Physician Hostility - page 4

Why are so many physicians threatened and hostile toward NPs? What are the strategies in dealing with these types of professionals,and in what ways can we make it easier to practice together?... Read More

  1. by   prmenrs
    Try not to let this discussion get TOO heated, and definitely NOT personal. I'd hate to have to come in here and be the mean moderator, but I'm prepared to do so if necessary. Take a break, get a soda, a snack, do a load of wash, hug your spouse/kids/pets.

    Thanks, guys.
  2. by   PA-C, DO
    Hey Randall, I appreciate your assumptions about my age and background, but unless you are elderly I doubt you have much up on me. I was putting in chest tubes in combat while you were wiping noses in your white student uniform. Hide behind your shield of knowledge of "normal medicine" but be ready to refer out the patients you simply cannot deal with while perusing your cookbook algorithms of how medicine should be. I have news for you; there are very few patient encounters that follow the book, and you have to be able to think outside the "normal box" to really help your sick patients. And don't assume that the body of physicians in this country do not want to work in rural areas. People like myself (NHSC scholar) have dreamed of going to rural areas to practice small town medicine, and be the one who does it all. You won't find any NP's going to small town America to deliver cradle-to-grave medicine because their scope will never allow it. Can you perform C-sections or do routine OB and deliveries as an FNP? Can you do in office vasectomies, minor OR lap choles, appies, hernias, and even hysto's? Can you do any manip at all? You guys just aren't diverse enough to be able to take over the world of medicine some of us practice in the sticks, no matter how much you want to dream about it. My partner has an NP, and I have a PA. We both agree that the NP is excellent at routine minor care, and even the NP agrees on such. Our PA actually shares call, first assists in the OR, and is quite knowledgable about zebra pathology. The NP sees most of the kids and does literally all the WWE's for my partner. I value the NP and PA alike, but they know their place. Why can't the entire profession be like that? You don't ever see renegade PA factions trying to become independent of physicians, and why? Because they know that even though their schooling is the closest professional equivilant to physician training, that they are still nowhere near capable of being independent.
  3. by   Dave ARNP
    I'll ask again.
    What is your speciality that you perfom OB, OB surgery, GYN surgery, as well as some general surgery... all in addition to primary care?

    Surely your not FP or IM? Are you?

    Very courious on this (for more than you'd expect)

    -Dave



    Quote from PA-C, DO
    Hey Randall, I appreciate your assumptions about my age and background, but unless you are elderly I doubt you have much up on me. I was putting in chest tubes in combat while you were wiping noses in your white student uniform. Hide behind your shield of knowledge of "normal medicine" but be ready to refer out the patients you simply cannot deal with while perusing your cookbook algorithms of how medicine should be. I have news for you; there are very few patient encounters that follow the book, and you have to be able to think outside the "normal box" to really help your sick patients. And don't assume that the body of physicians in this country do not want to work in rural areas. People like myself (NHSC scholar) have dreamed of going to rural areas to practice small town medicine, and be the one who does it all. You won't find any NP's going to small town America to deliver cradle-to-grave medicine because their scope will never allow it. Can you perform C-sections or do routine OB and deliveries as an FNP? Can you do in office vasectomies, minor OR lap choles, appies, hernias, and even hysto's? Can you do any manip at all? You guys just aren't diverse enough to be able to take over the world of medicine some of us practice in the sticks, no matter how much you want to dream about it. My partner has an NP, and I have a PA. We both agree that the NP is excellent at routine minor care, and even the NP agrees on such. Our PA actually shares call, first assists in the OR, and is quite knowledgable about zebra pathology. The NP sees most of the kids and does literally all the WWE's for my partner. I value the NP and PA alike, but they know their place. Why can't the entire profession be like that? You don't ever see renegade PA factions trying to become independent of physicians, and why? Because they know that even though their schooling is the closest professional equivilant to physician training, that they are still nowhere near capable of being independent.
  4. by   PA-C, DO
    Hi Terminator,


    FP all the way my friend. There are tons of FP residencies that are considered "high speed" in terms of getting you the numbers of procedures necessary to get credentialled to do them in rural areas. It is very common to practice OB and do these minor surgeries as an FP, but it means you are very busy!! We have a general surgeon but he is basically in retirement now, and he comes in to help with complicated procedures or when we get in over our heads. Even a simple herniorrhaphy can go bad and it is not anyone's fault but the anatomy. Take a look at some of these residencies on the AAFP website under "residents" and choose the residencies by state. Some of the best are the programs in Anchorage, Ak, Ventura, Ca, and John Peter Smith in FW, Tx. So do you see what I mean Terminator? No one will ever replace the small town physician, because it would require multiple specialists.
  5. by   zenman
    Hey Randall, I appreciate your assumptions about my age and background, but unless you are elderly I doubt you have much up on me. I was putting in chest tubes in combat while you were wiping noses in your white student uniform.
    I was mostly wiping butts! I made patients wipe their own nose...if they could. I see that you are 32 which is how long it's been since I've stepped into the hospital. I'm merely saying that I'm coming from practical experience in a lot of health care areas, one of them as a medic (91A, B, then 91C) in an Evacuation Hospital...Vietnam era. I've also been around some impressive docs: Denton Cooley at the Texas Heart Institute, James Hardy (surgery textbooks and first to do lung transplant) and Arthur Guyton (that good old physio textbook) at University of Mississippi. I have seen quite a bit...some of which I wish I hadn't. I'm also not an NP; just considering going back to school, probably psych NP) as I don't have enough initials after my name and I'm feeling inferior to others.

