Don't Hate Me, All....

[TakeBack]

I have been following your discussions here on the recent media coverage of the primary gap, and NPs place in it. I posted this on another forum that I moderate, and felt it was only fair to give you all a chance to chime in. I hope it doesn't come across as an attack, but rather a clinician of a different stripe with some real questions about how we market ourselves. The text below is addressed to PAs, so read in that context:

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I have been reading the coverage of the recent articles from CNN and Time that we discuss here, in particular the responses on allnurses.

Of course I have to provide my PA disclaimer.....I work with NPs.....about a dozen of them at my institution. I have never had a negative experience with any of them, and have no need to write a "hit piece". We confer, they give medical feedback, I give surgical, etc....collegial and pleasant.

That being said, I have read over and over again about the presumed advantage NPs provide over docs (this is in their words) becuase they offer a "nursing perspective", "treat the patient, not the disease", "look at the patient as a whole", "offer prevention as well as treatment", etc.....

I really don't see this as NP bashing, but I see these comments as somewhat elitist....or at least "leading the argument". The NPs I work with practice the same medicine (!) as the rest of us, PAs, MDs, etc. Their preop cardiac workups look just like any other. And they're good. A clinic NP treating OM...are they really offering that much of an edge over a non-NP due to their nursing background? What does the nursing backgroud teach about listening, empathy, and thinking about interdependent body systems that our medical model education does not?

This all seems like a phoney selling point that is SO subjective that there is no way to argue it, putting NPs in a position which is easy to defend and impossible to refute.

Thoughts?

Do you feel like you treat your patients any less holistically b/c you were trained in the medical model?

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Thanks for your feedback here.......

[mbreaz1]

The burden of proof is on NPs/DNPs to show that they can provide equal outcomes, not on the naysayers. It's like saying the easter bunny exists since you can't prove that he doesn't exist. That's not how it works.

It doesn't matter if all studies show equal outcomes if there are several confounders in each one. That's what invalidates those studies. You can't say that something is wrong with a study and proceed to accept the results as the truth.

Like I said already, the proof is in what is happenning out there in practice. If you want to discount the study, that's your problem. The proof is evident everyday. You can't discout that.

[dgenthusiast]

Like I said already, the proof is in what is happenning out there in practice. If you want to discount the study, that's your problem. The proof is evident everyday. You can't discout that.

The proof is not evident everyday. If it was, people wouldn't be questioning it.

I think you're confusing anecdotal evidence with scientific proof.

[mbreaz1]

Provide evidence. Your word is useless otherwise. Where is this rampant evidence published?

I am concerned for patient safety; I'm glad you understand the reason behind my arguments finally. We should let biology majors treat patients who don't have access. After all, according your argument, any treatment (no matter the quality) is better than no treatment right?

So you would rather die than be treated by a biology major? Makes perfect sense DG, you argue like a real winner.

[mbreaz1]

The proof is not evident everyday. If it was, people wouldn't be questioning it.

I think you're confusing anecdotal evidence with scientific proof.

The only person I see questioning whether the outcomes are equal is YOU. Like I said, physicians don't even question that. The only thing they question is whether or not NPs should be able to call themselves Doctor.

[dgenthusiast]

So you would rather die than be treated by a biology major? Makes perfect sense DG, you argue like a real winner.

So every medical encounter is a matter of life and death? You don't see ANY patients that will not die if not seen? Hmm.

If I'm not in a life or death situation, I'd rather NOT see a biology major who might do something to screw up my body even more. I'm taking it that you would be okay with it?

[dgenthusiast]

The only person I see questioning whether the outcomes are equal is YOU. Like I said, physicians don't even question that. The only thing they question is whether or not NPs should be able to call themselves Doctor.

Actually, if you look around, a LOT of physicians are questioning the direction of the NP/DNP movement (you know, that whole push towards equivalency, equal reimbursement, etc.). Take a look around the internet and you'd be surprised with the amount of info you'll find.

[mbreaz1]

So every medical encounter is a matter of life and death? You don't see ANY patients that will not die if not seen? Hmm.

If I'm not in a life or death situation, I'd rather NOT see a biology major who might do something to screw up my body even more. I'm taking it that you would be okay with it?

You have also argued that something is better than nothing before. You told me that independent practice is okay for rural areas where a physician is not available. You continually contradict yourself.

[mbreaz1]

Actually, if you look around, a LOT of physicians are questioning the direction of the NP/DNP movement (you know, that whole push towards equivalency, equal reimbursement, etc.). Take a look around the internet and you'd be surprised with the amount of info you'll find.

They however don't question the equality of outcomes, I will say it again. Only YOU question that.

[dgenthusiast]

You have also argued that something is better than nothing before. You told me that independent practice is okay for rural areas where a physician is not available. You continually contradict yourself.

Hmm. I don't recall saying that. If I did, it might've been in the context of doing so after many years of training rather than few.

It's funny that you point out that I contradicted myself in a post while you seem to do that every other post. For example, you say NPs will save money but then argue that they should be reimbursed equally as physicians. Another example: you say NPs have adequate training to practice independently but you're not okay with M4s doing to as well (you either keep avoiding that question or respond with "Who cares about M4s?!").

[dgenthusiast]

They however don't question the equality of outcomes, I will say it again. Only YOU question that.

They do question the equality of outcomes. They also question the training. It's not just me saying these. If you looked in other threads even on allnurses, you'll see many in nursing profession itself raise the same concerns that I have.

So, clearly, it's not just me that's questioning this. You're wrong about that part.

[dgenthusiast]

This is starting to feel like an AIM convo now with these rapid responses hah!

[mbreaz1]

Hmm. I don't recall saying that. If I did, it might've been in the context of doing so after many years of training rather than few.

It's funny that you point out that I contradicted myself in a post while you seem to do that every other post. For example, you say NPs will save money but then argue that they should be reimbursed equally as physicians. Another example: you say NPs have adequate training to practice independently but you're not okay with M4s doing to as well (you either keep avoiding that question or respond with "Who cares about M4s?!").

I argue for equal reimbursement, not increased reimbursement. What you can't stand is that I would advocate physicians having their reimbursement lowered. And yes, nobody really cares about M4s. You are the only one who cares about them because you claim to be one. What I have argued is very consistent. I support an experience requirement for certification for NPs, and I support lowered reimbursement rates for physicians.