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

IF the bill passes, would an independent NP still be governed by the state board of nursing and not the board of medical examiners? Never understood why a group practicing medicine would be governed by a nursing organization.

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No matter what I say, this will always be your reply, simply because you know I'm a physician.

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My father and one of my best friends are medical doctors. I'm not the one that has been posting on here saying doctors are just trying to make more money.

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You have tried to portray optometrist as getting similar training to ophthalmologists based on anecdotal evidence that is second hand information from your brother... Who happens to be an optometrist. All I did was point out the vast differences in training.

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It is anecdotal, which I readily admitted. However, he's had multiple MD's that he has received training under tell him that he is getting equivalent and even better training in certain areas. This is beyond that of simple refractions mind you.

It's fine that you have a different perception of that. I get that you have more personal experience in the area.

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Did you actually read all of that article?

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Yes, I only pointed to the part where it says that both Optometrists and Opthalmologists both agree that the former need and do not currently have proper training in most cases. The point of the article is that many clinics want to use Optometrists in an expanded role, but it points out why that may not be a good choice. At no point was I using the article to support any claims that Optometrists are something that they are not.

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Nurses will be so loud and obnoxious and fight to be doctors. If you don't believe it go look at a Nurse's facebook page.

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This is the most absurd allegation and is obviously based on an extremely small sample of nurses in comparison with the actual number of nurses that are licensed and presently practicing.

I have been an ER/Trauma nurse for 25 yrs. I entered USC at the age of 15. Yes, 15. I turned 16 a couple of weeks into my first semester at Carolina and graduated summa cum laude at the age of 19. Had I wanted to be a doctor, I assure you that I possessed the ability to become a doctor. 90% of my friends are nurses and, obviously, almost all of my professional aquaintances are nurses and I have never heard even one become loud or obnoxious about becoming a doctor, nor have any of them ever expressed a desire to fight to become one which conclusively negates your foundless statement regarding nurse's fb pages.

Yes, our jobs are extremely demanding, stressful and often thankless. But the majority of us went into the profession not for the laurels, praise or recognition that you seem to believe motivated us, but instead because we truly wish to help others and hope to make a difference in the lives of our patients and their families. Lord knows it certainly wasn't for the pay or the hours but those are also areas that we were fully aware of when we became nurses.

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The end game of optometrists is wanting to do cataract surgery.

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This is why way back when I first started posting in the thread I asked questions about bridge programs.

A poster or two was receptive to it, while another shot it down and said that the other medical specialties just don't have the right depth of knowledge. That poster used an example that they had nurses in their medical school class that failed out because they didn't have a good enough science base. It's funny, because that's no more anecdotal than anything I've said. In fact, I know a surgery resident here in Baton Rouge that went to nursing school before medical school.

A lot of doctors are quick to give the answer of "they should have gone to medical school if they wanted to work as a doctor." However, that is an incredibly narrow-minded way of thinking. Medical school is very hard to get into, and any small blemish on your academic record to ruin your chances of getting in.

Plenty of smart students goofed around as 18-20 year old kids because they were immature, and have to pursue other routes to get into the medical field. I can tell you that when I was teaching bio labs that most of my best students were older non-traditional students that came back after working in the military or other fields. It's not to say that you have to go to medical school when you are 22 and coming directly out of undergrad, but it becomes personally harder to go to medical school the older you are.

Nevertheless, there are plenty of students that don't hit their stride academically until they are much older. Many of them end up taking Plan B routes, such as PA school, to get into the medical field. With the landscape of medicine rapidly evolving, it is very apparent that expansion of scope of practice is not going away. I think the smarter approach is to find ways to bridge the gap in training for the best of the best providers that come from other backgrounds, and to set very hard lined standards for those are that are better off in a limited scope.

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It's not to say that you have to go to medical school when you are 22 and coming directly out of undergrad, but it becomes personally harder to go to medical school the older you are.

Nevertheless, there are plenty of students that don't hit their stride academically until they are much older. Many of them end up taking Plan B routes, such as PA school, to get into the medical field.

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It's not impossible. Any admission committee will take into consideration most the most recent grades as the trend at look at the old grades as just what you said. The immature 18 year old.

However, there is the great equalizer when it comes to medical school admissions, the MCAT. Do well and almost all will be forgiven regarding GPA.

I don't disagree with a 3-4 year residency either. At best, some optometrists only complete a one year residency in a specific therapy.

I wouldn't let a green Optometrist or medical doctor cut on me. However, I have had great experiences working with MDs right after they finished their residency. I'm all about gaining proper experience and training.

Say I'm a patient. One "doctor" of the eye says he is a doctor, wears a white coat, and lobbied to give meds and do surgery and now talks about optometric residency .

The other doctor of the eye went to medical school, and his field of training entails meds and surgery for the eye.

How in the world am I as a patient to realized that one is a full body medical doctor with twice the training and the other has been pushing his scope of practice forward through the legislature for several decades?

Tell me how this is not confusing to the patient. It appears as if there is an ongoing attempt to camouflage the two as one in the same which they are not

Straw man argument. The question is how much medical/surgical stuff do the optometrists have no knowledge of. They are the ones who attempt to change the law and their scope of practice.

Unless you're trying to get rid of the practice of medicine your argument is a straw man argument

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it becomes personally harder to go to medical school the older you are.

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While it becomes personally more difficult, it becomes exponentially easier for a non-traditional student to get accepted for most of the reasons you mention.

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Many of them end up taking Plan B routes, such as PA school, to get into the medical field.

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I am confused by this statement. The medical school door is open to them. They willingly choose an alternative path to the medical field. This is a great thing. There are alternatives to doctors- there are PAs and NPs that can be trusted with a great deal of autonomy. But none of those programs are designed to turn out independent practitioners of medicine. They're designed to turn out midlevels who can practice under the supervision of someone who is held to a high standard which they were taught.

No one doubts the intelligence of those folks. We doubt their training because it's significantly less intense. After having done an intern year in 6 weeks and being able to leave and practice medicine on my own if I felt like it, I know that any less training than I received would be far too little. I barely feel as if mine were enough at this point, and it's quite significantly more than what they've done.
Our foundations are much higher with clinical experience tacked onto the top of that. They have weaker foundations AND less clinical experience by the time this suggests they should practice independently. It's not closed-minded to think that less training should be required of them should they desire autonomy. It's experience and opinion. If there is a route through nursing to practice medicine, it absolutely needs to be built on the same foundation we practice. They should pass all the same boards as we pass. I have no qualms with a non-MD who has my foundation and my clinical experience practicing medicine under our medical board. Heck, they call the one group of folks who do that DOs. I insist that is the necessary minimum to be clinically competent, and it comes from personal experience, not an ego of superiority.

One last time- there are equally brilliant NPs and PAs as MD and DOs. I'll never doubt their intelligence for a second. But I will doubt their foundations of training for the above, obvious reasons.

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An optometrist is not a physician/doctor

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I just saw a patient with a large central dendritic ulcer. She was being treated for assumed allergic conjunctivitis by her "Doctor" with prednisilone drops. As you can imagine, her condition was getting significantly worse. Thank God she came in to see me. Call me whatever you choose, but it's quite possible I will save this woman's sight. If she needs a corneal transplant, I promise you that I will not try to legislate the privelage of doing this surgery. I am now going "surgically" remove a trichiatic lash.