ZDogg Talks about NPs (NSFW)

[Joelseff]

 

The discussion was about how doctors treat NPs and also about NP education/limits etc. Some NP commenters attack PA's and our education. They're more experienced blah blah blah...

 

Here's my exchange with an "Alexander"

 

 

 

Not a call to arms lol but check it out.

 

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[Marinejiujitsu]

He's trying to rationalize his worth. I've seen MDs, DOs, NPs, and PAs miss crap. That raging orbital cellulitis that was seen on a bounce back could have been missed because when the PA seen them there was no periorbital swelling/erythema/pain with EOM. That's why you tell people to come back if things worsen. Devils advocate. Same thing when a doc has some kid come back for a repeat abdominal exam and I find appendicitis, he didn't miss it, it was too early to diagnose.

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[Fernwood]

Every few years I see this PA vs NP debate start up. I’m a PA so have some bias but over the past 21 years I have worked with some good NPs and some not so good. Similarly I have seen some phenomenal PAs and some not so stellar ones. In reading the discussion it was apparent that J is an experienced PA who come about the PA profession through the “old model”as I will cal it. He was a Navy Corpsmen prior to becoming a PA. He had considerable medical experience prior to becoming a PA. The new model PA comes straight out of undergrad, does a 3 month stint as a ER tech and rolls into PA school. Not exactly much medical experience.(This new model was as much financially driven as demand driven. The proliferation of PA programs wanting to fill seats) I have worked with the new model PA students and while they are exceptionally bright they often times don’t have the maturity and prior experience to really apply their intelligence. Yes, I believe we need to push for “optimal team practice”legislation but I also feel that we must take a look at what how we have upended the PA model. I train family practice residents at an orthopedic clinic and recently had a young resident point out that he is seeing PAs coming out of programs and into practice that are really not up to the task. Do I feel that PA training is superior to NP training, yes, but I also feel that in many instances the NP years is actually more suited to pick up and run with it in a surgical sub specialty than many new PA grads.

in short, I think we need to return to recruiting individuals with prior medical experience. We also need to get our leadership to work more on making PAs more autonomous and less onerous to employ and quit with all the new CME metrics, i.e. SA and PI crap. NPs are not a threat to PA in an intellectual sense but are becoming more a threat in that clinics and hospitals see them as more easily managed.

 

t

[Joelseff]

Every few years I see this PA vs NP debate start up. I’m a PA so have some bias but over the past 21 years I have worked with some good NPs and some not so good. Similarly I have seen some phenomenal PAs and some not so stellar ones. In reading the discussion it was apparent that J is an experienced PA who come about the PA profession through the “old model”as I will cal it. He was a Navy Corpsmen prior to becoming a PA. He had considerable medical experience prior to becoming a PA. The new model PA comes straight out of undergrad, does a 3 month stint as a ER tech and rolls into PA school. Not exactly much medical experience.(This new model was as much financially driven as demand driven. The proliferation of PA programs wanting to fill seats) I have worked with the new model PA students and while they are exceptionally bright they often times don’t have the maturity and prior experience to really apply their intelligence. Yes, I believe we need to push for “optimal team practice”legislation but I also feel that we must take a look at what how we have upended the PA model. I train family practice residents at an orthopedic clinic and recently had a young resident point out that he is seeing PAs coming out of programs and into practice that are really not up to the task. Do I feel that PA training is superior to NP training, yes, but I also feel that in many instances the NP years is actually more suited to pick up and run with it in a surgical sub specialty than many new PA grads.
in short, I think we need to return to recruiting individuals with prior medical experience. We also need to get our leadership to work more on making PAs more autonomous and less onerous to employ and quit with all the new CME metrics, i.e. SA and PI crap. NPs are not a threat to PA in an intellectual sense but are becoming more a threat in that clinics and hospitals see them as more easily managed.
 
t

I totally agree and if you have been around this forum long, I have always advocated for the "old" PA requirements and do see the difference in the new grads. I think it was our "feather in our cap" so to speak that we brought with us considerable HCE in addition to our strenuous training and education. I think though that that ship has unfortunately sailed. I don't see schools reverting back to the old days. Heck my alma mater which has always been an HCE based program changed the program entirely and gas succumbed to the 500 hours shadowing model and tripled its tuition after 40 years.

