Anonymous wrote:Ok op then don’t expect free or cheap healthcare. Go to a concierge practice then you can see your doctor. If you are using insurance that will pay $60 for your visit, don’t expect a real doctor.

That's exactly what insurance companies want. Mid level provider creep is a real thing.
Based on the responses to this thread its very clear that most people are woefully uninformed about how healthcare works.
Having a bunch of undertrained APPs is bad for everyone!

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.

+1 - I’ve had great care from both NPs and PAs as well. I’d rather be seen more quickly by a competent provider than wait for a specific title.

Ok op then don’t expect free or cheap healthcare. Go to a concierge practice then you can see your doctor. If you are using insurance that will pay $60 for your visit, don’t expect a real doctor.

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.

Looks like the AMA spokesperson showed up.

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.

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.

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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.

I much prefer NPs for my annual GYN exam. If it's a serious illness or condition, sure, I'd like a doctor, but for routine stuff I find that they are willing to take more time and ask more questions. And if something is wrong, they consult the doctor.

+100

I like NPs I feel like they're more down to earth, easily approachable, and more relatable.. Doctors have the textbook knowledge, but the nurses have the clinical skills bc it's so routine for them.

NPs and PAs are middle class providers for middle class people.

Doctors are upper class providers for upper class people.

Um, no. What a strange take.

Well we do know that the uber wealthy have their own personal doctors and probably would consider themselves above an NP. So if she considers "upper class" only the .001%, then she's right. However, those who have their own doctors and consider those doctors to be the medical equivalent of a server in a restaurant often have worth health outcomes because they demand unnecessary interventions.

No, what several of us are saying on here is that we are not "UMC" and yet somehow have direct access and personal relationships with actual MDs. My PCP, GYN, allergist, gastroenterologist, and ophthalmologist are all MDs. And yet somehow I am not Shiv Roy.

Oh I know, I think it was a pretty absurd comment too (hopefully a troll). I just wanted to share that anecdote because I think it's interesting that there are occasions when having access to doctors exclusively (as opposed to having to see an NP on occasion) is related to wealth and it so happens that it's not better.

I've have some pretty major medical issues for about 16 years and I can't think of one time that a doctor was definitely preferable to an NP or a PA. I've had a lot of great doctors but also a lot of great PAs, NPs, and RNs. My only issue with any of them as a rule is that RNs tend to be a lot worse at pain management.

Anonymous wrote:

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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.

I much prefer NPs for my annual GYN exam. If it's a serious illness or condition, sure, I'd like a doctor, but for routine stuff I find that they are willing to take more time and ask more questions. And if something is wrong, they consult the doctor.

+100

I like NPs I feel like they're more down to earth, easily approachable, and more relatable.. Doctors have the textbook knowledge, but the nurses have the clinical skills bc it's so routine for them.

NPs and PAs are middle class providers for middle class people.

Doctors are upper class providers for upper class people.

Um, no. What a strange take.

Well we do know that the uber wealthy have their own personal doctors and probably would consider themselves above an NP. So if she considers "upper class" only the .001%, then she's right. However, those who have their own doctors and consider those doctors to be the medical equivalent of a server in a restaurant often have worth health outcomes because they demand unnecessary interventions.

No, what several of us are saying on here is that we are not "UMC" and yet somehow have direct access and personal relationships with actual MDs. My PCP, GYN, allergist, gastroenterologist, and ophthalmologist are all MDs. And yet somehow I am not Shiv Roy.

In my experience, NPs and PAs are much better to handle routine procedures and exam that require hands on work for routine procedures. For example, when you need to get basic things like bloodwork, EKG, and checkups. or if you have common urgent care type work. NPs and PAs often get handed many of the routine procedures, so they are more experienced with them and usually handle both the equipment and the procedure better.

If you want something that requires a little bit more research or something unusual or something that is not routine, then I would want an MD. In those cases, the MD often has broader knowledge and possibly experience that would help make them more knowledgeable in addressing and/or treating the situation.

Anonymous wrote:It used to be that you needed experience to be an NP. Now you don't , there are way too many novices walking around thinking they know more than they do.

This is also the case with doctors. Yes, I would take a novice doctor over an NP with zero experience, but even then there's no guarantee the doctor will be better with your particular ailment.

My mother, who lives in a rural area, has no option to see anyone but a rotating series of NP's.

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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.

It's like you have a honda civic vs ferrari f40. most of the time, either is fine. if you are driving the autobahns in germany, yes, def you want a f40. how often do you drive the autobahns?

OMG I love this analogy. Maybe we can squeeze in a situation where a Honda Civic is preferable? Once I was getting treatment for a major medical issue that I almost died from and while the emergency really did require a doctor's care, the doctor neglected to tell me some very important information about how to manage the recovery. If my nurse practitioner hadn't told me it would be been a really, really rocky road.

Anonymous wrote:It used to be that you needed experience to be an NP. Now you don't , there are way too many novices walking around thinking they know more than they do.

This is true! Our pediatrician has a very experienced NP who is amazing. However, now you can become a NP straight from school without any on-the-job experience (except the clinical training in school). My family member did that and went to her very first job where she was the only provider on site.