Physician Hostility

Dave ARNP · Feb 25, 2004

But Zenman...

To quote HelllloNurse.

You can't have a battle of wits with an unarmed opponent.

:D:

-Dave, proudly a NP.

CatskillNP · Feb 25, 2004

PAC-DO

you said: "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? "

A couple of responses come to mind.

First, how on earth do you get into a car, turn the key and drive, safely, without knowing the detailed intricacies of the workings of an automobile???

With that said, do you really believe that all MD's and PA's understand all the intricacies in all of medicine before they go and practice? Do they remember them today?

I've been in nursing for 20yrs, 10 as an NP, 6 years in Emergency medicine. Now in family care. The vast majority of medicine is routine wellcare with the minor acute's thrown in. That's the majority. Now every now and then, there is a case that doesn't go the way I'm expecting, and after further investigatin, it becomes clear that the requirements for evaluation exceed my knowledge base, then I refer to a specialist.

I've worked side by side with MD's for all those years, and know a handfull that were so full of themselves, they thought they knew what you're describing as a knowledge base. They were dangerous people. They wouldn't ask, they knew it. Make a mistake? Sure they did, often, waste money in tests? Yup. I've asked questions, been given very detailed answers, went home and researched the info on my own, and the MD wasn't even close!!!!

MD hostility, I personally find it rare, it's worse on the political side, and it's worse because it's about money and power. NP's are approaching practice issues as continuity of care, meeting needs of outlying communities. MD's are looking at the loss of revenue's, in areas they won't work, and how to keep control of health care.

I'm the first to admit the medical model provides a gold standard of medical information volume. I do not agree that they are the only ones able to meet the needs of health care in a safe, economical, caring manner.

Medicine ran the roost for decades, maybe even longer, they created a situation based on "keep the outsiders unknowing". Now that others are learning that health care isn't a mystery, the Medical profession realizes the jig is up and working like a mad man to get the horse back into the stable. It's too late, the horse is out, now it's time to sit together and create a health care system where care, skill, economics and the patient come first. There is money, enough for all to live comfortably. S

anonny27 · Feb 25, 2004

wouldn't want to offend anyone

prmenrs, RN · Feb 25, 2004

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.

PA-C, DO · Feb 26, 2004

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.

Dave ARNP · Feb 26, 2004

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

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.

PA-C, DO · Feb 26, 2004

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.

zenman · Feb 26, 2004

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.

Dave ARNP · Feb 26, 2004

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

fergus51 · Feb 26, 2004

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.

PA-C, DO · Feb 26, 2004

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. :)

fergus51 · Feb 26, 2004

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.