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Started By
Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 5/17/16 at 7:09 pm to Ole War Skule
Posted on 5/17/16 at 7:09 pm to Ole War Skule
quote:
No, I don't lack reading skills, but you apparently lack a connection to reality skills if you're going to suggest that getting an appointment 1 day after requesting it is anything close to reality for almost all people.
Urban or rural?
If Urban, they can walk into an urgent care within the hour, their doctor's office in the same day to 2 days.
If rural, there likely isn't an urgent care, which means the PCPs basically all take walk-ins. They'll also see you within 24 hours and often same/next day.
This, of course, assumes you can pay. There is a shortage of people providing care to medicaid (adult) and people with no resources to pay for their care- this is the UCC crowd I was talking about. They actually do have a shortage, but increasing the number of providers isn't going to do anything for the UCC group- those physician spots are typically salaried by someone who's writing off the cost of all the free care they're giving.
As for adult medicaid, If there was an argument where you strictly expanded the role of people providing adult medicaid walk-in primary care, you may have a point worth listening to. But most the places I've seen just treat them and don't even bother billing for it. That's right. Most physicians see them just the same and send them on their merry way without even accepting their medicaid. That's established patients. Those who aren't established need to become established, and that's where the shortage is.
Again, if you're not addressing that subset- the nonestablished adult medicaid crowd, I fear your view is not consistent with my experience.
0
Posted on 5/17/16 at 7:18 pm to Hopeful Doc
Can we just agree PT direct access is not a problem.
Posted on 5/17/16 at 7:23 pm to The Eric
I doubt it. They don't have the thousands of clinic hours and a residency to determine what a patient needs. Posted on 5/17/16 at 7:35 pm to The Eric
We can agree.
Posted on 5/17/16 at 7:57 pm to Hopeful Doc
You really deserve a complete point by point answer to your replies as they were well thought out, supported with facts, and you seem to be well-intentioned. Unfortunately I don't have time now to do so and apologize.
My post was not specifically addressing the NP bill, which I do not no anything about, but a general rant on my personal experiences in attempting to get medical care. I spend about 25k per year on insurance and deductibles for my family, with no one having any kind of ongoing treatment, and have nothing but clerical issues, waits, poor service and unsatisfactory care in return. I can't take my business elsewhere as I've tried and it's always the same.
The shortage is real in my experience, and in every person I've ever talked to about it. The facts back me up in this and I'm sure they understate the problem as many people, like me, don't even bother seeking medical care when they should because it's just too much trouble.
A very quick google brought me this from the NY Times. Much of it anecdotal, some of it valid data, but for people here to say we don't have a shortage of medical care is just nonsense.
"The study found that 26 percent of 2,002 American adults surveyed said they waited six days or more for appointments, better only than Canada (33 percent) and Norway (28 percent), and much worse than in other countries with national health systems like the Netherlands (14 percent) or Britain (16 percent). When it came to appointments with specialists, patients in Britain and Switzerland reported shorter waits than those in the United States, but the United States did rank better than the other eight countries."
"The waits varied greatly by market and specialty. For example, patients waited an average of 29 days nationally to see a dermatologist for a skin exam, 66 days to have a physical in Boston and 32 days for a heart evaluation by a cardiologist in Washington."
I am CERTAINLY no in favor of nationalized health care. What I am in favor of is making health care a more free and open market. Allow more students into medical school and residency programs, allow more people to write prescriptions, allow more people to treat non-life-threatening conditions, and allow people to make their own decisions on whether they want to wait and see a 'real' doctor, so someone to deal with their condition who is less qualified, but accessible.
My post was not specifically addressing the NP bill, which I do not no anything about, but a general rant on my personal experiences in attempting to get medical care. I spend about 25k per year on insurance and deductibles for my family, with no one having any kind of ongoing treatment, and have nothing but clerical issues, waits, poor service and unsatisfactory care in return. I can't take my business elsewhere as I've tried and it's always the same.
The shortage is real in my experience, and in every person I've ever talked to about it. The facts back me up in this and I'm sure they understate the problem as many people, like me, don't even bother seeking medical care when they should because it's just too much trouble.
A very quick google brought me this from the NY Times. Much of it anecdotal, some of it valid data, but for people here to say we don't have a shortage of medical care is just nonsense.
"The study found that 26 percent of 2,002 American adults surveyed said they waited six days or more for appointments, better only than Canada (33 percent) and Norway (28 percent), and much worse than in other countries with national health systems like the Netherlands (14 percent) or Britain (16 percent). When it came to appointments with specialists, patients in Britain and Switzerland reported shorter waits than those in the United States, but the United States did rank better than the other eight countries."
