So the director of psychiatry and some senior psychiatrists at my hospital are in a funk. It appears surrounding hospitals are offering incentives (increased salary and other benefits) to attract psychiatrists to their institutions - and its working. So far, we have lost four psychiatrists in the past five months to nearby hospitals that are offering those incentives. Those facilities also hire FNPs and PMHNPs whereas my hospital doesn't. Clearly there is no way for my hospital to match the benefits of the other competitive institutions and there is a huge shortage of psychiatrists in the area. So... I suggested that we start hiring NPs.
Bad move.
I never seen so much hatred from health professionals. One of the senior psychiatrists actually shouted at me for coming up with "a stupid idea." He then proceeded to tell me how many years of schooling and training he's had out of some need to compare himself to a PMHNP. What really bothered me is that the director said, "I HATE Nurse Practitioners" as if that was a good enough reason for not hiring them in our facility. What they think is what they think; I can't change that. But would I be overstepping boundaries if I drew up a presentation at our next meeting to outline the benefits of hiring NPs? The chief director of psychiatry will be present at the next meeting and I really think its worth a mention.
Exactly! MD and NP are two totally different things. So why do you feel the need to post articles that prove NP's have similar or better outcomes as MD only? Because if you want to get technical its MD/NP care teams that have the highest outcomes!
I do read research articles. I don't really feel it's necessary to post my set of research because you can just counter with your own. If you really want to go there I am more than willing to do so. But it's neither here nor there. That is why I have mainly been speaking about the general ideology of midlevels. The ideological is cheap labor.
I seriously doubt you have read a single legitimate study on this topic. If you had you would have posted a link by now. So yes, I want to go there, please share your "research".
You didn't answer my question. Do you search around your local grocery/convenience stores and buy the most expensive gallon of milk?
This is the reason why I originally stated to "think twice" about going the NP route. Because MD and NP greatly differ in the their opinions of the role of NP in practice. It's not that MD's are anti NP they are just concerned about patient safety and outcomes by having more NP's.
You are partially right. They are not many negative NP research articles. Hmmm I wonder why? lol maybe certain groups have a vested interested in only publishing research that paints NP as sunshine and rainbows! I do have two articles. lol yes only two! I'm trying post them but I don't think you could view them because I have a paid membership. I'm trying to find a free version of those articles.
This is the reason why I originally stated to "think twice" about going the NP route. Because MD and NP greatly differ in the their opinions of the role of NP in practice. It's not that MD's are anti NP they are just concerned about patient safety and outcomes by having more NP's.
Who cares if MDs and NPs differ in their opinion? Their "concern" isn't with patient safety (that's just what they use for an excuse). Their concern is their bottom line because the research has demonstrated there is no need for concern about safety.
You are partially right. They are not many negative NP research articles. Hmmm I wonder why? lol maybe certain groups have a vested interested in only publishing research that paints NP as sunshine and rainbows! I do have two articles. lol yes only two! I'm trying post them but I don't think you could view them because I have a paid membership. I'm trying to find a free version of those articles.
Yes. The JAMA must have a vested interest in the nursing agenda.
Mundinger, Mary O., et al. "Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial." Jama 283.1 (2000): 59-68.
I found this article interesting. It summaries the research comparing MD v NP. I think it's important to note that the authors point out. The fact that there is little research focusing on adding more MD's. I think that's telling. How about we research outcomes replacing NP with MD? But then that would never happen because MD's aren't cost effective. Just goes to show what is most important. The all mighty dollar!
Lol! Google Mary O Mundinger! She def has a vested interest in being pro NP!
So.......you're saying you will only accept research conducted by an MD?
Look, I don't have a dog in this race. I just think your points lack merit completely. Many states require physician oversight in mid-level provider care, which negates your point regarding lower quality of care coming from an NP or PA. With regard to the shortage of MDs in primary care and mental health, it's a double edged sword. More people are seeking care, more people are retiring. It's just the direction we're going. Instead of campaigning against the NPs and PAs with whackadoodle logic, campaign for better standards in education. If your concern is safety, lobby for educational minimums to ensure graduates have reached a level of competency you are comfortable with.
Your rants here do nothing to lend to your credibility. On one hand, I find myself wanting to agree with certain things (for instance, I do agree that diploma mills damage us as a whole), but I will never agree relying on an NP for my care is less safe than an MD.
And yes, for the love of God, YES, it is cost effective (would it make you feel warm and fuzzy inside if I said "cheap"?) to have NPs in practice. You know what you get for that "cheap labor"? A prevention-minded, holistic provider. The nursing model is, in my opinion, a better approach to healthcare.
When I first was drawn to nursing, it was midwifery that called my name. Outside of the U.S., midwives are the primary providers in pregnancy and birth. OBs only get involved when there is a complication. And guess what? We, relying on OBs and hospitals for almost all births, rank 37th in terms of good birth outcomes here in the U.S. The nursing model of care, midwifery model of care, in birth creates healthier, better outcomes.
I actually anticipate that the future of primary care, in the hands of nurse practitioners, might see similar outcomes. It's just a hunch, and no, I don't have science to back that up, but consider how strongly we focus on education, holistic care, and prevention, doesn't it just make sense?
I found this article interesting. It summaries the research comparing MD v NP. I think it's important to note that the authors point out. The fact that there is little research focusing on adding more MD's. I think that's telling. How about we research outcomes replacing NP with MD? But then that would never happen because MD's aren't cost effective. Just goes to show what is most important. The all mighty dollar!
Ok a few things.
It is an interesting article as the approach is slightly different from many of the other article on the topic as it compares NPs with physician residents, which we know is a major issue of late because hospitals are no longer able to exploit residents with 120 hour weeks.
The article is based in Canada, which as you know has a single-payer system much different from here in the US.
Lastly, the article outlines a large number of studies that all demonstrate the quality care of NPs via a number of markers. Look through the results of the studies presented, you wouldn't immediately assume it was a slam-dunk for NPs? But it's written from a physician point-of-view and (at times in the discussion) seems to almost distrust its own data.
As far as our discussion about "research" the paper you posted states it pretty clearly: there is only a single negative study done in 1979 and it was "negative" because it asked physicians to rate NPs; patients in that same study rated NPs well. You posted a link to 36 examples of the quality care of NPs. Weren't you arguing the other side?
Crazynut
160 Posts
Lol I will post some articles. I would like to see your articles as well including all acknowledgements conflicts of interests and funding sources :)