Physician Hostility

Hellllllo Nurse, BSN, RN · Feb 25, 2004

Do physicians deliver better care than Advanced Practice Nurses?

http://www.nursingadvocacy.org/faq/apn_md_relative_merits.html

The media sometimes suggests that physicians deliver better care than Advanced Practice Nurses (APNs). Is that true?

Not according to most scientific studies, which have found that care by APNs is as good as or better than that of physicians.

Some recent press articles have openly disparaged or devalued the care of APNs relative to that of physicians. And the government's slogan for their "Take Your Loved One to the Doctor" media campaign completely ignored APNs.

However, the following studies and articles show that the care provided by APNs merits at least as much respect as that of their physician counterparts.

Midwife care equal in morbidity at a lower cost, with more favorable outcomes and fewer interventions

June 2003 -- The American Journal of Public Health published a study funded by the US Agency for Health Care Research and Quality of low-risk patients receiving collaborative/birth center/midwifery care who had comparable morbidity, preterm birth, and low-birth weight rates to patients receiving physician only care. Collaborative care also resulted in more favorable outcomes and a lower cost to the health care system through spending less time as an in-patient, fewer C-sections, episiotomies, inductions, and vacuum or forceps assisted lady partsl births, and more prenatal services delivered despite the lower cost. more...

Nurse-midwives transfer embryos at least as well as gynecologists

May 2003 -- A clinical trial of 102 patients randomly assigned to receive embryo transfers from nurse-midwives or gynecologists found that clinical pregnancy rates were similar--31% for midwives and 29% for gynecologists. The study subjects had a high acceptance rate of midwives on a questionnaire. Bjuresten, K., Hreinsson, J. G., Fridström, M., Rosenlund, B., Ek, I. & Hovatta, O. (2003). Embryo transfer by midwife or gynecologist: a prospective randomized study. Acta Obstetricia et Gynecologica Scandinavica, 82 (5), 462.

London patients rate nurse-led GYN clinics significantly higher than physician-led clinics

April 2003 -- London scientists found that nurse-led GYN clinics had significantly higher patient satisfaction scores than physician-led GYN clinics. Patients rated nurse-led clinics higher in quality, competence, provision of information and overall satisfaction. Miles, K., Penny, N., Power, R. & Mercey, D (2003). Comparing doctor- and nurse-led care in a sexual health clinic: patient satisfaction questionnaire. Journal of Advanced Nursing, April, 42 (1), 64.

Multiple studies find no differences between care delivered by Nurse Anesthetists and Anesthesiologists

2002 -- See the American Association of Nurse Anesthetists' web pages comparing the care of Certified Registered Nurse Anesthetists to that of Anesthesiologists. A number of studies have found no significant differences in patient outcomes based on professional background.

Meta-analysis: NP patient satisfaction higher and care equal to or better than MD care

April 2002 -- In a meta-analysis of 34 clinical studies published in the British Medical Journal by Horrocks, Anderson & Salisbury comparing care by NP's and physicians, researchers found that patients were more satisfied with their care if it was delivered by a Nurse Practitioner (NP) than by a physician. Compared to physicians, NP's read X-rays equally well, identified more physical abnormalities, communicated better, gave patients more information and taught patients how to provide self-care better. NPs also "undertook more investigations" and spent significantly more time with patients, 14.9 minutes vs. 11.2 minutes for physicians.

Nurse experts interviewed on nurse practitioner and physician care differences

January 14, 2002 -- Linda Aiken Ph.D., RN and colleagues give a compelling interview to Medscape on differences in care delivery between nurse practitioners and physicians.

Physicians: higher patient satisfaction; NP patients: lower blood pressure in study

January 2000 -- M. Mundinger et al. from Columbia University School of Nursing published a randomized clinical research study of 1316 patients in the Journal of the American Medical Association (2000). The study compared care between nurse practitioners and physicians. Patients answered a satisfaction questionnaire after initial appointment and were examined 6 months and 1 year later. At six months, physicians received a significantly higher satisfaction rating (4.2 vs. 4.1 on a 5.0 scale). There were no utilization differences, and the only health status difference was that patients with high blood pressure who were cared for by nurse practitioners had significantly lower diastolic blood pressures.

