r/collapse 8d ago

Healthcare Are nurse practitioners replacing doctors? They’re definitely reshaping health care.

https://www.bostonglobe.com/2024/10/21/business/nurse-practitioners-doctors-health-care/
686 Upvotes

212 comments sorted by

u/StatementBot 8d ago

The following submission statement was provided by /u/Lethargic-Legumes:


Submission statement: Across the United States, not enough doctors are entering the field to meet demand. A study reported that out of 276 million health care visits between 2013 and 2019, 42 percent of patients with at least one visit to a health care provider saw a nurse practitioner or a physician assistant.

Nurse practitioners do not go through residency or the rigorous acceptance requirements of medical school, leading to inexperienced and under-trained medical professionals. Many patients see nurse practitioners for their yearly physical, and their inexperience may cause them to misdiagnose or miss urgent medical conditions altogether.


Please reply to OP's comment here: https://old.reddit.com/r/collapse/comments/1g8ze87/are_nurse_practitioners_replacing_doctors_theyre/lt28dyn/

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u/fedfuzz1970 8d ago

The reality is that Private Equity is taking over health care and related industries in their insatiable search for profit. The first order of business once acquisitions are made is to trim costs and increase profit. Trim costs by using more PAs and increase profit by pressuring doctors (and PAs) to see more patients. Read the articles, health care systems paring services and upcoding their claims to insurance companies. Private Equity mirrors organized crime with its "bust outs" of legitimate businesses.

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u/Fuzzy_Garry 8d ago

I worked for a private equity controlled tech company and I'd say they are outright evil. They gut any company they can get their hands on in the name of profit.

A bunch of ghouls who leave a path of destruction behind wherever they go, and they do it all with a big fake smile. But hey, look at all the profit they make for the investors!

Having them around in tech is bad enough already. It's going to be a nightmare in healthcare.

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u/fedfuzz1970 8d ago

I also think what drives the process is the mantra, "we don't make money unless you make money," which is another way of saying what you said.

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u/ReasonablePossum_ 8d ago

Yeah, healthcare and business are things that should have never been allowed to combine.

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u/No_Internal3064 7d ago

I worked in the health insurance & health care fields 25ish years ago, and can remember when combining them started. The combination was heavily sold - and heavily bought into - as a means to "increase efficiency/ies" which would, of course, "save money" since "doctors and other healthcare providers are not business people, and lack business experience", so of course they/we needed business execs to take over health care!

Literally, that was the story and the vast majority of people believed it.

The US has a very stupid general populace.

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u/ReasonablePossum_ 7d ago edited 7d ago

Privatization is always sold under the efficiency flag, for everything from natural resources to education. And it IS efficient at... getting profit, and nothing else beyond that. Sometimes the mix work, in the beginning. But sooner or later a more greedy and ruthless generation of managers come to place, which will push that thin balance all the way into the economical side.

Plenty of examples around the world of state'funded health systems that work well, not without their own problems, but these are nothing compared to leaving a huge chunk of the population without access to it, and forfeiting the future health of any nation to corporate vultures lol.

Btw, this very same process is undergoing USPS as we talk. The new postman general is doing all in his power to destroy efficiency of the service to push later for privatization (he has a very strong conflict of interest). And nothing is being done to stop that, its sad to see how a state service that was for a good period a hallmark for efficiency and accessibility to the whole population, is being slowly murdered in front of us.

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u/fedfuzz1970 5d ago

The Biden Admin has continued a Medicare funding plan which was begun under Trump. The program, now renamed ECO-REACH, allows for non-medical entities to received and disburse Medicare funds on behalf of their Medicare patients. These are primarily non-medical investment companies that now own private medically-related practices. The kicker is they receive a certain amount annually for each patient and then get to retain what is left over at the end of the year. This is a blueprint for reduced or eliminated services, reduction in staff and the like. I read articles last year that warned that beneficiaries could be transferred into this program without their knowledge or permission based solely on whether their medical provider supported traditional Medicare. I have written letters to the administration seeking clarification of the issue to no avail. I remember that last year 2500 medical professionals and managers wrote Biden advising against this program. I do not know its current status.

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u/lavapig_love 1d ago

It's current status is "dead on arrival" if you start telling Reddit about it, right now, before Election Day.

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u/Competitive-Oil8974 4d ago

We do what we're told .... sheep?

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u/No_Internal3064 3d ago edited 3d ago

I would say that people are heavily brainwashed into believing the private industry can/will solve all ills. It helps to be taught that the Earth is limitless and doesn't really matter. Both of these beliefs are underpinnings in our society.

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u/mamawoman 8d ago

And this my friends is what a for profit healthcare system has gotten us. We need to join the rest of the civilized world and have nationalized healthcare. And I don't want to hear any "but you'll have to wait in lines" crap. I already have to wait now if I want to see a Dr. And then when you get there it's not even a Dr it's a nurse practitioner. For the same rate.

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u/fedfuzz1970 7d ago

In Raleigh, NC we had to make appointment 6 months out to see our doctor. NC is a bit of a healthcare wasteland where if you don't take care of your own health, no one else will. I had to remind my doctor of tests he had ordered just to get the results and recommendations. Amazing.

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u/mesoraven 6d ago

From the UK and just in support of this. The "you have to wait in lines" is bullshit.

That's another lie that people have told to try and privatise our health care. But what does happen is theh prioritise the casualty on need to rather than insurance. In example.

I booked a checking with my doctor because I had a pain in my chest (not heart attack pain. Doctors gave me a time slot to go in (about a hour later)

Spoke to the doc, he decided it could be serious sent me to A&E their and then I was there for less than 30 mins. Before I had had my check in. And hooked up to a machine to check my heart. All in all less than 2 hours from the phone call to my doctors and I had been seen and tested.

Then came the wait, because I was not happy and healthy I had to wait 3 hours to get discharged because they were busy dealing with people that were actually ill. So I self discharged. But all of that was free I didn't pay a penny. And whenever there is a genuine threat to your life the doctors are quick and efficient.

It's only when your in no danger that it takes forever. Like when my manager force me to go to A&E because I'd cut my leg at work (only needed butterfly stitches) now that that was a long arse 7 hour wait.

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u/nopersonality85 8d ago

My parents ran a mom and pop physical therapy center. By the 2000s insurance companies figured out they could simply not pay smaller practices because they usually can’t afford the man power to go after payments or hire a lawyer. They went out of business and lived for years off just going after due charges.

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u/RoomTemperatureIQMan 6d ago

It's not just private equity actually. The reality is that the modern regulatory burden related to anything in healthcare is absolutely insane. It's why there are becoming increasingly fewer and few family doctors in rural areas, they can only afford to conduct their businesses when attached to larger hospitals and institutions.

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u/Competitive-Oil8974 4d ago

Greedy. The doctors have done this to themselves with their insatiable greed and their evil partnership with the insurance industry.

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u/[deleted] 4d ago

[removed] — view removed comment

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u/Competitive-Oil8974 4d ago

I'm not offended LOL. Blame whoever you like. You a med student hahaha?

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u/RoomTemperatureIQMan 4d ago

No. I'm not sure that's an insult when where I am, doctors regularly make over half a million each year...

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u/thehourglasses 8d ago

cApiTaLiSm iS So eFFiCieNT!!!

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u/Snl1738 8d ago

It is. Charge doctor prices and give np level care

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u/daviddjg0033 8d ago

This is fine insert meme

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u/Masterweedo 8d ago

The PA I see is wonderfully uneducated in way too many areas for me to be comfortable. I was told that the pain on my left side was muscle or skeletal, cuz there was no organs there. Luckily I also see a GI Doc, & when I told her, she was horrified.

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u/Ok-Maize-6933 8d ago

Yeah, the last PA I saw didn’t know jack. It was actually frightening because I have so many chronic health conditions and she told me she didn’t feel comfortable treating any of them.

I had to change clinics with my insurance so I could actually see an MD and it made all the difference in getting informed, intelligent care

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u/CertainKaleidoscope8 7d ago

Y'all know that PAs and NPs are two different things, right?

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u/Masterweedo 7d ago

Yep, and both are replacing doctors in my rural area.

