes through the door.
When I finish, I will have completed: 4 years of college, 4 years of medical school, and 6 years of post graduate training in the hospital (thats post graduation from med school to be clear). Im $300,000 in debt from student loans to pay my way through med school, currently make <60k/yr, and can look forward to some fricking administrator with a business degree telling me how I can and cant practice medicine. That administrator by the way, is the one with the 3 houses and 2 boats, not me.
When you have the choice, youre free to go see an NP over an MD. You can trust that that NP has had some training. She/he has probably gotten a bachelors degree (RN) in college followed by 2-3 years of NP school. They do some clinical rotations, which specify certain numbers of hours spent rotating through internal or family medicine clinics. Notice I said HOURS and NOT MONTHS. Just fyi, lots of NP programs are online programs. Thats right, ONLINE PROGRAMS. Oh yeah, and a significant portion of np school is spent writing papers on "nursing theory" and bullshite like that. And they dont do residencies.
NPs do make meaningful contributions, and thet have a role in healthcare. But it is delusional to compare their knowledge and experience to that of physicians. Like i said the other day in this thread, nurse and doctors have DIFFERENT ROLES in healthcare. A group is trying to gain the privileges to perform a different more complex task that is beyond their scope, without gaining the knowledge or experience that is currently required to perform that role. And what is at stake? People lives. No one seems to understand that, and i cant understand why no one understands that.
Deep thoughts, by DuppyConqueror.
Out.
Im in my early-mid 30s and am 2 years away from finishing my training and becoming an attending physician. I busted my arse for 4 years of college. Then I busted my arse to get a good score on that shitty mcat and get accepted to medical school.
Then I busted my arse for 4 years of medical school. The first two years of med school I studied my arse off night and day for 2 years, going to class all day and studying all night, learning basic and medical sciences (anatomy, physiology, histology, biochemistry, microbiology, pathology, etc...).
After finishing the first two years of med school, I spent over a month studying for what we call "Step 1" of the USMLE boards. I would wake up at 6, eat breakfast, take a shite, take a shower, and study from 7am-10pm, only stopping to take a lunch break for 30min-1hr. At 9pm I rewarded myself with a beer (douple ipa at that time) and did practice questions until i fell asleep. Did that every day for 4-6 weeks without a day off so i would do well on that "test." There were several periods of time during my first two years of med school where I didn't even walk outisde my house for 3-4 days at a time, and im not even joking. Didnt even walk outside bc i had so much to study.
Then I started the second 2 years of med school, which was spent in the hospital. Our clinical rotations 3rd year included 8 weeks surgery, 4 weeks psychiatry, 4 weeks neurology, 8 weeks pediatrics, 12 weeks internal medicine, 6 weeks family medicine, 6 weeks ob/gyn (maybe i forgot one?). 4th year I did 4 weeks neurosurgery, 4 weeks burn surgery, 4 weeks pathology, 4 weeks radiology, 4 weeks interventional radiology, 4 weeks anesthesiology, 8 weeks ER, 4 weeks psychiatry, and cant remember at the moment the last couple rotations of 4 th year.
Then I studied for and passed "Step 2" of the usmle boards.
Then i graduated med school, which was the easy part come to find out, and completed a 1 year internship. Then I studied for and passed "Step 3" of the usmle boards.
After that I started my residency in the specialty ive been working towards this whole time. And Ive worked my arse off in residency. Over a two year period during residency, I have worked nearly 100 24-hour call shifts. And by 24-hour call shift, I mean I worked for 24 hours straight. Did that 100 times over 2 years. Never slept a wink during any single one of those shifts. Each one was stressful as frick, trying to do my best for evry single one of my patients. Im in year 3 of a 4 year residency, and am doing a one year fellowship after that.
At this point, I feel like Im getting close to the point of having the knowledge, skills, and experience to safely and effectively practice on my own. But Im not there yet. Ive seen and learned a lot of shite about medicine and patients, and i learn something new from every patient. And everything I learn, I also am reminded of how much I still do not know, which is scary. But I know that all of this knowledge and experience that i have gained over these years and all of the sleepless nights Ive been through will help me be able to handle anything that comes through the door.
When I finish, I will have completed: 4 years of college, 4 years of medical school, and 6 years of post graduate training in the hospital (thats post graduation from med school to be clear). Im $300,000 in debt from student loans to pay my way through med school, currently make <60k/yr, and can look forward to some fricking administrator with a business degree telling me how I can and cant practice medicine. That administrator by the way, is the one with the 3 houses and 2 boats, not me.
When you have the choice, youre free to go see an NP over an MD. You can trust that that NP has had some training. She/he has probably gotten a bachelors degree (RN) in college followed by 2-3 years of NP school. They do some clinical rotations, which specify certain numbers of hours spent rotating through internal or family medicine clinics. Notice I said HOURS and NOT MONTHS. Just fyi, lots of NP programs are online programs. Thats right, ONLINE PROGRAMS. Oh yeah, and a significant portion of np school is spent writing papers on "nursing theory" and bullshite like that. And they dont do residencies.
NPs do make meaningful contributions, and thet have a role in healthcare. But it is delusional to compare their knowledge and experience to that of physicians. Like i said the other day in this thread, nurse and doctors have DIFFERENT ROLES in healthcare. A group is trying to gain the privileges to perform a different more complex task that is beyond their scope, without gaining the knowledge or experience that is currently required to perform that role. And what is at stake? People lives. No one seems to understand that, and i cant understand why no one understands that.
Deep thoughts, by DuppyConqueror.
Out.
Posted on 5/12/16 at 1:04 am to DuppyConqueror84
And yes, I realize no one is going to read a post that long. But frick it.
Posted on 5/12/16 at 5:42 am to LATigerdoc
Capitalism bro.
They do most of the work anyway.
They do most of the work anyway.
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