hogger

No I finished med school several years ago kind sir. I know what most MS4s are capable of. Much more than SRNAs or at least the ones going into anesthesia are especially if they’ve already done a few anesthesia or cc rotations. If one is going to argue equality in anesthesia it’s better to say that physicians are often overtrained for it than to say physicians are morons and nurses are here to save the day with efficiency and intelligence. Nobody is going to buy into that argument nurses have their place in health care as do physicians both are equally important but the command pole ends with the physician and it likely always will those who don’t lie it should have gone to medical school Also im sure that med students come up to you on a daily basis and say “hey dr greenbolt why don’t you teach us things” The tides will likely not change as much as you think if you seriously believe anesthesiologists will go out of business there are always cases that will require physician performance even if many cases can be done by a crna which nobody is arguing about eye roll

Right dude. Nobody is going to believe that CRNA school better prepare people for anesthesia than a physician residency. Give me a break nobody is buying this garbage. Med students are pretty involved in rotations at the place I work at. Just as involved as the crna students. I do agree that those not doing anesthesia do anesthesia for an easy rotation but those actually going into it go full on same schedule as CRNA students and at my shack are usually better prepared The part about talking MS4 through nerves and jitters? Yeah sure most ms4 lost their nerves and jitters of the real world half way through MS3. They don’t need crna students to hand hold them through rotations — to add nursing students and crna students are also gradually given more autonomy that’s how training works it’s not just medical students and residents who get hand holding I feel like every post you put on this site downplays the role and importance of physician education. Did you not get into medical school or something and maintain a chip on your shoulder? Do you feel inferior to MDAs? Are you made they make upwards of 4-5 while you bite the crums of 1/3 that? I guess that would bother me too since the APPs make a fraction of what we do. That seems to be the only logical answer to your thought processes toward physicians. I wonder if this air persists in clinicals, if so I am sure surgeons just love dealing with that type of non sense. Dont forget if it wasnt for physicians you would have no one to give anesthesia to. But it is 2019 and large sums of nurses tend to think they can run hospitals independent of physicianS Its easy easy for those who have not done medical training to downplay it but in real life MSs have as much required out of them as PA NP crna students but this is a nursing website so I digress.

So essential PAs can now set up shop in whatever specialty they want in these states? It’s confusing since they aren’t trained in a specific area as NPs are. Can a PA in ND open up a rheum clinic and dish out 5 figure drugs that a family practitioner or internets cannot due to insurance requirements?

I never understood the nursing montage in regards to them thinking med students do nothing for four years.

I personally have more bite with midlevels than CRNAs at least CRNA school provides adequate training for most things. The fires my colleagues and I have to put out from NPs on a daily basis is disheartening

Med students touch patients from day one for four years. I do agree with the part you say though that for anesthesia training much of the knowledge gained in MD school is not required since excluding complications non pain fellowshipped MDA do not really diagnose chronic illness (but still need to know what they are for repercussions of the disease on giving anesthesio as you know. If you want to argue that all of medical school is not needed for safe distribution of anesthesia I will agree with you. The amount of cases over 1-1.5 years of clinicals at most anesthesia schools is not equal to the three years of pure anesthesia/critical care of an anesthesia residency. I left out the intern year since it’s an intern year that probably does not need to exsist but does serve it’s purpose in understanding medicine in general. Not all crna sxhools teach peripheral blocks also TBH though if CRNA want full autonomy go for it. If you think you can do heads and hearts day one out of CRNA school then be my guest but I’ll def will be referring any of my patients to centers that have MDA backup or MDA core for their own safety. I would bet many crna schools send students to facilities too small to even have heart lung marchines/ CTS ! What are you gonna do day 1 when you need to give anesthesia to that open heart even though you never saw one in school. Many places don’t even let non chest fellow MDA in those patients