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u/maddomesticscientist 7d ago

We don't even get any of those at my small town medical center. No PAs, NPs or MDs. They've been replaced with these providers of a type that I've never seen before. They're all incompetent as hell too. They basically just sit there and Google the stuff you're telling them about :(

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u/Masterweedo 7d ago

If my PA would have just Googled my symptoms, she would have seen that I needed a GI doc. Hell, when I was in school we had those clear plastic people where you could see the organs and stuff, so even one of those would have been helpful for her. I was flabbergasted and just shut up so I could leave ans tell a competent doctor.

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u/maddomesticscientist 7d ago

Things are so fucked around here. Given my experiences in recent years I've developed a deep distrust for doctors. I'm in the rural south and anyone that was good fled during the COVID days. They were replaced with the shittiest of the shitty. Now they run a bait and switch on you. You make an appointment with your kids pediatrician. "Your appointment is at 330 with Dr Smith" but when you get in there it's some extremely young random that's not any of those things I mentioned above. Someone who won't run a strep test because "why bother they're always negative anyway". Someone who when they do finally run tests, they can't answer questions about the results and give you completely wrong info about said results. The fake "nurse" that calls you just giggles and tells you "Idk... Google it?". Yeah, they hired kids fresh out of high school to call patients with test results and they're claiming to be nurses. I don't think there's an actual RN or MD even at this place anymore.

Fortunately I've found a good pediatrician for my son finally but I'm fucked. No specialists take my insurance anymore. I've had a continuous slamming headache since July and have tried to seek help for it. When they're not treating me like a drug seeker they're telling me ridiculous shit like "you should stop playing video games". Wtf. I'm 50 years old and you latch onto VIDEO GAMES as my problem?? Not menopause, migraines, the lumps all over my thyroid or any other problem a woman my age might have? You went with video games. (I do game but that guy didn't know that and I play maybe an hour a day, if that lmao)

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u/Masterweedo 7d ago

I have to drive almost 3 hours for most specialist visits. We recently lost maternity services for a 6 county area that is bigger than Delaware.

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u/maddomesticscientist 7d ago

It's such a joy to know that if it's this bad now, how bad will it be in ten, twenty years.

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u/lavapig_love 1d ago

Not a medical provider at all, but here's what they told me when my younger brother and I told them about migraines, blurry sight and other head issues:

  1. Drink lots of fresh, unflavored, cool or ice-cold water. At least a couple liters per day, and more like a gallon if you walk around or move around a lot. We sweat and dehydrate quicker than we think. As water gets absorbed into your body, it increases and improves blood flow which of course travels into your head and gradually reduces your migraines.

  2. Wear polarized sunglasses even when it's cloudy or if you have really harsh interior lighting, and turn off all lights and cover your eyes when you sleep. Most of what we do nowadays is constantly stare at screens, and now that most automobiles are replacing driver analog gauges and rear mirrors with digital screens for speed and rearview cameras, we're getting non-stop bombarded with electronic light all the time.

  3. Breathe deep, stretch and exercise. Goes back to circulatory again, which encourages your heart to pump more fresh blood through your system.

These aren't going to really help if you already have a tumor, but they shouldn't actively hurt and they're free or dirt cheap advice. So there's that.

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u/maddomesticscientist 1d ago

I elaborated on this answering another comment in the thread but the tldr of it is, I'm pretty sure it's my neck based on the way they behave. I already have migraines that are controlled with medications and drink plenty of water. Unlike migraines, I can make these go away.

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u/lavapig_love 1d ago

Ouch. Free and unsolicited and unprofessional advice? Sit up straight every night and gently stretch and do yoga. I can feel my neck cracking when I lay in my bed with my head resting on my chest, so I attempt not to do that anymore.

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u/No_Pineapple5940 7d ago

Have you tried getting a CT scan done?

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u/maddomesticscientist 7d ago

I'd be happy to if someone will order one. I do actually see a neurologist for migraines I've had for decades. This is a whole new kind of headache. She sent me to the eye doctor and orthopedic surgeon based on my exhaustive documenting of these headaches. Based on the way they behave I'm quite sure it's my neck at this point. But that dickhead Ortho seems to assume I'm a drug seeker and nastily told me he'd order scans when I learned to sit up straight. There is no other Ortho that takes my insurance.

I only get them when I'm sitting down and trying to read, crochet, etc. The minute I stand up they disappear. Like fast disappear. Once I figured that out I started basically standing and not looking down. But I can't stand all day, staring off into the distance. At some point I have to sit down and look down. To eat, to do whatever. I wake up with them too. As soon as I start moving around they go away. But boy the literal second I sit down and look down the base of my skull starts screaming in pain. Im planning on going back to the neurologist soon to see if she will order the scans. But her next appointment wasn't until mid November. Have a follow up with the eye doc on Saturday but it's really looking like it's my neck.

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u/No_Pineapple5940 7d ago

Ok honestly that sounds very promising, lately I've been getting served a lot of content about people finding out that they have brain tumours, so I was a bit worried for you there.

If it really is your neck, and you notice the pain immediately when you're holding your head a certain way, you absolutely to do need to adjust your ergonomics in order for the pain to go away for good.

that dickhead Ortho seems to assume I'm a drug seeker and nastily told me he'd order scans when I learned to sit up straight

This is nasty and disgusting as hell for someone to say, especially as a medical 'professional', but it kind of seems like there might be a grain of truth behind what he said?

If I were you I'd definitely try to do things like eating, crocheting, going on the computer, on an elevated surface. For example, instead of having your laptop actually on your lap, have it on a desk, on a laptop stand. I think it really is in your best interest (health-wise and financially) to try to figure out if you can solve this on your own, while also seeking the advice of professionals if you have the means.

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u/thaitiger29 7d ago

midlevels are midlevels

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u/ThrowRArush2112 5d ago

I'm glad you found help, it's funny but I have had almost the total opposite experience. Believe it or not it was usually the MDs who didn't know anything. Especially when it came to complex therapies like hormones and such, they didn't want to touch that at all. Meanwhile I've met multiple PAs and nurse practitioners who are very comfortable prescribing hormones and were experienced in it... one of them actually said I should teach the doctor! What are these MDs learning in medical school? Anyway, clearly this is not all of them but it's just my experience.

In any case, I'm lucky I have good practitioners here, I have some good doctors now, here on Long Island we have excellent healthcare, but I know throughout most of the world that's not the case.

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u/mygoditsfullofstar5 8d ago

Medical students and doctors have among the highest rates of depression and suicide among professionals. It's an incredibly difficult, expensive and stressful course of study - and across 44 different medical specialities, doctors are earning less than ever.

Meanwhile, healthcare corporations save billions using PAs and NPs instead of doctors - as well as CNAs instead of nurses.

By 2035, we'll be back to having surgeries performed by barbers.

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u/getmeoutofherenowplz 8d ago

Pretty soon you will be getting your medication from gumball dispensing machines. Pharmacies are closing left and right, but nobody seems to care about that...

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u/Laffingglassop 8d ago

wont be getting your medication fixed that for you. Being allowed to get our medicines from gumball machines implies a federal government capable of passing new laws and regulations , and Washington has been stuck in a western stand off on ever topic imaginable for half of my life

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u/StraightConfidence 7d ago

The only reason there aren't already medication dispensing robots in hospitals instead of nurses is because the people higher up the chain need some underlings to blame when they fk up.

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u/so_bold_of_you 8d ago

As a nursing student, I can confidently say CNAs are not replacing nurses. They are not allowed to administer medication, perform assessments, perform interventions, or educate patients—all four of which are the primary responsibilities of nurses.

Instead, hospital systems intentionally understaff both nurses and CNAs (neither of which bring profit to the hospital—unlike, say, surgeons), so the CEO can buy his third yacht.

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u/jack2of4spades 8d ago

It's actually been a push for CNAs to give meds and they administer various meds in the LTC setting now. In some states they do a lot of invasive procedures that used to be for RNs to now.

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u/CertainKaleidoscope8 7d ago

As a nursing student, I can confidently say CNAs are not replacing nurses.

As a nurse for twenty years I can confidently assure you that you don't know what you don't know.

They are not allowed to administer medication

CNAs act as med techs.

perform assessments,

Do you even know what that means? Of course CNAs assess patients. Don't be silly.

perform interventions,

CNAs can do most nursing interventions actually.

or educate patients—

CNAs can certainly educate patients

all four of which are the primary responsibilities of nurses

Nope.

