I do not want to see an NP!

[Anonymous]

Anonymous wrote:

Anonymous wrote:It is horrifying to me how many people are unaware of how poorly trained the far majority of NP's are. They can get their degrees from 100% online programs (AKA degree mills). They may be absolutely lovely in person, but the bottom line is that they don't know what they don't know. It is an absolute travesty what they have done to the field of medicine. Primary care is one of the most difficult things because 99% of the time, everything is fine. But you need to see thousands of cases of normal in order to detect the abnormal.

At least an NP sees actually patients all throughout 4 yrs of nursing school and even if getting NP online, is likely working as a nurse seeing patients concurrently.

PAs see zero patients during all of undergrad while they major in biology or whatever science (or sometimes not even science) they pick as their major. During their 2 yrs of PA school, they have a couple clinal rotations for a portion of that time. If anyone is vastly undertrained, it is PAs

You can't get an NP without a lot of clinical hours. It's not just "likely" that they are seeing patients, it's required.
https://www.vhwda.org/healthcare-careers/nursing/nurse-practitioner/#:~:text=To%20become%20a%20nurse%20practitioner,experience%2C%20and%20pass%20certification%20examinations.

[Anonymous]

I don't want to see DO, either.

[Anonymous]

Anonymous wrote:The best nurses become NPs and PAs. The worst doctors become PCPs. I’m fine with NPs.

oh boy. Ok so I am a nurse. I think this used to be the case. However, more and more nurses are going into NP school without much, if any nursing experience. There are too many online BS NP schools. Not all NP programs are created equal. Some are hard core. And some will take nurses who are dumber than a bag of rocks. And PAs rarely have a nursing background. It's a totally different discipline. Also PCPs and hospitalists have their work cut out for them. Patients are getting older and sicker. BTW-NPs and PAs can be great resources in outpatient and inpatient settings when used appropriately.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It is horrifying to me how many people are unaware of how poorly trained the far majority of NP's are. They can get their degrees from 100% online programs (AKA degree mills). They may be absolutely lovely in person, but the bottom line is that they don't know what they don't know. It is an absolute travesty what they have done to the field of medicine. Primary care is one of the most difficult things because 99% of the time, everything is fine. But you need to see thousands of cases of normal in order to detect the abnormal.

At least an NP sees actually patients all throughout 4 yrs of nursing school and even if getting NP online, is likely working as a nurse seeing patients concurrently.

PAs see zero patients during all of undergrad while they major in biology or whatever science (or sometimes not even science) they pick as their major. During their 2 yrs of PA school, they have a couple clinal rotations for a portion of that time. If anyone is vastly undertrained, it is PAs

It is common consensus that PAs have better, slightly longer, and more rigorous training than NPs overall, mainly due to tighter regulations and their clinical rotations being actual rotations for their role, in mandated settings. Nursing students are not "seeing patients" when they are on the floor during their training to become a nurse. They shadow and help the nurses, none of this prepares them for diagnosing and differentiating diseases - it is different. Also, completely online nursing programs are increasingly popular. LPN to RN in 16 months online is also an option. Things are not how they used to be anymore.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The best nurses become NPs and PAs. The worst doctors become PCPs. I’m fine with NPs.

oh boy. Ok so I am a nurse. I think this used to be the case. However, more and more nurses are going into NP school without much, if any nursing experience. There are too many online BS NP schools. Not all NP programs are created equal. Some are hard core. And some will take nurses who are dumber than a bag of rocks. And PAs rarely have a nursing background. It's a totally different discipline. Also PCPs and hospitalists have their work cut out for them. Patients are getting older and sicker. BTW-NPs and PAs can be great resources in outpatient and inpatient settings when used appropriately.

+1

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This entire thread is so stupid. And OP, you are one dumba$$. If you want to see a doc, make sure your appt is with a doc. If you are happy with NP, then see NP. WTF are you folks arguing about?

Agree - all this tit for tat. We could spend months with example after example of where the NP/PA/MD did one wrong. This is where you get to be a consumer - you don't like it, move on.

