Anonymous wrote:

Anonymous wrote:

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.

+1

The people who don't like "anyone except a full MD" seem to not realize that you can deal with a bad MD just as much as a Bad NP/BadPA/Bad whatever other medical staff.

By and large, NP/PA take more time and get to know their patients and often provide a higher level of care, freeing up time for the full MD to see the patients with more urgent cases, who need surgery, etc.

A NP/PA can do my yearly exam/gyn exam. If they see any issues, they will always get me in to see the Gyn for follow up. But there is typically no need to see a Gyn if you don't have issues. Seeing the same NP/PA each year means they get to know you, know your minor issues and can send you for more tests/refer to MD as needed.
I have never dealt with a PA/NP that isn't highly qualified. OTOH, I've dealt with a few incompetent MDs, and plenty with no bedside manner and no recollection of me from my last visit even if it was 4 weeks ago, which is almost as bad as incompetent

(new poster) No. I am a specialist MD and routinely get patients who have received poor/inappropriate care from mid levels - way more than those who have gotten poor care from MDs. In my professional discussion groups, we routinely trade horror stories about mid level overmedication, dangerous medication interactions that were overlooked, grossly inappropriate dosing, missed diagnoses that were obvious, and overall quite a lot of intervention that led to more harm than if they had done nothing at all. It's not like these things never happen with an MD, but it's orders of magnitude less frequent. The scope creep is scary to me not just as a provider, but as a patient like everyone else.

Anonymous wrote:

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

So true.....I have been seeing an PC NP for five years now.....love her. She has provided superior care to my no account, no caring, Caribbean MD PCP!

Well unless the doctor themselves is originally from the Caribbean, I wouldn't see a dr who could not attend Med school in the US personally.

Anonymous wrote:

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.

+1

The people who don't like "anyone except a full MD" seem to not realize that you can deal with a bad MD just as much as a Bad NP/BadPA/Bad whatever other medical staff.

By and large, NP/PA take more time and get to know their patients and often provide a higher level of care, freeing up time for the full MD to see the patients with more urgent cases, who need surgery, etc.

A NP/PA can do my yearly exam/gyn exam. If they see any issues, they will always get me in to see the Gyn for follow up. But there is typically no need to see a Gyn if you don't have issues. Seeing the same NP/PA each year means they get to know you, know your minor issues and can send you for more tests/refer to MD as needed.
I have never dealt with a PA/NP that isn't highly qualified. OTOH, I've dealt with a few incompetent MDs, and plenty with no bedside manner and no recollection of me from my last visit even if it was 4 weeks ago, which is almost as bad as incompetent

Anonymous wrote:

Anonymous wrote:Soon all primary care will be rendered by NP/PA...like it or not. I don't have a preference, either way. It's all about the $$

I don’t know about primary care, for me the main issue is the use of NPs in the highly specialized doctor’s offices.

This is quite common. Then when you ask the NP when did they decide to specialize in X, the response is usually "last month". An NP can just hop from specialty to specialty. Because they don't actually have to know anything.

Anonymous wrote:Soon all primary care will be rendered by NP/PA...like it or not. I don't have a preference, either way. It's all about the $$

I don’t know about primary care, for me the main issue is the use of NPs in the highly specialized doctor’s offices.

Soon all primary care will be rendered by NP/PA...like it or not. I don't have a preference, either way. It's all about the $$

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.

This is an interesting point. I just got billed at the specialist rate for seeing an NP for an HRT prescription. This is the same GYN office that billed a separate appointment at my annual for referring me for pelvic floor therapy.

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

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.

Heath are experience...doing what exactly? That is laughable. Plenty of student have zero healthcare experience before entering PA school and it is most certainly NOT a requirement in a great many programs for acceptance. While some programs may require or give preference to some experience, plenty don’t.

https://paeaonline.org/our-programs?state=°ree=&healthcare=not-required&gpa=&month=

MDVIP.... same day appointments, phone and web access to doctors when traveling, being able to text doctor and get a prescription filled while traveling, always get to see your doctor when you make an appointment. Best $1,800 you can spend a year, if having enjoyable and dependable access to health care is important.

