re: SB 435 would allow advanced practice nurses to not work under a physician

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I believe this is what the Rural Scholars program is at LSUMC. 3rd and 4th year is more focused on IM or Family Practice instead or the normal rotations.

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This is very untrue. They still do every rotation that everyone else does. The one difference is that one half-day per week, they are in a continuity clinic. They still meet the requirements of every rotation and still take 4 years to complete training. Their 3rd year just contains a "rural" setting or a continuity clinic.
I put quotations around the word rural because it actually does not require them to be rural- just in an underserved area. Many rural scholars actually stay in New Orleans and work in an underserved clinic there.
In repayment of a tuition waiver, they must promise to complete 4 years of primary care in a medically underserved area in Louisiana, and they owe tuition back at an increased rate if they do not.


There was, at one time, talks of opening a 3-year "fast track" medical school focused on primary care in Lafayette. This never came to fruition, and I do not understand all the details of the curriculum that was to have been. The current system in place in New Orleans in the 4 year program currently has a few "breaks" in it that would not be given to them (there are 6-8 weeks between the first and second years. There is a two week break between 3rd and 4th years. There are 3 months which may be used for interviews, studying for board exams, or just vacation which would also be removed). I do not know what other requirements would be different, but they would still rotate through essentially all the fields of medicine (no one can make it through literally every one of them in the current state, there are requirements set by the ACGME to be approved, and requirements differ school to school anyway. For instance- when I was there, we did 6 weeks of Psych and 2 weeks of Neuro. They've changed it around and lengthened Neuro. Psych remains the same. In other medical schools, they do as little as a few weeks of Psychiatry.). In any instance, they may reduce some of the rotation lengths to make it "fit" better, but they would still be required to meet ACGME accreditation standards and fit most of what happens in 4 years a few hours East of them into the shortened time span.

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I believe this is what the Rural Scholars program is at LSUMC. 3rd and 4th year is more focused on IM or Family Practice instead or the normal rotations. I think a scholarship covers part of the tuition as well.

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Yes, but it’s not less training. It’s just a scholarship to ensure that you go into primary care in a rural setting. It’s a good idea, but it’s not less training like you would see in NP school.

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Well that’s bullshite, you should have to build trust with society through time of proving your worth. Not by riding the coat tails of MDs.

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Absolutely. If you want to be a doctor, go to med school.

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If there is liability to be had (which the MD owns if employing an NP)

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I think that's becoming less of the case. The last few med review panels I've been on, the MDs quickly clear the supervising physician of any wrong-doing and go directly at the NP, as it should be. However, they go a little unreasonably hard at the NP.

Another case of the white man holding down the black nurses who wants to practice but without having to get a doctorate. God damn white man, can't you let a black woman nurse get that Dr pay?

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I honestly do not see the big deal about this bill.

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Have you read it?

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I think this has the opportunity to increase the opportunities for people to access quality health care quickly in the city and in rural setting.

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This bill removes physician oversight of hospital and nursing-home employed nurse practitioners. How does that increase access to care? What nursing homes and hospitals are having shortages at this present time?

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I think Drs are afraid of this bill because they would lose power over the patient but they forget to realize it isn’t just their patient and several other qualified people are working within their education and scope to better the health of the individual.

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When talking about patients hospitalized and in nursing homes, you are talking about patients who are significantly more sick than the sniffles that walk through the door. Administrators who make the hires do not have any clinical skills. They see lower costs (to them, to the customer and insurance, the costs are the same (and by some studies, more due to ordering of unnecessary testing...while not well validated, it is also the pervasive anecdotal belief at this time)), cut corners, and patients in these settings are going to suffer.

What is really sad is that there is unfortunately no way to harp on that point without a physician sounding:
1) Financially insecure
2) Overbearing
3) Intellectually insecure


Further, when it comes to the standards people are held to, mid-level providers need to be just that- mid-level. If they want to practice independently, they need to be held to the standard of independent practitioners by the LSBME or new board designed to do just that- neither of which would be provided for by this bill. Otherwise, you allow for a second-tier of care to exist, and that is what the majority, including myself, would like to prevent from happening.

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Doctor is an academic title not a job title.

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Agreed, considering you can be a DNP and have doctor in your title as a nurse.

Actually no I have not read the entire bill. Have your senator?

There is always a shortage in hospitals and nursing homes. What about the ER? How many Dr. Do you know who are at the nursing home multiple hours a day everyday ?

Advanced Practice Nurses are not just mid-level providers, you are the one saying they are. They are nurses, who went back to school for a multiple years. They are educated professionals. That can manage plenty of comorbidities and like I said, if they are stuck they ask for help. Just like anyone should. Do they have stupid ones? YES but we all know Stupid Dr too.
They will be held to the standards of the state nursing board which is hands out punishments much faster than the medical board for malpractice or negligence.

The reason NPs won’t allow themselves to fall under the medical board is because they don’t want their scope of practice dictated by the MDs. I can only imagine what NPs scope of practice would be if they fell under LSBME. That’s one of the perks of being a NP vs PA. PAs will never get any autonomy. If MDs want NPs to fall under their rules, doesn’t it seem logical that there should be a NP on the LSBME to ensure that NPs are being treated fairly? It’s a moot point. It’s never going to happen. NPs will continue to stay under the nursing board and as such will determine what their scope of practice will be.