Thursday, April 15, 2010

Let The Frenzy Begin

Primary care doctors are in need. There is no debate about that. There really is nothing in the new health care reform bill that was passed to fix this problem. There is no question about that, either. What does this all mean? Well, it means it's time for a competition frenzy.

Here is example number one found on an article at KevinMD. It seems the Retail Clinics, you know the ones that just wanted to treat sore throats and ear pain, want a new "service strategy". Now they want to get into chronic disease management. Hmmm, that's interesting. Remember when their whole premise was just to help out with the quick and easy things and not compete with the local primary care doctors? All lies.

Here is example number two found in an AP article. Read how one nurse practitioner tells patients she's just like a doctor "except for the pay." NPs and PAs (yes, I know you are not mentioned in either article) are very sensitive groups. I have many that are friends and subscribers to the Placebo Journal who I risk losing by saying anything negative about them. I am going to be very careful here.

First, it is not about the word EQUAL. We are all created equal. It is not about intelligence as an NP I am thinking about right now (and I am sure many, many more) is smarter than me. It is about the word DOCTOR. If you want to be a doctor, then by all means, I implore you to become one. We need you. The training is a bitch and; unfortunately, a gauntlet you have to get through. You don't get that in NP school. You will be all the better for it, though. I really comes down to paying your dues. You just can't call yourself one because you, well, just want to.

Nurse practitioners came about to strengthen the healthcare system by making them "physician extenders" not "physician competitors". By going this new route the NP group has made this relationship uncomfortable at best. I will get "hate email" over this but I didn't do anything. The NPs are blatantly changing their strategy, demanding to be called doctors and are in direct competition with us yet I know they will rip me for pointing this out. The bottom line is the you are not a doctor. You are an nurse practitioner. It is a fact and it is not demeaning to say it. It is just a term. Get over it. I call myself the KING of medicine but just because I call myself one doesn't mean I am one. Or does it?

12 comments:

Pat said...

Doug let's be clear, you ARE the King of Medicine, undisputed. Now on to the non-doctors...
...maybe it's time to start a new publication: "Placebo Assistant" or "Placebo Extender"?

Seriously, as a med student I was part of a state lobbying effort to limit the scope and authority of nurse practitioners who were seeking to be doctors without all that burdensome medical training. It was in the early Nineties, the glory days of Primary Care when we were all destined to become comfortable, successful medical homes for grateful happy patients.
Fast forward bast the budget games Clinton played, the budget lies Bush told, and even before the Dear Leader, I have undergone a radical change of heart. It is being Quixotic I know - I know, dammit, stop snickering! - but I no longer think that government has any proper role in sanctioning medical providers. Docs have played along for the decades to protect the nobility of their art even as they let protective government become coercive government. Look at you previous "Discipline Numbers" story for a perfect example.

Now I say let the buyer beware, and let the individual disciplines determine how really is a neurosurgeon or cardiologist. If you want your TURP performed by the local NP, shaman, New Age healer, local cable access head thumping preacher, or actual board-certified urologist, then YOU do the research, make the call, and settle the post-op with your lawyer. As usual, the parties that support big self-regulations ultimately cede their own autonomy to those less-qualified than themselves.

Hopefully NP's will start pushing to be licensed medical marijuana prescribers, so this will all start to make more sense.

Pat said...

"WHO really is a neurosurgeon or cardiologist" Sorry about the typos

pat said...

"WHO really is a neurosurgeon or cardiologist"

Sorry about the typos

Anonymous said...

Yep, once again you guys did this to yourselves. The ability to write scripts is what has made the midlevels feel so empowered to consider that they too are able to provide the same service physicians do. And now they have power in number and public "need" due to your shortage. Unfortunate really. It would be interesting to compare the cost/necessity of so many diag tests/med "coverage" by PAs/NPs due to uncertain diagnostic ability. Watch for over 25 home meds on a lot of these pts rolling in the door. Where's the oversight?

Anonymous said...

I am a PA and do not proclaim to be a doctor (or even want to be a doctor) but I do know lots (and I am sure you do to) of doctors that are lets just say "horrible" I know many PA's that suck also. but I do know some PA's who I would go to long before I ever saw a doctor. I don't understand how paying more for an education and "paying my dues" makes one a better practitioner or any better qualified to read a HBA1C or a HDL level. when I was in school we had the same classes (some with "med" students in the actual classroom with us) as the "med" students same professors, same notes and same tests, the only difference I saw was they got summers off and we didn't and they had two 3/4 years of rotations and we had 14 months of rotations (and they paid twice to three times as much as I did for their education)
Do I think I am better than a doctor? no I am not, I have my limitations. (and I tell my patients this all the time) but I also think that after practicing for 10 years that I can manage a simple diabetic just as well as my supervising physician can, (actually I can probably do it better cuz I am not rushing to see 100 patients a day to re-pay my student loans!) so we do have our place and are not useless even in chrinic care!

Anonymous said...

I have been a PA for 25 yrs and I also tell patients tht I "do the doctors job and get the nurses paycheck"and I do the doctors job because my bosses can bill for it,period.I get almost no medical supervision these days but boy do I get supervision if there is any flaw in my billable documentation.You MD's can have your feelings hurt by this but you're not running the show anymore,the bean counters are.

Anonymous said...

I'm still saying you guys overprescribe, overtest because of your minimal ability to diagnose, (which probably should not be in your realm either) Chalk up those health care dollars, or just cushion your employer's a**.

Anonymous said...

Everyone wants to be a Doctor, no one wants to go to medical school.

Anonymous said...

I bit. What's with that? Lazy? No dedication to the course of action? Please spare me the whining. Most of these folks want easy money and autonomy, don't we all?, the problem for pt care is that there is an over confidence in the midlevel's consideration of their ability to diagnose. So over do it in all realms, home meds, diag tests, whatever, and lets not forget to keep those employers happy.

Pat said...

ONe "Anonymous' had it right that the bean counters run the show now, and THAT is the doctor's fault.

Another 'Anonymous' got it wrong, claiming that doctors over-test and under-diagnose. It's called FEAR, and you might have it if you had invested half as much. When we did the hard, heavy lifting to even get into medical school, it was without the knowledge that greedy, vengeful patients abetted by lawyers and politicians would target us for bleeding every time an imperfect body reacted imperfectly. Take your unsupported sanctimony and peddle it to someone who doesn't know better - like your patients.

Anonymous said...

Ya know, think about it--being a mid-level is a great deal. They get to play doctor without all that icky, time consuming, life-killing training, and if they mess up it's SOMEBODY ELSE'S problem. What would be not to like? But seriously, there's a reason we go to school longer than they do. I regularly see too much testing, too many referrals, and just plain wrong diagnoses by midlevels both in the minute "clinics" and if you really want to hear something scary, our ER. Only one of the ER doctors still calls to admit patients, the rest of the time it's a midlevel who hasn't a clue and I have to go behind them and make sure they don't kill anybody. I think they've fired all the docs there. Sure seems like it anyway.

Anonymous said...

I am a lowly RN who feels strongly that MDs are Medical DOCTORs and NPs are NURSE Practitioners. There are certainly brilliant NPs out there who do an excellent job at what they do, but in the end, they do not have the same amount of schooling and clinical time that an MD has (this is speaking for 2 practitioners that graduating at the same time). Will an NP with 20 years experience have an advantage over a new grad MD? YES! But they are still a mid-level practitioner who should know better than to call themselves MDs (lawsuit, anyone??).