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Message
re: LA legislature denies Independent nurse practice
Posted on 6/21/21 at 11:04 pm to BeepNode
Posted on 6/21/21 at 11:04 pm to BeepNode
quote:
So what? As long as they don't advertise themselves as doctors, why shouldn't they be allowed to offer services that are within the scope of their training? It would increase the supply of medical care and potentially lower costs.
there's also the fact that some do refer to themselves as 'the doctor' when they see a patient because its more understandable than a PA/NP, or the patient calls them doctor and they don't correct them.
that's the problem, its called scope creep. they are not trained for the scope they are reaching for. they were not trained for independent practice equivalent to a physician. also it would likely increase the cost of care with an increased number of mismanaged patients and excessive labs/imaging. somebody drank the midlevel kool-aid.
1
Posted on 6/21/21 at 11:10 pm to Jake88
quote:
Or, they could simply go to medical school.
Is it always that simple? Not everyone knows exactly what path to take in life when they are 18. Not everyone is a great student at that age either.
So, why is traditional medical school the gate keeper?
The way our educational system is evolving, it seems that core credit hours and a base licensing exam for “healthcare providers” is the logical solution. Overall scope of practice would then be determined based on hours in practical training programs (residency) and ability to pass board certification.
Posted on 6/21/21 at 11:10 pm to Jake88
quote:
Or, they could simply go to medical school.
But there is a real benefit to having someone who didn’t have the training I did see a lot of the low acuity stuff that doesn’t require my level of expertise. Our practice’s PA allows me to spend more time with and treat more patients with complex problems that require surgical intervention. He is more than capable of evaluating an incision and determining if sutures can come out and there is no reason I need to spend a second of my time reading or signing off on that chart. You don’t need to be a physician to see a post-op day 1 or day 2 on an inpatient floor and write discharge summary/orders. 25% of my day used to be stuff that didn't require my level of expertise to safely or effectively treat. Nothing wrong with allowing non-physicians to treat that stuff. Like I said earlier, you just to have more stringent requirements for doctor nurses to practice autonomously. They need more years of supervised practice and they need physician oversight on the state level from a licensing standpoint. If you always require them to have everything supervised then you’re back to wasting a good portion of my valuable time with crap I don’t need to be dealing with. There is a happy medium, just can’t let the doctor nurses be in charge of their own scope of practice.
Posted on 6/21/21 at 11:24 pm to USMEagles
quote:
I thought that was verboten
Whoooa....check out the big brain on Bret!
Posted on 6/21/21 at 11:27 pm to CajunDoc
This makes sense to me. I'm personally only comfortable seeing doctors for primary care
Posted on 6/21/21 at 11:30 pm to CajunDoc
quote:
denies Independent nurse practice
GOOD
Posted on 6/21/21 at 11:32 pm to Bmath
quote:
Is it always that simple? Not everyone knows exactly what path to take in life when they are 18. Not everyone is a great student at that age either.
So, why is traditional medical school the gate keeper?
The way our educational system is evolving, it seems that core credit hours and a base licensing exam for “healthcare providers” is the logical solution. Overall scope of practice would then be determined based on hours in practical training programs (residency) and ability to pass board certification.
mostly because medical school and residency is how you learn to practice medicine. ask an NP to explain differential diagnosis and reasonings behind their Rx, lab, and diagnostic orders. This is a big deal. We had a few who started school in my class well over 40, many over 25. not knowing your life path by 18 is a flat out false premise.
if you are such a bad student that you refuse to go to medical school in order to practice medicine... what makes you think you will be able to pass comparable board and licensing exams? There is a reason NP's aren't governed by the same bodies that physicians are, they are held to different standards of practice.
'healthcare provider' is a gross term used to bring doctors to the same level as midlevels. now if NPs/PA start getting equivalent training/education and pass equivalent boards this is not an issue. lol @ gatekeeping
Posted on 6/21/21 at 11:36 pm to CajunDoc
My regular medical clinic is owned by an NP. She’s awesome, I can even get my annual papsmear and mammogram at her clinic in Watson.
Posted on 6/21/21 at 11:39 pm to AMS
I believe you completely misinterpreted my post. It’s more to say that could there not be more than one beginning path that gets you to the final endpoint?
Everyone still needs to pass certain levels of exams and complete set hours in training.
It’s more that why force a PA to start school completely over again without any regard to their base knowledge?
Everyone still needs to pass certain levels of exams and complete set hours in training.
