Slowly getting us ready for the widespread use of mid-levels for primary care:
“The government and the VA system was the entity that dumbed us down from doctor to provider. That was to foster the environment in which registered nurses, nurse practitioners [NPs], etc would all be lumped into the category of’provider,’ and all would be considered’equals.’”“We are going to have NPs taking over primary care, just watch. High-tech specialties will have more doctors and they will disproportionately fix primary care with more NPs.”
Related posts:
- Does the AMA secretly want to kill primary care?
- Physicians as healthcare providers
- Will nurses be the new primary care providers?
- What role should nurse practitioners play in primary care?
- Why mid-level providers will not take over primary care
- My take: Mid-levels, PCP summit
- Will doctors get a pay cut under a public health option?
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{ 13 comments }
Providers in my neck of the woods includes Physician Assistants (PA’s) and Nurse Practitioners (NP’s) and a few specialized nurses such as CRNA’s. Does not include Registered Nurses. Funny thing, one ED Group in my area only hires PA’s as their Midlevel “Provider” because they like the name better than Nurse Practitioner. Its a fluff perception thing where many patients think they saw the Physician when they see the PA. The reality is that NP’s and PA’s
programs in many cases are combined. That seems to be the trend. Some remain stand alone. The NP was first a Nurse, usually at the Bachelors level, prior to going to NP school. PA goes directly to a program after aprox. 2 years of undergrad. Many had never worked in healthcare prior to becoming a PA. Generally speaking the NP has several years more training and hands on patient experience than the PA
the PA’s and NP’s won’t want to practice primary care either. It sucks for them too.
In Massachusetts, it’s now been suggested by the politicians that NPs take over many of the duties of the PCP, in order to partially compensate for the shortage of
PCPs in this State.
Also suggested was to pay off medical school loans for those MDs willing to enter primary care.
Has the world gone totally mad. If RNs wanted to practice medicine, they should have gone to medical school…I for one will continue to go to MDs, I’ve never gone to an RN for medical care.
Why should I, when I know more medicine than an RN?
This has already happened at the VA Health System in Western New York. When my husband got his pacemaker in July 2005, a physician did the procedure, but otherwise he sees two nurse practitioners – one for cardiology and one for diabetes management and other primary care. He hasn’t seen an actual doctor in at least two years.
Good. This is how it should be.
Using PAs and NPs for primary care wont work, because SHOCK! they want the higher paying specialties just like doctors do. Furthermore, SHOCK! they like the big cities much better than the poor underserved rural areas, again just like the doctors do.
I always laugh when I hear PAs/NPs are going to take over primary care. Over 70% of new PAs coming out of school work in specialty fields and want absolutely nothing to do with primary care.
I guess the politicians next idea is to let regular RNs and lab technicians write scripts and take over primary care. Good luck with that idea.
“Why should I, when I know more medicine than an RN?”
You really think reading medical blogs and some type of science background means you know more medicine than an RN Koko? You are deluded.
I guess KoKo cant read well. Also, Dr Tice has it totally wrong. RN’s are not midlevel providers – NP’s and PA’s are. In case you havent realized it there is a difference.
“I guess KoKo cant read well.”
# posted by ERMurse : 10:13 PM
Looks like “male” nurse failed English 101. Duh!
KoKo, PhD.
Thanks Koko “PhD” for your “insightful” and “relevant” comment. I happen to have a Ph.D and an MD. This is what I know from my experience.
1: Having a Ph.D does not mean you are medically trained and that you “know more” than a doctor or a nurse.
2: Having an MD does not mean you are trained to do research (many MD’s make this mistake).
Having done a postdoc and a residency I can say that In med school/residency I learned little on how to complete scientific research projects. Conversly, as grad student/post-doc I learned little nothing as to how to manage medical patients. Like most things in life Koko Ph.D it is EXPERIENCE that trains us to be competent in our chosen field.
Food for thought.
PS: Please do correct my spelling and make any pithy comments you would like.
Guess, we’ll all have to post as “anonymous”.
I have to chime in and say that I have generally deliberately chosen to use NPs for my primary care for the past several years, because I feel that I get more time with the provider and am treated as more of a whole person than when I go to regular docs. However, I should probably qualify that by saying that I have a specialist for my major ongoing issue (thyroid), and work in a large academic medical center. I really only need a PCP at this stage for basic things like general illnesses (strep, etc.), and I don’t see why an NP can’t handle that.
the problem with mid-levels is that, once you realize they missed something that an MD would’ve picked up, it’s generally too late: a couple of examples –
1- creatinine for a young “healthy” person doubles from 0.6-1.2 – still “normal” per lab record, but an MD would pick it up;
2- the ubiquitous chf exacerbation masquerading as a “URI”
so the myth that they can handle “simple things” is that recognizing when something ISN’T simple is a challenge that comes with years of education & training.
I look back at my basic science texts, ICU book, washington manual, etc. that all are highlighted & underlined like crazy, and I’m just amazed how much knowledge was taken in in those years. I’d say that the first semester of med school was more info than all of high school & college put together. Internship was way more than that even.
And somehow an RN with just 2 years of NP school goes from doling out meds ordered by an MD, to prescribing narcotics, juggling multiple meds in the elderly, and diagnosing & treating all sorts of conditions? just doesn’t make sense to me.
but people will clearly trade quality for cost. so be it.
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