Essentially the studies done by ASA show MDA is better. Ones done by AANA show crna are the same but not counting for near misses where anesthesiologist saved the day. Plus the patients taken care of by CRNA are just not as sick. Nobody is doubting crna ability for most cases but for all? That’s pushing it since MDA usually do heads hearts and trauma. Sick patients requiring surgery are often transferred to tertiary centers with MDA

This is like one of the most condescending posts I’ve ever seen. You talk to people like they are children if you disagree with them yet you are only a student crna. He makes valid points in stating that crnas have a fraction of the training of an anesthesiologist. They are good for bread and butter cases and nothing else unless they have a physician supervising them. But then again an ms 3 can do anesthesia for a bread and butter case as they let us back in medical school while they played on their phones

I bet the surgeons you work with never make fun of you in the lounge. I’m sure your supervising anesthesiologist also loves you with that nurse is god attitude. Or are you still a student at MTSA

I am not of anesthesiologist specialty but have to agree with what offlabel says. A lot of my surgeon friends work well with both crna and physicians but think it’s ridiculous that nurses are trying to blur the lines between anesthesiologist physicians and nurse anesthetists. If there was any question of competences then one should be OK with being called an anesthetist.... not further earning a doctorate in nursing and then attempting to change title to anesthesiologist. Its nothing more more than an attempt to blur the lines between physician and nurse in order to confuse patients. if CRNA are comfortable in their role then why hide what you are? It makes my surgeon friends chuckle and glad I work outpatient and not with CRNAs attempting to be real doctors and making the CRNAs who enjoy their profession as is.

Usually if the first place one here’s of something is on a nursing forum it is no less than propaganda for midlevels. We hear all the time the need for physician oversight is so great but not everyone wants to blindly do it now since many of your kind graduate from online nursing programs. Most I know only supervise pas of nps they knew before school. But if what you said was true true it must be why dr hospitalist groups are offering us ridiculous salaries since we aren’t needed

I know these are overblown statings since I work for a similar type of company and know of this not happening. Actually many hospitals are limiting midlevel scope due to declining educational standards and hospitals have picked up on this and even in states that require no collaborate hospitals subsequently still do. This is a forum however so truths are not to be expected to be prevelent plus making it sound as consults come to an area since midlevels are the hospital service is one of the more ridiculous things I have heard lol. I’ve never seen that on s job recruitment ad!

It is possible at some places but not most. Not at mine for sure. Nor do the studies explicitly state that. It’s still a comparison of residents vs midlevels who had probably never rotated in the icu before this rotation. So they are actually doing well keeping up

No I would agree having nps around is great but the major np groups are not welcome to the limitations that need to be in place. We couldn’t function without mlps since there are too many patients and not enough of us to go around. But we can’t forget that nps only make up a tiny amount of pcps even and in most places they are managed by attendings. When it comes to primary care it’s a moot topic often. It’s hard to really do a terrible deed to a patient and monitor outcomes in those studies. Too much moving of patients around to different providers , referrals, non compliance etc. I think most people could manage htn and dm adequately which is what most studies monitor. Since that makes up most mortality. But the things missed by mlps are missed very often and those aren’t really monitors by studies since the disease occurances are so infrequent the missing of RVHtn in a younger person barely shakes the statistics. Hence why I am for mlps but they should not be given equal rights nor work alone. But again physicians are part to blame because they love the cities and the coast and most sadly it’s our fault the interior is left to MLPs often i think we all know a burger in hand daily means more than your pcp

here is the study i see most often quoted. it states acnp and residents all share supervision by fellows and attending. this is the type of garbage that gets thrown out there. literally everything gets the final day through attending physicians yet midleveld act as if they did all this on their own. in addition they compare medical residents on icu rotation. why is it acnp vs residents? they aren’t even fully trained yet https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944779 ”Sharing of fellows and attending physicians was equal’’ honestly can’t wait for the day an np run hospital emerges and the crap hits the fan when no consults are available

lack of proof does not mean it does not exist. only studies i’ve ever seen inpatient are mid levels vs residents or fellows and the best part was all were supervised by attending. Never understood why nps on inpatient wards need to compare themselves to those still in training especially when both had attending physicians managing their care plans. as as we all know the government always signs into affect ludacris laws but the dominos will soon fall my friend. i think an rn could manage a patient if an attending was hovering over their every move as in the inpatient studies midlevels often quote

