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Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 5/17/16 at 5:06 pm to LATigerdoc
Posted on 5/17/16 at 5:06 pm to LATigerdoc
(no message)
This post was edited on 5/17/16 at 5:10 pm
0
Posted on 5/17/16 at 5:11 pm to Epic Cajun
quote:
Because they don't want anyone taking their market share? It isn't "fair" that someone who doesn't have their extensive training can take their patients.
That's pretty much what this boils down to. Anyone who doesn't have a bias can see that.
While this seems logical, here's a 2012 article which suggests a non-significant difference in salary rises/year in states which allow full scope of practice without supervision to APRNs vs those which are more restrictive. Interestingly enough, the states with the more liberal approach actually showed higher MD salary increases (again, non significant) in the fields of Family Practice, Pediatrics, and Surgery. It's quite interesting that they chose not to include Internal Medicine, as I would think they would be in just as big a "competing" field as FP/Peds. So a downfall is potential skew because NP's really encroach on the adult medicine patients, but most FPs see enough of them that I wouldn't expect it to really change the point of the article.
That said, even those of us who aren't affected by this since we're in fields other than FM, Peds, General Surgery probably still oppose it after reading this. It really isn't about money.
Posted on 5/17/16 at 5:11 pm to LATigerdoc
quote:
They lack the training which yields the clinical judgement as its end product
So you believe our training isn't even thorough enough to recognize conditions that warrant urgent or emergent referral?
Posted on 5/17/16 at 5:12 pm to guttata
quote:
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.
Nuff said. Doc banged your wife and now you hate all docs.
Obligatory OT Pics of wife?
Posted on 5/17/16 at 5:14 pm to guttata
quote:
Knowing a little about a lot and a lot about a little.
So should they be doing colonoscopies and placing central lines? Should they be seeing patients in the hospital with suspected heart attacks? Should they manage diabetics in ketoacidosis/hyperosmotic, non-ketotic states? Should they be diagnosing thyroid cancer? Should they cut cancers off of people's faces?
What do you think should be the difference in their scope vs the scope of a mid-level?
This post was edited on 5/17/16 at 5:17 pm
Posted on 5/17/16 at 5:17 pm to Scooby
quote:
So you believe our training isn't even thorough enough to recognize conditions that warrant urgent or emergent referral?
Absolutely.
Posted on 5/17/16 at 5:19 pm to Scooby
quote:
So you believe our training isn't even thorough enough to recognize conditions that warrant urgent or emergent referral?
From what I've seen? Many times that answer is no. And a tendency to over refer. Of course, the supervising physician could and should cut down on much of that.
Posted on 5/17/16 at 5:27 pm to SmackoverHawg
quote:
the supervising physician could and should cut down on much of that
The supervising physician that doesn't set foot in the clinic?
Posted on 5/17/16 at 5:28 pm to Parallax
Interesting
Posted on 5/17/16 at 5:32 pm to Scooby
quote:
The supervising physician that doesn't set foot in the clinic?
Could and should are different from "do".
I review all of my NP's visits and I'm available at all times to them for questions. The fact that many docs don't provide adequate oversight doesn't mean all oversight should be lifted. If anything, more is needed.
Posted on 5/17/16 at 5:37 pm to Hopeful Doc
Family practice docs can do all of that
Posted on 5/17/16 at 5:38 pm to Parallax
I think some will be missed
Posted on 5/17/16 at 5:40 pm to LATigerdoc
And for anyone who feels we are not being nice, now is the time for us to speak up. There's really not a bigger fight in all of medicine than this one. If ever to speak up it is NOW
This post was edited on 5/17/16 at 5:41 pm
Posted on 5/17/16 at 5:42 pm to SmackoverHawg
quote:
The fact that many docs don't provide adequate oversight doesn't mean all oversight should be lifted. If anything, more is needed.
I'm in favor of the LSBME proposal to force the supervision physician to be on-site long before allowing removal of supervision altogether as proposed in this bill.
Posted on 5/17/16 at 5:42 pm to Scooby
Medicine is incredibly vast and difficult; I'm challenged daily. If you think you could handle yourself in the wild with the quantity and quality of training NPs get, you're too dense to realize all of the things you don't know.
