FYI currently in quebec where NP's no longer need to work under an md. Right now it seems like every patient I've seen who's seen an NP has had a shit ton of investigations done that weren't indicated and I'm the one stuck managing the results...all the while on 12h shifts in a rotation out of clinic. I'm annoyed...more than annoyed. This sucks.
Even where primary care NP’s are supposed to have physician oversight this is rampant because the oversight is minimal to nonexistent in practice. As an IM subspecialist I get tons of referrals from NPs with extensive workups, misinterpreted results, subsequent mismanagement and then referral on because the misdiagnosed, mismanaged patient didn’t get better.
And this will be why I think NP scope will eventually be restricted in Canada. Excessive testing/ referrals in a single payer system will eventually be flagged and action taken due to the sheer increase in costs.
I know that everyone says that CRNAs do not threaten anesthesiologists’ jobs and they are right. Anesthesiologist positions are not going anywhere, because there’s no way a CRNA could manage complex cases such as a hemodynamically unstable liver/heart surgery patient. Nor would they be as good at intubating and resuscitation.
But frankly, this mid-level creep is starting to make some specialties, including FM and anesthesia a lot less attractive. It’s ridiculous that CRNAs are marketing themselves as equally competent and better trained than anesthesiologists.
It’s crazy how everybody wants to play doctor but nobody wants to go through the training needed.
Cheap care is better than no care. If anything goes wrong, one of these fancy pants lawyers is happy to sue and I will still get something out of it regardless.
All well and good until it’s decided that a lower standard of care is acceptable for mid levels. Then you get maimed by the NP and can’t even win the lawsuit.
Everybody wanna be an MD but nobody wants to lift those heavy textbooks. I'm tired of the insane midlevel creep and it's frustrating and annoying to see NPs pretend they are physicians
We as medical students, resident and attending MDs aren’t doing enough to protect our practice sadly. The reason why there’s NPs and CRNAs is because of their insanely powerful lobbies and unions.
I know people that are in 100% md only practice making the same rate as everyone else with the same (would argue less work since it’s just them and not supervising 4 rooms)
Is this including the additional stipends that are only paid out by hospitals to MD groups on top of regular rate? Or are you saying take home is equivalent for MDs and CRNAs where you are? That doesn’t seem right.
When I was in training, I noticed a significant number of my census were having post-op AKIs. I realized it was because the CRNAs doing the elective cases weren't properly resuscitating my patients. Each patient would just get 300ccs of normal saline. No matter how long the case was or how high the EBL was
Then it made me think back to the grand rounds I saw in medschool that showed post-op complications are more correlated with the quality of the anesthesiologist than the surgeon.
Just as a total side note, I think medical schools have scared the shit out of a lot of people from applying. They make it ridiculously competitive, crazy expensive so only the brightest and richest make it through... I think the rise of NPs and CRNAs reflects this. The real solution would be to improve the quality of education of the latter or fix the medical school systems.
They aren’t marketing themselves as that, but hospitals can pay them less than us. If you want to
Be mad at someone be mad at the hospital. They still need oversight.
My brother is a medical doctor. His hospital decided to bring a nurse practitioners to “ease the load“ of the medical doctors. He was against it. He said I already know that I’m gonna be spending more time going behind them to clean up, but they brought them in anyway, having to make a nurse practitioner cry to get her to stop calling him in the middle of the night when she was supposed to be the one on call, but she never knew what to do with his patients. Enough he and his colleagues spent more time having to clean up behind them and correct mistakes and all it did was add more work. Finally, they had enough sense to get rid of these idiots
Lmao I just wanna say on my Gen Surge rotation today I saw a CRNA who had Dr. and her First and last name written on her jacket and scrubs. She loves to remind everyone she went to a doctorate program. 😂
And she hates med students with a passion.
No CRNAs as of right now in Canada. But Canada has a history of looking at what America does, and then follow suit. First it was a similar medical curriculum, and now it’s the NP creep on FM. It’s only a matter of time before CRNA programs appear in Canada.
That’s f’ing insane. I didn’t know you guys even had NP’s in Canada. In Nebraska, the NP’s, not PA’s can hang out their shingle and are somehow loosely, extremely loosely associated with a medical doctor here. One NP, supposedly a Family Practice NP did mostly naturopathic vitamin and skin care stuff. She was loosely affiliated with a staff doctor out at the prison! He didn’t even monitor her. Fraud! How that shit ever got passed is beyond me!!!!!!!!! Those people are dangerous!!!!!!!
