Could an FPNP start an operate a "cash only" walk in...

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    clinic without a doctor onsite? If I couldn't become a CRNA I think that this would be my secondary goal. When I was a Corpman in the Navy I dreamed of going to medical school and gaining a Family Practice specialty. With such a degree, I felt that I could "bring back" MD housecalls to America even if I couldn't accept insurence. Well, it doesn't look like becoming an MD is realistic (right now getting my BSN is plenty of a challenge) so I was considering the "legal" feasibility of pursuing this concept with the NP license. I feel certain that I couldn't make "house calls", but how about a walk-in, cash only clinic (that would have a "sliding scale" fee arrangement based on income, and take payments)? Would physician supervision requirements be such that I would have to have an MD onsite? If not what sort of supervision would be required (and what sort of "split" would be typical). I would also like to be able to integrate alternative and complementary medicine that had significant science supporting its efficacy. Is this something that NP's are typically able to do within their "scope" of practice? I've had MD's tell me that THEY would like to utilize more A&C approaches, but fear professional ridicule (thus I suspect that it would be even HARDER for NP's to integrate such approaches).
    Last edit by Roland on Feb 22, '04

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  3. 31 Comments...

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    Quote from Roland
    I would also like to be able to integrate alternative and complementary medicine that had significant science supporting its efficacy. Is this something that NP's are typically able to do within their "scope" of practice? I've had MD's tell me that THEY would like to utilize more A&C approaches, but fear professional ridicule (thus I suspect that it would be even HARDER for NP's to integrate such approaches).
    alternative medicine is quackery. If its labeled "alternative" that means it hasnt been proven safe and effective thru double blind, randomized placebo trials.
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    Hopbalt, I would argue that there are many alternative approaches with dozens to hundreds of studies supporting their efficacy. There is of course a continuum between absolute proof and little to no scientific support for a given alternative intervention. Consider for example research that seems to support the use of coenzye Q-10 supplementation in the treatment of those on long term statin therapy (indeed there exists a good deal of evidence that coQ10 might be useful as a primary intervention for those with congestive heart failure and other sequlae of CHD, but I will confine my discussion here to its use in conjunction with statins). Even though a major US pharmaceutical company (Merck) patented the supplement for this very purpose it is very seldom, utilized in "mainstream" American medicine. Another, example of an "alternative" therapy with considerable support is the use of Garlic in fighting MERSA/ and even VERSA strains of infection (albeit there is less research for this usage than the one referenced above). Dismissing ALL alternative and complementary medicine as quackery may be indicative of a certain amount of intellectual laziness, and would seem to be a conclusion at variance with established scientific fact (at the very least such a interpretation requires a very subjective analysis of the available facts).

    A SMALL sample of Co-enzyme Q-10 research especially as it relates to CHD/ACS and statin treatment:
    1. Ellis CJ, Scott R. Statins and coenzyme Q10. Lancet. 2003 Mar 29;361(9363):1134-5.

    2. Singh RB, Neki NS, Kartikey K, et al. Effect of coenzyme Q10 on risk of athero- sclerosis in patients with recent myocardial infarction. Mol Cell Biochem. 2003 Apr;246(1-2):75-82.

    3. Ohmoto N, Fujiwara Y, Kibira S, Kobayashi M, Saito T, Miura M. Cardiomyopathy showing progression from diffuse left ventricular hypertrophy to dilated phase associated with mitochondrial DNA point mutation A3243G: A case report. J Cardiol. 2003 Jan;41(1):21-7.

    4. Fosslien E. Review: Mitochondrial medicine--cardiomyopathy caused by defective oxidative phosphorylation. Ann Clin Lab Sci. 2003 Fall;33(4):371-95.

    5. Engelsen J, Nielsen JD, Hansen KF. Effect of coenzyme Q10 and ginkgo biloba on war- farin dosage in patients on long-term war- farin treatment. A randomized, double- blind, placebo-controlled cross-over trial. Ugeskr Laeger. 2003 Apr 28;165(18):1868-71.

