- My Forums
- Tiger Rant
- LSU Recruiting
- SEC Rant
- Saints Talk
- Pelicans Talk
- More Sports Board
- Fantasy Sports
- Golf Board
- Soccer Board
- O-T Lounge
- Tech Board
- Home/Garden Board
- Outdoor Board
- Health/Fitness Board
- Movie/TV Board
- Book Board
- Music Board
- Political Talk
- Money Talk
- Fark Board
- Gaming Board
- Travel Board
- Food/Drink Board
- Ticket Exchange
- TD Help Board
Customize My Forums- View All Forums
- Show Left Links
- Topic Sort Options
- Trending Topics
- Recent Topics
- Active Topics
Started By
Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 5/13/16 at 11:33 am to Parallax
Posted on 5/13/16 at 11:33 am to Parallax
quote:
Message
Defeat the Nurse Practitioner expansion of scope of practice - Louisiana SB 187 by Parallax
quote:
Also, nurses get blamed for pretty much all of the doctors mistakes.
I don't think anyone but a nurse would say this.
Wrong
quote:
Nurses don't make decisions; they execute physician orders. The only time they are blamed is when they don't follow the orders.
Oh here we go. How about in the case where a doctor's orders are wrong and they are conveniently not available for a change? You either make the wrong decision and cause harm to the patient or alter the order and get blamed there. It's also convenient that anytime there is any type of malpractice investigation, it's almost always conducted by doctors, so that they get the last word on where to assign blame.
Doctors are seaguls, they fly in, take a shite, fly away and expect nurses to make it spotless for the next time they decide to grace everyone with their presence again. I'd rather doctors all decide to be pro golfers instead of trying to help anyone, since playing golf is on a higher pedestal than their patients anyway.
Sorry, unless you are focusing on being a surgeon, more than likely a NP can do a more complete job than you can. Better results for less pay.
This post was edited on 5/13/16 at 11:39 am
1
Posted on 5/13/16 at 12:53 pm to bountyhunter
You are so far off. If I had time I'd address all that
Posted on 5/13/16 at 1:15 pm to LATigerdoc
Last time I saw a primary provider, he didn't even shake my hand or spend enough time in the office to have a seat.
Yea, frick doctors.
Yea, frick doctors.
Posted on 5/13/16 at 1:27 pm to Womski
3rd leading cause of death in the United States.
If I were to go to an urgent care facility is there a doctor on duty? Genuinely curious.
What percentage of outpatient visits are for common colds and such the the doctor prescribes a generic antibiotic or cortisone?
How often does someone go to see a doctor for the doctor to order a lab test that is reviewed by someone else(flu bronchitis type stuff) and then how much of a decision is there to be made about how to cure it?
Can a NP solve every problem a doctor faces, certainly not, and I don't think anyone in this thread is pretending to believe they could. My guess is that they are more than qualified to make decisions about these types of simple cases and it would be more efficient and cost effective for a nurse to perform that job. And since you are so concerned about the patient, people may be more willing to go somewhere if they know it won't cost and arm and a leg to see a doctor for 2.5 minutes while waiting for 45 mins.
If I were to go to an urgent care facility is there a doctor on duty? Genuinely curious.
What percentage of outpatient visits are for common colds and such the the doctor prescribes a generic antibiotic or cortisone?
How often does someone go to see a doctor for the doctor to order a lab test that is reviewed by someone else(flu bronchitis type stuff) and then how much of a decision is there to be made about how to cure it?
Can a NP solve every problem a doctor faces, certainly not, and I don't think anyone in this thread is pretending to believe they could. My guess is that they are more than qualified to make decisions about these types of simple cases and it would be more efficient and cost effective for a nurse to perform that job. And since you are so concerned about the patient, people may be more willing to go somewhere if they know it won't cost and arm and a leg to see a doctor for 2.5 minutes while waiting for 45 mins.
Posted on 5/13/16 at 1:33 pm to LATigerdoc
quote:
If I had time I'd address all that
I'm sure you could find the time while riding b*tch in a golf cart.
Posted on 5/13/16 at 1:44 pm to Wasp
quote:
What percentage of outpatient visits are for common colds and such the the doctor prescribes a generic antibiotic or cortisone?
