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

We got mcat scores and act scores and step scores and maybe SAT and then board scores and also med school gpa

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My wife has been in practice 13 yrs. I guess that comes out to at least 22,000 clinical hours. Would that be enough? By the way, she has no desire to open her own clinic.

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Flying Cessna's for 13 years doesn't qualify one to fly a 777.

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For an unlimited license to practice medicine and surgery?

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We can't perform surgery now anyways. Again, this is not changing our scope of practice.

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but sometimes people just have abscesses on their arse

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Abscesses on their arse are a hell of a lot more serious than URI. They kill people not infrequently and lead to hospitalization often. They're also the source of chronic wounds in a big number of cases, something not even most physicians are trained to deal with- there's an entire field of wound care which sees these folks frequently because they're so difficult to manage.

This is an example of equating common things that you've heard of with being "simple" and "easy to manage." It's a lot more complex than you'd imagine, even what's seemingly simple and straightforward.

No one here argues NP's aren't capable of diagnosing and treating simple things. The argument is that what most people don't understand- simple complaints are frequently the result of complex problems. And for that reason, oversight of a mid-level provider should remain in place. That's why MD's who have graduated are no more than mid-levels at first. They can't treat patients without oversight until they've logged >3000 hours under supervision. And that's if they were grads of US/Canadian Med schools. The ones who are graduates of foreign medical schools, such as the schools down in the Carribbean are required to spend 3 full years in residency (about 5 times the requirement of the NPs in the bill) before the board will consider them eligible to see patients on their own without oversight. The LSBME is even considering doing away with those requirements and requiring everyone complete residency prior to being able to see patients alone.

And this seeing patients alone deal...that means that a guy born and raised in New Orleans who just didn't quite have grades for a US school and decided to go to the Carribbean for medical school instead of waiting a year and trying again, kills it, graduates, matches into a neurosurgery (pick whatever it is you think is the "smartest" field. It's really irrelevant) residency, completing 35 months of it and then getting in a car accident which makes him forced to leave residency for an extended period of time. That guy would not be allowed to hang a shingle and write you medicine for a cold without finding some way to complete another month of residency. But an NP who worked well under 25% of those hours with less schooling could. I find this to be a problem. I think the medical field should have one set of standards for the state, not multiple. The current system sets a bare minimum of ~3000 hours (an intern year) after medical school (which was itself about 3000 additional patient contact hours, or ~6x the number required in NP school) before allowing a qualified physician to practice without oversight- and the state board, and without influence from the legislation or anyone, is considering raising, not lowering that number. Further, as someone who is eligible for a license in another month, (and no attempt at bragging, but was a very average medical student and a very above average intern), I find it horrifying that I could leave and practice on my own in just 45 or so more days.

I think this bill creates unnecessary division in the name of delivering "cheaper" care. I think a better option is to recognize there is a shortage of primary care, add NP input to the state medical board, and come up with a plan for reducing the shortage by offering appropriately trained individuals who are under one, single set of standards from a governing society that knows about the field rather than an arbitrary piece of legislation that creates further division and a "tiered" approach that is designed to allow less-trained individuals the opportunity to practice without oversight earlier.

Family practice medical doctors have a full license to practice medicine and surgery in Louisiana. They have clinical judgement, a conscious and reason which guide them in their own clinical decisions to limit their scope

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They have clinical judgement, a conscious and reason which guide them in their own clinical decisions to limit their scope

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As do competent NPs.

They lack the training which yields the clinical judgement as its end product

BP, you still perform some surgical procedures correct?

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