I agree that it does no good in this forum to go after who got what wrong one time, although they're all valid personal experiences.

This is more about the fundamental lack of knowledge and understanding of the separate pathways and training of those who are seeing you and me as a patient. And it is about the lack of understanding that even though everyone gets something wrong; these different professions are held to VASTLY different standards, in every aspect of training and care, starting from different bachelor classes of the same topic, to rules/regulations, exams, licensing, ethics, all the way to the court system.

OP here. This is the problem I made an appointment to see a doctor. I was very clear about not wanting to see a mid level provider. The appointment was switched to an NP 24hrs before.
An NP is not the same as an MD. They have vastly different levels of training. An NP is fine for follow-up for some things.
If people want/prefer NPs that's fine. But that's not what I wanted or requested.

I'm have an NP for my PCP and I adore her and trust her.
But I would absolutely be pissed off if I were you. I've had that happen at my kids' dentist between two providers at their office and it always annoys me, even with the same technical degrees.
What did the office say when you protested? Can they get you in with the MD later this week?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It is horrifying to me how many people are unaware of how poorly trained the far majority of NP's are. They can get their degrees from 100% online programs (AKA degree mills). They may be absolutely lovely in person, but the bottom line is that they don't know what they don't know. It is an absolute travesty what they have done to the field of medicine. Primary care is one of the most difficult things because 99% of the time, everything is fine. But you need to see thousands of cases of normal in order to detect the abnormal.

At least an NP sees actually patients all throughout 4 yrs of nursing school and even if getting NP online, is likely working as a nurse seeing patients concurrently.

PAs see zero patients during all of undergrad while they major in biology or whatever science (or sometimes not even science) they pick as their major. During their 2 yrs of PA school, they have a couple clinal rotations for a portion of that time. If anyone is vastly undertrained, it is PAs

You can't get an NP without a lot of clinical hours. It's not just "likely" that they are seeing patients, it's required.
https://www.vhwda.org/healthcare-careers/nursing/nurse-practitioner/#:~:text=To%20become%20a%20nurse%20practitioner,experience%2C%20and%20pass%20certification%20examinations.

These "clinical hours" are often and increasingly a complete sham, in the sense that those for profit schools "beg" any private doc to take on a "shadower" for a few weeks and that's it. That's truly it. There is no way to know, unless you dig deep into the nurse practitioners schools which have sprouted up like mushrooms, and don't have to conform to any national standards. This is not a one-case-only situation - it's increasingly becoming the norm.

[Anonymous]

It’s funny that everyone is talking about PA/NP in primary care when for the most part most of PA/NP don’t want to be in primary care either! Primary care is awful for all parties involved. The midlevel take over is happening across the board - in specialists and surgery. When I consult a speciality in the hospital I’m often talking to a midlevel. This will absolutely erode the quality of our health care- shouldn’t we want the best and most well trained? Midlevels don’t even exist in a lot of countries. Capitalism will ruin health care and we all deserve it for playing along.

[Anonymous]

^ also in case you all are wondering- yes Midlevels perform surgery now. It’s not uncommon for a surgeon to train their PA in a procedure and leave them to do it while they go do another procedure at the same time for money. Easy way to make money off the backs of a PA who costs half as much to hire than a junior surgeon. I guess we are all okay with this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:That's your right OP. If that's what you want and willing to wait, insist on it. DW is a cardiology NP and had a patient like you. Rather than seeing DW, wanted to wait 6 weeks for a doctor. The idiot died of heart attack while waiting. DW could've saved his life by catching his problems but what can you do.

Well, I guess to counter this anecdote a NP missed my mom's skin cancer -- twice. I insisted she go to an dermatologist and OBGYN and both caught it.