"The waits varied greatly by market and specialty. For example, patients waited an average of 29 days nationally to see a dermatologist for a skin exam, 66 days to have a physical in Boston and 32 days for a heart evaluation by a cardiologist in Washington."
I am CERTAINLY no in favor of nationalized health care. What I am in favor of is making health care a more free and open market. Allow more students into medical school and residency programs, allow more people to write prescriptions, allow more people to treat non-life-threatening conditions, and allow people to make their own decisions on whether they want to wait and see a 'real' doctor, so someone to deal with their condition who is less qualified, but accessible.
Posted on 5/17/16 at 8:46 pm to LATigerdoc
quote:
Same with the optometry lobby. They are taught in school to lobby for their field and they have convinced the politicians that their work is equivalent to an MD though they went to school/training for 1/2 the time
So now you know what we are taught in optometry school? What class did they teach this? I must've missed it. Honestly, it was this attitude that allowed us to easily pass our bill 2 years ago. I do not practice ophthalmology . My partner does blephs, cataract surgery, pterygia andglaucoma surgery. He glady refers YAG capsulotomies, SLTs and chalazions to me. We have a wonderful vertically integrated clinic where we all practice to the extent of our license. It's best for our patients this way and it's better financially for the practice. He doesn't need to be doing IOP checks and punctual plugs. He needs to be in the OR. It is a fallacy to say I practice ophthalmology. My patients know exactly what I am and I am proud to admit it. I assure you that my limited scope of "surgical procedures" that I can perform are just as efficient and effective as yours. For the record, I do wear a long white coat. It's warm in the winter and I like the pockets
Posted on 5/17/16 at 9:01 pm to Ole War Skule
No
NPs
In
My
Field
Buddy
Why
Can't
You
Read
Maybe
Cataracts
?
Which
Is
Better
1
Or
2
NPs
In
My
Field
Buddy
Why
Can't
You
Read
Maybe
Cataracts
?
Which
Is
Better
1
Or
2
Posted on 5/17/16 at 9:03 pm to The Eric
Osteosarcoma buddy
Posted on 5/17/16 at 9:23 pm to LATigerdoc
The work up for osteosarcoma won't likely occur on the first MD visit. They will get a script to to go PT for knee pain/sprain. When the patient fails to make progress in the first week or so, and they complain of pain at night and there is not a clear mechanism of injury, they get sent back to the MD.
Horses first, then zebras.
Horses first, then zebras.
Posted on 5/17/16 at 9:27 pm to G Vice
Multiple times we've had patients that we referred back to a physician following an initial evaluation due to things not adding up.
Posted on 5/17/16 at 9:29 pm to LATigerdoc
I assumed that you were an ophthalmologist. I can read just fine. You were the one that attacked optometry with the lobby comment. I was simply defending what I do. I'm not at all offended by your 1 or 2 comment. It's part of what I do. My first 2 patients tomorrow are complicated post RK contact lens fits. It will be very rewarding to restore much of their lost sight.
Posted on 5/17/16 at 9:32 pm to LATigerdoc
all we ever hear are individual anecdotes on both sides. But if we look at wide studies we get the info in the graphic.
Chiropractors who have far less training have direct access.
Massage therapists who have far less training have direct access.
This post was edited on 5/17/16 at 9:34 pm
Posted on 5/17/16 at 10:00 pm to G Vice
Are you a family doctor? Ok if not let's leave it up to one. I'm not and do not claim to be
Posted on 5/17/16 at 10:02 pm to Blind Eye
I was just saying it's been said like 10x in this thread that we have no financial spiderweb with nps. People keep saying that's the motive which it certainly is not
Posted on 5/17/16 at 10:03 pm to The Eric
Ok no direct access is not something I would lobby for. Same principle as the np thing - things will get missed.
Posted on 5/17/16 at 10:05 pm to G Vice
And the MD might pick up on a bone cancer with the right clinical clues to be honest. There's a reason for courses in medical school. We are trained to think about pathology and the whole body in a way that physical therapists are not
Posted on 5/17/16 at 10:18 pm to LATigerdoc
Good PTs and bad PTs. Just like good MDs and Bad MDs.
A well trained PT does not look at shoulder pain and immediately assume rotator cuff tendinitis. A PT evaluation includes a detailed history of the patients previous/current medical issues, observations, palpating, neurological exam, musculoskeletal exam, special tests.