Good point. Over-prescription of anti-biotics has created strains of super bacteria. I still know of people today that go to the doctor with sinusitis and get antibiotics at least two or three times a year. Doctors are some of the most stubborn people I have met.
quote:
Can a NP solve every problem a doctor faces, certainly not, and I don't think anyone in this thread is pretending to believe they could. My guess is that they are more than qualified to make decisions about these types of simple cases and it would be more efficient and cost effective for a nurse to perform that job. And since you are so concerned about the patient, people may be more willing to go somewhere if they know it won't cost and arm and a leg to see a doctor for 2.5 minutes while waiting for 45 mins.
Right, I am speaking about the general practitioner role, not specialists. There is certainly a valid need for specialists, and without them we would basically have the medical capacity of most 3rd world countries. But the idea that nurses can't do (and aren't already doing) 90% of the work and critical thinking in most cases is a complete fallacy.
This post was edited on 5/13/16 at 1:45 pm
Posted on 5/13/16 at 2:14 pm to LATigerdoc
quote:u work at the Big House in Oakdale?
I don't treat strep throat.
Posted on 5/13/16 at 2:53 pm to bountyhunter
Until people start to wrap their heads around the fact that extraordinary percentages of the health care dollar is spent towards things not directly associated with patient care, they will never understand the erosion of the practice of medicine and the ultimate decline in quality of care for a given individual.
Essentially, the government wants to pay less on their end, the insurers want to maximize their profits, hospital administrators and committees that impose ridiculous criteria that must be met to receive compensation (despite the fact they usually have zero evidence based data to validate their requirements) all want money and the only pieces of the pie they cut are the actual providers. Do you think doctors all want to charge a ton of money and spend no time with patients? If permitted to run as a free market you'd see prices drop and more time would be spent w patients, but the government has the system rigged to price fix and physicians have no way to unionize.
Can some nurse practitioners handle routine issues? Of course they can. Can all? I'm not sold. Critical thinking skills are developed over an ever increasing level of curriculum with proper instructors over a proper amount of time and oversight. Today's world of education where degrees can be bought online and people seek out an ever growing list of letters behind their name is deceiving those they aim to help. The general public is often very unaware of the realities of education and training standards and they make assumptions based upon generalities because these issues don't usually concern them on a day in day out basis.
Much in the same way I don't know any of the details of what becoming an airline pilot or a fighter jet pilot or even a recreational pilot entail, I assume that there is a governing standard that is adhered to for screening prior to me being flown around by said pilot. The same is true for Doctors of Medicine. Though nursing has some of their own standards, they are for a nursing role. When the line between what is nursing and what is practicing medicine become blurred/blended is when regulations are side stepped and the assumptions the public makes about medical
providers becomes tragically incorrect.
I know when I have a medical issue that can be generally taken care of by an NP or a PA vs a physician. Does the general public? They don't know what they don't know, much in the same way PAs and RNs or BSNs don't.
Do ordering errors from physicians happen? Yes, but to act like nurses completely change orders is a bit of a stretch. Usually the order is misorderd by a dose, route of administration or frequency. It's part of a nurse's job to understand orders and carry them out and to question them if they seem off and clarify. This is part of the balanced approach of patient care.
I've had a nurse practitioner once say an atrial fibrillation patient was not tolerating their heart rate controlling medication and said she was just going to switch it over to an anticlotting (blood thinner) and just wanted to run it by a doc first (although she didn't technically have to).
You'll find me firmly on the side of keeping the practice of medicine to physicians since the country has already gone through the immense measures of standardizing its requirements. Most who argue against this stance are either:
Associated with or are nurses who stand to gain financially/professionally
Have had a bad experience with physicians and now carry that over to all physicians
Ceo/cfo of hospitals and insurance companies who can see ways to further decrease payments and access.
Now, please let me tee off and enjoy my round for F@$%'s sake.
Essentially, the government wants to pay less on their end, the insurers want to maximize their profits, hospital administrators and committees that impose ridiculous criteria that must be met to receive compensation (despite the fact they usually have zero evidence based data to validate their requirements) all want money and the only pieces of the pie they cut are the actual providers. Do you think doctors all want to charge a ton of money and spend no time with patients? If permitted to run as a free market you'd see prices drop and more time would be spent w patients, but the government has the system rigged to price fix and physicians have no way to unionize.
Can some nurse practitioners handle routine issues? Of course they can. Can all? I'm not sold. Critical thinking skills are developed over an ever increasing level of curriculum with proper instructors over a proper amount of time and oversight. Today's world of education where degrees can be bought online and people seek out an ever growing list of letters behind their name is deceiving those they aim to help. The general public is often very unaware of the realities of education and training standards and they make assumptions based upon generalities because these issues don't usually concern them on a day in day out basis.