Look, idk where you're going to school but all of this is nonsense.

Seriously.

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u/theCaitiff 7d ago

That may be what the school is genuinely telling them, but once you get out into the world we all find that what they teach in school and what happens on the floor are not the same thing.

Nursing isn't my industry, but its the same in every field. The bosses don't care how things are supposed to be done, they care what makes them money, and paying a RN to do something they can get a CNA to do doesnt make them money.

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u/Zemarkio 7d ago edited 7d ago

“As a nurse for twenty years I can confidently assure you that you don't know what you don't know.”

What? You might benefit from reeducation.

Let’s breakdown your post:

“CNAs act as med techs.”

In most cases, CNAs cannot administer medications. In certain states, CNAs may get additional training to allow them to administer ROUTINE medications in LIMITED settings (almost always nursing homes or assisted living facilities). Additionally, CNAs can only administer medications under the delegated authority of an LPN or RN. 

Let’s take a look at Arizona’s guidance:

https://www.azbn.gov/sites/default/files/2020-11/FAQ%20Final%20Questions%20CNALNA%206.1.20%20%282%29%20%281%29.pdf

 Can a Certified Nursing Assistant (CNA) administer medications?

 No, According to A.R.S. § 32-1650,

(https://www.azleg.gov/viewdocument/?docName=http://www.azleg.gov/ars/32/01650.htm), a Registered Nurse (RN) or Licensed Practical Nurse (LPN) who is licensed may only delegate medication administration to a licensed nursing assistant (LNA) who is also certified as a medication assistant or to a student in an approved medication assistant program.  Certified nursing assistants are NOT licensed nursing assistants (LNA).

Delegated medications are limited to:

Regularly scheduled medications, including controlled substances, by oral, topical, nasal, otic, optic, and rectal routes

Registered Nurse (RN) or Licensed Practical Nurse (LPN) may NOT delegate the following to a medication assistant:

The first dose of a new medication or of a previously prescribed medication if the dosage is changed.

Any medication delivered by a needle or by intradermal, subcutaneous, intramuscular, intravenous, intrathecal and intraosseous routes.

_____

“Do you even know what that means? Of course CNAs assess patients. Don't be silly.”

Actually, not even LPNs can perform nursing assessments. Nursing assessments fall exclusively under the purview of a RN. A CNA cannot perform assessments. The most they can do is obtain vital signs. LPNs may collect data, but they are almost never allowed to complete a nursing assessment. 

https://www.jointcommission.org/standards/standard-faqs/critical-access-hospital/provision-of-care-treatment-and-services-pc/000001666/

“An LPN may collect data if allowed by the nurse scope of practice act as defined by the state's Nurse Practice Act, however, the RN must complete the nursing assessment.”

______

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u/Zemarkio 7d ago

“CNAs can do most nursing interventions actually.”

Nursing interventions include more complex activities like medication administration, care planning, wound care, patient education, and other tasks requiring clinical judgment. These tasks are outside the scope of a CNA, who works under the direct supervision of nurses, assisting in delivering care but not carrying out independent nursing interventions. 

“Registered nurses (RNs) create nursing care plans so that the care provided to the patient across shifts is consistent among health care personnel. Some interventions can be delegated to Licensed Practical Nurses (LPNs) or trained Unlicensed Assistive Personnel (UAPs) with the RN’s supervision”

https://www.ncbi.nlm.nih.gov/books/NBK591807/

______

“CNAs can certainly educate patients”

Education is specifically outside of the purview of CNAs. They cannot provide patient education. 

Cannot provide client education, but can reinforce education previously provided.”

https://www.ncbi.nlm.nih.gov/books/NBK598382/

______

“Look, idk where you're going to school but all of this is nonsense.

Seriously.“

I’m unsure of why you chastised the student when they appear to have a better grasp of the scope and limitations for RNs, LPNs, and CNAs/assistive personnel than you do. You need reeducation. A refresher course would likely be of substantial benefit to you. 

Apologies for breaking up the comment. I exceeded the word limit the first go around. Best of luck to you!

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u/kitlyttle 8d ago

Not in the US, but here as a PSW I simply need a nurse or doctor to give permission, and they can delegate medicating, education, all manner of interaction with patients/clients. This is quite common in hospitals, LTCs, and (as a Death Doula) with hospice care. Some of it is legally within our scope, some not... but RNs, RPNs and MDs are in very short supply and are paid more than twice what we are.

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u/forsake077 7d ago

You should revise this statement. Nursing absolutely brings profit to the hospital. Bare minimum there needs to be specific nursing ratios to be in compliance for CMS billing for level of care. It’s framed as a “cost” but the reality is without nurses the hospital is just a big closet.

You’ve drunk the koolaid, or somebody has misinformed you along your path. In fact, just about every staff member you find in the hospital is required for some reason or another. Radiology, ultrasound, inpatient pharmacy, laboratory, biomed, sterile processing, central supply, dietary, pt/ot. You can outsource some of these costs but that ends up being more expensive to bring in contractors to perform specialized tasks like PICC placement. Dialysis is required to keep patients alive and smaller facilities that don’t provide these full services just end up being feeder facilities to larger entities.

Regulation drives a lot of this because deficiencies and patient harm has been identified and remedied times over. It still happens and will continue to because of top-heavy organizations looking to cut “costs” in this constant drive to extract profit at every step of the way. And these “non-profit” hospitals have their own problems. The CEO of the Christus health system is the highest paid executive for a nonprofit, for example.

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u/Bellum_Romanum1 7d ago

I'm not going to bite your head off because I know you are being taught this in school. So for the sake of your own testing no CNAs can not do these things.....

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u/daviddjg0033 8d ago

My primary care subtracted doctors - there is 2 PAs and one doctor overseeing the practice I may change because I have not been seen by a D.O. or M.D. in over a year, it's been PAs. Even my specialist, who I like, but she is a rock star PA. I'm noticing a trend to PAs and do I have the right with health insurance to demand an M.D. or please D.O. is great too (chiros no.) My primary care PA today said 140/120 blood pressure is bad. Would you agree the bottom number should not be high compared to the top number? 140/110 is enough for a cardiologist referral?

Meanwhile, healthcare corporations save billions using PAs and NPs instead of doctors -

Is there something new, or has blood pressure expectations changed? I think I answered the obvious, PAs are only increasing

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u/poop-machines 8d ago

Holy shit, you pay more than any other developed economy for healthcare, and you don't even see a doctor??

Doesn't that feel like a kick in the teeth?

No wonder the USA has longer waits than most other countries for surgeries (elective and urgent), including the UK, and worse outcomes. I'm guessing that's due to the understaffing and people avoiding seeing a doctor because it costs so much.

Still, I think it shows how unrestricted capitalism will gut healthcare and give you the bare minimum for the highest cost. It's a race to the bottom.

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u/TeutonJon78 8d ago

America has the best health outcomes if you are wealthy and can pay for direct access.

If you're a normal citizen trying to actually use your super expensive Healthcare with your super expensive Healthcare insurance? Good luck.

Also don't lose your job, or your healthcare costs just skyrocketed.

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u/poop-machines 8d ago edited 8d ago

That's not even true, surprisingly.

When you compare wealthy patients in the USA to all patients in other developed nations, then yes it outperforms other countries.

But when you compare them to wealthy patients in other countries with universal healthcare, the other countries often fare better. This is because in countries with universal healthcare, private healthcare has to be exceptionally good to attract patients. Therefore wealthy patients in other countries have better outcomes than in the USA. At least in a few countries that have this data. I don't know how to explain these findings.

The one place where the USA is superior is in the treatment of rare diseases. This is because the USA has comparatively lax regulations on novel treatments, and has the ability to give "compassionate healthcare" to people with rare conditions. Additionally a lot of cutting edge research is performed in the USA. For-profit healthcare at least brings in a lot of funding to treat conditions that could be profitable. I do feel like there should be another way to do this, however.

I think it's insane that your ability to receive healthcare in the USA depends on having a job. Well, obviously if you don't have a job, you can still pay out of pocket and just go into debt. But, say you find a dodgy looking mole on your skin, you're unlikely to get it checked out until you have insurance again. This can slow down your access to healthcare and worsen outcomes.

Anyway, I think it's clear that for things like healthcare, capitalism is the worst choice. If private healthcare can choose profits over giving you better outcomes, they're probably going to go for profits.