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[Boatswain2PA]

We won't be able to go back to the "old" model due to the degree creep from AS to MS.  

The typical 40 YO with 20 years experience as a military medic, paramedic, FF, or EMT also has a family to feed and mortgage to pay.  It was hard enough for them to drop out of the workforce for 2 years to get their AS, now they have to drop out of workforce for four years to get their undergrad, and THEN 2.5 years to get their MS.

I was able to do it at 40 but it took me 10 YEARS of planning, a military retirement income, and I moved back in WITH MY DAD (again, at 40 years old!!) in order to be ale to do it.


Regarding the PA/NP fight:  Yes, there are great/good/average/poor/terrible NPs, just like there are great/good/average/poor/terrible PAs, MDs, DOs, etc.  The primary difference between these are the educational experience.  Take Joe Blow and put him through MD/DO and residency and Joe will be a board certified physician, the top of the profession, and you should expect Joe to be able to perform at that level.  Take Joe Blow and put him through PA program and Joe should be ready to practice general medicine with physician supervision.  Take Joe Blow and put him through a NP program and....you have absolutely no idea what kind of education Joe got.  It may have been all-online with a preponderance of papers on nursing leadership and management of hair-bonnets in the OR, and then 500 clinical hours at his friend's minute-clinic.  Or Joe may have gone to a good program that tried to actually teach him some medicine....you just don't know.

[ajames]

One of the reasons I chose to become a PA is because of the team-based model and ability to collaborate with a supervising physician as a new graduate PA. I have thought how crazy it is to go from 2 years CNA to PA-C and how fast I will have to learn material. Even as I sat on two acceptances to schools due to my stellar academic performance, I thought about declining, pursuing RN and then eventually NP so I can gain more clinical experience. I also thought about how the transition from CNA to RN wouldn't be much different in giving care. I would have to learn medications and understand more hospital limitations. I agree that schools should require medical experience because experiences show the reality of medicine and the issues along with it.

I have chosen to continue on to PA. The reality is, someone else is going to take my seat and it isn't going to change the nature of the game with the new model. It really is here to stay. Rather than using 5 years to transition to RN/NP and gain more experience, why don't I complete my PA route and gain real experience as a PA-C? The longer I practice, the more experience I will gain, and the better provider I will become. I have the grit to learn, passion to provide quality care, and patience to overcome obstacles.

I pay my respects to those of you who are so wise in experiences and who give so much to this online community. I do think that the old model of PAs and those who have been practicing for x amount of time should be allowed more autonomy and have independent practice. For those who are new to the field, there should be supervision and regulation. It should be like that for NPs, too.

 

[PACrankset]

I totally agree with ZDogg on this one. You don't know what you don't know. If everyone PAs, NPs and MD/DO included could come to this realization healthcare would be better for it. The ability to recognize when you are in over your head and need another opinion is paramount to our profession and also to Physicians and NPs. The EM Physicians I work with consult specialties all the time, numerous cases a day. Why? Because they can't possibly know everything about everything.

I chose the PA route because the model speaks to me, I want to know why something is happening. I also believe that learning to practice medicine is something that should be done in person not partially online. You don't see online Medical Schools so why should it be ok for other professions to do the same? I am really disappointed that they decided to approve the Yale program, I think it is a step backward for our professions education standards.

[Jchen14]

The healthcare model should lean toward relationship-based care. Healthcare should be focused on the patient but instead it seems like we are in an unnecessary civil war. Why the hell are we fighting? MD’s and DO’s are physicians. They should be the ones calling the shots. They have the MOST training and hours in the class room. I don’t care what NP program or PA program you attended. Those programs trained you to be a NP or PA - not physicians, so don’t try to behave like a physician.

