unhappy doc/letter to editor

  1. Letters to the editor
    Last edit by oramar on Dec 25, '06
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  2. 26 Comments

  3. by   wtbcrna

    I can see why that physician didn't stay in the military with that kind of attitudes towards PAs and NPS.
  4. by   traumaRUs
    Hmmm well as one of the "scabs", I certainly take exception to this MDs outlook. I bet she is a joy to work with - whether you are a mid-level provider or one of the staff nurses. Bah humbug!
  5. by   oramar
    Quote from traumaRUs
    Hmmm well as one of the "scabs", I certainly take exception to this MDs outlook. I bet she is a joy to work with - whether you are a mid-level provider or one of the staff nurses. Bah humbug!
    I thought same thing. I have no problem with this physician having issues with the Gov. But I have to ask why a person who touts their education can't find a way to express their opinion without being so derogatory
  6. by   SCRN1
    I don't mean to offend anyone but I can see where this doc may be coming from. Before I say anything else, let me say I don't like that this doctor calls NPs & PAs "scabs" though.

    Insurance companies are telling their customers who they can see for healthcare and are trying to save themselves money in getting those customers to see NPs or PAs instead of MDs. I guess this doctor feels that doctors are being put out of business because of the patients being forced to see someone "less expensive". Along with that, having to accept what HMOs will pay and the high cost of malpractice insurance, it's causing a lot of doctors not to be able to afford to stay in practice.

    I have heard many nurses feeling the same way about Medical Assistants putting nurses out of jobs at doctor's offices because the MAs can do about the same things there as a nurse can without having to have the same education and license. Basically the same thing for doctors...NPs & PAs can do basically the same things as a doctor without the same education. It's all about money.
  7. by   traumaRUs
    I totally understand the frustration as far as the reimbursement issue goes. However, in most circumstances, mid-level providers actually add to the practice and thus to the MD's income. I work in a large nephrology practice and see patients on chronic homodialysis. Medicare says that in order to receive full reimbursement for the physician services, these pts must be seen a total of four times per month and one of these visits must be the MD. However, the mid-levels see the pts the other three times and receive 85% of the reimbursement that the MDs receive. However, it frees up the MDs to see pts in the hospital who are acutely ill and to accept more office patients and consults.

    The mid-level providers do generate a profit and income for the practice. So...I guess I see this MDs concern is more geared to this particular state's issues and in particular, this governor.

    However, from such a highly educated person, I would expect more eloquent and more unbiased comments. I also don't see any reason to resort to name-calling - this just actually demeans the physician writing it.
  8. by   PANurseRN1
    Things are particularly bad in PA, so while I don't like the manner in which the doctor expressed herself, I do understand to an extent.

    I knew this was going to generate a lot of hostility when Ed Rendell made this part of his plan for his second term.
  9. by   santhony44
    Quote from traumaRUs
    I totally understand the frustration as far as the reimbursement issue goes. However, in most circumstances, mid-level providers actually add to the practice and thus to the MD's income. I work in a large nephrology practice and see patients on chronic homodialysis. Medicare says that in order to receive full reimbursement for the physician services, these pts must be seen a total of four times per month and one of these visits must be the MD. However, the mid-levels see the pts the other three times and receive 85% of the reimbursement that the MDs receive. However, it frees up the MDs to see pts in the hospital who are acutely ill and to accept more office patients and consults.

    The mid-level providers do generate a profit and income for the practice. So...I guess I see this MDs concern is more geared to this particular state's issues and in particular, this governor.

    However, from such a highly educated person, I would expect more eloquent and more unbiased comments. I also don't see any reason to resort to name-calling - this just actually demeans the physician writing it.
    :yeahthat:

    You are absolutely right. Any physician should be able to figure out how to improve and inhance his or her practice with NPs and PAs. If the NP or PA is a drain on the practice, then either the doc hasn't figured out how to best incorporate that person into the practice, or just plain won't "let go" of any of the patients. (I've seen a few like that- every patient is "my" patient to the doc and he or she can't effectively transition into "our" patient.)