Advanced Practice Nurses: better compliance, higher satisfaction in meta-analysis

November 1995 -- Brown & Grimes from the Univ. of Texas at Austin School of Nursing published a meta-analysis of 33 randomized studies comparing the outcomes of primary care patients of nurse practitioners (NPs) and nurse midwives (NMs) with those of physicians in the journal Nursing Research. Patients of NPs had significantly greater patient compliance with treatment recommendations compared to physicians. In controlled studies, patients of NPs had greater patient satisfaction and resolution of pathological conditions than patients of physicians. Most other variables were similar. NMs used less technology and analgesia during labor and delivery than did physicians, and the two groups of providers had babies with similar outcomes.

NPs--better patient education, care continuity, knowledge about disease, less waiting

October 1995 -- Langner & Hutelmyer published the results of a patient satisfaction survey of 52 HIV-infected primary care patients at an urban medical teaching clinic in the journal Holistic Nursing Practice. Patients of nurse practitioners "fared more favorably" in clinic waiting time, provider knowledge about the disease, continuity of care, and patient education when compared to physician providers.

http://www.cnn.com/2000/HEALTH/01/05/nurses.vs.doctors/

Study: Nurse practitioners equal to doctors in some cases

Proponents of nurse practitioners say their training places greater emphasis on disease prevention

January 5, 2000

Web posted at: 3:35 p.m. EST (2035 GMT)

--------------------------------------------------------------------------------

In this story:

'High quality, competent providers of primary care'

'I do have limitations'

Findings and drawbacks

RELATED STORIES, SITES

--------------------------------------------------------------------------------

CHICAGO (CNN) -- Nobody says, "I have a nurse's appointment," but a controversial study suggests patients who have asthma, diabetes or high blood pressure and receive primary care from nurse practitioners fare just as well as those treated by doctors.

The study was published in this week's Journal of the American Medical Association, which also carried an editorial warning against reading too much into the findings.

VIDEO

CNN's Rhonda Rowland reports on the use of nurse practitioners in many medical practices.

Real 28K 80K

Windows Media 28K 80K

The editorial said it is unclear whether the results of the six-month study -- which involved mostly poor, Hispanic women in their 40s -- are representative of the population at large or whether the results would be the same over longer periods, when more complex medical problems might arise.

'High quality, competent providers of primary care'

The study involved 1, 316 patients who visited a hospital emergency department or urgent care center within the Columbia Presbyterian Medical Center system in New York.

Of the patients, 510 were assigned to doctors while 806 were assigned to nurse practitioners.

After six months, it was determined that patients in both groups got equal benefit medically and were just as satisfied.

Who are nurse practitioners?

* Registered nurses with advanced, specialized training in primary care

* Often practice medicine without doctor supervision

* Tend to spend more time with each patient

* Licensed in all 50 states

* Can write prescriptions in every state, although four -- Pennsylvania, Georgia, Michigan and Ohio -- require a doctor to co-sign the order

* About 65,000 nurse practitioners work in the United States

Read the study comparing nurse practitioners with doctors

Proponents of nurse practitioners say their training places greater emphasis on disease prevention, risk reduction and empowering patients to care for themselves.

"This study adds strong science to earlier studies that suggest nurse practitioners are high quality, competent providers of primary care who can achieve the same health outcomes physicians can," said the lead author, Mary Mundinger, professor of health policy and dean of the Columbia University School of Nursing in New York.

Dr. Wilma Lee, an obstetrician/gynecologist at the Emory Clinic in Atlanta, which was not involved in the study, agrees that six months is not long enough for an accurate accounting of health benefits, but says the findings match what she's seen in her own practice.

"The average ob/gyn practice is more similar to this population because it is overall a well practice, they're usually patients who are not acutely ill," she told CNN.

'I do have limitations'

Mundinger said more than 100 studies had been conducted over the past 30 years measuring nurse practitioner competence among patients from all walks of life, in all parts of the United States and with all age groups, including children.

"In the context of all those other studies, this strongly suggests that nurse practitioners with other populations will do just as well," she said.

Kathryn Rowan, a nurse practitioner at the Emory Clinic, is encouraged by the findings, but does not think they suggest nurses should replace doctors.

"Personally, I would never want to be in a position where I didn't have a physician to consult with," she said. "I've been doing this for a number of years and feel I do have limitations."

Most of the patients in the study were Hispanic women

Findings and drawbacks

The study, conducted between 1995 and 1997, found:

* The nurse-practitioners' patients fared as well medically -- measured by breathing capacity in asthmatics, blood-sugar control in diabetics and blood pressure in people with hypertension -- as the doctors' patients.

* The two groups of patients also had similar rates of referrals to specialists, hospitalizations and costs, and they were equally satisfied with caregivers.

"This study is a remarkable accomplishment, the most ambitious and well-executed comparison of nurse practitioners with physicians," an expert not involved in the work, Dr. Harold Sox of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, said in the accompanying editorial.

