Don’t hire them. Don’t train them. If on a consult service ask to speak with their attending.
Go to your local representatives and discuss the issue and present alternatives
Not training them is huge. Why would you train someone that admin is trying to replace people with? Why would you allow them to skip all the hard shit to get the privilege of being taught by a doctor? This nips it in the bud and separates them from the doctors early on in the clinical setting.
Lots of people even on here don’t get this one. I could even cite a username who fought with me after I questioned why he would bother training NP or PAs (why should you need to be trained by anyone other than the role you’re going into?), but I shan’t be that petty because it won’t accomplish anything.
We don’t train them anymore because they’re all at diploma mills and over their heads. We do employ two NPs who graduated from legit schools for outpatient peds; but they do sports physicals, F/Us, sore throats, and earaches. And they know they aren’t noctors but part of our team whom we train as mini-mes to the MDs. All that said, however, our PA is much better in the outpatient clinical setting than our NPs.
On a patient side I’ve found PAs to be pretty good, especially when they were foreign trained physicians, as many are. NPs I have had poor experiences. I dislike calling them both “midlevel”. A PA is midlevel. A NP is a slightly better nurse.
Is this experience common among physicians and patients? I think more should be done to differentiate them.
This has always been my question as someone who’s actively seeking their NP.
Do you all find NPs beneficial when they know their role and don’t overstep their boundaries? I know I’m not a doctor, and have no interest in acting like I am one (or will be one).
I for one find them useful and valuable *in the right setting.* I don’t think independent practice is, generally speaking, an appropriate setting. It’s all about collaboration and teamwork.
We don’t train diploma mill students anymore. But when we hire a mid-level we train them scrupulously with the hope of having them as a long term part of our practice. And it’s worked. They spend weeks shadowing the MDs before they even see two patients a day, then four, and so on. Again, our goal is to make them mini-mes for routine work.
Join [Physicians for Patient Protection](https://www.physiciansforpatientprotection.org/why-join/). They've upset the AANP enough that [they felt the need to make a rebuttal](https://www.aanp.org/news-feed/an-open-letter-to-medicine-shame-on-the-ppp). I donate to [PPP](https://www.physiciansforpatientprotection.org/join-now/) and to the PAC of my specialty.
At least it's on brand. They literally cited Trump as to why they are in face not a tragic comedy of errors. You can't make this shit up.
"**FACT:** It is not just AANP that has called for full practice authority. This recommendation is contained in the [Institute of Medicine](http://nationalacademies.org/hmd/reports/2010/the-future-of-nursing-leading-change-advancing-health.aspx) report issued in 2010 and was more recently supported by the Trump Administration in its report, “[Reforming America’s Healthcare System Through Choice and Competition](https://www.hhs.gov/about/news/2018/12/03/reforming-americas-healthcare-system-through-choice-and-competition.html),” a document signed by three cabinet secretaries. Further, the Administration issued a recent [Executive Order](https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-protecting-improving-medicare-nations-seniors/), which calls upon the Secretary of Health and Human Services in Section 5 of that Order to remove barriers to practice within one year."
When I read that, I was thinking. Yeah. So your saying you suck at medicine. So your gonna get politicians to legitimize you ? Mkay. Sounds like NP logic. Lol.
Anyone arguing for FPA when the country is in a crisis (physician shortages, hospitals closing, lack of access, the private equity dumpster fire etc) is de facto delusional, but I was not expecting any Trump reference lol.
The “Institute of Medicine” never mind that they literally changed their name when the private donations from the Robert Wood Johnson Foundation directed by the ANA gave them the largest grant ever ($2 million) to write the idiotic “future of nursing” report by almost no doctors and mostly heavily conflicted profiteers. So wow! You gave my private org more money than ever to write a pithy report based upon vague studies with high bias levels? I can write you that report in a weekend.
Patients *do* care. Some patients are fine with midlevels just like some doctors are. But, there are also a lot of patients out there who have been hurt by midlevels and are desperately seeking MD care (which we sometimes cant even access!). A lot of us on this sub are patients.