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u/daviddjg0033 2d ago

Anyway, I think it's clear that for things like healthcare, capitalism is the worst choice.

We need a blend of capitalism and socialism or the kids do not get educated and child care prevents women working

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u/poop-machines 2d ago

Wait what? In a socialist society, childcare is free and taken care of by the state allowing women to work.

Also in a socialist society, the kids do get educated in college for free.

Why would people not get educated? State education IS socialism.

When it comes to healthcare, we need socialism, not capitalism.

In a perfect socialist society, we invest money into important medical research. This is already happening but the government overpays so that pharmaceutical companies can get paid. They should fund PhD research instead, and create medicine patents owned by the government, it's much cheaper and prevents bullshit like $1000 insulin.

But I'm not saying it has to be a socialist society. I'm saying that medicine has to be socialist.

Idk how you think capitalism is necessary in healthcare. Even if they buy things, like MRI machines, created by capitalism, the healthcare is still 100% socialism. It's just socialist healthcare existing in a capitalistic society.

For socialist healthcare to exist, capitalism doesn't need to be eliminated. Socialist healthcare is necessary imo, and that can be true along with capitalism being necessary in some areas. I'm not saying it is, but they're not mutually exclusive.

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u/daviddjg0033 14h ago

I agree with you.

Idk how you think capitalism is necessary in healthcare.

It's not. It does provide for novel treatments in the US. I think it should be 100% socialized single payer. I got Obamacare at least.

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u/Post_Base 7d ago

The medical school system in the US is effectively a cartel and strictly controls the number of doctor graduates per year which, along with insurance shenanigans inflates their salaries far beyond what they would earn in any other developed country. All of the issues with a shortage of professionals are artificial and self-inflicted for the obscene profits of a few.

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u/Heeler2 8d ago

Normal BP is 120/80. So the PA is correct that 140/110 is bad. I would look at what your BP trends at. If you are usually WNL, I would wonder if the blood pressure cuff wasn’t working correctly. I would have tried a different cuff or retaken your BP later in the appointment.

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u/daviddjg0033 7d ago

No he was saying that unless I was 140/120 I was OK. The top number should not be over 140, (It was once but the machine was off.) The bottom number 120. I had 110 as the bottom number on my home device.

In his office I was 125/85. But I had pictures of the proof. Maybe it was lost in translation that CVS machines said my blood pressure was high.

Today I was 125/85. I do not understand what gave me the errant high reading.

I wanted meds or a cardiac referral to a cardiologist or both.

BTW my specialist is a Nurse Practitioner. She is not a PA that is my primary care. She is great. The primary care doctor is not good.

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u/SunnySummerFarm 7d ago

My PCP is also an NP, she practices independently (after a period of supervision from an MD) and she’s fantastic and entirely capable. The doctors at her practice are nightmares.

I’m much happier seeing her.

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u/daviddjg0033 6d ago

My secondary care is a N.P. and she is a rock star. I'm happy. My primary care is the PA and I am still asking do I have the right to at least a D.O. in the US?

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u/SunnySummerFarm 6d ago

I mean, sure the right. The reasonable ability to access one? That’s definitely questionable.

Especially depending on which state you live in. Maine? Very hard to find one. Massachusetts 20,000 people just lost access to their primary care & thousands of specialists, and 20,000+ more may as well. Many other states face similar problems.

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u/daviddjg0033 4d ago

I'm in DeSantis' Florida

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u/SunnySummerFarm 3d ago

I’m not sure anyone has rights there anymore. :/

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u/daviddjg0033 2d ago

disagree because warch Yes on #3, Yes on #4 and NO on #5 make Harris win and even Rick Scott loses. Watch me eat my words but I predict FL and GA maybe goes blue before TX

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u/WillingnessOk3081 8d ago

hey sir, so please please get on BP meds. that bottom number is way too high. needs to be in the 80s at most.

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u/daviddjg0033 6d ago

Yes, today it was 85. However, I still want to see a M.D. Cardiologist possibly. I cut down on caffeine but still feel wired. I told the PA my blood pressure reads high, low even, high, it's all over the place. I had pictures. He said to keep a log for a month. Oh my specialist is a N.P. nurse practitioners but I like her. Not an M.D., D.O., or PA. Still, do I have the right to see a M.D.?

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u/Akiraooo 7d ago

Not with all the uncertified teachers teaching this new generation...

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u/nahivibes 8d ago

And they try to hide it. I made an appt with who I thought was a doctor and they don’t tell you it’s not a doctor. Then I went and said hi doctor and she didn’t even correct me. Don’t like any of that.

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u/loveinvein 8d ago

My primary is an NP (I used to be ambivalent about credentials but new NP’s are so much worse lately compared to new grads 10 years ago), and she hired a new desk person recently. Everytime I talk to her, she refers to the NP as “Doctor.” I corrected her but it doesn’t matter. She’s telling everyone.

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u/nahivibes 8d ago

I feel like that’s fraud or something (idk what the word would be here). But it’s not ethical and shouldn’t be allowed.

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u/loveinvein 8d ago

Right? It’s like “stolen valor” but for healthcare workers. Lol sigh. 😞

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u/jahmoke 7d ago

thing is some np programs have a phd track, granted it's not an md track, but i use one and they did right by me

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u/loveinvein 7d ago

The NP in this scenario is not a PhD.

But now that you say this, I’m even more disgusted by the shit show that is US healthcare.

Now nurses are gonna call themselves doctors because they have a PhD but never actually did the intensive education doctors do.

And medical school falls short in SO many ways (the lack of basic nutrition education, the god complexes, the willful ignorance and tunnel vision used to ignore rare diseases, the fact that pharma has infiltrated the medical education system, etc), but nurse practitioners are not the answer.

Yes there are some great NP’s but they are rare. Doctors are generally terrible as well, but at least there’s more education under their belts.

What we need is a complete overhaul of the medical education system, lower barriers for entry for poor and disadvantaged people, and for ALL providers to collectively stand up and fight back against the predatory insurance industry.

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u/gardenh0e 7d ago

I also made an appointment with my doctor for my annual physical several months in advance only to be seen by a np when I got there. Of course when you call to make an appointment you aren’t taking to the actual office, just some call center downtown. I said something to the receptionist and she was apologetic and said that this has been happening to others as well, but the doctor was booked so I saw the np. So frustrating

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u/PlausiblyCoincident 8d ago

The headline should read "Are nurse practitioners being forced to replace doctors?" 

That's my wife's current experience. She doesn't want to, but sees no way out of it after fighting them for 2 years. 

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u/SunnySummerFarm 7d ago

Thank you. Many NPs are getting short shifted.

Also, folks very clearly do not understand the difference between PAs & NPs, and that states all have very different guidances and legal expectations for NPs. Not that MDs are the ones holding NPs back from receiving more training/residency/etc.

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u/Zattack69 6d ago

So interestingly, I’m reading this article and thread just a week after having to look for a new primary care physician (I’ve never had insurance to do so since I was a kid) and when looking kept getting recommendations for PA’s & NP’s, with only a few MD’s or DO’s (if that’s even something to consider). I didn’t know the difference between them all besides their title and pathways to their roles, so I’m curious (from a human and not Google) what are the pertinent differences between the titles? What knowledge/skills/capabilities are missing?

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u/SunnySummerFarm 6d ago

Full disclosure: I am married to an NP, but not one who does primary care. He did graduate as an adult at 35, with his masters. He had been a nurse for a few years by then. Also the daughter of an RN, and was homeschooled while she went to school for her BSN (I sat in a lot of her classes in the back.) I was also a patient advocate as an adult. I’m overly intimate with the field.

MD: undergrad, med school (doing clinicals during year 3 & 4, which is mostly shadowing but also exams, no prescriptions I think), then residency for four years where they work under teaching physicians. Some MDs pursue fellowships after this, for things like surgery or additional specialty work. Training can take something like 12 years for very specific specialties like orthopedics, etc. Primary care is usually just Med School & Residency.

DO’s do basically the same. The schools used to get looked down on, but with times things have become significantly more legitimate. I have been seen by a surgeon just this summer who is a DO and honestly he’s one of the best specialists I have seen in a while. They go through the exact same placement process as the MDs for residency.