Most surgeons are at least adequate. 3-4K hours training times 5 years after medical school makes the most mundane person into someone who can at least perform mediocre. The same cannot be said of 500 hours of an NP. But I always found it funny that nurses critique surgeons the most when there probably are less than a handful that could point on any more than 10 anatomical structures in an open colectomy luckily we have scrub techs

No we are doing well thanks. But I am glad an fnp student can call an entire system out for having a hiring problem. We have no shortage of MLPs not a shortage of students from online fnp programs to say no to when they ask us to precept

Of all provider types it’s the nps who are the most resistant to understanding their short comings. Hence why very rarely will I supervise one

Nobody in my system hires walden or any other for profit online Np graduate. We have had terrible experiences and I have no idea how these people got prescriptive authority. If a nurse asks me about becoming an FNP I tel them to go to a good school and that if they go to a crap school such as Walden or whatever I will not hire them nor will any of my colleagues no matter how good of a nurse they were before.

Overall the current supervision way is silly. I am not against it being done away with. Would really be easier not to have to worry about charts being signed for no reason. If I ever have co worker NPs in the same clinic they would have their own liability maintained by the hospital only and without my worthless sig on the chart, so if they mess up I won't be dragged to court with them for their fault. That part I am not contending with since it will more than likely happen state by state sooner or later. There are enough PCP patients for everybody at this moment and more than likely more NP will be pushed into federal funded work places anyway and the commercial patients will be shuttled to IM/FP physicians. The market will play its capitalistic game for benefit of patients. I more contend that many APCs think they can often do everything a fully trained IM physician can with less education. They maybe can the easy 80% of cases, but the other chunk requires a very deep knowledge of basic science to understand, as I have not found many APC have (some probably do, the self motivated ones). The physician control over NP practice is completely monetary due to the way it is set up to bring docs in money for signing charts. If any control at all was to be maintained it would be better done as we do with PAs where we sign off individual skills and tasks they are able to perform, but that is another story. The way the nurses tout these studies is somewhat unethical though, since to the uneducated eye they make it seem they= physician, which is just not true and I feel for patients that are misled into that thinking. So the political and monetary sin hammer swings both says. I also cannot leave out the note that NPs claim they are here to reduce healthcare costs, yet, many also argue for equal pay for services rendered to that of physicians. This also shows the nursing lobby has monetary motives which are at least as great as the physicians. On a third note, was it not the nursing lobby which posted prohibitory statements against medical students whom have graduated medical school providing medical care without a residency in severely rural and underserved areas? While touting that new graduate NPs with much less training should be completely autonomous? I would pick a newly minted MD/DO over a newly minted NP any day of the week, with or without residency as one to supervise due to the magnitude of clinical hours and training required to graduate medical school (6k+ vs I think 500-1200 hours). this is another showing of unscientific thinking on the part of the nursing lobby. But at least we do agree that its silly to have docs sign charts for no reason other than to collect a buck.

He does not present a very good argument. Neither side has done (questionable if they ever will) enough studies to compare all the outcomes. As part of an in house research presentation I had to do my third year of IM, we put together all of the information from np/md/do comparisons and put it on a posterboard for a presentation at a conference. The conclusion we reached (even though we just gathered data from secondary sources) was that NPs are just as good as managing the common/simple complaints, but no data was found on more complex issues. Most of the studies pretty much covered just Htn, lipids, run of the mill primary care stuff. Did have one that was very thorough and compared inpatient issues as well but the fine print at the end stated it compared physician/NP teams to physicians only, not just physicians vs NPs. There is no conclusive data either way for everything. Some of the nursing studies pump that they are as good at everything we are just by basic parameters but it does not really hit where it counts, which are more complex illness and patient's with tons of stuff going on. How anybody would put together a thorough study of everything beats me. Closest I have seen are levels of morbidity comparisons but again how does one really measure that? I left out any personal experiences since that's null and void to the argument, but have had way more unnecessary referrals from NPs than from physicians (for GI stuff at our teaching hospital). For anybody to state there is conclusive data for equal care in all aspects is silly, unless one can present info for every single condition out there, which probably isnt possible. But for the most common stuff, yeah, NPs can have it, it does not take 7 years post under grad to treat blood pressure and lipids. More of the complex stuff it sort of does.