Numerous studies have found that dermatologists are better at diagnosing skin cancer than other types of doctors, which one would expect.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It is horrifying to me how many people are unaware of how poorly trained the far majority of NP's are. They can get their degrees from 100% online programs (AKA degree mills). They may be absolutely lovely in person, but the bottom line is that they don't know what they don't know. It is an absolute travesty what they have done to the field of medicine. Primary care is one of the most difficult things because 99% of the time, everything is fine. But you need to see thousands of cases of normal in order to detect the abnormal.

Exactly, I work in medicine. NPs are poorly trained and are not cost effective. The patient is billed at the same rate as an MD but the reimbursement to the provider is lower. So the only person that wins is the insurance company. NPs order more tests and do a lot of unnecessary things because they do not know what they're doing.
I don't want to see an NP because I'm alarmed at the pace at which their scope of practice is increasing. Insurance groups are pushing the NP model because its a huge profit margin for them, but telling people that an NP is the equivalent of seeing an MD/DO trained in family medicine is disingenuous.
NPs misdiagnose all the damn time simply because they do not have the breadth of knowledge to know when something isn't right. I rarely go to the doctor but when I do I want to be seen by a physician.

Why are they billed at the same rate?

Why is that not fraud?

[Anonymous]

Anonymous wrote:^ also in case you all are wondering- yes Midlevels perform surgery now. It’s not uncommon for a surgeon to train their PA in a procedure and leave them to do it while they go do another procedure at the same time for money. Easy way to make money off the backs of a PA who costs half as much to hire than a junior surgeon. I guess we are all okay with this.

Wait, what???
I mean I have had the dermatology PA remove moles, but do PA's do more advanced surgeries?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It is horrifying to me how many people are unaware of how poorly trained the far majority of NP's are. They can get their degrees from 100% online programs (AKA degree mills). They may be absolutely lovely in person, but the bottom line is that they don't know what they don't know. It is an absolute travesty what they have done to the field of medicine. Primary care is one of the most difficult things because 99% of the time, everything is fine. But you need to see thousands of cases of normal in order to detect the abnormal.

Exactly, I work in medicine. NPs are poorly trained and are not cost effective. The patient is billed at the same rate as an MD but the reimbursement to the provider is lower. So the only person that wins is the insurance company. NPs order more tests and do a lot of unnecessary things because they do not know what they're doing.
I don't want to see an NP because I'm alarmed at the pace at which their scope of practice is increasing. Insurance groups are pushing the NP model because its a huge profit margin for them, but telling people that an NP is the equivalent of seeing an MD/DO trained in family medicine is disingenuous.
NPs misdiagnose all the damn time simply because they do not have the breadth of knowledge to know when something isn't right. I rarely go to the doctor but when I do I want to be seen by a physician.

Why are they billed at the same rate?

Why is that not fraud?

Because the public is not outraged by this. Everyone loves their NPs so I guess to them it’s worth the same amount of money? Since everyone is fine with this new reality, why wouldn’t you charge insurance the same and pay someone half as much and pocket the rest? This is essentially the model of private equity and their take over of EM.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My DS and DIL are physicians. Their time spend in school, residency and board testing cannot be compared to a NP or PA.

Please tell me they went into primary care. No? Ah, that is why you are seeing more NPs and PAs.

One is an internal medicine hospitalist and the other is family medicine.

[Anonymous]

Anonymous wrote:That's your right OP. If that's what you want and willing to wait, insist on it. DW is a cardiology NP and had a patient like you. Rather than seeing DW, wanted to wait 6 weeks for a doctor. The idiot died of heart attack while waiting. DW could've saved his life by catching his problems but what can you do.

Pretty shocking that you refer to your wife’s deceased patient as, “an idiot.” Such compassion.

Since I assume you heard the tale from her, that is even more appalling.

Another take on this might be that it was highly irresponsible (malpractice?) for the office to put off a patient with a life-threatening condition for six weeks, when all he wanted was to see his doctor. But still they found no way to move up his appointment.

Some practices might have felt awful about this turn of events. The incident might have caused them to investigate how the case was handled…but your wife and her colleagues just wrote this poor caller off as “an idiot. “

Please do share the name of the practice , if you think they operate to such a high standard.