MediMike Posted March 28, 2022 Share Posted March 28, 2022 https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope?fbclid=IwAR3oze6zVkKtJriTB2WFPnTHwzNNg8dGWqAazLTy07o0T5_amHBBCAhPJB4 Would love to know what the distribution of these patients were, how many were same day visits, if there was a more rural component or less compliant. Or maybe the APPs in this organization so punt more as they don't have the backup? Would also like to see the breakdown between PA and NP Quote Link to comment Share on other sites More sharing options...
sas5814 Posted March 28, 2022 Share Posted March 28, 2022 5 hours ago, MediMike said: Would also like to see the breakdown between PA and NP Me too but in the world of the physician you are either a physician or not a physician. They see no shades of gray. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 28, 2022 Moderator Share Posted March 28, 2022 saw this the day it was released emailed them that day to talk about it, learn more Need to see the data before any conclusions (although in the past 5 years I am starting to wonder the same thing with new grad NP's flooding the market and they do not provide a reasonable level of care) this line is the one that has my attention most: Nephrologist John M. Fitzpatrick, MD, president of Hattiesburg Clinic and another co-author of the study, said “four of the five top highest-cost providers were nurse practitioners.” That finding “prompted us to really analyze the whole population and, ultimately, led to the findings in the paper.” My questions 1) break it down PA to NP 2) break it down further with number of years out of school is their a local program that was feeding them new grads? Way to many questions, but honestly would not be surprised as the new grad NP's really have no idea what they are doing and they are doing so with limited supervision. First step is AAPA really going after them to get the data and figure out the above two questions I hope and pray that this one study might well show the difference with PA and NP and they stop lumping us together. 20 years ago it was fine, but now - nope I have no desire to be lumped in with NP at all.... new grad NP are scary and likely endanger their patients. See other threads for examples Established NPs and ones that learn are excellent, but the ANA has watered down the NP so much with online and distance learning that they truly are not educated enough IMHO 1 Quote Link to comment Share on other sites More sharing options...
Hope2PA Posted March 28, 2022 Share Posted March 28, 2022 14 hours ago, MediMike said: https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope?fbclid=IwAR3oze6zVkKtJriTB2WFPnTHwzNNg8dGWqAazLTy07o0T5_amHBBCAhPJB4 Would love to know what the distribution of these patients were, how many were same day visits, if there was a more rural component or less compliant. Or maybe the APPs in this organization so punt more as they don't have the backup? Would also like to see the breakdown between PA and NP I went to their site of around 350 providers, which included DPT, SLP, OT, Pharmacy, psych, physicians, NP and PA, rough count of 78 NP and 16 PA. Quote Link to comment Share on other sites More sharing options...
MediMike Posted March 29, 2022 Author Share Posted March 29, 2022 @ventana here's the link to their data https://ejournal.msmaonline.com/publication/?m=63060&i=735364&p=20&ver=html5 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 29, 2022 Moderator Share Posted March 29, 2022 So a little digging This MD that is the sole listed author seems to have a beef with NPs. https://www.buzzsprout.com/1475923/8572990-board-of-nursing-vs-board-of-medicine-a-case-study-of-nurse-practitioner-rock-doc-jeffrey-young https://www.podchaser.com/podcasts/patients-at-risk-1564106/episodes Please take a moment to head over to https://www.facebook.com/search/top?q=american medical association (ama) and take a moment to put some well thought out professional responses to some of the silly inaccurate comments getting thrown around. Quote Link to comment Share on other sites More sharing options...
Hope2PA Posted March 29, 2022 Share Posted March 29, 2022 15 minutes ago, MediMike said: @ventana here's the link to their data https://ejournal.msmaonline.com/publication/?m=63060&i=735364&p=20&ver=html5 The article stated that the MD along with NP colleagues, look forward to increasing regulation of NP education. Mentioned them setting up own limited clinical rotations and not being evaluated following rotations. Until then, they, physicians, can’t get behind FPA. So it’s okay for NP FPA with more regulated education. What about the PA education? It is regulated, exams after every rotation and continuing educational requirements equal to physicians. So is there where you say okay, we are regulated with consistent requirements, therefore consider FPA. Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted March 29, 2022 Share Posted March 29, 2022 Similar to MediMike's requested breakdowns, I would also like to know a breakdown of the patient populations (age, complexity, etc.) of individuals providers within the study. I don't know about others, but when I worked in FM I had an extraordinarily complex patient panel because the annoying and complex patients were pushed on the APPs. At my first job I actually was part of a committee that ran a data analysis and it was incredibly satisfying to throw in the physician's faces that the average patient age within APP patient panels was 68 and was 56 for the physicians. It seemed very similar at my second FM job, but I didn't have access to be able to run that kind of data...and now I'm not in FM/PCP and am never going back...I'll live on the street first. 2 Quote Link to comment Share on other sites More sharing options...