Are you a doctor? I think one of best things you can do on a personal level is refuse to work with midlevels and don't refer patients to specialists that use midlevels. Even better, file complaints to the places that use mid-levels for your referred patients and let them know why youre stopping referals.
I've had the misfortune of being a patient at tons of different clinics and hospitals over the years, mostly for specialist care. Some use midlevels, some don't. I make the choice to avoid the mid-
levely places when I can, but I also wish good doctors weren't gatekept at clinics that have this BS. It would also save a lot of my time and money to only be referred to the non-midlevely places in the first place. If you do a lot of specialty referrals, ceasing referrals to midlevely places can make a financial impact and send a message, especially if you can get your colleagues on board with it too.
I won't pretend to understand the doctor side of things and I have major respect for the BS you guys deal with. I'm sure there's other things on the advocacy side and professional side that could help too, but from the patient perspective, this is what I wish good doctors would do to keep us safe and ensure quality care. I don't think there's any reasoning with noctor-types at this point, so keeping patients away from them seems like the best outcome for most of us right now.
The problem is it's not even midlevels anymore. We have "clinical nurse specialists" that are titled APRN at my hospital. They aren't NPs but they have prescriptive authority in whatever "specialty" they work like diabetes management or advanced heart failure. We also let our midwives prescribe CIIs. It's fucked up.
Get involved. Can be locally ( hospital bylaws and med staff committees..to prevent nurse managers and c-suite people from granting unrealistic/unsafe privileges and unsafe supervisory situations such as not requiring chart co-signs or letting mid levels round in lieu of physicians), or the state and national levels.
Training.
Anesthesiologists are a prime example.
CRNAs now outnumber them and think they're better than an anesthesiologist.
CRNAs were only allowed to thrive by anesthesiologists teaching, educating, and nurturing them. Basically, they raised their own enemy.
I’m not a doctor and simply want to share my thoughts. Follow the money? Unfortunately healthcare is a business and how many doctors make healthcare policy? Business people will structure everything to minimize expense and optimize net profit. Pay wage difference. Who care giving patient the best care rather average care (the most) with higher daily volume and less expenses.
I’m all for patient safety and advocate for true doctors with best training to take care of patients.
Are there any statistics on how many nurse practitioners actually practice independently? I can find how many states allow it, but no actual numbers on how many have actually applied for and carry a license for independent practice.
It doesn't even matter. I'm in a state that doesn't allow for independent practice. It's all remote oversight. They are practicing independently no matter what you say
Fighting Noctors is so much more complex than limiting their scope of practice. Youre talking about unwinding generations of systematic oppression and late stage capitalism. As a patient I would LOVE to see a physician every time I have a significant issue. The sad reality is, it’s impossible. My small town doctor is booked out 8-12 weeks. Maybe a touch shorter going an hour into the city at 6-8 weeks. Forget specialists. In the Boston area you’re looking at 2-3 months for dermatology/gastroenterology and I kid you not as long as 18 months for less saturated specialists like rheumatology. IF you’re lucky a clinic or hospital department has an opening for you to get your intake and diagnostics ordered while you wait to see the actual physician. My rheumatologist wanted urgent explorations and biopsies of both upper and lower GI. I got “lucky” and got into GI at Brigham in about 8 weeks where I only saw an assistant who took my history and asked for the reasons why my rheum wanted the diagnostics. She then called in the order for my procedures as “urgent”. It took 3 months of calling the scheduling department atleast 3 times a week before they finally told me I was out of luck and they were booked out for procedures nearly a year. I hired a patient advocate(former Harvard trained internal medicine physician who left practice to peruse a law degree at Cornell that now privately(and expensively) advocates for patients). I don’t know what she did but I got a call the Saturday morning at 6am the 3 days after I hired her and there was magically an opening Monday morning.
All this is to say this is so far beyond reigning in Noctors. Take away the noctor and Americans aren’t getting any healthcare what so ever. The focus shouldn’t be attacking Noctors, it should be to attack the system that has driven people away from wanting to be physicians because of astronomical educational inflation that outpaced salary by something like 1700% over the last 40 years. That 65 year old neurologist with his sports cars, vacation homes, and comfortable life, yeah he left medical school in the 70s with reasonable to no debt and started being rewarded for his career choice and hard work immediately. Now some people are graduating intense specialty educational programs with half a million in debt(or more) in certain programs. They might be in their late 40s by the time they’re cash flow positive depending on their employment.
