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Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 4/9/16 at 10:01 am to Parallax
Posted on 4/9/16 at 10:01 am to Parallax
quote:
NPs overconsult, overtest, etc. This is a basic fact anyone exposed to healthcare knows.
This. Not to mention how many of the referrals aren't even to the correct subspecialty. And they have no idea or knowledge to oversee their specialist to make sure what they are doing is appropriate.
1
Posted on 4/9/16 at 10:01 am to SmackoverHawg
Congratulations. Seriously, I'm on your side and was just replying in kind to the arse hole.
Your mid level set up is how it's supposed to work, but many docs I know don't show the same diligence with their supervision. That said, bills like in the OP are already prevalent nationwide, and arguing against them on the basis of quality, without any regard to supply and demand, is shortsighted and can easily be interpreted as an industry protecting their competitive advantage.
I've also known and worked with enough excellent PA'S to know better than just dismiss their capabilities. Docs may not like it, but if politics keeps leading medicine down this path, mid levels will be providing primary care for the masses. You'll either have a large team of then at your practice, or you'll just go 100% concierge.
Your mid level set up is how it's supposed to work, but many docs I know don't show the same diligence with their supervision. That said, bills like in the OP are already prevalent nationwide, and arguing against them on the basis of quality, without any regard to supply and demand, is shortsighted and can easily be interpreted as an industry protecting their competitive advantage.
I've also known and worked with enough excellent PA'S to know better than just dismiss their capabilities. Docs may not like it, but if politics keeps leading medicine down this path, mid levels will be providing primary care for the masses. You'll either have a large team of then at your practice, or you'll just go 100% concierge.
Posted on 4/9/16 at 10:06 am 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.
I've seen this URI turn into a partial colectomy from a NP continuing to treat subsequent diarrhea with more antibiotics, while the entire time, c-diff completely obliterating the person's colon.
Ignorance does not equal bliss in the medicine; it can lead to dangerous events.
Will send prayers to you and yours when you do need a doctor, which you will. I don't have a summer home by the way, and your complete ignorance is disturbing.
Posted on 4/9/16 at 10:06 am to pleading the fifth
quote:
Ha what a surprise. Administrators have done more to royally F the healthcare system than docs could ever do. Shall we get into the brilliance of value-based purchasing, linking reimbursements to patients satisfaction scores (which is completely idiotic and only something bureaucrats could possible dream up), and Press-Ganey? I cannot wait to hear your thoughts on these.
Have +10000000000000000000000000000000 upvotes.
fricking admins. But frick the doctors that think they need them and have caved in. My major competitor has an administrator. They run 80-85% overhead. His compensation is based on revenue. Not profit. My runs about 33-40% tops. Currently about 40% as I'm over hired because I'm about to add another physician. I am our administrator. And I get any doc or NP I hand select because I run a tight ship that gives good care, keeps prices down, and lets the producers keep the spoils. Administrators
Posted on 4/9/16 at 10:06 am to Parallax
quote:
You have a wife that's a midlevel provider (and have called her a 'hepatologist' ). You're clearly biased and
And?
And she runs her own specialty clinic, with her own patients, and het own treatments and care plans. Her supervising just does the colons.
Kind of proves my point.
Posted on 4/9/16 at 10:07 am to Isabelle81
I work on Peds.....not Nicu. Rectal temps are the norm for healthy babies under a year old.
Posted on 4/9/16 at 10:07 am to MSMHater
quote:
I've also known and worked with enough excellent PA'S to know better than just dismiss their capabilities
So have all of us in the Healthcare field, but the key word in your statement is CAPABILITIES. While there is a role and need for more midlevel providers there are many things they are just not capable of handling on their own.
Posted on 4/9/16 at 10:09 am to SmackoverHawg
quote:
But frick the doctors that think they need them and have caved in
I think the phrase your looking for is "damn near all of them."
Blame the government for my rise, not me who filed the need.
Posted on 4/9/16 at 10:10 am to KarlMalonesFlipPhone
quote:
While there is a role and need for more midlevel providers there are many things they are just not capable of handling on their own.
Then hire the qualified people. Don't restrict the market to all of them.
Posted on 4/9/16 at 10:10 am to MSMHater
quote:
And? And she runs her own specialty clinic, with her own patients, and het own treatments and care plans. Her supervising just does the colons. Kind of proves my point.
