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

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But you never mentioned why you put yourself through this torture money power control or you love people.

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Haha, so I get to choose from "money, power, control, or love people?" Unfortunately many people think "money, power, and control" are the reasons people want to become physicians. I guess it is because some physicians make a lot of money and can be dickheads at times, IDK.

I went into medicine because I love science, the life-long learning, the challenge that each day and patient bring, the problem-solving, technology, etc…And yes, I actually do love to help people. If you don't like working with people, you're going to have a tough time in medicine. Hopefully at some point, I'll make some damn money, but its not going to be anytime soon, that's for sure. And if you go into medicine for the money, you're an idiot and will not be happy or good at what you do.

And here's one piece of advice that I think is invaluable. It is just my opinion, though, so you free to do whatever you want with it: If my wife, child, mom, dad, brother, sister, best friend, etc, or myself is sick and needs care, and I can choose between someone with good "bedside manner" or someone who is an a-hole but kicks arse at what he does. I'll take the a-hole that is a badass at what he does, all day long. Of course there are many great physicians who are excellent at their craft and have great bedside manner, but my point is, you don't go to the doctor to sit down and chat for 20 minutes. You go to the doctor to have your problem diagnosed and get the appropriate treatment, if necessary.

That being said, no one should be a dickhead. I'm very anti-dickhead.

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These are the types of wacko statements that scare me about this bill. So your brother the optometrist thinks he has better training than an Ophthalmologist?

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First, you should go back and read what I actually wrote. The Ophthalmologist, who runs several highly successful practices, stated this to my brother. Because the scope of Optometry is expanding, they are teaching pathology and pharmacology on the same level as a medical school, and go into more depth during their formal training.

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n addition, optometrist don't take call and see emergency patients, don't see hospital inpatients

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That's untrue. If fact, my brother did one of his rotations in a hospital where he worked alongside Opthalmology residents. He has considered working in a hospital after he finishes this summer.

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You brother will be the guy that keeps trying to manage a complicated patient when he is way over his head, then refer them to an Ophthalmologist when they are a train wreck.

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Times are changing. The clinic he works at currently the Optometrists handle treatment of pathologies and laser procedures. The Ophthalmologist mostly just handles cataracts.

I wish Doctors would return to fee for service and take all of the politicians and insurance companies out of the medical decision making (Which they are noir qualified to make....but make routinely)

Then i could go to a Dr., a real MD, while so many fools who don't value their education in medicine, could go to their Nurses. It would make wait times a lot less and my care a lot better.

My point is you got your information from an optometrist. The ophthalmologist didn't tell you that. I have a hard time believing the ophthalmologist told your brother he has better training than him.

Nothing you said defends any of your statements...

He works Alongside residents? What does that even mean? He watches them? I work in a hospital with Optometry students that work in the same offices as ophthalmologists and their residents. They see patients for glasses and contacts and work 8 to 5. Just because they work in the same building as ophthalmologists doesn't mean they see anything close to what the ophthalmologist sees daily.

He might work adjacent to a hospital but he is not seeing hospital consults.

And yes he can do a select few laser procedures because of legislation they forced down the throats of this country claiming access to care issues. That doesn't mean he knows what he is doing or has received the proper training.

I agree LATigerdoc. The education and direct clinical care of patients in residency is clearly superior to that given to NPs. But what if, oh say an NP, with 10 years of prior ICU and ER experience as a registered nurse, goes through NP school, and then practices in a rural health clinic (where you are the NP, MD, Neurologist, Endocrinologist, Pediatrician, dermatologist.....out of necessity because there are no PCPs, let alone specialists that will see them) for another 10 years of practice, logging in upwards of 30,000 hours of direct clinical care. What then? Do you still think that your semester of gross human anatomy trumps that real world experience? Sir, NPs are not supervised by physicians, PAs are. NP's are forced by law to "collaborate" with a physician. Guess what? Collaboration with a healthcare team (hopefully) happens every day in every office, with or without a paper document that says it needs to occur. NPs practice independently in 22 states already. They still collaborate. Only in those states, the NPs are not having to pay a physician a portion of their income for the "oversight". Oh, and by the way, NPs practice in 22 states independently AND have better patient satisfaction, equal patient outcomes, and reduced overall healthcare costs (mainly because they see people who would have otherwise had to go to an ER, because physicians who are so concerned about their health that they will scream to the rooftops if someone else invades their turf, refuse to see them). Its been proven in greater than 40 studies, even one done by AAFP. At some point in the career of an NP, even if it is after 5 years of experience, the chord should be cut.