 

On the other hand, there is NO reason that doctors should be putting down mid level practitioners. Down talk is both arrogant and unprofessional. The worst part? It compromises the care that the patient receives. Was it wrong for the anesthesiologist to behave the way he did? Absolutely. Is it wrong for NPs and PAs to act like physicians? Absolutely. We should stay in our scope of practice. ZDogg is right when he says that each profession possess skills that other professions don’t. For example, RNs interact and care physically for patients day to day so they should know how to empathize with them to provide them with the best care when they become NPs. Physicians and NPs should be collaborating to better the patient not compromise their plan of care. That’s just my 2 cents. It was frustrating listening to ZDoggs vlog because what he said was true and it’s the reality that’s plaguing our healthcare system. It also makes me wonder how many mistakes can be avoided if we all just got along.

 

 

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[CoastalPalm]

3 minutes ago, Jchen14 said:

On the other hand, there is NO reason that doctors should be putting down mid level practitioners. Down talk is both arrogant and unprofessional. The worst part? It compromises the care that the patient receives. Was it wrong for the anesthesiologist to behave the way he did? Absolutely. Is it wrong for NPs and PAs to act like physicians? Absolutely. We should stay in our scope of practice.

 

What do you mean by "act like physicians"?

[EMEDPA]

2 hours ago, CoastalPalm said:

What do you mean by "act like physicians"?

I was wondering that as well....

[CAAdmission]

3 hours ago, CoastalPalm said:

What do you mean by "act like physicians"?

I have always taken that as secret code for "be an a-hole."

[MCHAD]

4 hours ago, Jchen14 said:

 

On the other hand, there is NO reason that doctors should be putting down mid level practitioners. 

Maybe it’s because of the term “mid level practitioner” that’s used all the time makes them think that we provide mid level or mediocre care... I know there are some members of this forum that disagree with me but I think it’s a term that needs to be eliminated.  As I’ve said before, I am not held to a lower standard than physicians by the medical board when it comes to the level of care I provide.

[Joelseff]

Sigh. This guy is at it again. I posted separately to comment on the video this:

"JoeDaFivefoota19 hours ago

I'm a Primary Care PA and my team and pts appreciate the care I provide. Who cares what title I have or letters after my name? Medicine is not a "one man show." My education and training allow me to provide care within my scope and experience. I was an HIV specialist before I went back to IM/FP and my colleagues (MD/DO/NP) ask me for help for situations they are not familiar with like ID issues and I go to them for areas they are experts in. Screw the so called "hierarchy" and classism. This ain't High School!

Show less"

 

He goes and posts this:

"Alexander8 hours ago

This statement is actually on point. Differs a lot from you trying to belittle NPs when you were debating me."

 

So I posted this:

 

"

Bruh, The "belittling" you speak of was posted in response to your comment about PA incompetence so I brought up my own anecdote about my observations of PA students and NP students in clinical rotations. I Precept both for 3 local universities.   Whatever...who cares who started that debate but facts are facts.  Though, you never did respond to the question of direct entry NP programs that i brought up but I am sure, like my response to the "new" pa school requirement model that you brought up, you don't like these types of programs either. The one thing I wanted to point out though for you and for the other people reading this is, PA education never got watered down with non clinical theory or fluff papers. It has always been about the basic medical sciences and clinical medicine/practice and a focus on a well rounded clinical rotation series to prepare us as medical providers to function in a team based environment. In fact, the newer programs have added even MORE sciences and more collaboration/coeducation with med students at their corresponding med schools. Most NP programs I have seen consist a lot of the former (theory etc). Though they do have some clinical classes but to what extent I am unsure since, again, MY observation of the students I have taught prove to me that it is not deep enough nor broad enough.  Perhaps you attended an exceptional NP program that did but I was presenting my observations.  I won't go anymore into the differences, I have already posted that one should look up the differences yourself vs posting opinions as fact (mine included) on a youtube comment section. 

Now, I (I suppose like yourself) am for students to have best HCE whether it be a medic, Nurse, FMG etc. THEN go through rigorous ADDITIONAL training for APPs because we both do not have the benefit of the 4 year medschool 3+ year residency of the Physician model and we are expected to perform/function as they do.  I do however, expect all practitioners (and my students PA or NP) to know basics of pathophys and pharmacology and A&P.  