Much in the same way I don't know any of the details of what becoming an airline pilot or a fighter jet pilot or even a recreational pilot entail, I assume that there is a governing standard that is adhered to for screening prior to me being flown around by said pilot. The same is true for Doctors of Medicine. Though nursing has some of their own standards, they are for a nursing role. When the line between what is nursing and what is practicing medicine become blurred/blended is when regulations are side stepped and the assumptions the public makes about medical
providers becomes tragically incorrect.
I know when I have a medical issue that can be generally taken care of by an NP or a PA vs a physician. Does the general public? They don't know what they don't know, much in the same way PAs and RNs or BSNs don't.
Do ordering errors from physicians happen? Yes, but to act like nurses completely change orders is a bit of a stretch. Usually the order is misorderd by a dose, route of administration or frequency. It's part of a nurse's job to understand orders and carry them out and to question them if they seem off and clarify. This is part of the balanced approach of patient care.
I've had a nurse practitioner once say an atrial fibrillation patient was not tolerating their heart rate controlling medication and said she was just going to switch it over to an anticlotting (blood thinner) and just wanted to run it by a doc first (although she didn't technically have to).
You'll find me firmly on the side of keeping the practice of medicine to physicians since the country has already gone through the immense measures of standardizing its requirements. Most who argue against this stance are either:
Associated with or are nurses who stand to gain financially/professionally
Have had a bad experience with physicians and now carry that over to all physicians
Ceo/cfo of hospitals and insurance companies who can see ways to further decrease payments and access.
Now, please let me tee off and enjoy my round for F@$%'s sake.
This post was edited on 5/13/16 at 5:07 pm
Posted on 5/13/16 at 3:02 pm to 0jersey
quote:
I've had a nurse practitioner once say an atrial fibrillation patient was not tolerating their heart rate controlling medication and said she was just going to switch it over to an anticlotting (blood thinner) and just wanted to run it by a doc first (although she didn't technically have to).
If the pt is not tolerating digoxin and the rate will be uncontrolled would considering Coumadin not be reasonable? Ideally they would remain compliant on dig but if you have doubts wouldn't it be prudent to protect from thrombus formation?
Just curious...
Posted on 5/13/16 at 3:05 pm to 0jersey
quote:
You'll find me firmly on the side of keeping the practice of medicine to physicians since the country has already gone through the immense measures of standardizing its requirements. Most who argue against this stance either:
What would your solution be to the limited PCP supply in general, and specifically servicing the approximately 6000 HPSA/MUA's in this country? If you're firmly on the side on physicians maintaining solo "control" of providing medicine, then you have to tell me how your preference will serve as a solution to the existing infrastructure and supply problems.
quote:
Ceo/cfo of hospitals and insurance companies who can see ways to further decrease payments and access
Decrease access to what? Patient access to care? That's what your stance would do, so what are you trying to convey here?
Posted on 5/13/16 at 3:23 pm to bountyhunter
I obviously disagree with how the nurse practitioner community is going about this whole expansion of their scope of practice. However, I will say that i think being a nurse (and I mean RNs specifically here) is among the more difficult jobs out there, and good nurses are underpaid and underappreciated in general.
But that doesn't mean that I think they should be able to take over the job of an MD without completing equivalent training, though. Nurses and doctors are trained for different roles (as has been stated repeatedly in this thread). That is what this argument is about. It is as simple as that.
quote:
bountyhunter
Hahaha, damn. You mad. You need to calm down. You hate doctors, we get it. I can't even imagine how frustrating it must be to be someone like you, who has such an incredible and superior wealth of knowledge about medicine but has to take orders from someone that doesn't know shite about anything at all (medicine, politics, or life in general).
Could you not get into medical school? Or are you just burned out of working in healthcare?
Since you seem to know more about the practice of medicine than any doctor, do you have anything besides emotional ranting to contribute to this discussion?
Posted on 5/13/16 at 3:23 pm to LATigerdoc
Awesome. My buddy who is in NP school right now tells me that a ton of his classmates cheat all the time.
Posted on 5/13/16 at 3:38 pm to jennBN
The decision to anticoagulate and rate/rhythm control are separate issues. Do you even CHADS-2VASc bro?
This post was edited on 5/13/16 at 9:23 pm
Posted on 5/13/16 at 4:36 pm to Parallax
I'm replying to you but also addressing the earlier digoxin question. This is a perfect example of what I'm talking about and one which you basically addressed.