1. in response to offlabel- we do get more weak consults from np/pas by a moderate margin, that I take loose note of during outpatient referrals for stuff like persistent heartburn, achalasia- like- symptoms and what not. Many times its just Hpylori that nobody thought of testing for and what not. And a few other things I can think of. Only keep track of this stuff since I did quite a bit of homework on advanced practice providers taking up much of the primary care track which turned my interest into a specialty to sort of wall off any competition I guess for patients. But GI is more interesting than IM anyway to myself. If it wasnt for APPs (what they call them at the teaching hospital im at) I probably would have stuck with IM since who wants to be in training for another 2-3 years making table scraps lol. Not really sure how to do a head to head study though,, ,that seems difficult. In other news they frown heavily on pumping propofol in academic medicine here, even though most community hospitals do it pretty often. Especially frowned for upper endos... we usually use versed and fent so we dont go from 0-60 on the knockout scale. Colos sometimes prop but even then anesthesia is to keep it as light as possible. Not an anesthesia expert but we still, as in any procedural specialty, have to have a decent idea of what the drugs do, and even if we completely wanted to be oblivious we had to have learned them in med school, rotations, ICU rotations, ER rotations, and all I have to do is look over my shoulder to see bottles of the good stuff laying on the table. They also at least at this facility dont let CRNAs work in certain specialties such such as CTS, neuro surg, and transplant, so at least here they are not completely in the same regard as the MDAs. They do have a CRNA school here though somewhere in the area that does rotations here. no idea what its called or anything about it, just know they are with their preceptor people in on some scopes and what not. I think even MDA have to do a 1 year fellowship to get in on the bigger chest procedures, at least here.

yeah more than likely. all my fp buds got pretty good gigs though and I don't see that going away. Much of it was for providing supervision to NP/PAs in large clinic settings. It seemed even in the independent np states they said many hospitals always want an attending physician there with them for QA on some of the less seen cases. There is some anecdotal evidence though pointing toward primary care being more complicated than it has in the past, with places adding in genetic counseling and a few other ancillary services. in IM we had a whole section on genetics and had to do some loosely set up rotation in it with genetic expert people or whatever they are called now. I don't think they will ever completely get rid of primary care physicians, there will always be some market for them. Whether they maintain majority or not though is up to dispute either way. I see you are in crna school, I will give them credit for nearly always doing a good job though. Do not see much difference between mda/crna in on the cases I do, but then again I am not really doing many high risk procedures besides the occasional banding on some cirrhotic patient that's hemoing from EV. If I remember from past rotations they usually had an MDA in on most super-high-risk cases, but I never really paid much attention to what they did diff than CRNAs. I work with more crna/mda residents than people who have completed mda residencies since everybody wants a day off from the life of difficult to sit there and pump benzos and read books for scopes.

I think I could treat every metric provided in every single NP vs MD/DO comparison study half way through my third year of med school. Now do a study that compares treatment and management of actual difficult to manage diagnoses and if equal I might take this seriously. Don't get me wrong, as a resident I love working with NP/PAs, at least the ones who do not have the God complex this website person seems to have. I can dribble a basketball, and even dunk it, but that does not mean that i am Lebron James and as adequate at everything in the world of basket ball. My truck also drives just as well in a straight line at 60MPH as does a Porsche 911, doesnt mean it can do everything else as well. At least I am in GI and I don't see nurses trying to nab scopes and biopsies from us very soon lol.