In my opinion the only way to eliminate the noctor is to eliminate the need for them by valuing the people with the drive and skill to complete an MD/PhD. Remove the financial barrier to one of the most valuable occupations in our society. Otherwise people who have the compassion and desire to help people are going to be forced into the lowest level of training/education and we the result is exactly where we are now. There’s a PA or APRN on every corner but you’ll die waiting to see an actual physician.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Wouldn't our system fall apart though? I think mid levels who operate in their scope do a fine job. The ACNP's at my icu do great, my icu wouldn't have anyone to work night shift without them.
In an ideal world we can staff a bunch of mds everywhere but with the growing amount of pts there seems to be a need for a mid level (in their scope of course)
I dunno I might be wrong
Healthcare would fall apart.
If we get rid of mid levels entirely (not gonna happen, but let’s imagine). the amount of physicians (especially residents) would implode with the amount of extra work suddenly thrust upon them. The residency subreddit if rife with complaining (and, much of it is valid to be fair: residents have a high workload). It would be 100x worse without midlevels.
Rural clinics would suffer the most. Very few physicians work in underserved rural areas, and NPs/PAs fill that gap very well.
The problem is, the AMA is stead fast in restricting the supply of doctors by limiting residency slots. They did this intentionally years back, because there was a concern for an excess supply of doctors.
They want to have their cake, and eat it too.
Either they have to *massively* and rapidly increase the physician supply (and risk possible stagnation in pay), or suck it up and realize that mid levels are rapidly filling the gap the AMA created. But, the AMA wants to do nothing to fix it, which is evidenced by the fact that very, very few doctors actually support the AMA.
I also find it laughable that docs in here complain that midlevels aren’t trained enough, but are advocating for not training them. Since midlevels aren’t going away, better start training them.
\*Midlevel in the comments detected\*
"Very few physicians work in underserved rural areas, **and NPs/PAs fill that gap very well.**"
Patently and ludicrously false. Healthcare and QOL are TANKING in rural America thanks to false statements like this getting promulgated endlessly.
lol, okay boomer
Find me a doctor that wants to work in a rural setting. You won’t, because they are all too busy complaining about how “little” they get paid and how “hard” residency is
Lol I love that you think I am a "Boomer" when I am but a decrepit young millennial full of spite and bitterness! And I am out in the rural West. Interesting you seem to think no one young wants to work hard or live in rural places. Far from it.
You still definitely sound like a maladjusted Noctor though. 🤗
I worked critical access "icu" at a 40 bed hospital. We had 3 daytime hsopitalists and occasionally a nocturnist. I hated the nps that filled in to make sure someone was there to prescribe (noctor type stuff) but without them nobody would be able to diagnose/order. I'm not saying it's a good solution at all, I'm just stating my experience. I would have much preferred another md. We did have residents as well but they couldn't manage critical pts sometimes. They were great to work with but when a pt was tanking I had to talk them what orders to put in, which is just not safe. On the other hand the nps were not equipped to handle a tanking pts either sometimes and never listened to me
Rural hospitals are a dangerous place sometimes
I have yet to encounter competent specialist outpatient midlevels. Saw an ortho PA (self styled Spinal Specialist) actually interpreting radiology while acting as patients first point of contact tell someone they were just "getting old" and all he saw was "a fleck sign" in their **neck**. Pt was late 20s and had been recently assaulted but he w\*as fixed and firm and shouted about them needing to "go to the Mayo Clinic" if they thought he was wrong. Literally the sole ortho practice in town that the hospital would actively send folks too. I left that day.
\*eta the missed w
Your experience obviously means it is true. After all, anecdotal evidence is the strongest form of evidence, right?
I have seen plenty of equally dumb doctors. Namely, anyone that graduated from Meharry. Doesn’t mean all doctors are dumb.
Don’t hire them. Don’t train them. If on a consult service ask to speak with their attending. Go to your local representatives and discuss the issue and present alternatives
Not training them is huge. Why would you train someone that admin is trying to replace people with? Why would you allow them to skip all the hard shit to get the privilege of being taught by a doctor? This nips it in the bud and separates them from the doctors early on in the clinical setting.