I'm a specialist and we've had to provide lectures for midlevels in the ED because of the amount of inappropriate, unnecessary consults.
I'm a specialist and we've had to provide lectures for midlevels in the ED because of the amount of inappropriate, unnecessary consults.
Posted on 5/17/16 at 5:43 pm to L S Usetheforce
quote:
Nobody is denying that but sometimes people just have abscesses on their arse or URIs
The list of my clinic patients that have received care from NP's with resulting poor and or catastrophic outcomes is longer than my leg. Of course I know you won't acknowledge that because it is not a data point from a published study.
But to counter your above comment,
1 young Medicaid pt was seen in an ER for her sore throat and swelling of the neck. seen by same NP 3 times in a 2 week period. She was diagnosed with URI once and strep throat without swab or culture two times. Finally comes in to see me as a new pt and when entering the room I actually stuttered in my stride due to the mass on her neck which turned out to be a 7x10 cm lymphoma. That ER NP had direct physician oversight right there but failed to ask for help because she "knew" what she was doing on this simple case.
Another was a clinic opened by an off sight physician staffed with an NP who saw an uninsured little girl on Sat for a dog bite. No xray for tooth fragments, sutured the open contaminated wound closed, used vicryl for skin closure, prescribed amoxil for coverage, and sent her on her way. When she was seen in my office on Monday I admitted her to the hospital to have the resulting abscess drained in the OR and for IV abx to treat the septicemia she had now developed. The little girl will now have a large scar on her arm, missed a week of school during her STAR testing, and her family now owe the hospital a substantial sum, when the wound should have been managed with two simple outpt visits assuming it wasn't totally screwed up by the NP. That NP had a doc on call to discuss the case with but didn't bother to call because she was certain of her skills and knowledge.
Neither of those patients contributed to my bottom line in a significant way. In fact I rounded daily for 5 days on the little girl in the hospital for free and the two office visits she was billed at a greatly reduced rate. It is not about the money it is about properly taking care of patients.
Posted on 5/17/16 at 5:44 pm to Parallax
quote:
I'm a specialist and we've had to provide lectures for midlevels in the ED because of the amount of inappropriate, unnecessary consults.
Residency is where you should learn when to wake up the consultant, when to call them in the morning, and when to casually pass by and say "would you have done that same thing?" during lunch.
Posted on 5/17/16 at 5:48 pm to guttata
quote:
I totally agree. Family practice MDs shouldn't be doing any specialty outside of their training.
Fortunately Family Medicine Specialists are trained to provide complete and comprehensive care across all specialties with the exception of surgery. They receive some surgical training but not a complete surgical training.
Posted on 5/17/16 at 5:49 pm to Bleeding purple
quote:
young Medicaid pt was seen in an ER for her sore throat and swelling of the neck. seen by same NP 3 times in a 2 week period. She was diagnosed with URI once and strep throat without swab or culture two times. Finally comes in to see me as a new pt and when entering the room I actually stuttered in my stride due to the mass on her neck which turned out to be a 7x10 cm lymphoma. That ER NP had direct physician oversight right there but failed to ask for help because she "knew" what she was doing on this simple case.
Wife had a fellow that was seeing an NP come in the pharmacy. Had a "knot" on his neck. Was given abx three times. She asked if I would please check it as a favor and he was really nice and always polite. The "knot" of course was not an infected lymph node and had been seen by the NP about four of five times in the preceding months even before the three visits before the antibiotic was given. And his "Strep throat" ended up being a tonsillar cancer.
Posted on 5/17/16 at 5:49 pm to Bleeding purple
I fully support this measure. Also did you know that there are dangerously under qualified "mechanics" changing oil and even transmissions who never went to school for mechanical engineering? They're not even under engineering supervision!!
People go there cause it's "cheaper", but they'll pay for it in the long run when their cars catch fire and kill their families.
We must outlaw this irresponsible practice. We stand with you!!
People go there cause it's "cheaper", but they'll pay for it in the long run when their cars catch fire and kill their families.
We must outlaw this irresponsible practice. We stand with you!!
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