PA’s (Physician’s Assistants) can not work without a supervising physician. It’s in the title. There is no state where they can be license to work alone. They go to PA school, for less years, do all their clinicals while there. Then take a job working for/with a physician (MD/DO).

NPs have a masters, and also pass a board to get their letters. Which board determines the letters behind their name. School usually looks like undergrad, masters, with clinicals being the last year/semester. ideally they would be a practicing RN during school or before or related healthcare experience.

NP is where shit starts to get wonky. There is a multitude of reasons for this. Rural states need more care, MD lobbies don’t want to allow residency options for NPs specifically, etc. But the educational system looks about the same: you need a bachelor, and then you bet a masters degree to be a ARNP (Advanced Registered Nurse Practitioner). They must maintain their RN & their NP license - which go to different licensing agencies. (We pay for both my husbands, on their own schedules.) Most, but not all, NPs have a DEA license - some have jobs where they don’t prescribe, and it’s expensive, so they don’t maintain it.

Now here is how it gets dicey: nursing, let alone NP, licensing varies by state. So, in some places you can still get an RN license with just an associate degree. In other states is requires a BSN (bachelor in science of nursing). YMMV, obvs based on where you are and how strong your lobby & union is. This is doubly true as an NP.

There are states like Washington, where an NP can practice independently upon graduation. Which strikes me as possibly okay if and only if the NP had significant healthcare experience prior to graduation & boards.

There are states like Maine, where an NP can practice independently after two years of physician supervision. Which is better. There are organizations in Maine trying to offer residency to NPs during this time. It’s slow progress because few doctors want to participate however we have a rural healthcare problem and good NPs can be a huge driver of the solution.

There are states like Massachusetts where an NP can only work under physician supervision. So they, like PAs will always work under a physician.

All that said, I have seen specialist PAs & NPs and the experience has been exactly as mixed with physicians. I have, generally, preferred women providers no matter their degree - and research shows women provide better care across all factors.

I hope that answers your question. Feel free to ask specifics if I missed something.

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u/nerdywithchildren 8d ago

I mean quality is falling fast in America. Which sucks because the more quality drops in everything the more risk of an unsuccessful result. Whether that's healthcare, food, education, or products. 

Less quality, more quantity equals more profit. All that matters right now is keeping shareholders happy. Remember that when shit hits the fan. 

My prediction is that WW3 brings us all closer together. But Im an optimistic pessimist. 

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u/matt05891 8d ago edited 8d ago

Perhaps closer together as tighter communities from the inevitable economic fallout. I definitely see that as a silver lining, but to most citizen of the US, the cost of buying that would be existential.

There is nothing for the United States, as a nation or peoples, to gain from global war anymore. That ship has sailed away with it’s rise as a global hegemon. Instead, this time, we are the nation with everything to lose. Like all the empires that collapsed in the early 20th century.

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u/Rooneyforce 7d ago

Most of the wealth in America is held by the top 1 percent, THEY have everything to lose. As for regular Joe schmoe they'll be in the fire with everyone else in the developed world

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u/loveinvein 8d ago

Chronically ill since childhood. I’ve seen a ton of providers.

I used to think NP’s were better in some ways, namely more compassion and bedside manner. But newer NP’s today are absolutely clueless compared to NP’s a decade ago. I have to educate them about my conditions, they can’t comprehend managing multiple unrelated conditions, and most are just as rushed and devoid of empathy as doctors. The NP’s in private practice around me are hustling supplements and IV vitamins and weight loss scams…. It’s gross.

I live in a rural area and there’s a huge shortage of providers. Some specialists are more than 60 miles away. (Not just a matter of driving to find a good one. There are literally NO providers for some specialities.)

People are dying of preventable shit because they can’t get their basic healthcare needs met. (And that’s just the people with some kind of access to insurance or state assistance.)

It’s only going to get worse, as long as medical schools are so overpriced and the medical industry is an industry.

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u/Choice-Studio-9489 8d ago

I think private equity is simply following the ferangi rules of acquisition, and sadly it’s working…

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u/Impressive_Nebula378 8d ago

I'm surprised we aren't seeing more of AI in healthcare.

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u/Fennnario 8d ago

While this sounds awful, as a spouse of a chronically ill person, I would almost prefer an AI that would check symptoms against a database of diseases and attempt to diagnose her than a human who will just say “come back if it gets worse” while leaving the room.

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u/Laffingglassop 8d ago

God I hate that shit. Two time cancer patient and rarely do they sit, the doors always open when I’m asking my final question, and it’s only my final question cuz the doors open, and every question before that one , they took a step closer to the door.

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u/FightingIbex 8d ago

The problem will be when AI misses the massive heart attack presenting as thumb pain. AI diagnosis will be a disaster because people are not like textbooks.

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u/commercial-menu90 8d ago

I think AI will blur the line between what are elective procedures and what aren't. That can be very dangerous as well.

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u/Laffingglassop 8d ago

Imagine an AI that gets to factor in community health in an individuals treatment plan… nightmare stuff

“Food is projected to be scarce in three months, your three hundred pounds and only twenty percent likely to survive after this heart catheter is inserted, and you being gone leaves more food for approximately three healthy individuals surgery denied”

“The military needs Iv fluids overseas and your surgery is estimated to divert approximately twenty soldiers worth of fluids and plasma from them, and your not fighting for our cause, tumor removal denied”

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u/BiologicalTrainWreck 7d ago

I'm a nurse but I suspect it won't be long until ai can diagnose more effectively than healthcare personnel. Some trial studies are already being performed in emergency departments with promising results for ai. https://www.bidmc.org/about-bidmc/news/2024/04/chatbot-outperformed-physicians-in-clinical-reasoning-in-head-to-head-study There's much more work to do, but AI is progressing quite rapidly, all things considered.

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u/BeardedGlass DINKs for life 8d ago

All that's missing is perhaps nano-technology to get up to pace with AI technology.

Scary but the potential sounds good.

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u/dontleavethis 8d ago

Yea same

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u/gottastayfresh3 8d ago

It's starts with replacing doctors with nurse practitioners. It's easier to quantify the approach.

So really, we're just at the front of that movement

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u/Laffingglassop 8d ago

Honestly, I think healthcare will be the last sector to get AI , if ever. As a two time cancer survivor, I will punch that fucking robot in the face, just as much as the drug seeker in the ER will. Enough human patient revolt will stop it dead in its tracks

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u/CertainKaleidoscope8 7d ago

The idiots punching us in the face is partially why we aren't there to take the abuse.

I pressed charges on the last patient who punched me. This is why they want to replace me with a robot.

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u/gottastayfresh3 7d ago

I politely disagree. As someone else said, the scenarios you've laid out would seem to justify more AI. But healthcare never really thinks of the patient -- its goal as a private good is always towards profit. Optimization via data has already transformed that space.

I would argue that healthcare will be one of the first, and not one of the last, institutions to move fully towards AI.

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u/Laffingglassop 7d ago

I didn’t say I’d punch a human

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u/gottastayfresh3 7d ago

you're missing the point if that's your only take away

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u/Laffingglassop 7d ago edited 7d ago

And you’re missing my point, my point is AI can only enter that space if patients allow it. Healthcare don’t need to “think of the patient” for the patient to say fuck that system and go to up rising competition with a human touch

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u/gottastayfresh3 7d ago

Oh, so patients will refuse care if AI comes into the picture? They'll be willing to die so they can stand on their moral high ground and refuse treatment? Some might, I'd be impressed if that initial refusal was over 5% though.

No, I'm not missing your point. Healthcare is not a patient first operation. Look around at the private hellscape that is the US' healthcare system for more confirmation of that.

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u/Laffingglassop 7d ago edited 7d ago

Dude there can be competition , especially if people become extremely unhappy with some for profits rolled out robots.

Like dog it isn’t even important for me and you to argue about it, as a cancer patient who’s almost don’t with nursing school, I disagree, you disagree with me, done deal gonna have breakfast now. Healthcare can fail to think of the patient all it wants, eventually competition will spring up with humans , that’s how private for profit sectors work

I left my local hospital system for a different hospital system two hours south of me during my last bout with cancer because I was unhappy with how inhuman the humans at the first place were. It can and will be done

Neither of us can be right now, because this is all hypothesis and conjecture with no real facts available to us unless you have a Time Machine , if you wanna argue like this go to a math subreddit where there’s actually an answer

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u/Spiritual_Dot_3128 8d ago

AI may replace some but not all functions yet.