As an aside though to your assertion that NPs are "better" because they were RNs first, really on the surface sounds good but let's face it, a new grad NP is not ready to hit the ground running as a PROVIDER because no matter how many years they were a RN, they were NEVER a provider until thery were a NP. Same goes for PAs unless they were FMGs , or to some extent Ex military Corpsmen/Medic because we did function as primary care providers in some capacities but this in NO way replaces the need for a strong medical education. 

That's all I'll say. "

 

ANd I'm sure he'll hit back with something else but whatev... 

 

 

 

 

 

 

[Jchen14]

8 hours ago, CoastalPalm said:

What do you mean by "act like physicians"?

I mean what ZDogg described in his videos when he elaborated on when NPs are called doctors and do nothing to correct that. Don't let the patient believe that you, the NP, is in the role of a physician because you are not. 

[Jchen14]

4 hours ago, MCHAD said:

Maybe it’s because of the term “mid level practitioner” that’s used all the time makes them think that we provide mid level or mediocre care... I know there are some members of this forum that disagree with me but I think it’s a term that needs to be eliminated.  As I’ve said before, I am not held to a lower standard than physicians by the medical board when it comes to the level of care I provide.

As a future PA, I really don't mind the whole "mid-level" talk. I don't believe that it's a derogatory term used to play down the role of the nurse practitioner or the physician assistant. NPs and PAs are "mid-level" because at the hospital and in practices where there are physicians present, they are supervised and encouraged to consult with physicians.

I do understand where you are coming from, though. 

[Boatswain2PA]

More than a nurse, but not a Doctor.....Mid-level.

[Joelseff]

Sigh this dude.... I tried to end it to say let's agree to disagree then he hits back with

 

 

I ended it with

 

 

 

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[MCHAD]

1 hour ago, Jchen14 said:

As a future PA, I really don't mind the whole "mid-level" talk. I don't believe that it's a derogatory term used to play down the role of the nurse practitioner or the physician assistant. NPs and PAs are "mid-level" because at the hospital and in practices where there are physicians present, they are supervised and encouraged to consult with physicians.

I do understand where you are coming from, though. 

 

56 minutes ago, Boatswain2PA said:

More than a nurse, but not a Doctor.....Mid-level.

As a practicing PA I do find it demeaning. I’ve also had patients use it in a derogatory manor.  It holds us back and needs to go if OTP is ever going to succeed.  I hate it as much as when a patient says, “I don’t want to see the assistant”.  

As I said before, I’m not expected to only provide “mid level” care.  Or is it ok if I only help a patient get their diabetes or hypertension to a “mid level” of control? 

[kargiver]

There is absolutely nothing "mid-level" you do as a PA or NP.  The gold standard of care is the gold standard of care, period. The only issue relevant to PAs/NPs and increased autonomy is knowing what you don't know and knowing how/when to get help.  All MDs do it, all PAs do it, and all NPs do it. 

Participating in a pissing contest with an NP over autonomy is a waste of time... it's a false argument predicated on their practice of medicine being referred to as "advanced practice nursing."  There is no need for PAs to justify what they do and why they do it to them - why waste the time?  There are good and bad providers across the entire spectrum of providers - pointing fingers just makes us look childish.

With regards to ZDogg - I love most of his stuff - but he is a cult of personality.  Never forget that.  His dreams and visions of the future of medicine are not necessarily what medicine is or will be.  One can appreciate the role he is playing (and OMG does his DocVader just kill it) but in the end, he has to practice to the same standards you do - MD/PA/NPs all do. 

G

[Boatswain2PA]

10 hours ago, MCHAD said:

 

As a practicing PA I do find it demeaning. I’ve also had patients use it in a derogatory manor.  It holds us back and needs to go if OTP is ever going to succeed.  I hate it as much as when a patient says, “I don’t want to see the assistant”.  

As I said before, I’m not expected to only provide “mid level” care.  Or is it ok if I only help a patient get their diabetes or hypertension to a “mid level” of control? 

You find THAT demeaning?  As in "de-valuing your meaning in life"?  I would suggest you get some thicker skin my friend.