For the record I am not a cardiologist, but digoxin is rarely used today for afib purposes as there are superior agents that don't require level monitoring and potential toxicity. The NP was taking the patient off a calcium channel blocker and wanting to add Coumadin instead. You don't address rate control with anticoagulants as they are independent issues needing to be addressed separately for chronic afib. It's not like you add anticoagulation medication to a patient because you can't successfully rate control them.
What I meant by reducing access via the ceo/insurance standpoint is that they will begin requiring NP visits prior to allowing a physician visit. It will just prolong getting to the person you need to see. For minor issues it won't be a big deal, but will affect some patients that manifest symptoms that are similar to more serious pathology. The percentages will be small for sure, but that's the bet the "higher ups" make. For the few it adversely affects, the bulk will be largely unaffected and unaware anyway but at a cheaper cost.
To the earlier comment about docs always doling out antibiotics, do you really think doctors think it's a good idea? Patients started having the mindset that they spend all this time getting to the doctor that they need to leave with something or it was pointless. Patients in a large way will dictate their own care, not listen to advice given, and believe because they know someone that "x" it should be the same for them. We have long known the overprescribing of abx would become problematic but what is a primary doc supposed to do if patients stop coming to see them? Patients have the right to change doctors but it is very difficult for doctors to refuse seeing patients.
As to the issue of supply and demand and access issue-I think it is blown way out of proportion. No one gets turned away from care. Don't believe me? Go to any ER. Don't have insurance? You can still pay cash. Poor? You can still be seen somewhere. Urgent care, primary care or ER. Access to care is not an issue. There are a ton of foreign MDs that want to practice here. You want more primary docs? It starts with proper reimbursement commensurate with training.
People don't get paid as much for what they do as much as for what they know.
Lots of people work hard. Lots work even harder than most physicians. But most docs I know work 55-90 hrs a week. When you factor in a decade of minimal to no income and most times a home mortgage level of loans there needs to be a financial reward at the end of the tunnel. There's a sacrifice and reward involved in the deal. When it is being turned heavily into sacrifice and some of the rewards are being rewarded to those with less sacrifice it will drive people away from the commitment.
I think that there can be increase in NP responsibilities, but I think removing the doctor from the equation altogether is bad for the public. There needs to be more physicians, but who wants to sacrifice their time and money to become one these days when all it seems is that your training is being minimized and cut out from under you? Doctors no longer are allowed to develop relationships and trust with patients because the government and hospitals are trying their very best to make medicine a business with flow charts and algorithms in order to make it more profitable/cost less. They dictate the tests that must be run for preventing lawsuits and sometimes for making money for the hospital. If you think they aren't forcing these tests or using particular equipment you are naive. But why don't doctors just refuse? A lot of them are employees now with minimal rights afforded to other employees and they can now be replaced. Business people are treating doctors as nothing more than a cog in their money churning wheel. Some of the changes are good, but medicine is not a commodity based business where things can be streamlined like an auto factory. But now that business thinkers are in control of the care delivery choices and can be convinced of making decisions that affect all patients and care without having any experience or knowledge of what those decisions actually mean ultimately care for patients decline.
Too many factors go into what is actually happening to medicine and the future quality of practitioners to discuss over one leisurely round of golf. These birdies aren't gonna make themselves.
For the record I am not a cardiologist, but digoxin is rarely used today for afib purposes as there are superior agents that don't require level monitoring and potential toxicity. The NP was taking the patient off a calcium channel blocker and wanting to add Coumadin instead. You don't address rate control with anticoagulants as they are independent issues needing to be addressed separately for chronic afib. It's not like you add anticoagulation medication to a patient because you can't successfully rate control them.
What I meant by reducing access via the ceo/insurance standpoint is that they will begin requiring NP visits prior to allowing a physician visit. It will just prolong getting to the person you need to see. For minor issues it won't be a big deal, but will affect some patients that manifest symptoms that are similar to more serious pathology. The percentages will be small for sure, but that's the bet the "higher ups" make. For the few it adversely affects, the bulk will be largely unaffected and unaware anyway but at a cheaper cost.
