NYT: Nurses aren't doctors

[CableandThanos]

There are a few things happening right now that need to be addressed. There's a shortage of doctors, there's an increase in ER visits, and there's affordability issues in regards to access to medical care. An expanded scope of practice for NP's addresses these issues, and it's fact that a significant portion of a PCP's workload can be handled by an NP.

I don't have any figures to support a total US decline but I know in Memphis, So far this year our patient number visits have been drastically down from years past.

One of the hospitals I work at already sent out an email talking about how they are 14 million behind in expected patient/insurance payments. This was in just the first 3 months of this year. The CEO said it was because a lot of people have lost their insurance or are being dropped into a high deductible plan (I was dropped from really good but expensive insurance into a hi ded plan, GOD IT SUCKS). Since with a high deductible plan you have to basically pay a ton of money out of pocket that people are waiting longer to go to the hospital, trying to see if they can just get over whatever they have. The email also said that hospitals/insurance companies/doctors and all other medical staff needs to get use to the idea of making less money. It was a slick way of basically saying, you guys aren't getting raises any time soon.

My insurance was great, I didn't have a deductible, I only had small co-pays. Now I have to pay the first $1600 out of pocket for each person in my family (4 total), before insurance even kicks in. I went from basically no payments (small co-pay) to having to pay for every single thing in the world.

At my main Hospital we are already slow as hell (there is a normal slow down during the summer months, But it has started 3 months early. They are already talking about watching people hours and maybe cutting them.

Again this was an issue that people brought up with the ACA, when you shove people into high ded plans, not everyone has a bunch of money laying around to pay out of pocket, especially if you have more than one person in your family that is sick.

 

[Long Dark Blues]

A physician writes an article to protect his field and money scheme? No kidding. FYI, the article is complete garbage asserting causative relationships to correlational information. Not to mention he completely negates to mention the training NPs go through, including a three year "residency" under supervision of an MD including 1,000 clinical hours doing nurse practitioner school. That's in addition to the hours they spend in their primary employment as an RN, and in addition to the 900+ clinical hours they spend in their initial RN training programs.

That IOM report that the article cited (which I've read exhaustively, unfortunately for me), also cited that 55% of cases handled by physicians in the community are low-complexity. PA's and NP's were 56% and 57%, IIRC. In other words, there are 55% of cases that physicians handle that a PA/NP could also do, but the problem is then a physician wouldn't be able to gouge your insurance company for his over-priced time.

FYI, a nurse practitioner is not just a nurse. A nurse could be someone who has a 1 year junior college education (LVN/LPN), a 2 year associate program (ADN-RN), a four year program (BSN-RN), a four year program with an additional two years of education (MSN-RN) and also doctorate programs to go along with the additional training it takes to become a nurse practitioner.

So a nurse practitioner is someone with at least 6 years of education in addition to their years of experience in the acute care setting. This half-wit ass clown is trying to write that only people with an M.D. can do what a primary care physician in an office does. What a load of horse shit.

This attitude is all rooted in MD's shitting themselves because their cash cow (the ACA guaranteeing insured patients) slice of the pie getting smaller. They won't be able to bill your Blue Cross $750 for looking in your ear and giving you a refill on your life-long monthly prescriptions.

I'm off my soap box.

(Guess what I do for a living, by the way?)

+1

This.

applause.gif

 

[pine snake]

Funny thing is when you look at the distribution of NPs, they aren't going to fill mainly the rural primary care positions, even though that's what they lobby themselves as. They are going after the specialty care. Wonder why?

a blizzard of bills

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

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[dza76wutang]

I currently work in Health Insurance and Veggie is right on.

if, as a country, we want doctors to be the best and brightest then we need to reserve them for cases and situations that require the best and brightest.

I do not need a leading orthopedic surgeon to give me an air cast because I sprained my ankle.

I think it is great we have world class facilties and practitioners in the USA but we are foolish to use either for non-world class situations.

I think the rise of nursing is an excellent way to increase provider capacity without diluting the quality of doctors.