What the a$$hat doctor said to the neuro-PA (another thread here)...now THAT was demeaning, and I would have come out swinging to him.  But to call me a mid-level or a Physician ASSISTANT..well....that just doesn't rise to the level of "demaning" to me.  I knew what I was getting into.  I made a deliberate decision to not even ATTEMPT to go to medical school, yet I've got a great job, I'm paid VERY well, and life is good.  Sorry, just not going to get my panties in an uproar about being called a mid-level.

While there are a few of us (and probably over-represented here on these boards) who practice very independently, a LOT of PAs work in specialty practices where they truly are ASSISTANTS to the specialist.  The cardiology, neuro, CV, ortho, neph, (etc at nauseum) PA doesn't practice independently.

Regarding OTP - Is that, or is that NOT, about independent practice?  I'm all about reducing stupid burdens (co-sign, Doc/PA ratios, etc).  I think every state med board should have a ONE page form that lists out our supervising physician/alternates, and all supervisory requirements should be determined by the physician and PA....but I don't think that's what many of you think of when you throw out the term OTP.

[Jchen14]

5 hours ago, Boatswain2PA said:

You find THAT demeaning?  As in "de-valuing your meaning in life"?  I would suggest you get some thicker skin my friend.

What the a$$hat doctor said to the neuro-PA (another thread here)...now THAT was demeaning, and I would have come out swinging to him.  But to call me a mid-level or a Physician ASSISTANT..well....that just doesn't rise to the level of "demaning" to me.  I knew what I was getting into.  I made a deliberate decision to not even ATTEMPT to go to medical school, yet I've got a great job, I'm paid VERY well, and life is good.  Sorry, just not going to get my panties in an uproar about being called a mid-level.

While there are a few of us (and probably over-represented here on these boards) who practice very independently, a LOT of PAs work in specialty practices where they truly are ASSISTANTS to the specialist.  The cardiology, neuro, CV, ortho, neph, (etc at nauseum) PA doesn't practice independently.

Regarding OTP - Is that, or is that NOT, about independent practice?  I'm all about reducing stupid burdens (co-sign, Doc/PA ratios, etc).  I think every state med board should have a ONE page form that lists out our supervising physician/alternates, and all supervisory requirements should be determined by the physician and PA....but I don't think that's what many of you think of when you throw out the term OTP.

I think he meant "demeaning" as in he feels like his actions/responsibilities as a PA should garner more respect sometimes from physicians and patients. Even the title "physician assistant" can be demeaning, but hey it is what it is. If someone doesn't like it then he/she should fight for what they believe should be correct. Let your voice(s) be heard.

[Joelseff]

I feel you should take a good, hard, honest look as to why you are taking screenshots of conversations you are having with an internet stranger and smearing them around websites you have bookmarked.

Hahaha ok buddy...

I wanted to link the conversation but didn't know how from my phone so I took the screenshots. If it bothers you... Don't read it.

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[Lexapro]

2 hours ago, mcclane said:

I feel you should take a good, hard, honest look as to why you are taking screenshots of conversations you are having with an internet stranger and smearing them around websites you have bookmarked.

Gotta agree with you. People get way too riled up over stuff like this. And then making multiple posts of the argument in another forum all together to garner rancor? Yikes. Go take a walk or read a book... I have had almost nothing but good experiences with PAs professionally. This online hatred is divisive.

[Joelseff]

So I just posted on how I was DEFENDING PA education and I'm the D-bag? Ok...thanks for posting... Like I said if you are bothered by it... Don't read my post...or address my points...

 

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[krisephillips]

On 11/28/2017 at 1:16 AM, kargiver said:

The gold standard of care is the gold standard of care, period. The only issue relevant to PAs/NPs and increased autonomy is knowing what you don't know and knowing how/when to get help.  All MDs do it, all PAs do it, and all NPs do it. 

 

You hit it right on the head! 

I have seen bad PAs, NPs, MDs and great ones as well.  Knowing your limitations and asking for help/training when needed is a big talking point I have with my PA students during rotation.