re: LA legislature denies Independent nurse practice

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Doctors today seem like they're completely slammed.

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That's because the doctor's union (American Medical Association) artificially keeps the supply of doctors low.

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Well I can tell you this, I’m a practicing Occupational Therapists and had to take the same anatomy course as the med school students (that included the cadaver lab) at LSU health in Shreveport

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No you did not, you took an A&P course developed for allied health students in the summer taught in the gross anatomy lab (6 th floor) taught by some of the same professors as med school ( Dr clausen?, Dr penny?) but it was not the same course taught to med school students in fall and spring

That being said I would put my money on a good PT or OT for musculoskeletal anatomy over a MD (other than an orthopedic or similar) any day

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CajunDoc

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You are more concerned with your market share than you are patient health. The rest of the country has NP and PAs delivering primary care at a range of facilities. Louisiana took the brave stance not to allow that, interesting decision in a state that struggles with 1) a lot of terribly unhealthy people 2) many people unable/unwilling to pay for their own health care.

How much are your association dues? I have to admit, they are paying dividends.

To clarify:

1. No one (in healthcare) has the same level of “book smart” or “academic rigor” as medical students.

Wife and I are physicians and our oldest child just got done with the MCAT. She studied 300 hours for the test (while keeping a 4.0 GPA in college). I repeat, she studied 300 hours for the test to APPLY to medical school. Her friends did similar levels of preparation.

No other medical discipline studies like that. The number of hours she will study in her 1st year alone of medical school will surpass any mid levels total training for their career.

2. I supervise and lecture mid levels as well as primary care medical residents.

The difference between the two groups (in lecture and clinic) is in stark contrast.

The types of questions I get during a lecture, the way they process information, and the clinical questions I get throughout the day.

We utilize NP’s to see routine complaints in our offices, but we have MD’s in the same clinic with protected time to be available for questions which always arise. We also have several specialists (I am one of those) available by computer message. We can review the patients chart and give advice.

I have never had a medical resident make a “What were you thinking?” type of mistake in diagnosing or dosing a medication. I probably get 1-2 of those mistakes per week with my mid levels.

NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.

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No problem here.
Nurses aren't Drs
And this is why access to health care is extremely out of high and out of control

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FIFY

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I'm often of the opinion that if LA is going against national model, we are probably wrong...

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LA is actually more in line with the majority of states, but the balance will flip within 4 years is my guess. mostly because the midlevel lobbying is robust and has business interests of large medical management and hospitals.

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This has been asked several times, but no clear answer given... what do other states do? What is the national standard here?

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for midlevels there is no clear answer or national standard, it depends on the state. basically main categories are full (independent), reduced (collaborative), or restricted practice (supervision or designated team roles). LA is reduced practice. the majority of states are reduced/restricted practice for midlevels. the rigors of those reduced/restricted agreements change per state. but essentially it means the physician may be vicariously liable for midlevels as they are 'practicing under' a physician.

collaboration generally entails chart auditing/sign off, general management outlines, and consultation availability.
restricted is more limiting on the scope, how/what midlevels can prescribe, treatments, exams, order, perform procedures, and are more closely tied to a physician.
independent practice is allowed in some states after x time of supervision/collaboration, as soon as they are licensed, or with DEA registration.

an intern year physician 1 year out of medical school is much more trained than a midlevel will ever be, but cannot practice independently. In many of the independent practice states you might as well start letting 4th year medical students open up their own practice as they have more training than recently minted midlevels who are practicing independently.

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an intern year physician 1 year out of medical school is much more trained than a midlevel will ever be,

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Trained, or classically educated?

I would think an NP with 20 years exp has "seen" more things in the field... but the physician 1 year out of medical school has probably learned more things from books/lectures/labs.

Or is there really no distinction?

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I have no idea the laws in LA but in Alabama:

1. I have to review 10% of the charts (chosen at random) from a NP’s caseload.
2. I can supervise up to 9 NP’s at a time

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and that is what i am getting at, not sure what the law is in LA, so was trying to get a clear answer but no one is offering......

my vague understanding is that our law is similar, retro chart review on a small % of patients and be available by phone...... and if that is the case, it is bull crap and is doing very little, likewise if that is what this fight is about ....keeping this as law or eliminating it, why fight it? as it is doing nothing anyway, and it also confirms this is a turf battle.

if this fight is about strengthening the regulations then lets hear it

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No one (in healthcare) has the same level of “book smart” or “academic rigor” as medical students.

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And there's actually just as much of a shortage of mid levels in some states too.

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NP’s or PA’s practicing alone or with retrospective chart review by an MD is a very bad idea.

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100% agree. Which means Louisiana is doing the right thing at the moment. Which surprises me.