But Sox said the patients were a select population -- they were younger, mostly female, Spanish-speaking and on Medicaid -- and that a six-month study may not have been long enough to see the full spectrum of complex medical problems such patients could face.

Correspondent Ronda Rowland and The Associated Press contributed to this report.

Dave ARNP · Feb 25, 2004

PA-C, DO -
I am an ADN RN, and several of the terms you listed are familiar to me. In fact, I have done tutoring on SIADH.
Personally, I prefer to see an NP. Generally, they spend much more time w/ their pts, and do much better assessments and histories. And..... they don't have that "I can't be bothered" attitude that so many docs have.

Helllllo Nurse,

I am so glad I wasn't the only one who recognized those terms. I beat ya though, I got ALL of them .

Would you ever have dreamed that little ol RN's and NP's would be able to grasp these concepts?

Shocking... I know.

-Dave

Dave ARNP · Feb 25, 2004

You're my HERO!

I hunted an hour for that article. Googling isn't my strong strength, ya know

:kiss YOU ROCK!

-Dave

Do physicians deliver better care than Advanced Practice Nurses?
http://www.nursingadvocacy.org/faq/apn_md_relative_merits.html
The media sometimes suggests that physicians deliver better care than Advanced Practice Nurses (APNs). Is that true?
Not according to most scientific studies, which have found that care by APNs is as good as or better than that of physicians.
Some recent press articles have openly disparaged or devalued the care of APNs relative to that of physicians. And the government's slogan for their "Take Your Loved One to the Doctor" media campaign completely ignored APNs.
However, the following studies and articles show that the care provided by APNs merits at least as much respect as that of their physician counterparts.
Midwife care equal in morbidity at a lower cost, with more favorable outcomes and fewer interventions
June 2003 -- The American Journal of Public Health published a study funded by the US Agency for Health Care Research and Quality of low-risk patients receiving collaborative/birth center/midwifery care who had comparable morbidity, preterm birth, and low-birth weight rates to patients receiving physician only care. Collaborative care also resulted in more favorable outcomes and a lower cost to the health care system through spending less time as an in-patient, fewer C-sections, episiotomies, inductions, and vacuum or forceps assisted lady partsl births, and more prenatal services delivered despite the lower cost. more...
Nurse-midwives transfer embryos at least as well as gynecologists
May 2003 -- A clinical trial of 102 patients randomly assigned to receive embryo transfers from nurse-midwives or gynecologists found that clinical pregnancy rates were similar--31% for midwives and 29% for gynecologists. The study subjects had a high acceptance rate of midwives on a questionnaire. Bjuresten, K., Hreinsson, J. G., Fridström, M., Rosenlund, B., Ek, I. & Hovatta, O. (2003). Embryo transfer by midwife or gynecologist: a prospective randomized study. Acta Obstetricia et Gynecologica Scandinavica, 82 (5), 462.
London patients rate nurse-led GYN clinics significantly higher than physician-led clinics
April 2003 -- London scientists found that nurse-led GYN clinics had significantly higher patient satisfaction scores than physician-led GYN clinics. Patients rated nurse-led clinics higher in quality, competence, provision of information and overall satisfaction. Miles, K., Penny, N., Power, R. & Mercey, D (2003). Comparing doctor- and nurse-led care in a sexual health clinic: patient satisfaction questionnaire. Journal of Advanced Nursing, April, 42 (1), 64.
Multiple studies find no differences between care delivered by Nurse Anesthetists and Anesthesiologists
2002 -- See the American Association of Nurse Anesthetists' web pages comparing the care of Certified Registered Nurse Anesthetists to that of Anesthesiologists. A number of studies have found no significant differences in patient outcomes based on professional background.
Meta-analysis: NP patient satisfaction higher and care equal to or better than MD care
April 2002 -- In a meta-analysis of 34 clinical studies published in the British Medical Journal by Horrocks, Anderson & Salisbury comparing care by NP's and physicians, researchers found that patients were more satisfied with their care if it was delivered by a Nurse Practitioner (NP) than by a physician. Compared to physicians, NP's read X-rays equally well, identified more physical abnormalities, communicated better, gave patients more information and taught patients how to provide self-care better. NPs also "undertook more investigations" and spent significantly more time with patients, 14.9 minutes vs. 11.2 minutes for physicians.
Nurse experts interviewed on nurse practitioner and physician care differences
January 14, 2002 -- Linda Aiken Ph.D., RN and colleagues give a compelling interview to Medscape on differences in care delivery between nurse practitioners and physicians.
Physicians: higher patient satisfaction; NP patients: lower blood pressure in study
January 2000 -- M. Mundinger et al. from Columbia University School of Nursing published a randomized clinical research study of 1316 patients in the Journal of the American Medical Association (2000). The study compared care between nurse practitioners and physicians. Patients answered a satisfaction questionnaire after initial appointment and were examined 6 months and 1 year later. At six months, physicians received a significantly higher satisfaction rating (4.2 vs. 4.1 on a 5.0 scale). There were no utilization differences, and the only health status difference was that patients with high blood pressure who were cared for by nurse practitioners had significantly lower diastolic blood pressures.
Advanced Practice Nurses: better compliance, higher satisfaction in meta-analysis