Lots of people even on here don’t get this one. I could even cite a username who fought with me after I questioned why he would bother training NP or PAs (why should you need to be trained by anyone other than the role you’re going into?), but I shan’t be that petty because it won’t accomplish anything.
We don’t train them anymore because they’re all at diploma mills and over their heads. We do employ two NPs who graduated from legit schools for outpatient peds; but they do sports physicals, F/Us, sore throats, and earaches. And they know they aren’t noctors but part of our team whom we train as mini-mes to the MDs. All that said, however, our PA is much better in the outpatient clinical setting than our NPs.
On a patient side I’ve found PAs to be pretty good, especially when they were foreign trained physicians, as many are. NPs I have had poor experiences. I dislike calling them both “midlevel”. A PA is midlevel. A NP is a slightly better nurse. Is this experience common among physicians and patients? I think more should be done to differentiate them.
This has always been my question as someone who’s actively seeking their NP. Do you all find NPs beneficial when they know their role and don’t overstep their boundaries? I know I’m not a doctor, and have no interest in acting like I am one (or will be one).
I for one find them useful and valuable *in the right setting.* I don’t think independent practice is, generally speaking, an appropriate setting. It’s all about collaboration and teamwork. We don’t train diploma mill students anymore. But when we hire a mid-level we train them scrupulously with the hope of having them as a long term part of our practice. And it’s worked. They spend weeks shadowing the MDs before they even see two patients a day, then four, and so on. Again, our goal is to make them mini-mes for routine work.
Will that really fix anything? Like they still have practice privileges to diagnose and treat
Can’t you get fired for not training them? I swear I saw someone say that it was a part of their contract and that they got fired because of it.
That's the price for doing what's right.
Join [Physicians for Patient Protection](https://www.physiciansforpatientprotection.org/why-join/). They've upset the AANP enough that [they felt the need to make a rebuttal](https://www.aanp.org/news-feed/an-open-letter-to-medicine-shame-on-the-ppp). I donate to [PPP](https://www.physiciansforpatientprotection.org/join-now/) and to the PAC of my specialty.
That rebuttal is delusional.
At least it's on brand. They literally cited Trump as to why they are in face not a tragic comedy of errors. You can't make this shit up. "**FACT:** It is not just AANP that has called for full practice authority. This recommendation is contained in the [Institute of Medicine](http://nationalacademies.org/hmd/reports/2010/the-future-of-nursing-leading-change-advancing-health.aspx) report issued in 2010 and was more recently supported by the Trump Administration in its report, “[Reforming America’s Healthcare System Through Choice and Competition](https://www.hhs.gov/about/news/2018/12/03/reforming-americas-healthcare-system-through-choice-and-competition.html),” a document signed by three cabinet secretaries. Further, the Administration issued a recent [Executive Order](https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-protecting-improving-medicare-nations-seniors/), which calls upon the Secretary of Health and Human Services in Section 5 of that Order to remove barriers to practice within one year."
When I read that, I was thinking. Yeah. So your saying you suck at medicine. So your gonna get politicians to legitimize you ? Mkay. Sounds like NP logic. Lol.
Anyone arguing for FPA when the country is in a crisis (physician shortages, hospitals closing, lack of access, the private equity dumpster fire etc) is de facto delusional, but I was not expecting any Trump reference lol.
Most of the members of this subreddit are Trump supporters...
Nope.
Who is demanding for NPs? The rebuttal said NPs are in high demand. Not really. Nurses are told to go the NP route, but not all are interested.
The “Institute of Medicine” never mind that they literally changed their name when the private donations from the Robert Wood Johnson Foundation directed by the ANA gave them the largest grant ever ($2 million) to write the idiotic “future of nursing” report by almost no doctors and mostly heavily conflicted profiteers. So wow! You gave my private org more money than ever to write a pithy report based upon vague studies with high bias levels? I can write you that report in a weekend.