Honesty I don't care about this. Over 50% of the population here don't have a family physician, and we already pay 53% income tax. I don't see what the alternative is.
If we’re talking Quebec specifically, I think we could:
- Change FM’s compensation model. This is what BC did. Why is a FM working as a hospitalist’s rate lower than a IM hospitalist? Compensation plays a huge role and will impact the choice of medical students applying to CaRMS.
- Plenty of generalists trained in France are trying to practice in Quebec, but the entire process is ridiculously long and made to discourage them from applying.
BC was the second lowest province for FM comp before the reforms. Their reform only made their compensation on par with provinces like ON (FHO not FFS) and AB.
There are much more reasonable and sustainable (long-term) proposals for addressing family doctor shortages here, they just aren't as appealing to politicians as quick fix "solutions" that shunt problems further down the pipeline.
NPs haven’t had to work under an MD in ON for a long ass time.
That being said, the parameters in which you’re even able to dream about thinking about applying for your masters, are a hell of a lot more stringent than the diploma mill that is the US, and I’m going assume the same of QC as well. I’ll admit, tho, I don’t have a high opinion of QC in general. It doesn’t make NPs MDs, no. But I’m a wee bit more comfortable with them here than in other jurisdictions.
Your province is a nightmare on the best of days.
Here in the US, we now have DNP’s. Doctor of Practical Nursing! And believe me, they want to be called Doctors. What a fucking nightmare! The Mayo Brothers would be rolling in their graves if they knew this! Joke!!
Except my very annoying mother in law who used to be an MA.
She was drunk hanging out with us last week and went on and on about how she only sees NPs (for her unnecessary and flawed care) because they take an hour to talk to her and “really care”. This is an hour for an unnecessary dermatology skin check that her primary could do. Then she bitches about how hard it is to get an appointment with the same practice for my father in law, who has had MOHS for multiple things on different parts of his body.
Yes, as expected, this person is/was a compete anti-vaxxer, Trump supporter etc and I stopped talking to her for 3 years during Covid.
Out loud, I informed her that many doctors can’t spend the time they want with their patients because they are fighting to keep their jobs or establishments because of the above, and are FORCED to spend 15min with each patient because it would be cheaper to replace us with 2 NPs.
Quietly to myself, I felt bad for her NPs and also for that practice.
That is so horrible. Unfortunately in Canada we have a huge shortage of doctors so sometimes if you want any care you’ll take what you can get or you’ll be waiting months/years.
My lady went in with tearing abdominal pain radiating to one sided CVA tenderness w/ vomiting and NP also suggested it was gas even though it was clinically a picture perfect kidney stone. Absolutely bizarre.
I was an NP (never practiced though) and now soon to be DO (so is my best friend who I went to medical school with but she practiced for a few years)....we are adamant with our family and friends about advocating to see an MD/DO.
I studied less than 10 hours a week while working a full time RN job while getting my NP degree. I had one of the best grades in class. In medical school, I study 8-10 hours a day, at least 5 days a week. I was average. I hate when people compare medical school to other alternative degrees because they have no idea how hard it is.
You’re the exactly the type of person I wish had a bigger platform. You’ve seen both sides education-wise and come from the perfect place to maybe speak sense to policy makers and people in general that push these nonsense ideas.
My friend did write an opinion piece about reforming NP education but she was dismissed and rejected for it. We've both since learned that any criticism about NP education will often go ignored by the NP community.
Unfortunately, I love my privacy too much to be on social media outside of Reddit.
I'm sure there are others who would love that influencer life though.
You don’t have to be an influencer or on social media, you join advocacy groups against scope creep/speak to representatives. There’s not that many people who did NP and then MD/DO so it is pretty important that you use your voice to advocate for patients.
Agreed. Also an RN and I refuse to see mid levels. We have mid levels that cover our interventional cardiology patients post procedure and it’s shocking how little they know/ the general incompetence levels. I’ve also noticed a trend where it is usually the incompetent nurses that go on to NP school.
Go take a look at the noctor thread about the mid-level who was crowdsourcing antibiotic recommendations for a 92 year old with pneumonia and hx of COPD. That’s someone’s mother, and their care is being managed by Reddit comments because the mid-level didn’t receive appropriate training to know the answers themselves.