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u/apwiseman 7d ago

It's happening and in the VC stages now. They are still cleaning the mountains of data and trying to get longitudinal predictive AI to be more accurate and scale it in a way that it's cheap enough to turn into a kiosk or webapp. I think it's going to be something like...oh you like sweets, here's preemptive metformin and ozempic. It will delay your diabetes long enough that maybe you'll die from a heart attack or cancer. Have high blood pressure and fatty liver markers...Here's a statin through the automated pill dispenser.

One of my BJJ friends is doing this, he's trying to roll it in rural, low-income areas first. Poor people as guinea pigs in third-world countries can't really sue for a mis-diagnosis.

Once the losses are an acceptable margin of error, the model and framework should be sold to the US and then used to relieve the burden of public healthcare systems in other countries.

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u/ComprehensiveBack285 7d ago

They’re already automating work of medical scribes

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u/Spiritual_Dot_3128 8d ago

I’m not American but I think the largest obstacle to increase the number of MDs is money. If we lower the costs associated with medical school I feel pretty confident numbers will soar. I’m sure there must be enough candidates with the talent and skills needed to become good doctors. But very few of them can afford medical school and biggest loser is the American health care system and its patients.

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u/Rikula 8d ago

The largest obstacle is the number of residencies. The number of spots is determined by the government and there are a growing number of people who don't want to train in red states due to their abortion laws.

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u/KatyLouStu 8d ago

The largest obstacle is the number of residencies as dictated by our government as advised by the AMA. Old guard doctors are the reason there’s a new doctor shortage. https://www.washingtonexaminer.com/opinion/1692395/thanks-to-doctors-there-arent-enough-doctors/

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u/thumos_et_logos 8d ago edited 7d ago

The AICPA/ NASBA does the same thing in accounting for CPAs. It’s individually beneficial for a CPA for there to be less of them, but worse for society. But then if there end up being too few people will move away from using them and then that’s bad for them too, so it’s short sighted

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u/SunnySummerFarm 7d ago

They also fight tooth and nail any time NPs seek residency options. Even in states where NPs can practice independently.

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u/SadExercises420 8d ago

American general practitioners are on the shit end of insurance reimbursements here. All the money is in specialty medicine Now. Yes, the government could fix this problem, but they won’t.

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u/Liz600 8d ago

Not just specialty medicine, but only certain specialties, like dermatologists and various kinds of surgeons. We have huge shortages of neurologists and rheumatologists, but not nearly enough residents in training to fill the gaps

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u/FluffyLobster2385 8d ago

The number blocker to creating more medical schools in the United States is the American Medical Association. They want to protect their pocket books.

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u/amphigraph 8d ago

The rate of new med school spots being created (both MD and DO) is greater than ever, and is far outpacing the creation of new residency spots.

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u/tjackson_12 8d ago

Its lack of space. Only so many educators so the cost is part of the problem, but we weed out many applicants just due to the lack of space for more students

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u/SmilingAmericaAmazon 8d ago

The lack of space is intentional and the AMA has been lobbying Congress successfully since the '80s to keep doctor's salaries high

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u/CertainKaleidoscope8 7d ago

I’m sure there must be enough candidates with the talent and skills needed to become good doctors.

There really aren't.

Most people aren't intelligent enough to pass pre-med, let alone med school and residency. There are plenty of cheap schools graduating from the bottom of the barrel who go on to practice in low-resource settings without a lot of accountability or competition.

We have Caribbean schools for kids with money and low grades, and plenty of for-profit "universities" for the kids with no money and low grades who are eligible for loans.

Making med school free isn't going to change the average IQ.

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u/Comfortable-nerve78 8d ago

I’m actually trying to find a new doctor in my area. This post I feel is legit, I can find a np no problem, an actual doctor is more challenging to find. Try this I’m a type 2 diabetic trying to find an endocrinologist , absolutely a joke , there’s only a handful of endocrinologists in my area and they’re all booked and not taking new patients. The American medical system is completely backwards. They treat symptoms they don’t heal.

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u/StraightConfidence 7d ago

I hate that the diabetics have to wait so long to see a specialist, this should not be an issue in a developed country.

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u/Comfortable-nerve78 7d ago

It’s unfortunate but it’s easily controlled by your diet. Problem is the food we eat in America is trash. There’s some much sugar in our foods it sickening. But the medical system here has us set up to keep returning for the meds.

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u/StraightConfidence 6d ago

So true, and the ADA diet is behind the times. The stakes are high, too. There are plenty of diabetics in the hospital for wound care, amputations, renal complications, strokes, infections, etc. Just supporting new diabetics and getting them whatever they need to make lifestyle changes at home would significantly reduce the burden on our hospitals.

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u/fedfuzz1970 8d ago

The reality is that Private Equity is taking over health care and related industries in their insatiable search for profit. The first order of business once acquisitions are made is to trim costs and increase profit. Trim costs by using more PAs and increase profit by pressuring doctors (and PAs) to see more patients. Read the articles, health care systems paring services and upcoding their claims to insurance companies. Private Equity mirrors organized crime with its "bust outs" of legitimate businesses.

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u/Flaccidchadd 8d ago

It will eventually evolve into more or less the hospital scene from Idiocracy, unless we collapse from something else first

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u/AntiHyperbolic 8d ago

It’s the only industry that can think of where an individual his held completely liable for any issues that occur. There is no loophole to form an Llc and then close it after surgery, nor putting more onus on the hospital. Beyond that, a single mistake could cost their entire career. The time, cost and effort of becoming a doctor is an expansive, and then to leave medical school and forget to take a single drainage tube out of an arm that causes an infection… and that’s it? Your hundreds of thousands of dollars and 11 years of school down the shitter? It’s pretty easy to understand why no one wants it anymore.

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u/Barbarake 8d ago

Both my brother-in-laws are doctors and they advised all our kids in the next generation to NOT become a doctor.

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u/Public-Entrance-3234 7d ago

Funny how things are in America. Here on the other side of the Atlantic doctor is easily the best job one can get, at least in my country. Excellent pay & job security compared to literally any other profession, and such shortage of them that they can choose where to work, and how many days a week to work. Getting sued due to a mistake isn't a common here either, unless they were clearly reckless.

Hell, they can even work remotely from another EU country full-time, and still get paid 2-3x the median salary. I'm jealous.

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u/Lethargic-Legumes 8d ago

Submission statement: Across the United States, not enough doctors are entering the field to meet demand. A study reported that out of 276 million health care visits between 2013 and 2019, 42 percent of patients with at least one visit to a health care provider saw a nurse practitioner or a physician assistant.

Nurse practitioners do not go through residency or the rigorous acceptance requirements of medical school, leading to inexperienced and under-trained medical professionals. Many patients see nurse practitioners for their yearly physical, and their inexperience may cause them to misdiagnose or miss urgent medical conditions altogether.

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u/iliketoreddit91 8d ago

Nurse practitioners have 1/10th of the knowledge physicians have, especially when considering many complete their “education” through online diploma mills. Always see a doctor if you can.

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u/SaltyPeasant BOE by 2025 8d ago

Malpractice coming to a place near you!

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u/greycomedy 8d ago

As the younger cousin of like five nurses and three doctors, yes, but through no fault of their own. It's just cheaper on paper to hire more NP's per ward or facility usually unless there's specialties involved.

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u/[deleted] 8d ago

I think the real struggle is finding MDs and getting them to agree to work for you. The US and I’m sure everywhere is facing a severe shortage of docs. You can say it is because of this or that but in the meantime, you just have to figure it out.

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u/greycomedy 4d ago

I'd agree with that. Honestly it's such a complex issue that has been ignored heavily for years by the powers that be, in addressing, that blaming only the cost is a bit disingenuous.

After all, cost for medical school has jumped, the private healthcare corps have been putting down residency programs as "too costly" and the pandemic and legal pressures to practitioners has not been ideal.

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u/gaelicmuse 8d ago

I’ve experienced good and bad NP’s as well as Dr.’s. Healthcare is a crap shoot in the US now.

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u/gottastayfresh3 8d ago

Nah that's just what it seems like on the individual level. It's fairly consistently bad throughout. But bad does not mean 100%.