    There is also the issue of rural areas. I've been in rural areas since I've been a NP and it's very difficult to attract physicians- or maybe it's physician's spouses- to those areas. A lot of them want to be close to big cities, like Dallas, Houston, Atlanta, etc and don't want to live out in the "boonies" where things like opera, ballet, symphony, and high-end shopping aren't readily available. In the rural areas, we often end up with foreign-born docs who have fewer alternatives. This isn't to knock foreign-born docs- I've worked with very good ones- but dealing with them can be more difficult for patients in rural areas who have less exposure to other cultures and languages. The docs are often unhappy, too, and leave as soon as they can, so there's more provider turnover.

    I mentioned physican's spouses because I once had a recruiter tell me that it wasn't the docs who wanted the big cities, it was the wives.

    Statistically most NP's and PA's probably aren't in rural areas, but in some rural areas we are crucial to health care.

    Personally, I enjoy rural/small town living and don't think you could pay me enough to live in a city of over 250,000 people, but that's just me.

    And one more thing. Physicians often say, or imply, that NPs and PAs have less education and therefore provide inferior care. That totally denigrates the considerable experience some of us have, some of it in teaching hospitals helping medical students/interns/residents learn their jobs. I have yet to see anyone offer any statistical evidence that NPs or PAs provide inferior care. I don't expect to see it, either, because I don't think it's true!
  10. by   TazziRN
    Yes, she is derogatory towards NPs and PAs, BUT........aren't we having the same problem with trying to make sure that nursing positions aren't taken by MAs and other lower-level nursing care practitioners? I agree that she could have been a whole lot nicer, however if you look back at the threads about the different nursing care levels, a lot of RNs touted their educations too.
  11. by   penguin2
    Quote from SCRN1
    I don't mean to offend anyone but I can see where this doc may be coming from. Before I say anything else, let me say I don't like that this doctor calls NPs & PAs "scabs" though.

    Insurance companies are telling their customers who they can see for healthcare and are trying to save themselves money in getting those customers to see NPs or PAs instead of MDs. I guess this doctor feels that doctors are being put out of business because of the patients being forced to see someone "less expensive". Along with that, having to accept what HMOs will pay and the high cost of malpractice insurance, it's causing a lot of doctors not to be able to afford to stay in practice.

    I have heard many nurses feeling the same way about Medical Assistants putting nurses out of jobs at doctor's offices because the MAs can do about the same things there as a nurse can without having to have the same education and license. Basically the same thing for doctors...NPs & PAs can do basically the same things as a doctor without the same education. It's all about money.
    I have to agree. I think the term "scabs" is derogatory, and detracts from the message. However, I do understand the frustration of being replaced by less trained personnel, and thus a potential for a lower standard of care for our loved ones, and ultimately ourselves!
  12. by   traumaRUs
    sanathony - you are right on. I totally agree. As healthcare has evolved, the role of nurses, both staff and advanced practice as well as the influx of PA's have changed as well. You can play the game, "I liked it the way it used to be," but in the end you are shortchanging your staff, your patients and yourself. So...as we all must get used to the new healthcare with its changes, so must our MD's. I personally think this MD needs to step out of her invory tower and come on down to the trenches with us!
  13. by   traumaRUs
    Tazzi - I agree with you to a point. However, MA's don't receive reimbursement for their services and mid-levels do.

    And...I stand behind my statement that if you have to rely on name-calliing to get your point across, it's not going to be well-received.
  14. by   PANurseRN1
    Let's be clear, mid-levels do not have the equivalent education of a physician. They may have a lot of practical experience, but that is not the same as the education one receives to become a physician.

    There's a place for mid-levels, but I think they do themselves more harm by trying to argue how they are just as well educated as a physician. Sorry, go course for course, curriculum for curriculum...it's not the same.

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