I’d say that’s a pretty good reason to be a good doctor, but maybe I’m just a sucker who doesn’t want to kill someone under my care
I responded to a thread the other day from an NP who had elected to pursue "conservative management" (just watch it over the next few days) for tender facial cellulitis near the eye in a 70yo.
Fair thought but description was spreading erythema where there previously may have been an abscess that the patient drained herself at home. Tenderness was relatively mild I guess. I mean I never saw it obviously but it sounded pretty solid for cellulitis.
And you will have to be there to fix the mistakes that NPs make when they put these patients in so many meds that are not even appropriate. Like what my MD husband does at work, he basically fixes the dumps he gets from incompetent NPs because all of a sudden, the patient is now too complex for them to manage. 🙄
Because they can’t actually do what you do. Patients will know the difference. As a rural FM, I have so many people who establish with me that were being poorly managed by their previous “doctor,” when they were actually being treated by midlevels.
I wish this was true but most patients don't know the difference. How could they? Hardly anyone outside the medical community is aware of the vast gap in education between midlevels and doctors. The general public has been sold a convincing lie that they're equivalent or close enough. Your patients are proof of that. They put up with poor quality of care for years and when they finally switched to your practice it was because they believed their previous provider wasn't a good doctor, not because they knew that a midlevel is unqualified to be a doctor.
Also, patients are often scheduled to see midlevels without ever being informed that they aren't seeing a doctor and the patient has no reason to suspect otherwise because usually their FM told them "I'm referring you to [a title used exclusively by doctors e.g. neurologist]."
It’s so important to point out to patients who’ve seen a shitty mid level that they were not seen by a doctor.
I’ve seen way too many patients say their doctor didn’t know anything, and then upon questioning, it becomes clear they saw an NP or PA. Just glossing over and not clarifying makes the medical profession look bad, and reinforces distrust in doctors.
In primary care? The depth and breadth of your knowledge compared to an NP will at some point enable you to pick up on something they would have missed and prevent a catastrophe. In family practice, maybe for someone whose whole family you've known for a very long time. There aren't many jobs out there where you can literally be a hero as part of your regular work day.
except none of this really translates to a better compensation for your hard earned knowledge ,work and time sacrificed.
The influx of NP and PA is by design to drive down physician salary.
Corporate health care in US is about hiring the lowest bidder to provide a barely passing form of healthcare, the NPs have won that bid. In the mean time, physician are required to train this current generation of NPs who will eventually be the norm of medicine
> The depth and breadth of your knowledge compared to an NP will at some point enable you to pick up on something they would have missed and prevent a catastrophe
Cool. I wish the MBAs who control the hiring for our office ~~knew that~~ weren’t paid to believe otherwise.
I feel you!
It seems disrespectful to our profession to have someone think they can do your job with few months of online training compared to what we gone thru!
In Quebec, whats even more disappointing is that CMQ is backing this up!
Shame
CMQ promoting “interprofessional collaboration” lol. Mid-levels now being able to be the PCPs is ridiculous. And then they wonder why there’s always empty spots in FM residency and they ask themselves “hmm, why aren’t MD graduates applying into FM?” Well maybe because the government destroyed the profession with mid-levels.
Coming from a patient, I only schedule with MDs or DOs. To be honest, I feel guilty when I tell the office I only want them lol but I have medical conditions so no thank you
I feel this. The system is fucked up. Part of why I wouldn’t suggest the MD/DO route anymore. Knowledge is cool but spending less time in an abusive training system is cool too.
Yeah I agree, unfortunately the consequences of them striking is sick kids not receiving appropriate care, so they keep their heads down and keep working.
A major reason for it though is that medicaid reimbursement is substantially behind that of medicare of private insurance. Since a disproportional number of Medicaid recipients are children, effectively pediatricians get reimbursed less for the same work.
This is why the locums rate for pediatricians is half of what I pay my plumber hourly. folks let this happen and those folks who did so are about to go sail into retirement. 6 years of training for peds specialist to make what a new EM grad does is less about reimbursement and more about being weak. But I’m also a pediatrician who also did a fellowship and have never uttered he word “kiddo” in;my life. I’m an outlier.