November 1995 -- Brown & Grimes from the Univ. of Texas at Austin School of Nursing published a meta-analysis of 33 randomized studies comparing the outcomes of primary care patients of nurse practitioners (NPs) and nurse midwives (NMs) with those of physicians in the journal Nursing Research. Patients of NPs had significantly greater patient compliance with treatment recommendations compared to physicians. In controlled studies, patients of NPs had greater patient satisfaction and resolution of pathological conditions than patients of physicians. Most other variables were similar. NMs used less technology and analgesia during labor and delivery than did physicians, and the two groups of providers had babies with similar outcomes.
NPs--better patient education, care continuity, knowledge about disease, less waiting
October 1995 -- Langner & Hutelmyer published the results of a patient satisfaction survey of 52 HIV-infected primary care patients at an urban medical teaching clinic in the journal Holistic Nursing Practice. Patients of nurse practitioners "fared more favorably" in clinic waiting time, provider knowledge about the disease, continuity of care, and patient education when compared to physician providers.
© 2003-2004 The Center for Nursing Advocacy, Inc. All Rights Reserved.
http://www.cnn.com/2000/HEALTH/01/05/nurses.vs.doctors/
Study: Nurse practitioners equal to doctors in some cases
Proponents of nurse practitioners say their training places greater emphasis on disease prevention
January 5, 2000
Web posted at: 3:35 p.m. EST (2035 GMT)
--------------------------------------------------------------------------------
In this story:
'High quality, competent providers of primary care'
'I do have limitations'
Findings and drawbacks
RELATED STORIES, SITES
--------------------------------------------------------------------------------
CHICAGO (CNN) -- Nobody says, "I have a nurse's appointment," but a controversial study suggests patients who have asthma, diabetes or high blood pressure and receive primary care from nurse practitioners fare just as well as those treated by doctors.
The study was published in this week's Journal of the American Medical Association, which also carried an editorial warning against reading too much into the findings.
VIDEO
CNN's Rhonda Rowland reports on the use of nurse practitioners in many medical practices.
Real 28K 80K
Windows Media 28K 80K
The editorial said it is unclear whether the results of the six-month study -- which involved mostly poor, Hispanic women in their 40s -- are representative of the population at large or whether the results would be the same over longer periods, when more complex medical problems might arise.
'High quality, competent providers of primary care'
The study involved 1, 316 patients who visited a hospital emergency department or urgent care center within the Columbia Presbyterian Medical Center system in New York.
Of the patients, 510 were assigned to doctors while 806 were assigned to nurse practitioners.
After six months, it was determined that patients in both groups got equal benefit medically and were just as satisfied.
Who are nurse practitioners?
* Registered nurses with advanced, specialized training in primary care
* Often practice medicine without doctor supervision
* Tend to spend more time with each patient
* Licensed in all 50 states
* Can write prescriptions in every state, although four -- Pennsylvania, Georgia, Michigan and Ohio -- require a doctor to co-sign the order
* About 65,000 nurse practitioners work in the United States
Read the study comparing nurse practitioners with doctors
Proponents of nurse practitioners say their training places greater emphasis on disease prevention, risk reduction and empowering patients to care for themselves.
"This study adds strong science to earlier studies that suggest nurse practitioners are high quality, competent providers of primary care who can achieve the same health outcomes physicians can," said the lead author, Mary Mundinger, professor of health policy and dean of the Columbia University School of Nursing in New York.
Dr. Wilma Lee, an obstetrician/gynecologist at the Emory Clinic in Atlanta, which was not involved in the study, agrees that six months is not long enough for an accurate accounting of health benefits, but says the findings match what she's seen in her own practice.
"The average ob/gyn practice is more similar to this population because it is overall a well practice, they're usually patients who are not acutely ill," she told CNN.
'I do have limitations'
Mundinger said more than 100 studies had been conducted over the past 30 years measuring nurse practitioner competence among patients from all walks of life, in all parts of the United States and with all age groups, including children.
"In the context of all those other studies, this strongly suggests that nurse practitioners with other populations will do just as well," she said.
Kathryn Rowan, a nurse practitioner at the Emory Clinic, is encouraged by the findings, but does not think they suggest nurses should replace doctors.
"Personally, I would never want to be in a position where I didn't have a physician to consult with," she said. "I've been doing this for a number of years and feel I do have limitations."
Most of the patients in the study were Hispanic women
Findings and drawbacks
The study, conducted between 1995 and 1997, found:
* The nurse-practitioners' patients fared as well medically -- measured by breathing capacity in asthmatics, blood-sugar control in diabetics and blood pressure in people with hypertension -- as the doctors' patients.
* The two groups of patients also had similar rates of referrals to specialists, hospitalizations and costs, and they were equally satisfied with caregivers.
"This study is a remarkable accomplishment, the most ambitious and well-executed comparison of nurse practitioners with physicians," an expert not involved in the work, Dr. Harold Sox of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, said in the accompanying editorial.
But Sox said the patients were a select population -- they were younger, mostly female, Spanish-speaking and on Medicaid -- and that a six-month study may not have been long enough to see the full spectrum of complex medical problems such patients could face.
Correspondent Ronda Rowland and The Associated Press contributed to this report.

