pianoman511

There is really no way to monitor v leads with a 3 lead system. With the good old einthoven's triangle, the idea is that the three leads make a triangle which has a center point corresponding to the center of the chest. When looking at precordial leads, the V leads are one electrode and the "combination" of the standard leads are the other "electrode". Without all three leads that virtual electrode would not be in the center of the chest, so the precordial leads would not be looking "through" the heart. The reason to titrate the nitro to pain free is to resolve as much of the ongoing myocardial ischemia as possible. You kind of hit on it in your post when you said that the depression resolves when the pain resolves. They want the ischemia limited and also make the coronaries as dilated as possible. As a sidebar, with marked ST depression in V1 and V2 it might be more of either a right sided or even some posterior involvement. A septal infarct would more likely be seen in V3 or V4.

Valproic acid (theoretically) increases the level of GABA in the brain. Since GABA is an inhibitory neurotransmitter it may decrease pain signals in the central nervous system. http://www.biopsychiatry.com/gaba/pain.html

And what's the problem with practicing with physician oversight ? PAs are not advocating for independent practice rights since the degree (just as NP) was conceived with the idea that they would be mid-level practitioners with enough education and training to handle most (but not all) of the tasks a physician would perform. We have heard from many providers thus far that the physician oversight they receive serves more as a resource for care and not a hindrance to care.

Specialists require an internal medicine residency before their specialty training which does require the same amount (more in the case of family practice) than a PCP. No doubt NPs are doing a SIMILAR job than their PCP colleagues but it's not the SAME job. When a physician starts working they have completed many years of post graduate training where they are supervised (residency). And no, they aren't sleeping most of the time. Also, the experience during residency is completely different than on the job experience as an NP. If independent practice comes for all states, then NPs will have practice rights immediately after school ends, so the experience argument is null.

Almost all PA programs at this point (except around 3 - maybe less at this point) are masters programs (two years) which requires both a bachelors and health care experience which within itself is more clinical hours than what is in the ENTIRE DNP program (since it's not a clinical doctorate, but a NURSING practice doctorate). And why would you get a DNP if it afforded the same practice rights as a tmasters program ? (and many are online...)

I don't know the exact number of clinical hours, but the average is 80 hours a week for residents, resulting in about 4,000 clinical hours in a year (2005 numbers, but i don't think there has been much change - http://www.npr.org/templates/story/story.php?storyId=4512366 ). The shortest residencies are three years resulting in 12,000 clinical hours for residency. Then add in 3rd and 4th year rotations which generally mirror that of residency since students rotate with residents (can't post the article link - subscription service) which would add about 8,000 more - so actually 20,000 hours not including any extra time during 2nd year since some schools add that on. I would empasize that it doesn't take a smarter person to go to med school, just someone willing to sacrifice many years of their life in training and subsequent debt (personal, financial, social, etc). In terms of financial management, there is no linking to any proof that what you are saying is anything other than opinion (which is fine, since that's what most of us are posting). Bottom line, anyone can run a practice with lower overhead regardless of NP or MD/DO status. If one is an independent practitioner, they can charge whatever they want and manage their practice any way they want - but the costs will still be there.

No problem. NY State - http://www.nydoctorprofile.com/ Doc Finder - http://www.docboard.org/docfinder.html (links to other states) In the past there have been insurance companies which had direct links to doctor profiles in their provider searches, but the direct links appear to not be there any more (when i went looking again).

They already do, most states have doctor profiles that the public can freely access and some insurance companies link to those profiles when people go to the site to find a new pcp.

I won't be, but the public needs to know the differences in training and realize this can provide for suboptimal care. In addition if they go see a DNP ("doctor") then they need to know that it's not the same as an MD/DO (DOCTOR).

Just because doctors make more money does not mean they have more disposable income. I am not in any way saying i am better or smarter than any other profession. Nor would I have any idea how to do an accountant's job or vice-versa. What I am saying is that medicine is far more different and the stakes are higher than accounting. In addition, the cost of business is higher in the medical field. It is B.S. to continuously bash physicians as being inferior business people and elevating NPs as superior because you think all physicians have a god complex. Many physicians are getting their MBAs and/or hiring practice managers with business degrees and yes they listen to those people.

Experience is NOT the most important factor. If you are practicing independently then you have no one to "train you", something that is the whole idea behind a residency and is especially important if you have very little clinical training and would benefit from physician oversight. Sounds like what the nursing profession is advocating in BSNs and DNPs - in fact that's exactly what they are looking to do. It's all about the money.

Ok....i thought i did - it's no different than my argument all along. If someone does not have the training and education to perform the job then people will die or get suboptimal care.

More disposable income ? How do you arrive at that conclusion ? Also, medicine IS more challenging, otherwise college would be shorter, training would be easier, and there would be no standardized testing. I am not talking about someone being smarter than someone else - but to go through school and training and amass the knowledge to practice medicine is a task that is definitely more challenging than an accountant's job. Numbers on a page do not change, people have an infinite number of variables, many of which cannot be measured or factored in when a diagnosis is made or when a treatment is prescribed. I am just wondering why you have this opinion that physicians don't know how to manage their money ? I am sorry, but just because someone is an NP doesn't make them experts at practice management or money management and doesn't make them selfless enough to say that they will charge enough to break even and only see 5 patients a day.

They will be the same for an NP assuming independence as a practitioner. If the NP is charging less then why would they be able to see the same number of patients in a day ? Unfortunately one year of experience is a lot different than one year of "college" (btw medical school is not "college"). In addition, one year of working in a low acuity community hospital is a lot different than an urban hospital. I can learn in the office/hospital that you give antibiotics for strep throat or diuretics for CHF, but if I don't understand why they work then there's alot of things that can go wrong. And unfortunately, people don't make that call. It cost more than that per year in taxes to train, staff, and pay for apparatus for a fire department - yet it is paid nonetheless.

Four years of undergraduate training, four years of medical school, and 3-10 years in residency (average 3 for FP, 5-6 for IM). As for student loan debt, remember that most other professions either enter their chosen field earlier or allow for participants to work or make some income during school - not an option in medical school. There IS a disproportionate burden on physicians. And yes, medicine is more challenging than other professions. Also, this cost of business will affect NPs too.