    6. Singh RB, Kartik C, Otsuka K, Pella D, Pella J. Brain-heart connection and the risk of heart attack. Biomed Pharmacother. 2002;56 Suppl 2:257s-265s.

    7. Sarter B. Coenzyme Q10 and cardiovascu- lar disease: a review. J Cardiovasc Nurs. 2002 Jul;16(4):9-20.

    8. Piotrowska D, Dlugosz A, Pajak J. Antioxidative properties of coenzyme Q10 and vitamin E in exposure to xylene and gasoline and their mixture with methanol. Acta Pol Pharm. 2002 Nov-Dec;59(6):427-32.

    9. Tran MT, Mitchell TM, Kennedy DT, Giles JT. Role of coenzyme Q10 in chronic heart failure, angina, and hypertension. Pharmacotherapy. 2001 Jul;21(7):797-806.

    10. Feher J, Papale A, Mannino G, Gualdi L, Balacco Gabrieli C. Mitotropic compounds for the treatment of age-related macular degeneration. The metabolic approach and a pilot study. Ophthalmologica. 2003 Sep- Oct;217(5):351-7.

    11. Blasi MA, Bovina C, Carella G, et al. Does coenzyme Q10 play a role in opposing oxidative stress in patients with age-related macular degeneration? Ophthalmologica. 2001 Jan-Feb;215(1):51-4.

    12. Muller T, Buttner T, Gholipour AF, Kuhn W. Coenzyme Q10 supplementation pro- vides mild symptomatic benefit in patients with Parkinson's disease. Neurosci Lett. 2003 May 8;341(3):201-4.

    13. Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the function al decline. Arch Neurol. 2002 Oct;59(10):1541-50.

    14. Beal MF. Mitochondria, oxidative damage, and inflammation in Parkinson's disease. N Y Acad Sci. 2003 Jun;991:120-31.15. Beal MF. Bioenergetic approaches for neu- roprotection in Parkinson's disease. Ann Neurol. 2003;53 Suppl 3:S39-47; discussion S47-8.

    16. Kishimoto C, Tomioka N, Nakayama Y, Miyamoto M. Anti-oxidant effects of coen- zyme Q10 on experimental viral myocarditis in mice. J Cardiovasc Pharmacol. 2003 Nov;42(5):588-92.

    17. Jauslin ML, Meier T, Smith RA, Murphy MP. Mitochondria-targeted antioxidants protect Friedreich Ataxia fibroblasts from endogenous oxidative stress more effective- ly than untargeted antioxidants. FASEB J. 2003 Oct;17(13):1972-4. Epub 2003 Aug 15.

    18. Sandhu JK, Pandey S, Ribecco-Lutkiewicz M, et al. Molecular mechanisms of gluta- mate neurotoxicity in mixed cultures of NT2-derived neurons and astrocytes: pro- tective effects of coenzyme Q10. J Neurosci Res. 2003 Jun 15;72(6):691-703.

    19. Chuang YC, Chan JY, Chang AY, et al. Neuroprotective effects of coenzyme Q10 at rostral ventrolateral medulla against fatality during experimental endotoxemia in the rat. Shock. 2003 May;19(5):427-32.

    20. Shults CW. Coenzyme Q10 in neurodegen- erative diseases. Curr Med Chem. 2003 Oct;10(19):1917-21.

    21. Kishimoto C, Tamaki S, Matsumori A, Tomioka N, Kawai C. The protection of coenzyme Q10 against experimental viral myocarditis in mice. Jpn Circ J. 1984 Dec;48(12):1358-61.

    22. Mancini A, Milardi D, Conte G,. et al. Coenzyme Q10: another biochemical alter- ation linked to infertility in varicocele patients? Metabolism. 2003 Apr;52(4):402-6.

    23. Lamperti C, Naini A, Hirano M, et al. Cerebellar ataxia and coenzyme Q10 defi- ciency. Neurology. 2003 Apr 8;60(7):1206-8.