Roland · Feb 25, 2004

That's some really good stuff and will take some time to really digest. Also, PAC-DO the Law of Diminishing Returns is also relevent to your post. How many patients per thousand presenting in an ambulatory setting would manifest a rare condition? A good NP will know their scope of competency and refer out to physicians as needed. In addition, I noticed that you are a DO. Did you realize that the founder of Osteopathy Dr. Andrew Taylor Still was accused of heresy for his radical revelation from God about medicine? He was even prevented by the medical establishment from explaining the CONCEPT of Osteopathy at Baker University in Baldwin, Kansas, an institution to which he had donated hundred of acres of land and which he had PHYSICALLY helped to build. Still he practiced his new brand of medicine that utilized a more holistic approach and he prospered because it worked! What is more DO's have contributed procedure that could probably VASTLY improve our health care system. Unfortunately, in their desire to avoid the derision of more traditional, allopathic physicians they have abandoned many of the techniques that set them apart. Consider just one DO insite that might be useful:

"A study published in the peer reviewed British Journal of Medicine (Nicholas, AS, et al: A somatic component to myocardial infaction. BMJ 29(16):13, 1985) found that palpation of the thoracic vertebrae could reliably identify those with coronary atherosclerosis. Patients in this study received a standardized musculoskeletal examination by qualified osteopathic physicians within a week of a coronary angiography. Somatic dysfunction at the 4th thoracic vertebra had a 91 percent predicative value of at least FIFTY percent stenosis of one or more coronary arteries. Another study revealed that somatic dysfunction of the 1st through the 4th thoracic vertebrae was highly correlated with patients diagnosed with acute myocardial infarction veres controls. This was statistically significant to the level p<.0001 from holistic health and healing by mary anne bright rn cs edd p.>

My point is two fold. Firstly, MD's at one time said many of the same things about DO's as they now do about NP's. Second, abadoning those aspects of NP education that render it unique from the "medical model" may not be in the best interest of providing optimal patient outcomes.

caroladybelle, BSN, RN · Feb 25, 2004

How can an NP practice without knowing some of the more detailed pathophysiology taugth in medical schools? I mean if you are an NP, and the following terms are foreign to you, then my guess is you don't have the in depth knowledge necessary to practice as an independent practitioner.
Rapidly progressive glomerulonephritis (RPGN)
Focal Segmental Glomerulosclerosis (FSGS)
Carcinoid Syndrome
PTHRP secreting tumors of the lung
MEN I II and III
SIADH
Wegener's
Waldenstrom's macroglobulinemia
Her2/Neu
P53
Prader Willi
Finasteride
These are just off the top of my head, and are things that are common in my everyday vocabulary now, but were probably not known well to me as a PA-C when I was practicing. I would not have a problem hiring an NP in family medicine, OB, peds, but in IM, I would choose a PA, as well as in nephro, cardio, pulmo, gastro, any surgical field, and in EM I think the two are equal. But I worry about putting an NP in a rural setting alone because they have no supervisory requirements.