If you love your specialist doc, but they keep pushing NPs for some of the visits, which are simply not addressing all your problems the way MD would … do you just leave that practice? Or did you ever succeed in a polite request to only see the MD?

I am in this position right now and I am concerned that MD will just ask me to go to a different practice if I am not willing to see the NP most of the time.

MD is one of the most highly regarded specialists in the field btw … otherwise I would just go and find a new doctor.

I used to see MDs at a University setting and was often seen by doctors doing their specialization under the direction of the main MD, but they always circled back to the main MD and I was perfectly ok with that.

I have a feeling that NPs don’t report on every single visit back to the main doctor to get a feedback. Am I right?

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.

That's fine for your DW but patients who want to see a cardiologist MD and make an appt to do so should be able to as well. It's not irrational to have the preference for the person with more training, sorry.

MD cardiologist - had to take premed courses, take MCAT and score above 90th percentile, medical school with multiple board exams, 3 years of internal medicine residency working over 80 hours a week. Had to at the same time publish and be top of resident class to
Match into cardiology. In addition to another board exam and also internal medicine boards.Then 3-4 years of rigorous fellowship training in cardiology with board exam at end.

NP- nursing school, then NP school (sometimes accelerated) with 500 or so clinical hours in a variety of fields. Then immediately works in cardiology.


Yes of course they are the same.

You want some wine with your cheese doc? You are the exact type of shi&head, arrogant doc that everyone hates.

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

So true.....I have been seeing an PC NP for five years now.....love her. She has provided superior care to my no account, no caring, Caribbean MD PCP!

The current system is broken. Mid level providers are supposed to be supervised by a physician and in many cases they are not. Mid level providers are attractive to medical practices and hospitals because of the lower salary requirements. But the salaries are lower because the training and scope are way below that of a physician.
NPs and PAs can switch specialties like t shirts. Doctors aren't allowed to do that! Because they simply wouldn't be able to master the specialty. We are headed to cliff and the bus is being driven by insurance companies.

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.

You don't give up your rights when you walk through the doors of a medical practice. I remember calling a few years ago and asking which doctors were board certified. The receptionist had no idea what that was and said it didn't matter. I told her to put me on hold and the next doctor walking by to ask that doctor if they thought it mattered if they were board certified. Luckily, the doctor walking by was and so I got in to see that doctor. When I spoke to the doctor at then end of the appointment, the doctor was appalled. She was proud she was board certified.
Now you have to beg just to see a doctor. And you have no idea if the NP would have been able to coordinate care. You then go on to say, "patients have agency", which makes no sense in this practice because they do NOT. According to you patients have no right to see a medical doctor, yet they will get charged the same amount if they see a NP who doesn't have nearly the same amount of training. And to add to the insult, patients aren't even informed upfront on who is going to treat them. As the other person posted, you are an awful human being for calling the deceased patient an idiot. Mortuis nihil nisi bonum.

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.

This is what infuriates me! If I see a NP it shouldn't cost as much. Just like how I am charged more for seeing a specialist instead of a GP. I really don't understand how this is allowed.

NP are great for easy to diagnosis issues. If I have something like strep throat and need antibiotics, then it's great to see a NP. But if I am going to get charged the same whether I see a Ob/gyn doctor or NP for an annual exam, I am going to go with the Ob/gyn.. Last time I saw the Ob/gyn I had an issue that needed surgery. If I had gone to the NP, I would have had to make another appointment with the Ob/gyn doctor to discuss the issue and get approval for surgery. My son saw an allergist and had a major reaction during a procedure. The doctor was able to think so quickly on her feet that I couldn't be convinced a NP would have figured out what was going on and reacted so decisively and quickly.