Anonymous wrote:

Anonymous wrote:Why? Not enough doctors, too much demand, a lot of recently trained NPs, and cheaper cost to hire the NPs that you can find instead of the doctors with higher salaries and whom you can't find anyway.

There were a lot of physician deaths during COVID, and there were even more people who tried earlier, c switched to nonclinical work, or just left the profession.

That's simply not true. All told, 4,511 physicians died during this early phase of COVID-19—622 more deaths than would have occurred had the pandemic not happened. Excess physician deaths peaked at 70 in December 2020 among all active physicians, followed by a rapid drop in 2021 when safe and effective vaccines became available.

Active physicians had lower excess death rates than nonactive doctors and the general population despite having higher risk for contracting SARS-CoV-2 infection throughout the pandemic.

https://www.ama-assn.org/practice-management/physician-health/new-study-tallies-excess-physician-deaths-during-early#:~:text=All%20told%2C%204%2C511%20physicians%20died,and%20effective%20vaccines%20became%20available.

That is still a lot of physician deaths, and it lowers the pool of people who are seeing patients, because there are both patient-heavy practicing physicians and those who don't dee patients at all. And your numbers cover mortality, not morbidity.

I saw patients in the COVID ward despite my cardiac history. I'm now on multiple medications for cardiac arrythmias after catching COVID in the first wave. I can see how much you matter my life, though.

Thanks for making it clear. I appreciate the lack of a filter -- it allows for others to judge you as you are.

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.

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.

That's why I go to a dermatologist every year for a skin check. So that the specialist MD can look at my skin. That has nothing to do with the fact that I have an NP as a PCP.

My mom specifically made two appointments with her for the open sore. So what you say has ZERO bearing on it.

Anonymous wrote:

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.

My PA diagnosed me with something my PCP never did. If you go to a top Dr which I do, their PA or NP is usually just as good.

If they have been "together" for 20-40 years this can be true. They take more time because they are allowed to, physicians would like to take more time with their patients, too. They will not know there that there is something drastically wrong if the presentation is subtle. So if you are seen/examined by both, it's ok, but in many places that's not the case anymore.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op made an appointment with a doctor, months in advance, and then the office switched it to an NP a few days in advanced. That’s not cool and I can understand why she is upset.

Sometimes I prefer NPs - I find they have better personalities and are less arrogant a lot of times.

It's infuriating. I've had the exact same thing happen several times with a gastroenterologist in Arlington, even though I specifically state I do not want to see his NP. They agree, make the appointment with the doc (supposedly) and then when I show up I'm stuck with the NP.

With specialists, it’s a different story. That does seem unethical and infuriating. NPs can be great in general practice, but not when specialists are using them this way.

I think that NPs for specialists are fine if it is just for management. I see an NP half the time and I'm fine with that. I want to be seen by a doctor (in addition to an NP for a followup because two heads are better than one) if I know something funny is going on, regardless of the issue in question.

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?

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.

That's why I go to a dermatologist every year for a skin check. So that the specialist MD can look at my skin. That has nothing to do with the fact that I have an NP as a PCP.

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

This could not be more untrue on all accounts. You don't even have to have ever worked as a nurse to become an (D)NP. You can go straight from a 15+months online degree after your bachelors to working as an NP. Nurses cannot become PAs. Your doctor statement is just an imbecile insult. Primary care physicians are family medicine residency trained, or general internal medicine residency trained, or pediatrics residency trained. Which residencies are more competitive to get into changes every year and also changes greatly over longer periods, and this change is due to a lot of factors.

Anonymous wrote:

Anonymous wrote:Op made an appointment with a doctor, months in advance, and then the office switched it to an NP a few days in advanced. That’s not cool and I can understand why she is upset.

Sometimes I prefer NPs - I find they have better personalities and are less arrogant a lot of times.

It's infuriating. I've had the exact same thing happen several times with a gastroenterologist in Arlington, even though I specifically state I do not want to see his NP. They agree, make the appointment with the doc (supposedly) and then when I show up I'm stuck with the NP.

With specialists, it’s a different story. That does seem unethical and infuriating. NPs can be great in general practice, but not when specialists are using them this way.

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.

My PA diagnosed me with something my PCP never did. If you go to a top Dr which I do, their PA or NP is usually just as good.