To the earlier comment about docs always doling out antibiotics, do you really think doctors think it's a good idea? Patients started having the mindset that they spend all this time getting to the doctor that they need to leave with something or it was pointless. Patients in a large way will dictate their own care, not listen to advice given, and believe because they know someone that "x" it should be the same for them. We have long known the overprescribing of abx would become problematic but what is a primary doc supposed to do if patients stop coming to see them? Patients have the right to change doctors but it is very difficult for doctors to refuse seeing patients.
As to the issue of supply and demand and access issue-I think it is blown way out of proportion. No one gets turned away from care. Don't believe me? Go to any ER. Don't have insurance? You can still pay cash. Poor? You can still be seen somewhere. Urgent care, primary care or ER. Access to care is not an issue. There are a ton of foreign MDs that want to practice here. You want more primary docs? It starts with proper reimbursement commensurate with training.
People don't get paid as much for what they do as much as for what they know.
Lots of people work hard. Lots work even harder than most physicians. But most docs I know work 55-90 hrs a week. When you factor in a decade of minimal to no income and most times a home mortgage level of loans there needs to be a financial reward at the end of the tunnel. There's a sacrifice and reward involved in the deal. When it is being turned heavily into sacrifice and some of the rewards are being rewarded to those with less sacrifice it will drive people away from the commitment.
I think that there can be increase in NP responsibilities, but I think removing the doctor from the equation altogether is bad for the public. There needs to be more physicians, but who wants to sacrifice their time and money to become one these days when all it seems is that your training is being minimized and cut out from under you? Doctors no longer are allowed to develop relationships and trust with patients because the government and hospitals are trying their very best to make medicine a business with flow charts and algorithms in order to make it more profitable/cost less. They dictate the tests that must be run for preventing lawsuits and sometimes for making money for the hospital. If you think they aren't forcing these tests or using particular equipment you are naive. But why don't doctors just refuse? A lot of them are employees now with minimal rights afforded to other employees and they can now be replaced. Business people are treating doctors as nothing more than a cog in their money churning wheel. Some of the changes are good, but medicine is not a commodity based business where things can be streamlined like an auto factory. But now that business thinkers are in control of the care delivery choices and can be convinced of making decisions that affect all patients and care without having any experience or knowledge of what those decisions actually mean ultimately care for patients decline.
Too many factors go into what is actually happening to medicine and the future quality of practitioners to discuss over one leisurely round of golf. These birdies aren't gonna make themselves.
This post was edited on 5/13/16 at 5:09 pm
Posted on 5/13/16 at 4:45 pm to Chuker
quote:
Sorry doc, I'd rather pay a NP $30 to write me a antibiotic prescription for my strep-throat than pay you a $100.
May have to sell that summer home in Mankato bay.
Will send prayers.
This. In my home town there is a NP that's on the verge of running the 2 available pediatricians out of town.
Posted on 5/13/16 at 5:06 pm to JJBTiger2012
Maybe that will happen for your town. That will be cool won't it? You get what you pay for. Isn't going to the doctor only $10-15 these days anyway with your copay? That's what people seem to think it's worth.
Vaccines are dumb too. It's great that minimum wage is going way up as well, right? I know you also think trees are pretty sweet. If only there was a way for you to see a large grouping of them.
Vaccines are dumb too. It's great that minimum wage is going way up as well, right? I know you also think trees are pretty sweet. If only there was a way for you to see a large grouping of them.
Posted on 5/13/16 at 5:10 pm to skinny domino
Oakdale is the infamous home of the Louisiana surgical optometrists
Posted on 5/13/16 at 5:12 pm to 0jersey
Off topic but somewhat relevant. Why is there such a discrepancy between the cost of self pay and the cost if you have insurance? I had a surgical procedure done and I chose a doctor that was out of network because I trusted him. We discussed cost prior to the surgery and since I was self pay, it was roughly $500. When I went to pay, they accidentally had it down to bill my insurance. That cost was over $3,000. They corrected it and I paid the self-pay cost. But why is there a 600% markup if insurance was to be billed?
This post was edited on 5/13/16 at 5:13 pm
Posted on 5/13/16 at 5:15 pm to LATigerdoc
quote:Give it a rest
Oakdale is the infamous home of the Louisiana surgical optometrists
Posted on 5/13/16 at 5:18 pm to LATigerdoc
even though I agree, i do have to point out (I assume) you are a doctor and risk having your salary diminished or even job eliminated.
so ease up on the passion speech about patient care. we know why you are really up in arms.
so ease up on the passion speech about patient care. we know why you are really up in arms.
Page 42 of 127
Popular
Back to top
Follow TigerDroppings for LSU Football News