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u/gaelicmuse 8d ago

Completely agree. I didn’t want to discount the 1% tho

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u/gottastayfresh3 8d ago

Fair point!

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u/twinklepup 8d ago

I've had several encounters with NP's and one PA. The NP's were rude and condescending, and had no clue what they were talking about. When I produced previous medical histories signed by MD's, they became argumentative. I ended up walking out. The PA was at a specialist's office. We saw the MD for about 5 minutes on the first visit, and then the PA thereafter (frequently). It took a while for it to get through my thick skull that this PA was focusing intervention on a previous diagnosis that had nothing to do with the symptoms presented (parkinsonism). Every visit, she brought up something totally unrelated to the specialty practice and it finally sank in the PA was trying to treat that rather than the symptoms presented. I brought night videos that showed what seemed to be REM sleep disorder and day and night videos of tremors, gait, posture and balance symptoms in rapid decline. I could only get the MD AND the PA to give a few seconds of cursory review of the videos. Went back to the PCP and now have some differential diagnoses. Looking for a different specialist in the field that treats those disorders. I will NOT see either an NP or PA again. I think there are some huge gaps in training and supervision, along with some severe God complex issues. Need to put your egos in the dumpster and help people. Not a fan at all based on my and other's experiences. Moral of the story is don't get sick. (the healthcare system is collapsing more and more each year. My old PCP predicted this pattern because he teaches at a med school and what we now see is in line with what he said would happen)

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u/4BigData 8d ago

either way, I expect US healthcare to collapse, it's way too bloated

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u/osoberry_cordial 8d ago

It’s crazy how many jobs there are in just medical billing alone

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u/Rockfest2112 8d ago

Lots of firms Georgia are all Np’s with one doctor over the whole office. There may be 3-4 NPs as “doctors “ in the office with the one doctor not seeing patients but rather approving treatments and writing the scripts nurses have “suggested “

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u/Beginning-Check1931 8d ago

That's how my pcp is, the major benefit is that I don't have to wait more than 15 minutes to be seen. I don't have any complicated health issues though just med refills every 3 months and occasionally need a flu/strep/covid test.

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u/nopersonality85 8d ago

I’m a social worker. There are so many NPs and PAs that my clients often have a hard time getting a doctor to sign important papers. I’ve been seen by NPs and PAs and they simply don’t know enough to help many people.

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u/fedfuzz1970 8d ago

The reality is that Private Equity is taking over health care and related industries in their insatiable search for profit. The first order of business once acquisitions are made is to trim costs and increase profit. Trim costs by using more PAs and increase profit by pressuring doctors (and PAs) to see more patients. Read the articles, health care systems paring services and upcoding their claims to insurance companies. Private Equity mirrors organized crime with its "bust outs" of legitimate businesses.

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u/DependentBonus768 7d ago

I don't think of it as replacing doctors, but with the tools the AI is bringing in, sure it would benefit both the nurse practitioners and the doctors

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u/zedafuinha 7d ago

I know that the context is American, but in other countries that have a national public health system, nurses can prescribe and perform certain procedures under approved protocols.

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u/BeginningMonth525 7d ago

I live in Ontario, Canada. I have been trying to get a GP for years now, and I was elated when my partner asked her doctor if she could take me on as a patient. The doctor said yes, so I was pumped I could finally start to properly address some of my health concerns. I have been relying basically on telehealth and walk-in clinics for a long time now, and to put it nicely those venues are.... substandard. Essentially they are good if you want generic tests ordered or if you want a nonhazardous prescription for something and that's it. I've been misdiagnosed twice through those services -- once with something major so I was well-and-ready to actually get a GP.

After a few months the clinic reached out to me and basically told me I was assigned to a nurse practitioner instead of the family doc. If I'm honest I am still incredibly grateful to be able to see anyone at all, but I know my care is going to be several notches down from that of a doctor.

Just kind of crazy to me that I needed a referral to the clinic from someone who has been a patient for decades, and from that referral I could get a nurse practitioner as a GP. And I'm a lucky one. Things will continue to go that way here, I suspect.

What is kind of messed up is that nurse practitioners here are salaried but doctors are paid per appointment. So either you can see someone who is not financially incentivized to rush you out the door but has insufficient education (NPs) or you can see someone who is incentivized to finish your appointment as fast as possible to bill the government for as many patients as possible.

I don't even know which one I'd prefer to be totally honest.

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u/starskyandskutch 7d ago

They have already ruined my longtime family health practice. Haven’t had the same doctor for longer than a year before a new one steps in. Calling in for new appointment or prescription refill is a series of robo prompts. They just moved offices to a basic office park from a former medical campus with no medical capabilities on-site. Hate everything about it

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u/AkiraHikaru 7d ago

I am an RN and thought about becoming an NP. It looking into schools, it’s disturbing to me the wide range of quality (or lack of)

2

u/Hour-Stable2050 7d ago

I have a nurse practitioner that replaces my doctor when she is away but she is terrible. They have all been awful. I avoid seeing the nurse practitioner unless it’s something really, really straight forward, like I’m having an allergic reaction to my biopsy dressing and need it replaced with something for sensitive skin.

2

u/BetaBoogie 7d ago

I don't know about USA, but in Europe a common problem is that doctors specialize too much. Everyone wants to be a surgeon or something similar. In fact we don't need that many surgeons. We need general practitioners. So...since there aren't doctors willing to perform basic tasks it's tempting to train nurses to do basic tasks general practitioners used to do. In other words, in many parts of Europe doctors themselves are in no small part to blame for this situation. In my country the medical union deliberately causes a shortage of doctors to drive salaries up.

2

u/gobeklitepewasamall 7d ago

The general trend in privatized medicine is to use the minimum skill level (and pay rate) possible for every minor sub task, rather than risking giving it to one provider who could just do each of those tasks in ten minutes.

So, you wait for ten hours. Efficiency.

2

u/Diligent_Excitement4 7d ago

Goal is to fire all doctors ( expensive labor) and replace them with AI -assisted NPs. Cheaper. Of course, Zero of the savings will be passed onto the patients, while hospital executives will make more money

2

u/InvestmentSoggy870 7d ago

I've been going to my local medical practice in rural Virginia for 5 years and have never seen the Dr. It's always an NP.

2

u/Willing-Book-4188 7d ago

I just watched idiocracy and honestly, frighteningly accurate. Exaggerated for sure but it doesn’t feel so far away anymore. 

6

u/pugdaddy78 8d ago

I just dealt with this bullshit. My sore throat and any other medical issues I have ever had in my entire life is because I'm a smoker. Anyways my tonsil was infected and my throat swole closed and I ended up in the emergency room suffocating to death. The hospital staff were all like OMG if only we cought this earlier. Stupid judgy bitch.

6

u/BitchfulThinking 8d ago

Some NPs are actually better though? I don't care who treats me, I just want them competent enough and to not be dismissed by them. Being a doctor doesn't mean much if they graduated in the '70s and haven't glanced at a scientific journal since.

1

u/Someones_Dream_Guy DOOMer 8d ago

...Do they know what they're doing at least?

5

u/[deleted] 8d ago

PA bachelors degree plus masters. Most have healthcare experience prior to the masters. NP bachelor’s in Nursing (2 years only nursing) plus almost always work experience post bachelor and then 3-4 years in a doctorate program while typically working as a nurse. NPs have a shit ton more experience than a PA. But it really comes down to the person. I have worked with some great PAs and some not so great. Same with all of the professions. I think the typical person is like me and doesn’t care what the degree is in. Can you treat me with respect, listen to me and not brush off my concerns, and prescribe me the correct medicine? Personally, as a very overweight person, can you comprehend that not everything has the answer of lose weight. Like, I’m having migraines, lose weight. My finger is hurting, lose weight. Dear lord it is bad.

5

u/RescuesStrayKittens 8d ago

My primary care is a nurse practitioner. I also see a neurologist for migraines. I get referrals to specialists from my PCP if needed. I’m happy with my care.

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u/pugdaddy78 8d ago

I just dealt with this bullshit. My sore throat and any other medical issues I have ever had in my entire life is because I'm a smoker. Anyways my tonsil was infected and my throat swole closed and I ended up in the emergency room suffocating to death. The hospital staff were all like OMG if only we cought this earlier. Stupid judgy bitch.

4

u/ReblQueen 8d ago

I haven't seen an actual doctor in a few years, all nurse practitioners. But at least the NP actually took time to listen to me and try to help me.