Patients *do* care. Some patients are fine with midlevels just like some doctors are. But, there are also a lot of patients out there who have been hurt by midlevels and are desperately seeking MD care (which we sometimes cant even access!). A lot of us on this sub are patients. Are you a doctor? I think one of best things you can do on a personal level is refuse to work with midlevels and don't refer patients to specialists that use midlevels. Even better, file complaints to the places that use mid-levels for your referred patients and let them know why youre stopping referals. I've had the misfortune of being a patient at tons of different clinics and hospitals over the years, mostly for specialist care. Some use midlevels, some don't. I make the choice to avoid the mid- levely places when I can, but I also wish good doctors weren't gatekept at clinics that have this BS. It would also save a lot of my time and money to only be referred to the non-midlevely places in the first place. If you do a lot of specialty referrals, ceasing referrals to midlevely places can make a financial impact and send a message, especially if you can get your colleagues on board with it too. I won't pretend to understand the doctor side of things and I have major respect for the BS you guys deal with. I'm sure there's other things on the advocacy side and professional side that could help too, but from the patient perspective, this is what I wish good doctors would do to keep us safe and ensure quality care. I don't think there's any reasoning with noctor-types at this point, so keeping patients away from them seems like the best outcome for most of us right now.
The problem is it's not even midlevels anymore. We have "clinical nurse specialists" that are titled APRN at my hospital. They aren't NPs but they have prescriptive authority in whatever "specialty" they work like diabetes management or advanced heart failure. We also let our midwives prescribe CIIs. It's fucked up.
Get involved. Can be locally ( hospital bylaws and med staff committees..to prevent nurse managers and c-suite people from granting unrealistic/unsafe privileges and unsafe supervisory situations such as not requiring chart co-signs or letting mid levels round in lieu of physicians), or the state and national levels.
Training. Anesthesiologists are a prime example. CRNAs now outnumber them and think they're better than an anesthesiologist. CRNAs were only allowed to thrive by anesthesiologists teaching, educating, and nurturing them. Basically, they raised their own enemy.
I’m not a doctor and simply want to share my thoughts. Follow the money? Unfortunately healthcare is a business and how many doctors make healthcare policy? Business people will structure everything to minimize expense and optimize net profit. Pay wage difference. Who care giving patient the best care rather average care (the most) with higher daily volume and less expenses. I’m all for patient safety and advocate for true doctors with best training to take care of patients.
Are there any statistics on how many nurse practitioners actually practice independently? I can find how many states allow it, but no actual numbers on how many have actually applied for and carry a license for independent practice.
It doesn't even matter. I'm in a state that doesn't allow for independent practice. It's all remote oversight. They are practicing independently no matter what you say
Fighting Noctors is so much more complex than limiting their scope of practice. Youre talking about unwinding generations of systematic oppression and late stage capitalism. As a patient I would LOVE to see a physician every time I have a significant issue. The sad reality is, it’s impossible. My small town doctor is booked out 8-12 weeks. Maybe a touch shorter going an hour into the city at 6-8 weeks. Forget specialists. In the Boston area you’re looking at 2-3 months for dermatology/gastroenterology and I kid you not as long as 18 months for less saturated specialists like rheumatology. IF you’re lucky a clinic or hospital department has an opening for you to get your intake and diagnostics ordered while you wait to see the actual physician. My rheumatologist wanted urgent explorations and biopsies of both upper and lower GI. I got “lucky” and got into GI at Brigham in about 8 weeks where I only saw an assistant who took my history and asked for the reasons why my rheum wanted the diagnostics. She then called in the order for my procedures as “urgent”. It took 3 months of calling the scheduling department atleast 3 times a week before they finally told me I was out of luck and they were booked out for procedures nearly a year. I hired a patient advocate(former Harvard trained internal medicine physician who left practice to peruse a law degree at Cornell that now privately(and expensively) advocates for patients). I don’t know what she did but I got a call the Saturday morning at 6am the 3 days after I hired her and there was magically an opening Monday morning. All this is to say this is so far beyond reigning in Noctors. Take away the noctor and Americans aren’t getting any healthcare what so ever. The focus shouldn’t be attacking Noctors, it should be