The PT in the house Heath and wellness committee hearings was able to correctly determine that a simple shoulder issue had neurological components, no musculoskeletal origin, and coupled with the patients history of a recently treated bout of breast cancer determined there was some sore of issue within the neurological system that needed to be reassessed by her doctor (who missed it). The patient had a large mass. The doctor missed it. The PT got it. Again, it's an isolated story. But so are the stories of the PTs who missed things.
The facts remain that the majority of states have direct access and there has been no detriment to the patient base. Instead money was saved, treatment was sooner, outcomes were better, fewer patients were prescribed prescriptions and insurance claims did not go up.
It will happen eventually.
A well trained PT does not look at shoulder pain and immediately assume rotator cuff tendinitis. A PT evaluation includes a detailed history of the patients previous/current medical issues, observations, palpating, neurological exam, musculoskeletal exam, special tests.
The PT in the house Heath and wellness committee hearings was able to correctly determine that a simple shoulder issue had neurological components, no musculoskeletal origin, and coupled with the patients history of a recently treated bout of breast cancer determined there was some sore of issue within the neurological system that needed to be reassessed by her doctor (who missed it). The patient had a large mass. The doctor missed it. The PT got it. Again, it's an isolated story. But so are the stories of the PTs who missed things.
The facts remain that the majority of states have direct access and there has been no detriment to the patient base. Instead money was saved, treatment was sooner, outcomes were better, fewer patients were prescribed prescriptions and insurance claims did not go up.
It will happen eventually.
Posted on 5/17/16 at 10:22 pm to The Eric
What is the status of your bill? We are kind of getting off topic on a tangent
And just to be fully forthright, the good and bad PTs are not "just like" the good and bad MDs. The MDs have trained and studied for far longer about far more coursework and so they are not just alike
And just to be fully forthright, the good and bad PTs are not "just like" the good and bad MDs. The MDs have trained and studied for far longer about far more coursework and so they are not just alike
Posted on 5/17/16 at 10:29 pm to Blind Eye
quote:
He glady refers YAG capsulotomies, SLTs and chalazions to me. We have a wonderful vertically integrated clinic where we all practice to the extent of our license. It's best for our patients this way and it's better financially for the practice. He doesn't need to be doing IOP checks and punctual plugs. He needs to be in the OR. It is a fallacy to say I practice ophthalmology. My patients know exactly what I am and I am proud to admit it. I assure you that my limited scope of "surgical procedures" that I can perform are just as efficient and effective as yours. For the record, I do wear a long white coat. It's warm in the winter and I like the pockets
I was a big fan of the legislation for the most part- the final passing version that is. The one the previous year seemed a bit too aggressive. I do have still one small complaint about it, and it's the same complaint I've echoed ad nauseum in this thread. When it comes to multiple groups performing the same procedure/service, I feel it's best for their to be one governing body to set forth standards in training, competence, continuing education, and who allows folks to do it. There's no question that an optometrist can diagnose a chalazion. It's nuts to think they're not capable of acquiring the surgical skill required to manage one either. I forget whether optometrists were limited from vs allowed intraocular injections. Same principle. Otherwise, with regards to being limited to non "full-thickness" procedures was very appropriate. I'm a little hesitant concerning the push to remove growths around the eye (I forget where we landed on that, too), but getting to the point:
"Tiers" of care are bad things when we deal with people's health. Holding folks to a lower standard allows the anchors to drag the capable down. Thus, in medicine, if I want to cut a simple basal cell carcinoma off the face, I better do it as well as a dermatologist. And if I want to cut an appendix out, I need to do it as well as a general surgeon. Now, I haven't gone back and checked to see what exactly the board of optometry did in terms of governing itself in terms of what training is required, who must supervise, and what the standard of care is. And if they do hold themselves to the standard of a board-certified ophthalmologist, then kudos to them.
But I don't like legislation with language loose enough to allow it to "sink" to a lesser tier.
I'm glad we have plenty of good optometrists who can now put some gloves on every now and again. And finally get paid for "surgery" such as pulling an eyelash that's turned in out. Heck, i even took the OAT and almost left LSU after junior year to go to optometry school. But I do still wish that when it came to care, one set of standards applied.
Posted on 5/17/16 at 10:37 pm to Hopeful Doc
Optometrists doing intravitreal injections is pretty far fetched. I would say that is way out of their scope by like a mile.
Chalazions might look harmless but occasionally it's a sebaceous carcinoma and the patient ends up dead if it's missed for long enough and serious enough of a problem
Chalazions might look harmless but occasionally it's a sebaceous carcinoma and the patient ends up dead if it's missed for long enough and serious enough of a problem
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