LoRezSkyline Posted April 30, 2014 Share Posted April 30, 2014 yeee-ouch - i've not even read the comments thread on this one yet, but something tells me i'll need a flame-retardant asbestos suit to make it out alive on the back side?!? http://www.nytimes.com/2014/04/30/opinion/nurses-are-not-doctors.html?_r=0 Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted April 30, 2014 Moderator Share Posted April 30, 2014 At least PA's weren't mentioned in a negative light. Link to comment Share on other sites More sharing options...
DennisG Posted April 30, 2014 Share Posted April 30, 2014 No link to the study he's citing? Maybe if he wants everyone to be "doctors" there should be a reform to make it look more appealing to the undergrad students that are already racking up debt with insane interest rates. It's sad that there's students out there that divert to nursing or the PA route, not because of the career itself, but because it's cheaper and makes "just as decent money." This issue won't be resolved by impeding the autonomy of mid-level providers. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted April 30, 2014 Moderator Share Posted April 30, 2014 No link to the study he's citing? Maybe if he wants everyone to be "doctors" there should be a reform to make it look more appealing to the undergrad students that are already racking up debt with insane interest rates. It's sad that there's students out there that divert to nursing or the PA route, not because of the career itself, but because it's cheaper and makes "just as decent money." This issue won't be resolved by impeding the autonomy of advanced practice clinicians Fixed it for you Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 30, 2014 Moderator Share Posted April 30, 2014 I can't fault him much for feeling threatened But lets point out some thoughts 1) I think it is absurd to think that a new grad NP - who might have done a direct entry program - has the ability to safely and effectively treat PCP patients 2) I am not aware of the NYS law but if it does not have a tiered level - ie after 5 years of clincal practice you can go independent, then I would agree with him. 3) I have been relatively underwhelmed by the new NPs and to a lesser degree PAs that are coming out right now. 4) Time spent as an RN is not time spent as a provider - I am tired of hearing this from the nurses - too many times an RN does not have any where near wide enough Ddx - and if fact is an expert at treating the routine but truly has very little idea of the true Ddx. Seen it to many times, even with good-->great nurses..... There is a difference in giving versus taking orders. Granted 20 years nursing gives you an awesome foundation. 5) The training of NPs is substandard in the hard sciences - have said it before- when asking a np-s what top 3 bugs of sinusitis are and they just look at you with a the deer in the headlights look - that is not good. They need a much better education in the hard sciences. BUT After 3-5 years out an NP that has hit the books, learned from those around him/her and continued their education should be able to set up their own practice IMHO, as should a PA. I really do not think that PA or NP is a replacement for MD/DO especially in the first 3-5 years of practice - but after a training period - ie 3-5 years we are certainly more then capable of being pcp Remember how the Doc's got here - Medicare set reimbursement rates (which is set by a panel of doc's dominated by specialists) and the have priced themselves out of the primary care market - they did it to themselves and now some are grumbling..... oh well Link to comment Share on other sites More sharing options...
SocialMedicine Posted April 30, 2014 Share Posted April 30, 2014 looks like most comments are not opposed to more NP involvement in care. In my 5 minutes of browsing did not see many smart anti NP or PA comments. Not many posts .... if anyone has a NYT account you should share some forum ideas. Link to comment Share on other sites More sharing options...
blueridge Posted April 30, 2014 Share Posted April 30, 2014 .... if anyone has a NYT account you should share some forum ideas. I have a NYT account. I am unsure what you mean by forum ideas? Link to comment Share on other sites More sharing options...