    People like myself (NHSC scholar) have dreamed of going to rural areas to practice small town medicine, and be the one who does it all.
    I appreciate that a lot. However, you have to see what has historically happened when FP programs were created. I haven't looked lately but I remember that it backfired as FPs stayed away from the rural areas.

    Can you do any manip at all?
    Yep! I'd really also like to know what kind of manips DOs do. I haven't seen any in action in that area.

    You don't ever see renegade PA factions trying to become independent of physicians, and why?
    I venture that it's because their training doesn't allow for that.

    Moderator, I apologized if I've broken any rules. I'm a smart ass (can I say that) and rarely read rules, or policy and procedure manuals as I feel they are for people who aren't creative. I'll try to behave.
  6. by   Dave ARNP
    I'll be the first to admit that I showed some hostility towards PA-C, DO when he first started posting, but you really have to look at what he says.

    Take a look at some of his points, and you will see he does have points. Be it knowledge or scope of practice, there are things DO/MD's can do, that NP's cannot. I won't give that NP's are less skilled, but I promise you that I would be completely lost in the operating room outside of a completely normal C-section (afterall, if you've watched the Discovery Channel once or twice, you've seen 200 normal c-sections).

    Please try to remember, that for the best care to be given to OUR patients... we have to work together. That's CNA's, LPN's, RN's, NP's, MD's and DO's. Everyone brings some amazing skills to the table, and we both need to recognize what they are.

    -Dave
  7. by   fergus51
    Well, I am just a regular nurse, but we have a heck of a time getting doctors to set up shop in rural areas out here. If not for NPs or the rare locum docs, some people would have no access to primary care providers.

    I personally wonder if the doc poster is a troll. I have never heard any of our docs come off like paranoid egomaniacs.
    Last edit by fergus51 on Feb 25, '04
  8. by   PA-C, DO
    See Randy, we have more in common than you thought. I was a corpsman with Marine infantry for 4 years and spent the entire GW campaign on the ground in a damn hole! can I say that here?? I have actually been in the OR with Dr.Cooley when I was in PA school when he was really big at St. Lukes. I have also worked with Red Duke, and I know you know who he is. But I have to disagree with you on one point Randy. NP's cannot do manipulation and certainly cannot bill for it. MD's believe it or not, can do manip and bill for it but most are smart enough to take a course on it first to learn how. After all, DO's take about 3000 hours of OMM in medical school. Crazy enough though, you nurses are starting to grow on me. I do understand much of your animosity toward physicians in general, but there are plenty of us out there who are not condescending and do know who really runs the hospital.
  9. by   fergus51
    Again, I am just a regular nurse, but if NPs don't get any real patho training, why are they the ones teaching the residents patho on our unit? I haven't worked with many NPs previously, but the two we have here are excellent.
  10. by   zenman
    See Randy, we have more in common than you thought. I was a corpsman with Marine infantry for 4 years and spent the entire GW campaign on the ground in a damn hole! can I say that here??
    Great,we probably do have a lot in common. Let's drink to that!

    I have also worked with Red Duke, and I know you know who he is.
    Sure do; he's a famous guy from the Republic of Texas!

    But I have to disagree with you on one point Randy. NP's cannot do manipulation and certainly cannot bill for it.
    As a Zen Shiatsu therapist, I don't do that dreaded "manip" but do seem to get patients lined up with purposeful stretches. Remember, I'm not a NP...I'm Dr. (Hon) Feelgood!

