I do not want to see an NP!

[Anonymous]

Anonymous wrote:

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?

Yes they do- for example, when I rotated in surgery as a med student one of the private practice plastic surgeons worked 1:1 with a PA and trained her to do things like breast reconstruction. She probably made at least 250k.

[Anonymous]

Anonymous wrote:I find that the NP’s and the PA’s in the practice I go to are excellent. They seem to be much more thorough and take more time with the patients than the Md’s. If there is something drastically wrong they consult immediately with the MD’s.

This. At the practice I initially went to in the city I preferred to see the PA. Much more thorough and also better bedside manner. MD was short, dismissive, and really didn't take the time to find out what was wrong with me when I was sick.

[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.

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.

yeah, no. that's not how it works. when you are a patient of the practice you are a patient of the practice, and you need to agree to how they manage cases. if you don't like it you should find another practice. But it's simply not a thing to insist on "I want to see the doctor and nothing else is acceptable." The practice decides how to triage cases. If this guy had come to his scheduled appt the NP would certainly have been able to coordinate his care and get him what he needed, but the patient refused. Patients have agency in their care. This was an unfortunate outcome but hardly the fault of the practice.

[Anonymous]

Anonymous wrote:

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.

Because insurance companies run the show! People have no idea how screwed up healthcare is. Rather than fix the problem which is the high cost of training. Insurance companies try to sell people on the idea that most people "don't need a doctor". This dangerous idea is going to get people killed.

[Anonymous]

Anonymous wrote:

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.

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.

yeah, no. that's not how it works. when you are a patient of the practice you are a patient of the practice, and you need to agree to how they manage cases. if you don't like it you should find another practice. But it's simply not a thing to insist on "I want to see the doctor and nothing else is acceptable." The practice decides how to triage cases. If this guy had come to his scheduled appt the NP would certainly have been able to coordinate his care and get him what he needed, but the patient refused. Patients have agency in their care. This was an unfortunate outcome but hardly the fault of the practice.

This is incorrect. “The practice” does not set the standard of care.

[Anonymous]

Anonymous wrote:The devolution of the US medical system to increasingly poor quality levels is the fruit of corporatization, abetted by the appalling power insurance companies have been permitted to amass over what constitutes “appropriate” care. Corporate-owned practices (which increasingly are the only thing you can find if you want to use your preposterously overpriced insurance) hire non-physicians to do what properly is physician’s work because the non-physicians are more readily available, are significantly cheaper and allow vastly increased financial leverage and a concomitant increase in profit. People say that their non-physician “provider” is great and will refer them if anything is “serious.” The problem is that few patients have even the slightest ability to determine how “serious” their condition is; regardless of their misplaced self confidence, non-physicians lack the training to avoid mistakes that a physician would catch. Given the rate of physician error, it is terrifying to think how much non-physicians may be missing. I am alive today because a physician noticed a deadly skin cancer when I was in for something else entirely. I have very little confidence that a non-physician would have caught that.

I caught my husband’s melanoma, so pretty sure an NP could as well.

[Anonymous]

An NP told me that my skin cancer was just me, doing some skin picking. By the time I got to see a doctor, who referred me to a dermatologist, my whole face had to get sliced and diced. All the NP had to do was to give me a referral and she didn't do it.

Only a sample of one, but it infuriated me and I won't go back.

Soon after my surgery, I saw her in the grocery store and she literally gasped and ran away.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

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.

yeah, no. that's not how it works. when you are a patient of the practice you are a patient of the practice, and you need to agree to how they manage cases. if you don't like it you should find another practice. But it's simply not a thing to insist on "I want to see the doctor and nothing else is acceptable." The practice decides how to triage cases. If this guy had come to his scheduled appt the NP would certainly have been able to coordinate his care and get him what he needed, but the patient refused. Patients have agency in their care. This was an unfortunate outcome but hardly the fault of the practice.

This is incorrect. “The practice” does not set the standard of care.

Not sure what you think “ standard of care” means. Patient refused appointment. Had a deadly outcome. The practice had no obligation to let him pick his provider, they gave him an inroad to care and he declined. As unfortunate as this situation is, nobody who knows the first thing about healthcare would call this “malpractice.”

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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?

Yes they do- for example, when I rotated in surgery as a med student one of the private practice plastic surgeons worked 1:1 with a PA and trained her to do things like breast reconstruction. She probably made at least 250k.

Total BS

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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?

Yes they do- for example, when I rotated in surgery as a med student one of the private practice plastic surgeons worked 1:1 with a PA and trained her to do things like breast reconstruction. She probably made at least 250k.

Total BS

Seems far fetched that a PA is making that much

[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

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.

You are talking about two separate things. Nursing students getting their RN or BSN is entirely different than the schooling for when that nurse moves on to become a NP. They absolutely “see patients” in their NP clinical rotations. NPs have way way more clinical experience and hands on patient experience- which is really important. A lot of what these mid level practitioners are doing are recognizing what is not normal and then getting help. They aren’t Dr House

[Anonymous]

Why don’t you pay extra for concierge practice if you feel so strongly about it?

[Anonymous]

Anonymous wrote: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.

This! it's all well and good to love your primary NP at the ambulatory setting because she really listens to you about your UTI symptoms and remembers to order a culture (not just a UA) and is conscientious about calling you with the results and switching your empirical antibiotic (Macrobid!) to a better one that's sensitive to the pathogen that grew on the culture. That's great, and I do it myself as a veteran RN.

But damn. You guys had better hope you don't develop something like a small bowel obstruction, a perf, and resulting sepsis. Because you're going to be treated by allllllll the midlevels during that frantic process while the attending rolls in at the last second to distractedly review the NP's notes and the PA's procedure and closure. Even at Georgetown or Hopkins. Ask me how I know.

It's the inpatient stealth situation that you guys seem not to know about. And it's just wrong, but a fact of life in post-pandemic 2023.

[Anonymous]

Anonymous wrote:I find that the NP’s and the PA’s in the practice I go to are excellent. They seem to be much more thorough and take more time with the patients than the Md’s. If there is something drastically wrong they consult immediately with the MD’s.

this x100

[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

Such BS. Please do some research before you spout untruths.
PAs are required to have over 1K HOURS of clinical experience before they can even apply to PA school.