Brigid2010 Posted March 29, 2022 Share Posted March 29, 2022 15 hours ago, mgriffiths said: Similar to MediMike's requested breakdowns, I would also like to know a breakdown of the patient populations (age, complexity, etc.) of individuals providers within the study. I don't know about others, but when I worked in FM I had an extraordinarily complex patient panel because the annoying and complex patients were pushed on the APPs. At my first job I actually was part of a committee that ran a data analysis and it was incredibly satisfying to throw in the physician's faces that the average patient age within APP patient panels was 68 and was 56 for the physicians. It seemed very similar at my second FM job, but I didn't have access to be able to run that kind of data...and now I'm not in FM/PCP and am never going back...I'll live on the street first. True 'dat! Only, I'm still in this sh*&-show 12 years and holding, w/ 9 years at my current FQHC...I'm reading the signals, that it's time to move on... Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 30, 2022 Moderator Share Posted March 30, 2022 Have spent time looking over this article (still can't get the raw data) A few talking points if it comes up at work It is an extremely underpowered study even in the best sense. We are talking about no more then 150 APP - seriously underpowered They never once give a P interval for any of their end points - we have no idea what the confidence interval is and therefor we have no idea if the results are statically sig They do not touch on the fact that the Doc REFERRED OUT MORE - maybe they sent more patients to specialists and this is why they showed data - assuming the data is valid and sig which you can not do and the single biggest thing************************** Appears this company is dominated by NP's. 3500 practicing NP in the state and about 600 PA. Per their own report “four of the five top highest-cost providers were nurse practitioners.” Additional points not touched on are how experienced the NP's are. If they are coming out of an online 400 hour observational program, yup they are likely worse and need supervision - but this is not our battle. In summary Clearly with no P values, no confidence interval, underpowered study, and one that is dominated by NP (as demonstrated by their own admission that 4/5 top cost providers are NPs) this study clearly does not apply to PA. Please bring up these points to admin and docs who start to talk about this and point out that we all strive to follow EBM and not be swayed by junk studies. Acknowledge that there is a problem with the new grad NP and total lack of knowledge and ability, but fight for out profession which should have NEVER been included in such garbage statements. "bad data is worse then no data" 3 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 30, 2022 Moderator Share Posted March 30, 2022 2 3 1 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted March 30, 2022 Share Posted March 30, 2022 1 Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 30, 2022 Moderator Share Posted March 30, 2022 On 3/28/2022 at 2:46 AM, MediMike said: https://www.ama-assn.org/practice-management/scope-practice/amid-doctor-shortage-nps-and-pas-seemed-fix-data-s-nope?fbclid=IwAR3oze6zVkKtJriTB2WFPnTHwzNNg8dGWqAazLTy07o0T5_amHBBCAhPJB4 Would love to know what the distribution of these patients were, how many were same day visits, if there was a more rural component or less compliant. Or maybe the APPs in this organization so punt more as they don't have the backup? Would also like to see the breakdown between PA and NP There is no data because it isn’t published. It’s just “hey we noticed this.” It’s the equivalent of noticing polio goes up in summer, so it must be caused by ice cream. Yes, medicine said that briefly. the AMA cannot even tell anecdote from a peer reviewed study data anymore. This level of evidence is the same as “letter to the editor” opinion piece. 1 1 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted March 30, 2022 Share Posted March 30, 2022 14 hours ago, LT_Oneal_PAC said: the AMA cannot even tell anecdote from a peer reviewed study data anymore. They can tell. They know exactly what they are doing. 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 30, 2022 Moderator Share Posted March 30, 2022 2 hours ago, CAAdmission said: They can tell. They know exactly what they are doing. Im really not sure they can. Their salary depends on them believing and ignoring bias. Quote Link to comment Share on other sites More sharing options...
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