SocialMedicine Posted April 30, 2014 Share Posted April 30, 2014 represent the forum ! hah. post something pro PA or interesting. Link to comment Share on other sites More sharing options...
marktheshark89 Posted April 30, 2014 Share Posted April 30, 2014 as a heads up, I believe anyone can create a free account and post. Link to comment Share on other sites More sharing options...
whoRyou Posted April 30, 2014 Share Posted April 30, 2014 yeee-ouch - i've not even read the comments thread on this one yet, but something tells me i'll need a flame-retardant asbestos suit to make it out alive on the back side?!? http://www.nytimes.com/2014/04/30/opinion/nurses-are-not-doctors.html?_r=0 Link to comment Share on other sites More sharing options...
blueridge Posted April 30, 2014 Share Posted April 30, 2014 Oh, I already did that post something very pro PA and interesting, and it has received a good number of "recommends" though it is now buried among the comments. I have the digital subscription to the NYT, and I read portions of it daily (always the health and sections). Over the years, I have made many pro PA posts and provide back-up to others as well as confront some negative PA posts. It has been interesting over the years to see how the mindset of the readership has changed in relation to PAs, which overall, I feel has become more positive. I recall one article about 6 or maybe 7 years ago in which a fellow and I, politely, went back and forth for many posts (not as much action in the health articles comment sections back then), and he finally came around. Assessing public perception of PAs over the years in the NYT articles/comments is what has led me to believe that now is the time for PAs to be yet bolder (and really push for the title change). Overall, the ragging of PAs has lessened considerably and more PAs post comments also, which is another manner of how though the numbers of PAs are considerable fewer than NPs, their presence can be magnified. Plenty of policy makers do read the NYT. Link to comment Share on other sites More sharing options...
LIPPER Posted April 30, 2014 Share Posted April 30, 2014 So how does this relate to earlier thread touting NP's only? ... It's all a no-win situation when only focusing on the negatives Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
KMD16 Posted May 1, 2014 Share Posted May 1, 2014 The bill passed. Signed by Gov Cuomo. Can't be reverse. Done deal! The MDs can cry as much as they wants. It's official. They're independent. Here comes cheap labor. I practice in the tri-state region and sure will be following this very closely. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 1, 2014 Moderator Share Posted May 1, 2014 Looks like CT is also going to be indpendent practice for NPs meanwhile in Mass, I can't sign a death cert, MASSHEALTH is playing games about recognizing PA as PCP (stupid) while NPs can do both these things Link to comment Share on other sites More sharing options...
KMD16 Posted May 1, 2014 Share Posted May 1, 2014 I can't fault him much for feeling threatened But lets point out some thoughts 1) I think it is absurd to think that a new grad NP - who might have done a direct entry program - has the ability to safely and effectively treat PCP patients 2) I am not aware of the NYS law but if it does not have a tiered level - ie after 5 years of clincal practice you can go independent, then I would agree with him. 3) I have been relatively underwhelmed by the new NPs and to a lesser degree PAs that are coming out right now. 4) Time spent as an RN is not time spent as a provider - I am tired of hearing this from the nurses - too many times an RN does not have any where near wide enough Ddx - and if fact is an expert at treating the routine but truly has very little idea of the true Ddx. Seen it to many times, even with good-->great nurses..... There is a difference in giving versus taking orders. Granted 20 years nursing gives you an awesome foundation. 5) The training of NPs is substandard in the hard sciences - have said it before- when asking a np-s what top 3 bugs of sinusitis are and they just look at you with a the deer in the headlights look - that is not good. They need a much better education in the hard sciences. BUT After 3-5 years out an NP that has hit the books, learned from those around him/her and continued their education should be able to set up their own practice IMHO, as should a PA. I really do not think that PA or NP is a replacement for MD/DO especially in the first 3-5 years of practice - but after a training period - ie 3-5 years we are certainly more then capable of being pcp Remember how the Doc's got here - Medicare set reimbursement rates (which is set by a panel of doc's dominated by specialists) and the have priced themselves out of the primary care market - they did it to themselves and now some are grumbling..... oh well The law requires 36000 hours as an NP before flying solo effective 2015 thru 2021. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 1, 2014 Share Posted May 1, 2014 36K hours? Really? If there are 2080 work hours for an average individual/year (40 x 52) that would take 17.31 years to obtain this status! By that time I had already begun to forget stuff! Link to comment Share on other sites More sharing options...
CoastalPalm Posted May 1, 2014 Share Posted May 1, 2014 The law requires 36000 hours as an NP before flying solo effective 2015 thru 2021. 3,600 hours, not 36,000. Link to comment Share on other sites More sharing options...