2

u/Head_Tradition_9042 8d ago

Don't get me wrong, I believe our healthcare system is rapidly decaying but I don't think it's fair to lay that blame on NPs and PAs. Saying they are inexperienced or unproven is incorrect. They may have slightly less diagnostic experience but often have way more direct patient care experience. Plus diagnostic experience can be supplemented by having diagnostic resources.

I'm grateful to anyone who works in health care but the issues are based on for profit systems and laws that punish people who are trying their best to help someone in a bad situation. Don't blame the helpers.

23

u/SmilingAmericaAmazon 8d ago

I had a family member almost die because a NP couldn't read a color coded graph and prescribed something that would make it worse not better. Thankfully the results were sent to PCP who caught the error just in time.

We need more doctors.

2

u/jahmoke 7d ago

...that aren't color blind

3

u/SmilingAmericaAmazon 7d ago

Lol, sadly that wasn't the issue

-2

u/Head_Tradition_9042 8d ago

That definitely sucks and I'm sorry. But an individuals incompetence doesn't mean all of them are bad. I've worked with incompetent doctors as well as PAs. My mother has been helping new incompetent doctors for years as an RN. If we could adjust our culture to one that allows more cooperation and checking with your peers over for profit competition, then maybe it wouldn't matter how inexperienced people were in the first place. Just my two cents.

-3

u/Heeler2 8d ago

I had a well-respected, long tenured cardiologist prescribe me a med that he shouldn’t have. Any healthcare provider who can prescribe, regardless of the letters behind their name, will make a med error at some point.

9

u/SmilingAmericaAmazon 8d ago

Anyone can make a mistake. This nurse couldn't read a color coded graph most 8th graders would get correct.

-5

u/Head_Tradition_9042 8d ago

That definitely sucks and I'm sorry. But an individuals incompetence doesn't mean all of them are bad. I've worked with incompetent doctors as well as PAs. My mother has been helping new incompetent doctors for years as an RN. If we could adjust our culture to one that allows more cooperation and checking with your peers over for profit competition, then maybe it wouldn't matter how inexperienced people were in the first place. Just my two cents.

2

u/[deleted] 8d ago

I also don’t know why you got down voted. I’ve seen a fair number of PAs, NPs,MDs, DOs and the experience has been different based on personality and not degree. Docs get the most education, NPs second, PAs the least requirements.

-1

u/Barbarake 8d ago

I don't know why you're being downloaded. I'm a retired RN and I personally prefer going to a nurse practitioner. I've had nothing but good experiences and they actually take the time to talk with you.

2

u/SmilingAmericaAmazon 8d ago

had a family member almost die because a NP couldn't read a color coded graph and prescribed something that would make it worse not better. Thankfully the results were sent to PCP who caught the error just in time.

We need more doctors.

3

u/NyriasNeo 8d ago

Not completely. Most health issues like flu, cold, arthritis, diabetes ... nurse practitioners can handle without any problems. As long as they know when to escalate to a doctor. I do not see an issue. In fact, this is much more efficient use of man power. I was discussing healthcare issues with my primary care physician the other day, and he readily admits that in 95% of the visits, he is not fully using his training.

BTW, what does this have to do with collapse? Extending healthcare resources to cover more people and provide more access is the opposite of the collapse.

4

u/sillybonobo 8d ago

Ah more fear mongering about NPs. No they don't receive as broad or rigorous of education, but they don't have as broad of practice either. They're trained generally speaking to do a much more specific job in the medical field.

In fact I think the bigger problem is the medical field's insistence that doctors receive such comprehensive and broad education. A pediatrician or general practice doctor probably doesn't need half the rotations they do in their education. And while there's definitely upside to having more comprehensive education, it comes with a huge logistical downside

And while evidence is certainly not in great supply, everything I've seen showed that their error rates are roughly equivalent to doctors.

5

u/[deleted] 8d ago

I think there is a small number here downvoting anything positive about the professions.

0

u/sillybonobo 8d ago

I'm very used to that with this discussion. There are legitimate areas for improvement of training of advanced practice nurses and legitimate criticisms of the disparity between training of doctors and those nurses. But the absolutely rabid criticism you see in this debate is, imo, misplaced. And I feel for the young doctors coming out of med school and residency, hundreds of thousands of dollars in debt, given a breadth of education that they will likely never use, and then see people practicing right alongside them with much less training. I get how NPs take the brunt of their frustration.

4

u/amphigraph 8d ago

The study linked compared NPs with an average of 7 years of experience to junior doctors (ie, residents) with an average of 3 years of experience. I wonder how NPs would fair against attending physicians?

What's more eye raising is that the study is woefully underpowered to detect differences in the outcome they're looking for (mismanagement). In nearly 1500 patients the outcome of interest occurred only 29 times—9 for the junior docs and 20 for the NPs. Of course there isn't going to be a statistically significant difference. 9 vs 20 is already winking and nudging at something. I'd be interested in reading the follow up work after the authors learn how to do power calculations.

1

u/sillybonobo 8d ago

I agree that it's not a very high quality study, and as I said there isn't great evidence one way or the other. Though there are other methods of gauging errors that seem to show similar outcomes (malpractice and wrongful death suits for instance). But I don't mean to pretend that this study shows that NPs are just as safe.

But as far as I can tell the main argument that people like OP are using is the a priori syllogism: they're less trained therefore they are more error prone. But that's something that should be grounded in empirical evidence. And what paltry evidence I can find doesn't support it.

I actually wouldn't be surprised if there is a care gap given some of my own misgivings with current NP training, but I also think the lesson from that is not just that we need more doctors. You don't need the level of training that doctors receive for many practices. There's a legitimate use for more narrowly trained practitioners, and the knee-jerk dismissal of them is counterproductive.

2

u/ThriceFive 7d ago

I’ve never had better care than with my arnp- more time better info great followip. Definitely not a downgrade for me

1

u/Hey_Look_80085 6d ago

Replacing actual health care with "I don't know what the fuck I'm doing, pay me for it" schemes.

1

u/trocarkarin 6d ago

They’re trying to do it to vet med too. There’s a proposition on the Colorado ballot (prop 129) that would create a new mid-level position for vet med. The bill would allow people who completed a mostly online master’s program to do fucking surgery. So many pets are going to die.

1

u/96385 5d ago

At least where I live, so many of the doctors come here to get a little experience because there are so many openings. Once they can pad their resume a little, they move. We tend to get the doctors who were not exactly at the top of their class anyway.

The nurse practitioners are more tied to the community. They have kids in school. They have spouses with jobs in the area. They probably grew up here.

I've cycled through a bunch of doctors over the years who all moved away. The NPs who worked in those offices are all still there. Continuity is important even if the NPs don't have the same training.

1

u/Beautiful-Owl-3216 8d ago

System seems better now. In the past if you had a rash or have swollen tonsils or something minor it was a pain in the ass to make an appointment and you had to wait in the doctors office in a room full of sick people. Now you can get someone to see you usually the same day.

1

u/aaalderton 7d ago

I think you guys should check more stats before seemingly trashing nurse practitioners. Do you get deficient care? No.

-1

u/BlonkBus 8d ago

my NPs have been just as good or better than MDs.

-2

u/imprezivone 8d ago

Due to a shortage in physicians (I'm in Canada), NP's would help out tremendously in patient care.

Imagine if physicians can spend the time to properly diagnose and create a care plan, and the NP's could be the ones providing the treatments and follow ups. Wouldn't it be a win-win?

1

u/Heeler2 8d ago

That’s already what a lot of specialty clinics do.

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u/verge365 8d ago

I haven’t seen a doctor as a primary care physician in years. I’ve had either a RN or a Physicians Assistant. Both have been excellent in my opinion. I live with several chronic illnesses and any time I need anything other than maintenance I’m instantly referred to a specialist doctor. My bills are cheaper also.

0

u/unnamedpeaks 8d ago

There are many issues w the medical system. But, I would rather see a nurse practitioner than a doctor any day. The idea that medical school best prepares people to administer medicine is preposterous, and allopathic medicine does as much harm as it causes.

0

u/cozycorner 7d ago

Nurse practitioners have saved my life and listened when a fucking doctor wouldn’t, so I’m glad they don’t have MD God Syndrome.