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

Is it not? He asked me why I hail from oakdale

I appreciate the response and I was blown away by the difference. It's such an inflated system, and I am in no way blaming the doctors.

I absolutely hate the confusion and restrictions surrounding how doctors are paid.

Also, you should always get a full print out or audit of a hospital bill. They are notorious for overcharging and adding on items you didn't use or buy. There's always some wiggle to om in there. I know a guy that had his bill reduced from 16000 to about 4900.

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I absolutely hate the confusion and restrictions surrounding how doctors are paid.

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It is an embarrassment to the field which, despite what some would believe, is unavoidable on the physician's part.

That's probably a question for a cardiologist. Answer would probably vary considerably given age, comorbities, etc. My hospital does a lot of surgical ablations/Maze procedure.

I'm at a top-20 hospital for Cardiology and Heart Surgery (per US News) and might see a patient on digoxin once a month.

The question is should NP's be able to practice outside of a Physicians oversight and the answer is NO... They are not experts of medicine and have a fraction of the knowledge of physicians. Furthermore, the reimbursement scales shouldn't even be close when a an office visit or any procedure is performed.

If you go to the California NP page they inform NPs it's okay to let your patients call you Doctor. What a bunch of twats? NPs just don't like paying physicians the oversight fee and think they should receive similar compensation to doctors.

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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.

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/thread

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It is an embarrassment to the field which, despite what some would believe, is unavoidable on the physician's part.

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It really is fricked up. Sometimes when I take a trip to fantasy land, I imagine all of the health care professionals in America (MDs, RNs, NPs, PAs, OTs, PTs, DMDs, etc...) uniting and regaining control of the medical field from all of the fricking scum-sucking leeches that have no business influencing the practice of medicine. The government and insurance companies have no business influencing how providers practice medicine. But they are in complete control and treat providers and patients like little bitches.

Patient costs keep rising while physician reimbursements keep getting slashed. All of the moves to cut healthcare spending are aimed at the ones in the trenches actually doing the work. Then I think about the several sales reps I know around my age who don't have a college degree (much less any medical training whatsoever) but are pulling in 6 figures to stroll into the OR lounge and hand out the brochure of the latest total hip from Striker.

Last year one of the business administrators from the hospital system gave us a business lecture that was just a basic rundown of medical device costs, including everything from arthroplasties to coronary stents to the plastic urinals and bed pans patients use. It was unbelievable. I couldn't find the numbers a second ago with a brief google search, but honestly didn't put much effort into it. But from what I recall, a total hip arthroplasty costs something on the order of $80 to produce, and they charge anywhere from $8,000-$15,000 in the US, depending on the region of the country. And don't go thinking they have to charge that much bc of R&D costs. That's only a small fraction of their expenses. The percentage of their profits that goes into R&D is lower than what they pay their sales reps.

In Europe, several countries got together and basically said "frick you, we aren't paying that. You either take $500 for the total hip, or none of us buy from you." So now the same exact piece of metal costs at least 10x more in the US.

Healthcare professionals in the US need to grow some balls, come together (I don't even want to use the word unionize, so i'll say unite), and say "frick you" to all the leeches, and take back what is ours. Get the government, insurance companies, and all the other dickheads out.

Now back to reality. And a fresh beer.

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I am asking from a RN to an MD what would be your choice for a noncompliant (rate control wise) pt with a fib?

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That's a difficult question, and I'm not sure exactly what you mean by "non compliant." There are some which take no meds. For them, it doesn't even matter. They aren't taking it at all.

For unreliable patients especially, I prefer Lopressor to Toprol XL. It's much better in the long run if they miss it twice a week. Digoxin is far from first line with the agents we have today, but I still like writing it in certain patients. It's great in a small subset that need a little better rate control with no impact on BP and avoids to multitude of problems that exist with amio (my least favorite of the rate controls...dig toxicity is a short term thing that can be worked out fairly easily, amiodorone is just a cruddy long-term drug (great post CABG, though, and good in other subsets, but in relatively uncomplicated a-fibbers, I look elsewhere first by a lot))


But either you've created a side conversation out of person interest, or I fear you've missed the point of the original post that spawned this- that particular NP asked if it was OK to forego rate control and start on anticoagulatiom instead. The problem here is that patients should always and absolutely be on both (again talking about general, run of the mill otherwise pretty healthy fibbers). His explanation leads me to believe that her understanding was that if the patient were rate controlled, they didn't need anticoagulation.

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that include pharmacists?

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Yes. Pharmacists are getting fricked too. Just wait until techs are able to fill without a pharmacist. Of course, by then pharmacists may not give a shite after having reimbursement for meds cut to hell.