    24. Langsjoen PH, Langsjoen A, Willis R, Folkers K. Treatment of hypertrophic car- diomyopathy with coenzyme Q10. Mol Aspects Med. 1997;18 Suppl:S145-51.

    25. Langsjoen P, Langsjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med. 1994;15 Suppl:S265-72.

    26. Langsjoen H, Langsjoen P, Langsjoen P, Willis R, Folkers K. Usefulness of coen- zyme Q10 in clinical cardiology: a long-term study. Mol Aspects Med. 1994;15 Suppl:s165-75.

    27. Langsjoen PH, Langsjoen PH, Folkers K. Isolated diastolic dysfunction of the myocardium and its response to CoQ10 treatment. Clin Investig. 1993;71(8 Suppl):S140-4.

    28. Folkers K, Langsjoen P, Langsjoen PH. Therapy with coenzyme Q10 of patients in heart failure who are eligible or ineligible for a transplant. Biochem Biophys Res Commun. 1992 Jan 15;182(1):247-53.

    29. Folkers K, Hanioka T, Xia LJ, McRee JT Jr, Langsjoen P. Coenzyme Q10 increases T4/T8 ratios of lymphocytes in ordinary subjects and relevance to patients having the AIDS related complex. Biochem Biophys Res Commun. 1991 Apr 30;176(2):786-91.

    30. Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci U S A. 1990 Nov;87(22):8931-4.

    31. Langsjoen PH, Langsjoen PH, Folkers K. A six-year clinical study of therapy of car- diomyopathy with coenzyme Q10. Int J Tissue React. 1990;12(3):169-71
    Last edit by Roland on Feb 21, '04
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    alternative medicine is quackery.
    Don't know if you're trolling or not but you will be shot down in flames (as many others have) if you want to engage me in a discussion of this subject.
    If you want to continue, let's do so. Hopefully, you are a physician or scientist so I'll have a more interesting time. Now let's start by you looking up and comparing the death rates from western medicine and "alternative" medicine. Later.
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    CoQ10 is NOT alternative medicine. As you can see, there is clinical trial data to back up its effectiveness. Doctors are now starting to embrace it.

    Alternative medicine is stuff like aromatherapy, chiropractic, homeopathy, etc.

    Those are all forms of quackery.

    Chiropractic is effective for CERTAIN KINDS OF LOW BACK PAIN. Of course, your chiro wont tell you that, he'll tell you that spinal manipulation cures cancer, heart disease, asthma, etc. He'll tell you that all vaccines are evil ploys by doctors for mind control. He'll tell you that his back popping technique can cure your infertility.

    Homeopathy is probably safe for the most part, but its 100% placebo effect. The fact that people claim that they feel better is irrelevant, because people feel better taking a sugar pill too, yet thats hardly considered "medicine"
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    Not to change the subject, but back to the original post, YES, in some states a NP can open and have their own clinic without a physician there. You probably would want to have a physician that you could call or about a problem, but that does not mean back-up. You are operating with your own license, not under the physician.
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    warning! do not feed the trolls!
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    how about we compare the death rates with western medicine and without western medicine:

    1) a patient comes in with dense hemiplegia and a history of a-fib... do we treat him with western medicine (thrombolytics?) or do we watch his stroke become permanent.

    2) a patient comes in in a coma after a fall - do we provide decompression for a subdural bleed or do we watch him die?

    3) a patient comes in with end-stage liver failure - do we provide him a liver transplant - and bridge him with a liver machine?

    4) a neonate is born with a diaphragmatic hernia - ???

    5) a septic nursing home patient with a UTI - ???

    don't give me this crap about western medicine having a higher death rate than alternative medicine.... that is like comparing morbidity/mortality of the treatment modalities of ventricular rupture vs. "achy" elbow...

    and zenman - don't get all high and mighty - i think the OP has some good points, that are worth discussing...
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    I thought this forum was for NURSE PRACTITIONERS.

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    i figured since most posters aren't NPs that i could throw in my 2 cents as well ---- sorry if i intruded.

    by the way, MD terminator --- why the handle, if you are planning on becoming a doctor? any insecurities there?

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