In article ,
"Robert Green" wrote:

You're also a nurse, which could color your thinking about nurse
practitioners a tad. I have no such dog is the hunt, only the experience
that my last NP was fighting way above her weight and it showed. As soon as
a doctor got on the case, the problem went away. I also had extensive
discussion with my GP/MD about NPs and he had some serious reservations,
too, about the delta in training and experience.

I haven't been a nurse for over 10 years now and since I have a lowly
AD degree in nursing it is no skin off my nose.


I've been told (but have not verified) that Medicare *requires* a licensed
MD to be on site at one clinic I visit even though most patient interactions
are with NP's who have narcotic prescribing authority in my state.
Not actually. Those are mostly state requirements and they vary widely
from having a doc to oversee to not.
Medicare pays NPs two ways. If they want to bill under the doc's
MCaid number at 100% of what a doc would get, then the doc has to be on
site (which makes sense). If they bill at the NP rate of 80% of the
docs rates then they don't have to be onsite.



As for the studies showing NPs do just as well as MDs: "Physicians say this
study is hardly the last word on the debate. An article published in the
American Medical Association Journal of Ethics early this year said the jury
is still out on whether nurse practitioners are as effective as doctors -
and that previous studies on the topic, including the 2000 JAMA study, were
lacking or incomplete."

And yet you call MY merely having the initials coloring my thinking?
Heck under that criteria, maybe you should be running in the other
direction screaming. (grin).


As NPs strive for fewer restrictions and the ability to work independently,
who's to say the outcomes won't change drastically (for the worse) when the
doctor is not present to handle emergency cases? It's quite a contentious
subject in the medical field as I am sure you know. It will be interesting
to see how it shakes out since the need for GP's in the boonies is only
increasing and the supply falling way short of demand.
Largely contentious on both sides beause of the money involved.
Also, it is contentious (and deservedly so as I pointed out) in some of
the more specialized areas such as ERs, ICUs, etc. We'll see how the
research works out. In those areas I think there will be a hierarchy
established of what patients/duties the NP can safely undertake.
Much to the chagrine of the NPs, docs call the field (PA and NPs)
physician extenders. I think that will be more of an apt description in
hospital than in the community.



Still, I think it's a little "hopeful" to think NPs can hope to replace MDs,
even for general practice work. From the same article:

"even the most skilled advanced practice nurses receive just a fraction of
the medical training family practice doctors get - a maximum of 5,300 hours,
compared to doctors' 20,000 hours, according to an analysis by the American
Academy of Family Physicians. And they don't go through grueling residency
programs like doctors do, the physicians say, leaving them less prepared to
handle emergencies or unusual conditions."

Which constitute a breathtakingly small percentage of the patient
population (especially in FP situations). As for grueling residencies,
there has been no differences in outcomes between newly minted docs (who
did their residency under an 80 hour week restriction) and docs with 10
years or more experience who did their residencies under the old
essentially unlimited hours experience. (Although to my mind, the most
interesting part was the seeming lack of difference I would expect just
because the older doc has 10 years of experience... but I digress.) You
know if it was any other endeavor, residency would be classified as
hazing.




Fifteen THOUSAND extra training hours has to mean something, and from what
I've seen, at least *some* NP's aren't up to the tasks they have been
assigned to.


Yeah and you haven't ever run into an incompetent doc anywhere.
--
³Statistics are like bikinis. What they reveal is suggestive,
but what they conceal is vital.²
‹ Aaron Levenstein