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Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 5/24/16 at 6:23 am to WashRSkins
Posted on 5/24/16 at 6:23 am to WashRSkins
quote:
It seems like they are just pumping people through these schools like crazy.
This is where it will all fall apart. If they continue to lower standards for admission and raise tuition just to generate more and more money (similar to what happened with lawyers) you are going to have some really scary people practicing medicine with no oversight. This is what happens when nothing is standardized (some schools have online classes, some don't. You can pick your own preceptor, etc.)
By the way, can you explain the process of picking your own preceptor. Can it be any primary care MD? Is anyone overseeing the curriculum that they are teaching you?
1
Posted on 5/24/16 at 8:41 am to WaWaWeeWa
I can only speak for my experience. My class work was not 100% online. I actually felt better sitting in a classroom with an instructor. Online classes just seem useless to me. I'm assuming the State Board of Nursing sets some sort of standards for school admission and curriculum but I don't believe all the curriculum is exactly the same. Certain core classes are the same but their is differences between the schools.
You can choose any preceptor. It can be either an MD or NP. I followed MDs for my OB/GYN hours and NPs for my family and Peds hours. I graduated as a FNP so the majority of my hours were based in the Family care/Primary Care setting.
But like I said before, it needs to start with the schools and curriculum before something even remotely close to this bill should be passed. I feel like NPs are jumping ahead of themselves.
I'm sure certain experienced NPs who are in support of this bill do not like what I'm saying. But I'm just speaking from a new graduate perspective.
You can choose any preceptor. It can be either an MD or NP. I followed MDs for my OB/GYN hours and NPs for my family and Peds hours. I graduated as a FNP so the majority of my hours were based in the Family care/Primary Care setting.
But like I said before, it needs to start with the schools and curriculum before something even remotely close to this bill should be passed. I feel like NPs are jumping ahead of themselves.
I'm sure certain experienced NPs who are in support of this bill do not like what I'm saying. But I'm just speaking from a new graduate perspective.
This post was edited on 5/24/16 at 8:43 am
Posted on 5/24/16 at 8:50 am to Bleeding purple
quote:
This IS us if you are interested.
My plans are currently to head on back to my home town. Guy I've known pretty much since birth is inviting me back.
And I'm just an intern, anyway (though I guess that's just 5 more weeks). I will give you a shout a year from now when you guys are looking for someone closer to being finished. But I'll say it now- it's hard to beat going back to family.
Posted on 5/24/16 at 9:17 am to Hopeful Doc
I think it's telling that some of the nps do not support it. Have not heard of an MD who's expressing anything besides opposition to this bill
Posted on 5/24/16 at 9:58 am to LATigerdoc
quote:
Have not heard of an MD who's expressing anything besides opposition to this bill
Go ask the MDs who hire NPs for dirt cheap to see their established patients while they go to the Bahama's and you may get a different response.
Posted on 5/24/16 at 10:03 am to WarmBubble
quote:
Go ask the MDs who hire NPs for dirt cheap to see their established patients while they go to the Bahama's and you may get a different response.
Those would be the exact people who don't want this bill to pass. It's those NPs who have practiced practically unsupervised who will create their own practices and take his patients.
Posted on 5/24/16 at 10:04 am to WarmBubble
I don't support that behavior either
Posted on 5/24/16 at 10:29 am to MrSpock
quote:
Those would be the exact people who don't want this bill to pass. It's those NPs who have practiced practically unsupervised who will create their own practices and take his patients.
A well established MD is not going to worry about NPs taking their patients. A smart one would have a non-compete contract that NPs sign that wouldn't allow them to practice within certain parishes if they were really worried about this. It's also not that simple for a NP to just open up and start seeing patients.
Posted on 5/24/16 at 10:32 am to WarmBubble
Non compete clauses are worth about as much as the paper they are written on. You can't stop someone from making a living. The only way they would be enforceable is if there was some sort of trade secret protection involved.
This post was edited on 5/24/16 at 10:36 am
Posted on 5/24/16 at 10:34 am to WarmBubble
Regardless, their education has not prepared them for any of this.
