discussion regarding education of NP (DNP) and PA compared to MD/DO

prairienp · Feb 23, 2010

prarienp
it is fluff, not for many, it is fluff for anyone. seriously, can you be taught to communicate? i take quite a lot of time explaining my patients conditions to them and making sure they understand all possible treatment outcomes and options, but i didn't need 2 years of "communication and health promotion" classes to do it. if your training focuses on differential diagnosis and treatment that will come naturally unless you don't care about what the average person knows. and if you think the majority of your patients have the slightest idea what they need you are either sorely mistaken or work with a very select group of educated patients. i can tell you after nearly 3 years of working i've never had a patient population greater than 50% that ever truly understood everything i would have liked them to, although i did usually get them to understand enough, they really never grasped the full understanding of their disease. that's why we get paid. don't kid yourself.
that is also why patient satisfaction is retarded. it's based completely on subjective criteria. i've known terrible doctors, whose patients absolutely adored him. why is it used? only by practitioners trying to prove something that isn't true.

i am not sure if you have taken a graduate level communication course? i have taken two, i guess it depends on how you define fluff. i learned a lot about communication, and worked hard to excel in the courses. yes, you can be taught to communicate, i would encourage you to take one of these "fluff" communication courses, i suspect your opinion will change.

i do believe my patients have an idea of what they need, over the years of developing rapport with "communication" techniques and educating my patients so they understand. being humble is one of my strongest characteristics, expecting my patients to understand is essential to (yes) patient satisfaction. i also know that when i take a history it is entirely "subjective" and listening to the patient often results in increased patient satisfaction. i am sure you are aware that most healthcare providers already know the diagnosis after taking the patient history, without ever needing further objective findings to validate the subjectivity. thus yes, practitioners are using objectivity most often to prove something that isn't true.

if you are truly worried about the legal costs you will find a significant reduction in malpractice suits amongst those providers with high patient satisfaction. are you associating high patient satisfaction with being a bad provider?

i would appreciate any further responses to be presented in a professional manner. reading some of these posts has become disheartening. are disparaging remarks required to make a point?

mbreaz1 · Feb 23, 2010

Springing, there's no use arguing with self righteous windbags. Society has villianized doctors and the healthcare profession in general. The average person goes to the doctor but resents his high bills. Most wouldn't hesitate to sue you for the slightest mistake. People demand perfection in their healthcare providers, but want it at the price of mediocrity.
There isn't a person alive who would knowingly subject themselves to a career in medicine without the compensation that a physician deserves. Let this guy believe what he wants. I just hope we all have the balls to strike and leave them to the consequences when legislation finally cuts salaries to the breaking point.

Whoa, you guys resort to name calling a little bit too much. Self righteous windbags? Look who is talking. Society hasn't villianized doctors and the the healthcare profession. They have villianized themselves by their own actions. I don't go to the doctor, but I still get to resent their high bills, oredering of unnecessary tests, excessive prescription writing, etc. Do you know why I resent them? Because even if I don't use the service I am forced to pay for them. Doctors get sued for a small fraction of mistakes that they make. The truth is that they deserve to get sued far more than they actually do. People don't demand profection from their healthcare providers, they just want honesty, which is a quality that they rarely get from physicians these days.

Here we go again with the entitlement mentality. "the compensation that a PHYSICIAN deserves". Good grief! A physician deserves to earn what the market will bear just like every other worker out there. The breaking point? We could go down at least 50% and not reach that. There are no consequences at all for a 20% cut in reimbursment rates. Please go ahead and strike and we will have DNPs replacing so quickly it will make your head spin.

mbreaz1 · Feb 23, 2010

PRARIENP
It is fluff, not for many, it is fluff for anyone. Seriously, can you be taught to communicate? I take quite a lot of time explaining my patients conditions to them and making sure they understand all possible treatment outcomes and options, but I didn't need 2 years of "communication and health promotion" classes to do it. If your training focuses on differential diagnosis and treatment that will come naturally unless you don't care about what the average person knows. and if you think the majority of your patients have the slightest idea what they need you are either sorely mistaken or work with a very select group of educated patients. I can tell you after nearly 3 years of working I've never had a patient population greater than 50% that ever truly understood everything I would have liked them to, although I did usually get them to understand enough, they really never grasped the full understanding of their disease. That's why we get paid. don't kid yourself.
That is also why patient satisfaction is retarded. it's based completely on subjective criteria. I've known TERRIBLE doctors, whose patients absolutely adored him. Why is it used? only by practitioners trying to prove something that isn't true.