 

[Bagatur]

I know quite a few nurses, and none of them ever aspired to me an MD.

"sure, they just wanted to keep their options open" Gaylord Focker

 

[Seriously-Dead]

You're right. You don't necessarily need a doctor for simple conditions. A nurse practitioner can diagnose an ear infection. But you should see a doctor because he has the education to catch the bad stuff that you really worry about. NPs just don't have the training to catch the rare/complex things. And a lot of times they are not going to refer out because they don't know what they don't know. That's why they need supervision.

Just no. Most PCPs are so busy that they don't look at anything other than what the patient is primarily complaining about. They don't catch the rare/complex things until it is painfully obvious.

Just look at it in terms of training even. [Going by the Canadian model that I know] PCPs have two years of med school training, two years of school/internship (where you a really more of just a passive observer), and two years of residency (one of which is essentially reliving the rotations they did in internship). That's six years total in training. NPs go through at least this amount, and usually have at least a few years of actual work experience on top of it all.

My girlfriend is a doctor, guess who she goes to see when she needs her prescription refilled or has a minor problem?

 

[panamaican]

Have to agree with Veggie.

The article is written by a doctor to protect the way of life he is most familiar with. My dad's an MD, a specialist in 2 fields and my mom's a nurse. OVer the years that they ran a practice together, a significant amount of the patients they saw needed basic care. Something most nurse practitioners can provide.

Also...why is the author citing to a 1999 study on nurse practitioners when there are much more recent studies to look at? Like this one from 2010.

http://www.ncbi.nlm.nih.gov/pubmed/20409261

 

[Uchi Mata]

Lots of butt hurt nurses ITT.

Lots of butt hurt doctors who quiver at the idea that for many common problems a NP could do as good of a job as they could. That would seriously cut into their bottom line, which I would think you would be in favor of as it's essentially a market solution to a portion of the high health care cost problem.

 

[Seriously-Dead]

The very limited evidence we do have is that when you attempt to hold nurses to the same standard, they fail horribly (e.g. 50% of DNPs failed a very watered down version of the USMLE 3, an exam that 97% of MDs pass without even needing to study).

I can't speak for the USMLE, but the LMCC [Canadian version] deals with mostly complex cases - of course NPs would fail it, are they really expected to pass the sections of OBGYN, legaity and CH&E, internal medicine, etc? Hell no, that's not what their job is. Most question on the LMCC are not "a patient walks into your office complaining of ear pain and has no other symptoms", "a patient complains of minor cough and congestion with no other symptoms", "a patient seeks a method for quitting smoking", etc.

Seriously, if we are going to handle the oncoming onslaught of sick and dying baby-boomers we need to broaden the base of professionals that can treat those of us with minor problems, and free up time for the load of complex problems these boomers are going to be coming in with.

 

[JohnnySagebrush]

Here we have PAs, not NPs. I had a poor experience with a PA. Had a dog bite to the nose. I asked for stitches. The PA glued the wound-well, one of the few contraindications for use of derma-glues is animal bite. My wound opened up and I got an infection. Thanks a lot. NPs and PAs are fine for treating "minor issues" until they misdiagnosis your meningitis as a cold and send you home.

 

[jackietreehorn8]

A physician writes an article to protect his field and money scheme? No kidding.

This was pretty much my only reaction to the article.

I'm open-minded on this one. Seems like NP's can cover a lot of territory that doctors currently do. I also believe doctors are on a different level than NP's (generally speaking) so I always appreciate the chance to see one and get evaluated and pick his brain over some issue I'm having.

But this NYT op-ed... Guy could not be more biased or transparent with his argument, he doesn't have any sort of greater interest in mind when he writes that opinion, it's pure shilling for his profession.

 

[Cherdawg]

Wow, ignorant thread. Good work dousing the propaganda with facts Veggie.

Lol how did i know you would be all over this.