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the chord should be cut.

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LOL....no one stops these people from going to med school except themselves. If you want to practice medicine....become an MD. Its really just that simple.

Stop trying to circumvent that by legislation.

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He works Alongside residents? What does that even mean? He watches them? I work in a hospital with Optometry students that work in the same offices as ophthalmologists and their residents. They see patients for glasses and contacts and work 8 to 5. Just because they work in the same building as ophthalmologists doesn't mean they see anything close to what the ophthalmologist sees daily.

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He was identifying and treating pathologies.

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And yes he can do a select few laser procedures because of legislation they forced down the throats of this country claiming access to care issues. That doesn't mean he knows what he is doing or has received the proper training.

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Then push for legislation to get them trained. Let them compete in the same residencies that Ophthalmologists enter. Unfortunately, there aren't very many programs, which is why the scope of practice has greatly expanded for Optometrists in most states because there aren't enough Ophthalmologists to meet demands.

I'm not advocating unsafe medical practices by allowing undertrained individuals free range to do whatever they want. My point is that the writing is on the wall, and you can either progress forward or stay in the stone age. Again, you have a large number of highly educated and trained individuals, many of which are more than capable to expand upon their knowledge base to meet board certification.

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Diabetes? Dude, a monkey can treat diabetes.

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Hahaha you are very naive

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Once an NP has had umpteenth hours of real, clinical practice, the clinical research shows that they are as good in some areas, and better in others, than physicians.

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All those studies are of NPs practicing under MDs for years, essentially doing a residency. Who will those hours be under after this bill? They will just teach themselves medicine?

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uggghh. Its objective evidence. and I know it

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Have a link to AAFP article? Would like to read it.

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This whole conversation is just typical 2000's America. A bunch of patients who think they know medicine are whining because they want their prescriptions NOW. They know as much about medicine by going to the doctor's office and using Google as I know about warfare by playing Call of Duty.

There are also a bunch of underqualified nurses and optometrists complaining because they want a shortcut to more money and prestige. There's a reason medical training is so long... because there's an incredible amount of information to absorb and because pattern recognition is paramount. It takes thousands and thousands of hours to even become somewhat competent at practicing safe and effective medicine.

Well, if the current down-spiraling pattern continues Americans are going to get exactly what they deserve, lower quality medicine that is delivered less efficiently and at no lower a cost. We will keep vilifying the "rich" and "lazy" doctors. We will reward shortcuts and keep slashing physician pay. We will ignore the fact that physician satisfaction is consistently below 50% across ALL specialties because it's patient satisfaction that matters most, after all.

The funny thing is that doctors will be fine. They will always make good money. They will always have quality healthcare because they know all the quality doctors. Doctors also look out for one another. It's the patients who will suffer. Doctors see it coming, but nobody is listening. Eventually doctors will just wash their hands of all of it. Health care is a right! Hurray for universal health care!

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Other than sounding quite pompous at first, you are absolutely right. MD's will either take the Health system employee route, or the concierge route, and do just fine either way. They will see the "best" patients and do nothing but chart review on the common folk.

And with that said, ya'll are fighting an unwinnable battle with this NP/PA thing. It's happening. I don't care what administration you install, access & cost will be priorities over quality. And mid level providers are the obvious answer to both. And let's be honest, you don't have enough residency spots available, and even if you did, you don't have a system that encourages young docs to become PCPs. What solutions are there to increase supply to meet current demand levels? Foreign medical grads are doing that to some degree now, but it's still not enough. There are still plenty of MUA's with hardly any MD supply. What's the solution? This bill is the obvious (political) solution. Will it effect quality? Sure. But the mantra some docs in this thread have would seem to indicate they prefer patients have no access instead of sub-standard quality. And that doesn't resonate with normal people.

One more thing, this thread is casting these NP/PA providers as basically solo practitioners, and that will be the case in some place. But it will be health systems and large physician groups that take advantage of this more than the individual mid level. If I, as an administrator, can open a clinic/service without the expenses associated with a physician, and STILL receive 80%-100% of my typical reimbursement for all the same services...that's an EASY decision. In reality, there will likely be an MD serving in a supervision role, but it would be more administrative than clinical.

Your typical NP/PA will not have the ability to establish and operate their own clinic in this environment, unless that clinic is one of few options in a MUA.