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.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My primary doctor is an NP! Never had a more attentive and thoughtful diagnostician — much better than any MD I’ve gone to as an GP. And I’m not alone. She is full and not taking new patients (and a number of her patients are doctors!).

Correction: Your NP is NOT a physician.

I’ve seen NPs who have doctorate degrees in nursing. And they call themselves “doctor”. This seems very unethical to me.

This is of course not common. You are implying NPs are unethical as a generality. The amount of unethical behavior among physicians is staggering.

Anonymous wrote:

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.

You've hit the nail on the head. Most consumers of healthcare do not have perfect information and simply cannot objectively judge if they are receiving good care. Sometimes its left up to the NPs judgment if they involve a physician, that's absolutely crazy.
People are putting their lives in the hands of someone that did a few hours of school online. There are places that offer NP training online in as little as a year! There is no universe where 1 year of online school replaces med school, residency, fellowship etc.

This is true about doctors too! I have been to doctors who had all the perfect credentials and seemed amazing, and later it turned out that they actually sucked. I've learned that for the layperson, the best indicator of the quality of a healthcare professional, regardless of credentials, is how many questions they ask and how well they listen to the answers before they start poking at you and deciding what to do next. When they get that bored look in their eyes as you explain to them what's going on, or when they seem really cocky about their knowledge and defensive about questions you have for them, you should get suspicious.

Of course feel free to insist on a doctor but don't tell those of us who are okay with being seen by NPs alongside a doctor that we are ignoramuses.

There are bad doctors that's a given. I'm simply pointing out that the NP vs MD training is vastly different.

True, but what we need are people who are willing to get routine and basic medical care including primary care routine visits handled by NPs and PAs. There are way too many people now who are like OP for all care, not just specialized care. But we don't have enough MDs in primary care and so trying to get people in to see MDs when they don't need one is part of the problem. I don't know what OP needs to be seen for, but if OP wants to see an MD for basic routine care, like a checkup or exam, then they are part of the problem. Making it harder and harder for the limited number of MDs in primary care to see all the patients that they need to see.

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.

I was not aware of this, but I do go to the doctor a lot and I'm still okay with being seen by an NP. I don't know if my experience is unique, but I have never been seen exclusively by an NP over the course of treatment/management. On of two things happens: the doctor and NP or PA switch off or I see an NP to do the more thorough Q and A thing and then the doctor sees me more briefly. I would be dismayed if my first meeting with a healthcare professional about a particular issue was with an NP, but for preventative care and continued management I think it's fine, especially since you can often communicate with your doctor through a portal.

You were not aware that the training of doctors of nursing practice is less than 1/20th of the hours of physician training? That all their "practical training" consists of "shadowing" someone only, no hands-on? That their doctorate is about nursing advocacy and similar topics, not medicine? You didn't know that there are no unified graduating exams or anything even remotely resembling the nationwide USMLE Licensing Exams for physicians? You didn't know that nurse practitioners and doctors of nursing practice are held to the *nursing* standard, because they are nurses, and not to the *medical standard* of care in the US *and* in front of court? You didn't know that basic *working experience as an actual nurse* is not required anymore for the path to doctor of nursing practice? You didn't know that you can go from online-only degrees straight to independent practice in over half of all states? Did you know that there are no rules or regulations for specialties as far as NPs/DNPs are concerned, and that they are allowed to switch specialties as they please? What would you think of your cardiologist, if you knew he had been a psychiatrist until two weeks prior? Or of your pediatrician, who switched from a geriatrics practice? Physicians are not allowed to do any of this.

I'm sorry, PP, that I'm using your post as an example, but it's shocking to me how most of the public is not aware of the realities of what our system has become.

Anonymous wrote:Op made an appointment with a doctor, months in advance, and then the office switched it to an NP a few days in advanced. That’s not cool and I can understand why she is upset.

Sometimes I prefer NPs - I find they have better personalities and are less arrogant a lot of times.

It's infuriating. I've had the exact same thing happen several times with a gastroenterologist in Arlington, even though I specifically state I do not want to see his NP. They agree, make the appointment with the doc (supposedly) and then when I show up I'm stuck with the NP.

I'm older and have had both. I don't mind NPs. A good one knows her (it's usually a her) stuff and has a good "bedside manner" on top of it. I have one right now, and I had a choice of NP or doctor.