 

[AznTrojan]

i hand off a lot of my basic neurology and ICU cases to my APCs (advanced practice clinicians) also known as physician assistants and nurse practioners.. they do however order a shit ton more tests than i do which costs a lot of money so it's probably not in the hospital's bottom line.. in the end.. they make my life a lot easier so i don't have to deal with as much paper work or work as hard..

 

[James Keith]

In other news, lawyers think you should always hire a lawyer when making decisions and accountants advise against doing your taxes on your own.

 

[LucasWithLidOff]

Lots of butt hurt doctors who quiver at the idea that for many common problems a NP could do as good of a job as they could. That would seriously cut into their bottom line, which I would think you would be in favor of as it's essentially a market solution to a portion of the high health care cost problem.

If you want to risk using an NP as your primary healthcare provider, more power to you, but I certainly wouldn't. I don't know a single one subscribes to any scientific journals, let alone keeps up with the primary literature. The majority of what a primary caregiver does is prevent issues and catch them early, not deal with minor issues even though that is part of it. You get what you pay for and it is better than nothing. Whether or not it will cut costs in the long run, we will see.

Oh yeah and.... Lots of butt hurt nurses ITT.

 

[DoomAndDarkness**]

Doctor is just appealing to his own authority because he's threatened by the nurses. No different from a chef talking down to a cook. One has the title, the other has the actual skills.

 

[LucasWithLidOff]

Doctor is just appealing to his own authority because he's threatened by the nurses. No different from a chef talking down to a cook. One has the title, the other has the actual skills.

Shitty analogy.

 

[Flippant]

A physician writes an article to protect his field and money scheme? No kidding. FYI, the article is complete garbage asserting causative relationships to correlational information. Not to mention he completely negates to mention the training NPs go through, including a three year "residency" under supervision of an MD including 1,000 clinical hours doing nurse practitioner school. That's in addition to the hours they spend in their primary employment as an RN, and in addition to the 900+ clinical hours they spend in their initial RN training programs.

That IOM report that the article cited (which I've read exhaustively, unfortunately for me), also cited that 55% of cases handled by physicians in the community are low-complexity. PA's and NP's were 56% and 57%, IIRC. In other words, there are 55% of cases that physicians handle that a PA/NP could also do, but the problem is then a physician wouldn't be able to gouge your insurance company for his over-priced time.

FYI, a nurse practitioner is not just a nurse. A nurse could be someone who has a 1 year junior college education (LVN/LPN), a 2 year associate program (ADN-RN), a four year program (BSN-RN), a four year program with an additional two years of education (MSN-RN) and also doctorate programs to go along with the additional training it takes to become a nurse practitioner.

So a nurse practitioner is someone with at least 6 years of education in addition to their years of experience in the acute care setting. This half-wit ass clown is trying to write that only people with an M.D. can do what a primary care physician in an office does. What a load of horse shit.

This attitude is all rooted in MD's shitting themselves because their cash cow (the ACA guaranteeing insured patients) slice of the pie getting smaller. They won't be able to bill your Blue Cross $750 for looking in your ear and giving you a refill on your life-long monthly prescriptions.

I'm off my soap box.

(Guess what I do for a living, by the way?)

Great post. I'm taking a break from emptying Foleys ATM.

 

[tkotom]

God, no. But a friend of mine is a qualified MD. Frankly, even if I had the ability and drive to become a Doctor, which I certainly do not, the stories she's told me would put me right off. The training is exceptionally long and hard, the burn out rate is brutal, and while you get a certain amount of status and a good wage, you're not going to be a millionaire any time soon.

If you screw up someone will die and, on top of the emotional toll that takes from you, you could lose your license. Of course, you can do everything right and the patient will still die. It takes a considerable amount of mental toughness to be a successful Doctor.

Becoming a Doctor is a bit like joining Special Forces units like the Seals, Delta or the SAS; many people are attracted by the glamour and status, but very few have the ability to become part of the elite.

A great take on it.

It truly does sound like something for which you need a passion.

 

[AgentOrange24]

NP's are fine for 75% of whatever medical problems you'll encounter in your life.