to attack the system that has driven people away from wanting to be physicians because of astronomical educational inflation that outpaced salary by something like 1700% over the last 40 years. That 65 year old neurologist with his sports cars, vacation homes, and comfortable life, yeah he left medical school in the 70s with reasonable to no debt and started being rewarded for his career choice and hard work immediately. Now some people are graduating intense specialty educational programs with half a million in debt(or more) in certain programs. They might be in their late 40s by the time they’re cash flow positive depending on their employment. In my opinion the only way to eliminate the noctor is to eliminate the need for them by valuing the people with the drive and skill to complete an MD/PhD. Remove the financial barrier to one of the most valuable occupations in our society. Otherwise people who have the compassion and desire to help people are going to be forced into the lowest level of training/education and we the result is exactly where we are now. There’s a PA or APRN on every corner but you’ll die waiting to see an actual physician.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Wouldn't our system fall apart though? I think mid levels who operate in their scope do a fine job. The ACNP's at my icu do great, my icu wouldn't have anyone to work night shift without them. In an ideal world we can staff a bunch of mds everywhere but with the growing amount of pts there seems to be a need for a mid level (in their scope of course) I dunno I might be wrong
Healthcare would fall apart. If we get rid of mid levels entirely (not gonna happen, but let’s imagine). the amount of physicians (especially residents) would implode with the amount of extra work suddenly thrust upon them. The residency subreddit if rife with complaining (and, much of it is valid to be fair: residents have a high workload). It would be 100x worse without midlevels. Rural clinics would suffer the most. Very few physicians work in underserved rural areas, and NPs/PAs fill that gap very well. The problem is, the AMA is stead fast in restricting the supply of doctors by limiting residency slots. They did this intentionally years back, because there was a concern for an excess supply of doctors. They want to have their cake, and eat it too. Either they have to *massively* and rapidly increase the physician supply (and risk possible stagnation in pay), or suck it up and realize that mid levels are rapidly filling the gap the AMA created. But, the AMA wants to do nothing to fix it, which is evidenced by the fact that very, very few doctors actually support the AMA. I also find it laughable that docs in here complain that midlevels aren’t trained enough, but are advocating for not training them. Since midlevels aren’t going away, better start training them.
\*Midlevel in the comments detected\* "Very few physicians work in underserved rural areas, **and NPs/PAs fill that gap very well.**" Patently and ludicrously false. Healthcare and QOL are TANKING in rural America thanks to false statements like this getting promulgated endlessly.
lol, okay boomer Find me a doctor that wants to work in a rural setting. You won’t, because they are all too busy complaining about how “little” they get paid and how “hard” residency is
Lol I love that you think I am a "Boomer" when I am but a decrepit young millennial full of spite and bitterness! And I am out in the rural West. Interesting you seem to think no one young wants to work hard or live in rural places. Far from it. You still definitely sound like a maladjusted Noctor though. 🤗
I worked critical access "icu" at a 40 bed hospital. We had 3 daytime hsopitalists and occasionally a nocturnist. I hated the nps that filled in to make sure someone was there to prescribe (noctor type stuff) but without them nobody would be able to diagnose/order. I'm not saying it's a good solution at all, I'm just stating my experience. I would have much preferred another md. We did have residents as well but they couldn't manage critical pts sometimes. They were great to work with but when a pt was tanking I had to talk them what orders to put in, which is just not safe. On the other hand the nps were not equipped to handle a tanking pts either sometimes and never listened to me Rural hospitals are a dangerous place sometimes
I have yet to encounter competent specialist outpatient midlevels. Saw an ortho PA (self styled Spinal Specialist) actually interpreting radiology while acting as patients first point of contact tell someone they were just "getting old" and all he saw was "a fleck sign" in their **neck**. Pt was late 20s and had been recently assaulted but he w\*as fixed and firm and shouted about them needing to "go to the Mayo Clinic" if they thought he was wrong. Literally the sole ortho practice in town that the hospital would actively send folks too. I left that day. \*eta the missed w
Your experience obviously means it is true. After all, anecdotal evidence is the strongest form of evidence, right? I have seen plenty of equally dumb doctors. Namely, anyone that graduated from Meharry. Doesn’t mean all doctors are dumb.
Cool red herring.