It’s more that why force a PA to start school completely over again without any regard to their base knowledge?
Posted on 6/21/21 at 11:42 pm to scott8811
quote:
This makes sense to me. I'm personally only comfortable seeing doctors for primary care
midlevels expanding to independent primary care is the scariest of scope creep expansions. The problem is they don't know what they don't know. dunning kruger effect. their real benefit is in more specific environments with training and support.
they are valuable resources for soft admits from an ER, handling lacs, I&Ds, sports injuries, discharge orders for inpatients, well checks. and allow docs to handle the harder to manage patients.
Posted on 6/21/21 at 11:45 pm to CajunDoc
Mid level isn't an appropriate term for Nurse Practitioners, nothing about being a Nurse Practitioner should be considered mid level. It isn't like nurses are low level and doctors are high level, they are simply doing different roles.
Those who complain about NP's going to the doctor to consult are just stupid, would you rather the NP just wing it or make some shite up instead of consulting a doctor? You better bet doctors consult each other, online resources... even google... when they need some information. I was working with a doctor and they pulled up some info about a drug I had a question about and I asked what resource they used, trying to be good student and all, they used google... I thought she had a good drug book app or something. Lexicomp is what I was given access too but I like some of the other books better.
Anyway, I have no problem seeing a NP, the vast majority of the time I go see a doctor I already know the diagnosis and know what they are going to prescribe I just need a permission slip to get the proper drugs to take care of the problem. I have even seen NP's as my case manager (I have organs that do not work) and the Doctor just reviewed what was going on. Hell, I have never met or spoken to my endocrinologist, I don't even know where he is. He orders tests, he reviews tests, I see a NP to review what he said.
Those who complain about NP's going to the doctor to consult are just stupid, would you rather the NP just wing it or make some shite up instead of consulting a doctor? You better bet doctors consult each other, online resources... even google... when they need some information. I was working with a doctor and they pulled up some info about a drug I had a question about and I asked what resource they used, trying to be good student and all, they used google... I thought she had a good drug book app or something. Lexicomp is what I was given access too but I like some of the other books better.
Anyway, I have no problem seeing a NP, the vast majority of the time I go see a doctor I already know the diagnosis and know what they are going to prescribe I just need a permission slip to get the proper drugs to take care of the problem. I have even seen NP's as my case manager (I have organs that do not work) and the Doctor just reviewed what was going on. Hell, I have never met or spoken to my endocrinologist, I don't even know where he is. He orders tests, he reviews tests, I see a NP to review what he said.
Posted on 6/22/21 at 12:01 am to Bmath
quote:
So, why is traditional medical school the gate keeper?
Because it's so fricking rigorous that dummies drop out and even the worst of the people that make it through 4 years of medical school, a year or two of internship, and maybe a year or two of specialization in family medicine and then passes board exams PROBABLY won't kill you misdiagnosing what you think is a lingering flu but is really some kind of lymphoma.
Someone with 4-6 years of less rigorous training and no board oversight might diagnose your flu and all the complications you'll suffer right into your grave.
This post was edited on 6/22/21 at 12:13 am
Posted on 6/22/21 at 12:06 am to Bmath
quote:
I believe you completely misinterpreted my post. It’s more to say that could there not be more than one beginning path that gets you to the final endpoint?
Everyone still needs to pass certain levels of exams and complete set hours in training.
It’s more that why force a PA to start school completely over again without any regard to their base knowledge?
you may have misinterpreted my post. Regarding their base knowledge it just isn't equivalent. PA school may cover most of the same topics, but not at the same depth. While in med school there multiple midlevels getting consults from the physician for questions I could answer without blinking.
Im empathetic to them having to start all over but given midlevels curriculum and foundational knowledge gaps the answer should just be no. the problem is midlevels are reaching for equal scope without equal training responsibility and liability. Now sure if they come up with an appropriate midlevel-->physician bridge including covering education gaps, complete a physician level residency, and licensing exams, and are held to the same standards of practice but that just describes going to medical school and residency.
Posted on 6/22/21 at 12:08 am to CajunDoc
You gotta be careful where you get your medical care. Buddy of mine tried to save money by getting one of those "back alley" colonoscopies, and let me tell you, it was not worth it. Not at all.