BruceBanner Posted May 1, 2014 Share Posted May 1, 2014 The nursing profession continues to do political laps around us while the AAPA wastes time and resources "educating the public" rather than fight fire with fire. I think NPs could very easily eclipse us in terms of hire-ability if we don't start fighting tooth and nail for evolved practice rights (and titles). One day we'll wake up and say "Hey, why cant I get a job? Oh, right. I need an SP and cant legally do x, y, z in my state." Link to comment Share on other sites More sharing options...
KMD16 Posted May 1, 2014 Share Posted May 1, 2014 3,600 hours, not 36,000. I meant 3,600 hrs. Link to comment Share on other sites More sharing options...
KMD16 Posted May 1, 2014 Share Posted May 1, 2014 The nursing profession continues to do political laps around us while the AAPA wastes time and resources "educating the public" rather than fight fire with fire. I think NPs could very easily eclipse us in terms of hire-ability if we don't start fighting tooth and nail for evolved practice rights (and titles). One day we'll wake up and say "Hey, why cant I get a job? Oh, right. I need an SP and cant legally do x, y, z in my state." True. These hit home. I think whenever stuff like this happens. AAPA should seize the opportunity. I'm currently working with my state chapter on putting out article on difference of training (PA vs NP). PAs training >>>NP/DNP training. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 1, 2014 Moderator Share Posted May 1, 2014 The nursing profession continues to do political laps around us while the AAPA wastes time and resources "educating the public" rather than fight fire with fire. I think NPs could very easily eclipse us in terms of hire-ability if we don't start fighting tooth and nail for evolved practice rights (and titles). One day we'll wake up and say "Hey, why cant I get a job? Oh, right. I need an SP and cant legally do x, y, z in my state." where is that PA-->DNP program??? Link to comment Share on other sites More sharing options...
BruceBanner Posted May 1, 2014 Share Posted May 1, 2014 True. These hit home. I think whenever stuff like this happens. AAPA should seize the opportunity. I'm currently working with my state chapter on putting out article on difference of training (NP vs NP). PAs training >>>NP/DNP training. It really is, but honestly I wonder if educating the public about PAs is a lost cause. PAs have been around for how long?? 40-some years? I'd say about 10-15% of my patients actually know what a PA is and our scope of practice. It can be annoying, but if I wanted instant professional recognition I'd have been a physician. What's disconcerting is the prospect becoming second-string in the job market. where is that PA-->DNP program??? I'm working on one using Word and GoDaddy web hosting. You too can have a DNP for $50,000 and 12 credit online course. Link to comment Share on other sites More sharing options...
andersenpa Posted May 2, 2014 Share Posted May 2, 2014 Think about "Goal Directed Therapy"- looking at how the means achieve an outcome rather than the perceived merit of individual approaches. We PAs have been clamoring for a looong time about our outcomes, patient satisfaction, and cash-on-cash returns for our practices. We are not physicians but we provide physician level of care as part of a multidisciplinary system. No one is working in silos anymore. NPs have less intense (using the historical standard of clinical bedside hours) training than PAs. Yet they are collecting a larger and larger market share of the PCP business. No strong evidence to support the "risk to patent safety" argument against NPS (granted, not huge evidence on either side pro or con). I've said many times - there's more than one way to train a PCP. PAs have done it. NPs have done it. While we resent the independent status NPs have earned (from relentless legislative efforts that PAs can't match), and feel we are just as "worthy" of it.....we can't refute their role as PCPs unless we see significant evidence that they are unqualified. If we do so then we argue against our own (philosophical) position that MD/DO should not hold the monopoly on primary care. Link to comment Share on other sites More sharing options...
MedicinePower Posted May 2, 2014 Share Posted May 2, 2014 Nurse practitioners receive approximately 600 hours of clinical instruction during their entire formal education I thought the number was closer to 800, which is still far less than PAs. Has anyone fact-checked this or confirmed this with NY State requirments for NP training? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 2, 2014 Moderator Share Posted May 2, 2014 I thought the number was closer to 800, which is still far less than PAs. Has anyone fact-checked this or confirmed this with NY State requirments for NP training? the min is 500, a few are around 800- 1000. Link to comment Share on other sites More sharing options...
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