All I know is that I've picked up a few pt's from a NP "endocrinologist" in the Monroe area. She does have care plans and manages the pt's diabetes and comorbid conditions....like shite!!!!!!!!!!! So doing it and doing it well are two different things. Not saying one way or another about your wife's. Just saying. Thinking you are doing good is easy when you don't have a doc saying "Hey dumbass!!! WTF are you doing here?!!!".
I win either way. I have NP's. I'll add NP's. Pt's know the difference. I don't need any admin telling me how to do shite or what's better. Give the best care at competitive prices, treat people well, give oversight to your mid-levels and win.
Posted on 4/9/16 at 10:14 am to SmackoverHawg
Again, I am happy your system works for you. That's good news for your patients. I hate that you have a shitty endo to refer to. I would love to take those patients off your hands.
Fwiw, my endos don't use mid levels. They are more like you in that regard. And they are the best docs I've ever worked for.
But I'll still contend the OP is going to be a reality very soon.
Fwiw, my endos don't use mid levels. They are more like you in that regard. And they are the best docs I've ever worked for.
But I'll still contend the OP is going to be a reality very soon.
This post was edited on 4/9/16 at 10:16 am
Posted on 4/9/16 at 10:14 am to MSMHater
quote:
I think the phrase your looking for is "damn near all of them." Blame the government for my rise, not me who filed the need.
True. And I don't dislike you personally.
And yes, all this gov't bullshite has made practicing medicine a nightmare.
Posted on 4/9/16 at 10:17 am to LATigerdoc
quote:
How are you gonna operating on a cornea in an OR when you don't go to the OR and you don't have experience with anesthesia?
You let the anesthesiologist do his thing and call you in to do the corneal work maybe?
Posted on 4/9/16 at 10:24 am to KarlMalonesFlipPhone
quote:
So have all of us in the Healthcare field, but the key word in your statement is CAPABILITIES. While there is a role and need for more midlevel providers there are many things they are just not capable of handling on their own.
Upvoted
Posted on 4/9/16 at 10:30 am to nolatiger711
Thanks for the input - you are proving my point. There is no substitute for experience. Autonomy should come only with mandatory residency training after graduation and with full liability for all decisions and treatment plans enacted.
Posted on 4/9/16 at 10:30 am to SmackoverHawg
Smack, what are you recommendations for physicians not in primary care (I am in a sub specialized surgical field)? I'm probably screwed, huh?
Hanging your own shingle or small private practice groups are exceedingly rare in my field, especially in the places I want to live. I'm an ahole and refuse to waste my time with administrators.
Hanging your own shingle or small private practice groups are exceedingly rare in my field, especially in the places I want to live. I'm an ahole and refuse to waste my time with administrators.
Posted on 4/9/16 at 10:33 am to Parallax
quote:
I'm an ahole and refuse to waste my time with administrators.
We are pretty unbearable. Needy as shitty to.
Posted on 4/9/16 at 10:36 am to Parallax
quote:
Hanging your own shingle or small private practice groups are exceedingly rare in my field, especially in the places I want to live. I'm an ahole and refuse to waste my time with administrators.
What subspecialty if you don't mind saying?
Posted on 4/9/16 at 10:41 am to Tiguar
quote:
lol frick off with your protectionist bull shite. The ama and other doc associations are holding healthcare back. You don't need 12 years of school/residency to manage common chronic disease states or run a rapid strep/flu test
Come on mannnn. You are attacking the wrong part of the system. Doctors salaries account for 10% of healthcare spending. Cut them by 10% and you save $26 billion. A drop in the bucket when compared to the annual cost of administration... $360 billion. You are going after some of the only people in the system that may have a shred of interest in your well being. The OP isn't trying to protect his salary. Do you think he will run out of primary care patients to see if this bill passes? Lol. He is TRYING TO PROTECT YOU because he knows what goes on behind the scenes.
All these administrators and other waste in the system will act like they have all the answers but the one administrator in here has yet to answer my simple question about who he would see if he was diagnosed with stage 3 Lymphoma, since NPs diagnose and treat cancer so well.
Posted on 4/9/16 at 10:42 am to nolatiger711
quote:
Here is the next 2 year program you must enroll in after the 18 month MSN program you linked. Vandy DNP.
So the DNP program at Vandy requires only 500 hours of clinical work. The rest of the curriculum looks like ivory-tower academic nursing theory - not hands on patient care.
quote:
Students must complete 35 credits of coursework at Vanderbilt School of Nursing, including 500 hours of clinical integration, and a scholarly project.
Yikes - and this person gets to call themselves "Dr" and take care of patients. At least they had to do a scholarly project.
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