If you can't help more than 50% understand enough, then you need to find a different profession. You act as though the concepts are rocket science, when most of them are very simple to explain if you know how to communicate. Maybe you just need to go through nurse practitioner training and take some of those fluff courses and all will be fine. Please refrain from using terms like "retarded". That is offensive and doesn't belong here. As has been proven before, patients are never satisfied with incompetence or poor service. You are trying to disprove the fact that patient satisfaction is important with some ridiculous statement of your own opinion regarding TERRIBLE doctors. Can you show some proof that customer satisfaction is not important and that patients are satisfied with incompetent doctors???

springing · Feb 23, 2010

Who cares if you have to pay them back during residency? When was that ever the point? NOBODY CARES! GET IT? NOBODY CARES if you conisder it to be a GOOD salary or not. DEAL WITH IT. If someone chooses a profession then they have to deal with the good and the bad that goes along with it. So you mean to tell me that you made over $42,000 per year working at Costco in juinor high? LIAR! Show me the evidence of that. I would love to see that pay stub. You are arguing apples and oranges again and I think you have a magical little calculator like your friends do.

And that's a wrap. Your whole argument is based on emotion, not logic. I have no idea what made you hate doctors so much, but I hope it doesn't cause you to avoid a good psychiatrist for the subject. Physicians are pretty integral to the health system and one would assume you'll have to deal with them on a customer basis eventually.

Your pathos adds absolutely nothing to this discussion.

It doesn't matter whether you think it's irrelevant; people do care, so your statement is automatically wrong. Student loan debt is a crisis in this country. It has risen over 3 times as fast as inflation. It doesn't matter whether you think a kid is selfish for not wanting to accumulate 300,000 in student loans before interest; that's a choice many people think twice about, and if it endangers the supply of physicians, it needs to be looked at.

You haven't shown me anything that says that average debt for physicians is 150,000 in grad school alone. Why would I need to dig up any figures for you? I am throwing out hypotheticals just like you are, so don't go asking me for evidence just because I am able to poke holes in your weak examples.

*sigh*

One would think you would have looked this up before coming to a forum thread like this.

http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt.shtml

I am very happy to hear that these cuts might finally make it through without Congress heading them off again. They should have happened years ago. So I say bring them on. I think a 10% cut is a great start. If you were in business and someone came to you and said you have a competitor opening up down the street who can do this for 10% less than you can, you would figure out how to cut your costs. That is what I would do. Why is it that you think physicians are entitled to be paid a certain amount for their services? Physicians aren't entitled to a set amount. They need to figure out how to make it by being innovative instead of expecting someone to drop it in their lap.

Again, your arguments have no basis in medical economics whatsoever. This isn't going to increase competition, at least not for primary care. It's going to decrease the amount of practicing primary care physicians, not INCREASE. Where's the competitor? The supply will continue to DWINDLE.

The average person goes to the doctor but resents his high bills. Most wouldn't hesitate to sue you for the slightest mistake. People demand perfection in their healthcare providers, but want it at the price of mediocrity.
There isn't a person alive who would knowingly subject themselves to a career in medicine without the compensation that a physician deserves. Let this guy believe what he wants. I just hope we all have the balls to strike and leave them to the consequences when legislation finally cuts salaries to the breaking point.

I think it's yet another symptom of the rampant anti-intellectualism in this day and age. Doctors receive a minimum of 11 years of education after high school. They are some of the most educated individuals in the country AND they are in a position where they tell a person what they should and should not be doing with their lives. That makes a lot of people angry and resentful.

mbreaz1 · Feb 23, 2010

And that's a wrap. Your whole argument is based on emotion, not logic. I have no idea what made you hate doctors so much, but I hope it doesn't cause you to avoid a good psychiatrist for the subject. Physicians are pretty integral to the health system and one would assume you'll have to deal with them on a customer basis eventually.
I don't hate doctors, I just hate listening to them cry about money when they make more than 90% of the population. I never said they weren't integral to the health system, just that you told lies about what they actually make and that you are crying over your own lies.
Your pathos adds absolutely nothing to this discussion.
It doesn't matter whether you think it's irrelevant; people do care, so your statement is automatically wrong. Student loan debt is a crisis in this country. It has risen over 3 times as fast as inflation. It doesn't matter whether you think a kid is selfish for not wanting to accumulate 300,000 in student loans before interest; that's a choice many people think twice about, and if it endangers the supply of physicians, it needs to be looked at.
Most people don't care what physcian's student loans are given how much compensation they receive. Student loan debt is a crisis in this country for people who don't make a six figure salary. I hardly call it crisis when you are compensated like physicians are. Furthermore, we need fewer physicians in this country, that is part of our problem, we have too many.
*sigh*
One would think you would have looked this up before coming to a forum thread like this.
http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/medical-student-debt.shtml
Again, your arguments have no basis in medical economics whatsoever. This isn't going to increase competition, at least not for primary care. It's going to decrease the amount of practicing primary care physicians, not INCREASE. Where's the competitor? The supply will continue to DWINDLE.
You wouldn't know anything about medical economics if it hit you squre in the face! The competitor is the independently practicing nurse practitioner. That will increase competition and then we will need fewer primary care physicians, so plenty of them that are in practice right now can either take a pay cut or just go away.
I think it's yet another symptom of the rampant anti-intellectualism in this day and age. Doctors receive a minimum of 11 years of education after high school. They are some of the most educated individuals in the country AND they are in a position where they tell a person what they should and should not be doing with their lives. That makes a lot of people angry and resentful.