Uuuuhhhh, Sorry to disappoint you, but as an ADN nurse I am familiar with these, and have worked with most of them. But it does sadden me that YOUR school didn't familiarize you with them. It also teaches me to avoid PAs because of the quality of the education (not to mention the attitude towards nurses as fellow health care professionals).

But then, the last PA that I have seen was in a Dermatology office. I do see the NP at my Internists ocasionally.

PA-C, DO · Feb 25, 2004

I have no doubt that NP's satisfy patients, often to a level better than physicians. I have no doubt that NP's spend more time with their patients and make them feel more special. I did all those same things as a PA, and when I left to go to medical school I left behind a huge practice of patients that felt abandoned and without their "doc". But I was personable and caring because I knew I had to be in order to compete with doctors who knew a lot more than I.

But just because a patient feels satsified does not mean they received the best care. Lets face it, 90% of patients that come to the FP's office could probably leave after a consultation with the LVN and do just fine. But the other 10% need a bit more that PA's and NP's cannot provide. The biggest problem though is that you have to be trained to know what you "don't know" in order to know you don't know it!!! Its easy as an NP to say that you will refer out things when you need to, but how do you know you need to?

And don't kid me Terminator, you didn't know half the things on that list, because some of them are just molecular medicine that is not taught even in medical school. So one of you knew and taught about SIADH. Whoopteee....!!!! That was by far the most recognizable term on the list.

And what do DO's and MD's alike have in common? They each put in 4 years with the EXACT basic sciences, yet DO's receive an additional 2 years of manipulation that they can either choose or not choose to embrace. I personally find about 50% of manip rather useless, while the other 50% is useful. DO's also have the same number of required years in residencies, and are licensed to practice autonomous medicine and surgery and worthy of the title physician in all states. We also take the USMLE, the same licensing exam that would in my mind put this whole argument to rest were NP's actually allowed to take it. Personally, I would be more than happy to vote to allow you guys and PA's to take all 3 steps of the USMLE. I say this because even being a PA prior to medical school, if I had tried to take one of these exams, I would never have passed. I simply did not know "what I didn't know" until I made it to the higher level and started paying some real dues.

And Roland, how hard was it for you to come up with a study in the British Journal of Medicine about osteopaths?? Were you even aware that osteopathic physicians in Britain are not equivilant to US DO's? They are not medical doctors in England, and are the equivilant of a chiropractor. I think the good NP's out there are going to be really dissappointed when you renegade NP's make your whole profession lose its scope of practice. Your profession could easily find itself without a legal right to practice unsupervised if you try to force the issue of equality, but my guess is that the AMA and AOA will eventually allow you to make your own bed and lay in it. That is, I think they will allow you to take the physician licensing exams that you would have about a 5% pass rate on or less. Then it really won't be an issue. And yes, I may actually hire an NP sometime, but I will allow them no more and no less autonomy than my PA. Why is it that PA's far surpass NP's in starting and average salaries anyway? My guess is that physicians still tend to be the sole hirers of NP's, and they know the true value of each profession.

zenman · Feb 25, 2004

Posted by PA-C, DO: Your profession could easily find itself without a legal right to practice unsupervised if you try to force the issue of equality, but my guess is that the AMA and AOA will eventually allow you to make your own bed and lay in it.

You're a confused young fellow aren't you? I don't think NPs want to be equal to MD/DOs otherwise they would go to medical school. Why would they want to take a step backwards...they offer something different. Hell, my own very ill parents prefer their NP over the MD.

Why is it that PA's far surpass NP's in starting and average salaries anyway?

Have you studied the economics of health care?

My guess is that physicians still tend to be the sole hirers of NP's, and they know the true value of each profession.

Sole hirers...guess again. True value of each profession...you got to be kidding me.

zenman · Feb 25, 2004

Some insight in medical education:

O.T. Bonnett, M.D., author of Confessions of a Healer: The Truth From An Unconventional Family Doctor, in talking about his peers, stated that, "Unfortunately, like most physicians, they were trapped into rigid patterns of thought, belief, and action bought on through years of the intellectual brainwashing that has passed for medical education. Actually, doctors are poorly educated! Their education consists of training along a very narrow path, and they wear huge intellectual blinders as they go. Anything appearing in their intellectual peripheral vision is suspect, frightening, and likely to be ignored."

More from Dr. Bonnett..."The doctors finally graduate and finish training but with little real skill in applying it in life situations, for they have been trained not to get close to or familiar with their patients. Highly trained as they may be, they are virtually isolated from feelings, the humanity of their patients, and the world in general. Many new doctors are, therefore, both frightened and defensive."