    Crazy enough though, you nurses are starting to grow on me. I do understand much of your animosity toward physicians in general, but there are plenty of us out there who are not condescending and do know who really runs the hospital
    Yes, we're wearing you down and training you in the right way. Soon, grasshopper, it will be time for you to leave! Now, remember MDs do not run health care...it's the big business guys. All of us are merely small players. I really have no animosity towards MDs. They are like everyone else...good and bad ones...and I've chewed up a few bad ones...chewed up a few attorneys also...that damn contempt of court thing was expensive, your honor!
  11. by   PA-C, DO
    Fergus, you are out in left field. You do not learn pathophys as a resident. You learn it in medical school. You may get some clinical concepts related to path reinforced in residency, but pathophysiology is a basic science of medicine. As a resident, one has already proven that they have mastered the basic sciences by passing the USMLE steps one and two. No NP would be teaching a resident pathophys in residency. They might be teaching some via their vast clinical experience, but lets not try and make it sound like midlevels are routinely teaching residents on service. Don't take this wrong Fergus, but as an RN, you really wouldn't be sure if you were listening to a path lesson or not. You are describing an abnormal phenomenon when midlevels teach residents, and that is not to say it is wrong, because there are many midlevels who are good enough at what they do to teach like this. But this usually means they are not well rounded in the other areas of medicine that the resident has already had to master. That is what makes physicians unique. They have to be responsible for everything. Remember, you can teach a janitor to do a pap smear and have them teach residents to do them as well. But this is not teaching anything other than personal experience and technique, and this is where midlevels excel.
  12. by   zenman
    From MD Terminator: Please try to remember, that for the best care to be given to OUR patients... we have to work together. That's CNA's, LPN's, RN's, NP's, MD's and DO's. Everyone brings some amazing skills to the table, and we both need to recognize what they are.
    That's basically it, MD Terminator! We need to look at the system cause it's not working. Medicine is based on newtonian physics which is 300 hundred years old and was proved totally inadequate 50 -60 years ago. Yet the foundation of our scientific training is based on this inadequate info. Nursing is screwed up also and nursing education needs to be re-worked.

    Consider:

    --Most illness are self-limiting, as with the common cold, yet we spend a big chunk of money and waste our time with advanced diagnostic techniques while waiting to heal.

    --"The American health-care system is at once the most expensive and the most inadequate system in the developed world," according to the New England Journal of Medicine.

    --Medical errors rank as the eighth leading cause of death in the United States - higher than motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516) - Agency for Healthcare Research and Quality, 2002

    --One in five Americans (22%) report that they or a family member have experienced a medical error of some kind. This translates into an estimated 22.8 million people with at least one family member who experienced a mistake in a doctor's office or hospital. - The Commonwealth Fund, 2002

    --If our healthcare system is so great, why are we ranked 37th of all countries studied (World Health Organization) as to the health of the population, cost of health care, allocation of public and private funds for healthcare and the ratio of our current state of healthcare compared to what we could be. Even Cuba was ahead of us! France ranks number one in case you want to pack your bags and move quickly!

    Here's what I'm asking. All modalities of healthcare should look at each other's systems. They all have something that works. There is a reason that the western population is disenchanted with our current system and is demanding more. Figure out why.

    Study the role of the brain and mind in healing because that's where the common theme between all systems of healthcare resides. Shamans were the first mind-body practitioners and "tricked" many patients into getting better, even when their patients knew they were being tricked! We sometimes do the same thing today with the placebo effect. Study it more!

    Yes, there are frauds and quacks in all systems of healthcare. Weed them out. But don't knock another system because you think there is nothing to it. You're just being ignorant...that goes for people in any healthcare modality.

    I'll wrap up with Serge Kahili King, Ph.D., psychologist (and shaman) and author of Instant Healing: "One very significant thing I have noted is that no matter which system is used, some people are healed through it, some people are not healed through it, some people are healed without it, and some people are healed in spite of it."

    Required reading for everyone in health care:

    Health Care Meltdown: Confronting The Myths And Fixing Our Failing System
    Do We Still Need Doctors: A Physician's Personal Account of Practicing Medicine Today
    Code Green: Money-Driven Hospitals and the Dismantling of Nursing
    Wall of Silence: The Untold Story Of The Medical Mistakes That Kill And Injure Millions of Americans
    Confessions of a Healer: The Truth From An Unconventional Family Doctor
    The Future of Healing: Exploring the Parallels of Eastern and Western Medicine
    Becoming a Doctor: A Journey of Initiation in Medical School
    The Desire To Heal: A Doctor's Education in Empathy, Identity, and Poetry
    The Lost Art of Healing: Practicing Compassion In Medicine
    Complications: A Surgeon's Notes On An Imperfect Science
    What Price Better Health: Hazards Of The Research Imperative
  13. by   fergus51
    Actually, I do know they're teaching patho because the resident told me and there are postings all over the place. Even with my puny intellect as an RN, that seemed pretty clear to me. I have no reason to think he was lying to me and don't know why you would assume that you have a better idea at what teaching goes on in my unit. I never claimed this was the norm in residencies, because as I said, I haven't worked with many NPs.

    They do of course learn patho in medical school, but most of them had very little in sick prems or the odd kind of congenital issues we see in the NICU, or they are good actors! This is a very specialized unit, and our NPs are certainly very specialized (as are our docs). Believe me, our poor residents do not come to us with a great understanding of either clinical skills or the patho for this unit (I feel terrible for the way they are thrown in and think it's scary). That's not because their training is bad, it's because this is a specialized area. They don't seem to have a problem with learning patho from either of our NPs and the staff docs and hospital feel they are educated enough to teach, so I don't see a problem.

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