Originally Posted by caldje
I dont want my above post to confuse anyone as to give my position so I'll give my take on the issue.
NPs can have independence. Their scope of practice should be CLEARLY defined and CONFINED to primarily preventative efforts though. As a healthy person I would much rather see an NP and as a sick person I would much rather see a doc. I think midlevels do have an independent role in healthcare and should be afforded the opportunity to break the monopoly physicians have on healthcare. I think it would be VERY beneficial to the health of our society to encourage independent practice of preventative health practitioners who treat minor ailments and screen for major ones and then refer them to their counterparts more trained in that area. Why is that such a stretch?
Keep PAs with physician collaboration as dependent providers and let them take over the current midlevel position thata works collectively and cooperatively with physicians. (we're happy with that and also have a more similar training to physicians with stronger science background needed to collaborate on the more serious health concerns and critical care and surgical cases) Then, let the NPs create their own niche as long as it is clearly defined. It makes sense to me and people might be better off for it?
Caldje-
Thank you for your thoughts.
You have brought up a practice model that simply cannot be possible. What you propose is a design in which an already fractured system becomes even more splintered. Who do you want taking care of you on your "sick" days? Will it be the person with whom you have a relationship and who knows your history? Or, do you want to go to the most expensive, least continuous form of care we have today, the ED?
The major flaw here is the concept that people always know when they are seriously sick vs. NP-level sick as you propose. Sick folks rarely carry that unclean-and-ill sign we all sometimes wish for.
I am currently studying for the second step in my medical licensure odyssey. In my question study book I'm seeing about 20% of the questions starting with the stem "a well-appearing _ y.o. _ comes to the office for a well-visit, labs and v/s show________" This is then followed by a list of 5-15 tragic illnesses that are typically asymptomatic at their early stages.
This is not just an infuriating device to trip up the medical student. These questions are built around the real deal. The day to day practice of health care.
Can an NP see these folks and get it right? You betcha. However, I believe there must be a physician to oversee the not-so-obvious reapers lurking behind that "well" facade.
There is also the whole -who can afford preventive care? query. That is a real sticky question.
BTW-I went to medical school to be an Emergency Physician. The stand alone NP/DNP (heeeheee) is a guaranteed route for my job security. Not that EPs are lacking business.
Your second point that the scope must be well defined is an impossibility with today's advanced practice climate. Midlevels defy any constraints on their practice. Limited prescribing was not enough. Full rights were not enough. Intermittent doc supervision was seen as constraining. Stand alone practice with admitting prileges was still inadequate. Now the very title is up for grabs. I will say again that the AACN will not rest until its members are seen as physician equivalents regardless of ability.
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