And more..."Physicians have a vested interest in rejecting new ideas. Part of the reason for this is that most doctors have little training in deductive thinking. What serves as thought is mostly recalling, with accuracy, what has been previously memorized."

And finally..."One of the most compelling reasons physicians reject new ideas is fear of change and the need to protect their block of medical information, which serves as their clearest bridge to others and the world."

In all farness to the medical profession, this type of behavior probably happens in many professions.

Physicians are also socially ignorant as they have their nose buried in books during a formative period in their life when they should be out hiking across Europe or engaged in other fun activities! While in business school, a fellow student and recently retired thoracic surgeon, admitted that he had no social skills outside the operating suite. "I'm useless at parties," he told me!

zenman · Feb 25, 2004

Posted by PA-C, DO: I think physicians just cannot possibly understand how an NP can even feel comfortable practicing solo medicine.

Maybe because nurses are used to spending so much time directly taking care of patients rather than popping in and out.

I mean come on, even right out of residency a physician is very green, and often needs to seek the advice of other physicians.

And can NPs do the same? And many MDs have even sought the advice of nurses, LOL!

How can an NP practice without knowing some of the more detailed pathophysiology taugth in medical schools? I am at least willing to admit that NP's probably get decent pharm and clin med courses compared to medical school, but without the detailed histo, path, embryo, immuno, how can one really feel confident that they know enough to practice alone?

And how much of this detailed info is retained except for the specific area of practice? I have the occasion to ask questions of MDs and many freely admit that they do not remember...and we all just have a good laugh and someone looks it up and refreshes all our memories!

I just can't see why NP's feel the need to try and be autonomous when they are more useful working with physicians.[/quotes]
They are trying to be NPs, not MDs. They bring a difference to the profession.
I mean if you are an NP, and the following terms are foreign to you, then my guess is you don't have the in depth knowledge necessary to practice as an independent practitioner.
Rapidly progressive glomerulonephritis (RPGN)
Focal Segmental Glomerulosclerosis (FSGS)
Carcinoid Syndrome
PTHRP secreting tumors of the lung
MEN I II and III
SIADH
Goodpastures
Wegener's
Waldenstrom's macroglobulinemia
GP41
Her2/Neu
P53
Prader Willi
Pregnenelone pathway
Finasteride
These are just off the top of my head, and are things that are common in my everyday vocabulary now, but were probably not known well to me as a PA-C when I was practicing. And the list could go on forever.
You had to dig for these. In 30 + years I've rarely seen some of these diagnosis and most MDs probably have not either, again unless they were in that specific clinical area.
PA school is way more rigorous than NP school and we all know that...
And you know this how? PA school might be more rigorous but that's so the PA can catch up to the NP knowledge base..or at least the part relevant to them.
But I worry about putting an NP in a rural setting alone because they have no supervisory requirements.
Are you aware that this is one area where MDs do not want to practice. Once again, nurses step in to fill the gaps...and you're complaining that someone is trying to provide a service to patients?

PA-C, DO · Feb 25, 2004

So nurses fill gaps huh? Don't give me that crap, because if it became popular overnight for docs to want to go to rural areas, NP's would find some reason to feel that they are more qualified to be there. You say you want to fill niche markets where physicians won't go, but your rhetoric is more about convincing physicians and the world that you are just as qualified.

And why do you feel the need to lump all physicians into this mold of being inconsiderate, socially inept, uncaring, incapable...???? For your information, MD and DO schools alike have changed for the better over the past decade. The "patient centered" process is the model followed by most medical schools to train physicians how to deal with people, and evaluations are constantly done to be sure young physicians are capable of using all the qualities you seem to think we don't have.

But whoever it was that said the list I provider earlier is a list of rare diagnoses, I thank you for proving my point. None of those things listed were more in depth than basic pathophysiology, and many were not even diagnoses. Some were just common terms used to describe features of disease. For instance p53 is a tumor suppressor gene that goes awry in many and most cancers. Her2/neu are tumor markers that give a poorer prognosis in breast Ca. In fact, each of these things listed are hit heavily on even step one of the USMLE. So any of you ready to take the USMLE?

It is arrogant of you to think that because you are better socially with patients that you don't need to know the basics of path. You guys are dangerous, and you are slowly alienating yourself from the medical world. Don't forget that physicians own and operate medicine, and you can do nothing without their support. Good luck to those of you who understand your limitations and embrace the team approach.

Dave ARNP · Feb 25, 2004

Please do not insult other members.

Please do not make false statements that NP's are dangerous.