Posted on 5/24/16 at 10:42 am to LATigerdoc
Once this bill passes, MDs will be opening up urgent care clinics all over the place. I highly doubt many NPs are going to throw a shingle up and start seeing patients. I think what you will actually see are the business MDs setting up urgent care clinics all over the place and just let the NPs run them. Once they don't need to provide the oversight, this will free them up from having to spend time reviewing charts and the ones who have a business sense will use the new laws to their advantage.
Posted on 5/24/16 at 10:42 am to guttata
Most MDs with well-established practices are just bringing in NPs for additional revenue. The patients that the MDs have been seeing for years are not going anywhere because they do not want to leave their comfort zone.
If a NP decided to leave and patients followed, it would most likely be patients that the NP has treated from the very beginning, not having been seen by the MD at any point. It would not be that big of a loss to the MD. The MD would just hire the next crop of NPs who just recently graduated, and bring in new patients for the NP to evaluate and treat.
If the bill passed, a NP would still need to collaborate with a MD anyway for about a year before they could go off on their own.
NPs would still need to get contracted with their new practice location, which could take several weeks, sometimes months.
All in all, MDs worried about NPs "taking their patients" really shouldn't be an issue unless the MD in private practice had a poor business plan and was struggling to get established.
If a NP decided to leave and patients followed, it would most likely be patients that the NP has treated from the very beginning, not having been seen by the MD at any point. It would not be that big of a loss to the MD. The MD would just hire the next crop of NPs who just recently graduated, and bring in new patients for the NP to evaluate and treat.
If the bill passed, a NP would still need to collaborate with a MD anyway for about a year before they could go off on their own.
NPs would still need to get contracted with their new practice location, which could take several weeks, sometimes months.
All in all, MDs worried about NPs "taking their patients" really shouldn't be an issue unless the MD in private practice had a poor business plan and was struggling to get established.
Posted on 5/24/16 at 10:43 am to guttata
And the ethics of that would be very questionable
Posted on 5/24/16 at 10:45 am to LATigerdoc
Why would this bill passing make them want to do that any more than whatever present motivators there currently are to that type of behavior?
Posted on 5/24/16 at 10:46 am to LATigerdoc
I think what you would see if it passes is NPs opening up their own shop and misdiagnosing stuff and then referring their trainwrecks to the md
Posted on 5/24/16 at 10:48 am to LATigerdoc
I would think more about hospitals and FQHC companies opening up more NP clinics as soon as this happens. The majority of NP's are not going to strike it out their own but the Hospitals and grant writers are going to see the increased revenue streams in the unreachable places.
Posted on 5/24/16 at 10:50 am to Itismemc
quote:
I would think more about hospitals and FQHC companies opening up more NP clinics as soon as this happens. The majority of NP's are not going to strike it out their own but the Hospitals and grant writers are going to see the increased revenue streams in the unreachable places.
You are exactly right.
Posted on 5/24/16 at 10:58 am to MSMHater
That's exactly what will happen. They'll pay NPs a bit more b/c now the NP won't need the collaborating physican. Whether it's right or wrong, ethically, they will see the ability to make $$.
Posted on 5/24/16 at 11:06 am to guttata
And it's the health systems that have the finances and economies of scale available to expand their market.
It's foolish to think this will result in a boom of privately owned solo NP practices. That's not the endgame here. Expand the market and brand access to areas currently undersaturated with MD's. Opening the primary care gateway in those markets will generate downstream referrals for the systems profit centers.
If Oschner can operate a primary care clinic out of the CVS in Venice, with only mid levels, that can ultimately result in volume for their New Orleans based specialists.
Once patients are "in the system", they are usually in "all the way". Cardiac referrals. Endo referrals. GI referrals, etc...
It's foolish to think this will result in a boom of privately owned solo NP practices. That's not the endgame here. Expand the market and brand access to areas currently undersaturated with MD's. Opening the primary care gateway in those markets will generate downstream referrals for the systems profit centers.
If Oschner can operate a primary care clinic out of the CVS in Venice, with only mid levels, that can ultimately result in volume for their New Orleans based specialists.
Once patients are "in the system", they are usually in "all the way". Cardiac referrals. Endo referrals. GI referrals, etc...
This post was edited on 5/24/16 at 11:16 am
Posted on 5/24/16 at 11:12 am to Itismemc
And then you will have removed the doctor from the exam room and left the patient with a mega hospital, an insurance company and a nurse
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