I don't really care how much education doctors receive, but they are certainly not some of the most educated individuals in the country. There are far more educated people in many walks of life than doctors will ever dream of being. Furthermore, your attitude regarding doctors being in a position to TELL people what to do goes to the core of the issue here. Doctors aren't in a position to TELL people anything. They are in the business of selling advice. Which means they offer advice based on their expertise. The problem is that they see themselves as being in the position of GOD and that they are there to issue ORDERS that are not to be questioned. That is the reason people are far more satisifed with the work of nurse practitioners. They get the advice without the GOD complex.

springing · Feb 23, 2010

Everything you post is a rant...it's a little alarming. None of it is based in logic, it's a continual, froth-mouthed screed against physicians. You are so blinded by ideology and hatred of doctors you don't even realize that Medicare cuts and malpractice insurance/suits affect NPs as well. As more and more NPs become independent of doctors, all those problems that affect medical professionals are going to affect nursing professionals as well.

mbreaz1 · Feb 23, 2010

Everything you post is a rant...it's a little alarming. None of it is based in logic, it's a continual, froth-mouthed screed against physicians. You are so blinded by ideology and hatred of doctors you don't even realize that Medicare cuts and malpractice insurance/suits affect NPs as well. As more and more NPs become independent of doctors, all those problems that affect medical professionals are going to affect nursing professionals as well.

I'm certainly not sure that you would ever be accused of using sound logic in your arguments. What you reason is that physicians are the only important piece of healthcare. The truth is that they are a very small part of it. They have been able to make themselves the most important part of it by lobbying the government. I do realize that Medicare cuts and malpractice suits affect NPs as well. NP's work for half of what a doctor gets paid though, and malpractice suits are not really the problem that physicians make them out to be. If you had done a little research on that one, you wouldn't bring it up at all. Nurse practitioners can absorb the hits on these whereas doctors aren't willing to. You are just against having any competition. All the physicians are against competition too, so I guess that isn't surprising at all. You are terribly predictable. You go along with all of the myths that physicians and the healthcare industry try to feed us every time the issue comes up. You try to tell us that nurse practitioners can't do the job for cheaper, that it will "compromise the quality of care", and that "physicians will simply up and leave their posts if you cut their pay". All of these are simply fabrications intended to scare the public and they are irresponsible. Don't try to create a myth to scare people and then act like you actually believe it.

springing · Feb 23, 2010

If you can find one place where I actually said any of that, I'll be happy to concede the point. Except, I never did. You are blinded by ideology and bringing the tone of the thread WAY down.

wowza · Feb 23, 2010

Nobody was discussing an hourly rate. We were talking about professional salaries. So your point is completely invalid about what you made in high school. There are tons of lawyers and CPAs who work more than 80 hours a week and make less than a resident and I have plenty of proof to show you as soon as you submit one shred of evidence to support your claims.

Serioiusly, stop making stuff up. You look foolish when you do. My wife is a lawyer. I have been with her since law school.

mbreaz1 · Feb 23, 2010

Serioiusly, stop making stuff up. You look foolish when you do. My wife is a lawyer. I have been with her since law school.

I used to date a bartender, what the hell is your point? Have you been in a monogamous relationship since law school too? I fail to see the relevance of any of that and would love to know how you think that means I am making stuff up and look foolish. Since you have no evidence to argue with the points I am making you resort to calling me names and throwing out irrelevant information about your wife.

Trauma Columnist · Feb 23, 2010

Ok, enough already! Stop the in-fighting! Sometimes it is better to put a particular poster on "ignore" than to continuously engage them in a futile manner...

Lets get back to the topic at hand....thanks.

mbreaz1 · Feb 23, 2010

If you can find one place where I actually said any of that, I'll be happy to concede the point. Except, I never did. You are blinded by ideology and bringing the tone of the thread WAY down.

You are the one who is blinded and by your own emotion. You fail to actually argue any of the points that I am making, and furthermore it is only the argument that I care about, not the "tone of the thread". I fail to see how my posts are bringing it "WAY down" though. There are plenty of other people who agree with me on this.