Posted on 6/22/21 at 12:09 am to LSUAngelHere1
My wife is a NP,she doesn’t want to be an independent practitioner.She know what she knows and what she doesn’t know.I would guess her Dr. is able to carry twice the patient load he could otherwise.He’ll be tied up in cath lab,she makes rounds and takes care of some issues.Other patients have issues that she wants to discuss with Dr. so she goes to cath lab and passes it by him.
In clinic, there are patients that only want to see the Dr.and then there are pts. that prefer to see her.Neither of them get butthurt over pt.preferences..It’s worked well for them.
I know several NP’s that are excellent and I would be happy to see them if I was sick.At the same time I worked with some nurses in ICU that weren’t particularly good nurses and they went to NP school.The thought of them being independent practitioners is scary.
In clinic, there are patients that only want to see the Dr.and then there are pts. that prefer to see her.Neither of them get butthurt over pt.preferences..It’s worked well for them.
I know several NP’s that are excellent and I would be happy to see them if I was sick.At the same time I worked with some nurses in ICU that weren’t particularly good nurses and they went to NP school.The thought of them being independent practitioners is scary.
This post was edited on 6/22/21 at 9:05 am
Posted on 6/22/21 at 12:09 am to AMS
There is a wide swath of diagnostic and basic medicine that isn't really being performed as often as it should be performed.
Doctors today seem like they're completely slammed.
Doctors today seem like they're completely slammed.
Posted on 6/22/21 at 12:30 am to armsdealer
quote:
Those who complain about NP's going to the doctor to consult are just stupid, would you rather the NP just wing it or make some shite up instead of consulting a doctor? You better bet doctors consult each other, online resources... even google... when they need some information. I was working with a doctor and they pulled up some info about a drug I had a question about and I asked what resource they used, trying to be good student and all, they used google... I thought she had a good drug book app or something. Lexicomp is what I was given access too but I like some of the other books better.
from physician perspective its informed criticism if an NP is consulting a doc for basic management info that even a med student would know. But i agree its often stupid from a patient perspective, they wont know the difference in that vs a consult for something a physician would get a consult for.
nothing wrong with googling something from time to time, not everything requires dusting off textbooks or wheeling through uptodate. the doc probably had an appropriate plan and the piece of info you were asking was not going to change the plan in a way that would require a deeper dig. she probably knew it would be easily found in google.
quote:
Anyway, I have no problem seeing a NP, the vast majority of the time I go see a doctor I already know the diagnosis and know what they are going to prescribe I just need a permission slip to get the proper drugs to take care of the problem. I have even seen NP's as my case manager (I have organs that do not work) and the Doctor just reviewed what was going on. Hell, I have never met or spoken to my endocrinologist, I don't even know where he is. He orders tests, he reviews tests, I see a NP to review what he said.
generally agree with that sentiment. that seems appropriate use of an NP for endocrinology, but that's not close to the same as independent practice.
Posted on 6/22/21 at 12:32 am to armsdealer
quote:
It isn't like nurses are low level and doctors are high level, they are simply doing different roles.
Well on the spectrum of “critical thinking requirements and decision making responsibilities in patient care” they certainly are low level and high level
Posted on 6/22/21 at 12:48 am to BeepNode
quote:
There is a wide swath of diagnostic and basic medicine that isn't really being performed as often as it should be performed.
Doctors today seem like they're completely slammed.
better to just let folks with less than 10% of the training/education hours act independently as a physician then huh?
what we don't need is a bunch of undertrained people shooting from the hip regarding tests and medicine. There is also such a thing as over and unnecessary tests/treating. knowing when to use, and how to interpret those tests and medicine is important if you're going to be practicing medicine independently. Those things are part of that foundational knowledge and training gap I keep referring to.
Instead of lowering standards of practice you should consider support for increasing residency opportunities and funding so that we can train more doctors
Posted on 6/22/21 at 12:49 am to AMS
quote:
nothing wrong with googling something from time to time
I’ll occasionally google peds doses (mg/kg) of certain drugs. When you don’t prescribe them regularly and uptodate is a pain to get to (goofy institutional access on a remote desktop), it happens. I’ve got some weird path results before that have caused me to do a quick google search. Mostly because it’s fast and I’m at a computer and it’s good enough. I’ll save any lit reviews or textbook searches for later. Sometimes the super secret, non google, physician reference materials aren’t as readily available as the quick and dirty you can find online. And we’re still talking stuff that you might see 2-3 times in a career. The decision to obtain the biopsy (for example) because of subtle irregularities in the presentation is the important part and why I get paid more than an NP.
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