Please be aware of the TOS you agreeded to when you joined the site.

-Dave

So nurses fill gaps huh? Don't give me that crap, because if it became popular overnight for docs to want to go to rural areas, NP's would find some reason to feel that they are more qualified to be there. You say you want to fill niche markets where physicians won't go, but your rhetoric is more about convincing physicians and the world that you are just as qualified.
And why do you feel the need to lump all physicians into this mold of being inconsiderate, socially inept, uncaring, incapable...???? For your information, MD and DO schools alike have changed for the better over the past decade. The "patient centered" process is the model followed by most medical schools to train physicians how to deal with people, and evaluations are constantly done to be sure young physicians are capable of using all the qualities you seem to think we don't have.
But whoever it was that said the list I provider earlier is a list of rare diagnoses, I thank you for proving my point. None of those things listed were more in depth than basic pathophysiology, and many were not even diagnoses. Some were just common terms used to describe features of disease. For instance p53 is a tumor suppressor gene that goes awry in many and most cancers. Her2/neu are tumor markers that give a poorer prognosis in breast Ca. In fact, each of these things listed are hit heavily on even step one of the USMLE. So any of you ready to take the USMLE?
It is arrogant of you to think that because you are better socially with patients that you don't need to know the basics of path. You guys are dangerous, and you are slowly alienating yourself from the medical world. Don't forget that physicians own and operate medicine, and you can do nothing without their support. Good luck to those of you who understand your limitations and embrace the team approach.

zenman · Feb 25, 2004

Posted by PA-C, DO: So nurses fill gaps huh? Don't give me that crap, because if it became popular overnight for docs to want to go to rural areas, NP's would find some reason to feel that they are more qualified to be there. You say you want to fill niche markets where physicians won't go, but your rhetoric is more about convincing physicians and the world that you are just as qualified.

Why do I get the feeling that MD/DOs are not reading their own journals? It has yet to be popular for Docs to go AWAY from the more financially feasible, ie, big city areas. This is also kinda like MDs doing acupuncture because so much money and patient visits are made in that arena. In ten years MDs will probably claim that they invented acupuncture...just kidding! You're really hung up on this "NPs feel thay are more qualified bit" aren't you. May I respectfully suggest some counselling...there are also Psych NPs you know and they charge less than psychiatrists. You'll feel better.

And why do you feel the need to lump all physicians into this mold of being inconsiderate, socially inept, uncaring, incapable...???? For your information, MD and DO schools alike have changed for the better over the past decade. The "patient centered" process is the model followed by most medical schools to train physicians how to deal with people, and evaluations are constantly done to be sure young physicians are capable of using all the qualities you seem to think we don't have.

Based on the fact that I was already working in hospitals when you were born, I didn't feel that I was qualified to say what I did. That's why I was quoting one of your respected peers. Personally, I like DOs better and have been known to tell one, "Oh, a real doctor!" And I aware that medical schools are improving; some even have nutrition courses now as well as how to interact with patients.

But whoever it was that said the list I provider earlier is a list of rare diagnoses, I thank you for proving my point. None of those things listed were more in depth than basic pathophysiology, and many were not even diagnoses. Some were just common terms used to describe features of disease?

You have already mentioned this; they were in my Guyton's if I remember correctly. Now do you get my point...as to why I'm "zenman?"

It is arrogant of you to think that because you are better socially with patients that you don't need to know the basics of path.

We know the basics as you say. At what point do NP level practitioners need to be able to quote Guyton's? Again I was telling you what a physician friend (yes I socialize with those rascals), said about how he was just useless at parties because he spent all his time in the OR and didn't know crap about the real world. I don't just make this stuff up. I don't have writers either.

You guys are dangerous, and you are slowly alienating yourself from the medical world.

Are you reading all those studies showing that lowly trained NPs function just as well as MDs? God, it must be a shock!

Don't forget that physicians own and operate medicine, and you can do nothing without their support. Good luck to those of you who understand your limitations and embrace the team approach.

Where in the world are you hiding? Big business owns medicine and you better wake up quick. You do very little without a high school graduate in another state telling you what you can order and what they will pay!

Team approach does not entail one ego maniac who is socially inept trying to run the team.

Try to relax a little, Doc; we are just having a conversation here. Let me suggest something. Learn all you can using your left brain, then forget all that crap...I mean facts and figures...and let your right brain kick in after years of being asleep. Now, you'll be a force to be reckoned with!

Thanks MD Terminator, but I'm a martial artist and this isn't much of a fight, just an educational session.