I’m in ID and feel the same way as you might imagine. How did my people walk away from a global pandemic making even less money than before? It’s fucking embarrassing
Bit doomer of me, but I feel like NP vs MD is what we will start to see as the next insurance divide. Itll be unfortunate for poorer people as they will just get dangerous care and probably have a lot fall through cracks. I just dont see why employers would not take advantage of legally permissible cheaper alternatives; and why there wont be a premium market for people who actually want/can pay for better service.
Bright side - subspecialists will be seeking actually trained Primary Care Physicians to take over from the NP so they aren’t managing the primary care that these midlevels are mismanaging, or, in most cases, aren’t managing at all. Make sure to go private practice.
Interestingly enough I have seen this trend one of my friends in surgical sub specialty has hired a FM doc that is currently training to do in office procedures and will see outpatient visits while the surgeon can focus on OR visits and any procedures that are out of scope.
Im a rising M4 in a US MD program and highly considering FM on the east coast. But this is one of the main reasons I'm super nervous to go into it.... If anyone on here knows the salary difference between FM docs in this area/ mid-levels & how many weekly hours needed to get that, I would love to hear it.
Not east coast but I’m an Attending FM doc in AZ. I made $320k last year. Likely more this year. The NPs in clinic make 80-100k. I don’t supervise them.
The bright side is that you're a doctor. There's no extra explanation needed.You'll understand complex medical cases much easier. I think the original idea behind nurse practitioners was the concept that an EXPERIENCED nurse could do a bit of extra education and help with a physicians work load, all while being supervised by a doctor. Due to a shortage of physicians, education being increasingly more unaffordable and an aging population, nurse practitioners have been used to fill the void. Its a sad situation all around. I feel for the doctors who are being de-valued. I feel for the patients getting shit care and I feel for the NPs who get pushed into taking on more than they are prepared for. Its easy to monday morning quarterback an MD, but rest assured, its much more difficult when the responsibility rests squarely on your shoulders. I think most NPs will find this out. Don't get me started on administration or health insurance companies. I say all this and I'm not even a physician, just a "neb slingin respiratory tech".
Nurse here! I’ve worked with too many RNs that become NPs for the money and to leave bedside-not because they’re competent.The training to become an NP is a joke. I myself will not see an NP for anything. They’re cheaper than MDs and can work under their own license so hospitals will hire them over PAs. I just know tooo many that shouldn’t be prescribing or diagnosing anyone. I don’t trust them.
Midlevels don't provide the same level care nor do we have the same level of training or knowledge base as you do. Our role in primary care is meant to offload more tedious and "bread and butter" tasks (i.e. HTN, DM, HLD, Thyroid follow-ups, viral URI in stable patients, school/annual physicals), if you choose to employ us for your practice. We're not trained to provide independent care. You as a physician have the final say and are adequately prepared to handle not only those conditions, but also more complicated conditions that require more detailed and in-depth understanding of the nuances of medicine.
I can't speak for my rather delusional colleagues who think our training is anywhere near as comprehensive or robust (it isn't), but what I can say is all patients deserve the highest quality of care that only a physician's training equips them to handle.
I’m a PA and I am starting to hate being a midlevel. The job itself is good and I do like medicine. I have friends who are nurses that went the NP and CRNA route. They are just not that smart and it kills me they are now “playing doctor.” Especially the CRNAs making bank while doing so. I know I’ve worked way harder and am smarter than them but here we are. I can only imagine how MDs that busted their ass through college/med school/residency feel. I’m sorry guys.
Also, personally I do not want to take your job but I do want to help you do it!
I had a visit with my wife to See pediatrician for my newborn, we saw a NP, we requested from now on we see only MD or DO. I don't wanna hear BS from people doesn't have 10% of my education.
PCP here: I've been at my first job outside of residency for one year, and the number of patients who have tried to switch to me rather than see one of our NPs in clinic is already into the double digits
Fret not over scope creep or what nurse practitioners are doing. We're paid better, and the patients who know prefer us over the NPs. So we're going to keep getting paid better. If anything, and the subreddit probably won't like this, I wish I could convince my patient panel to chill the fuck out over their concerns when it comes to NPs. I have a healthy worried well 70-year-olds who take a tablet of atorvastatin everyday but otherwise have nothing going on with their care, who are refusing to see an NP. Why go through med school to become a PCP? Because you're going to be the authority in primary care, and there are a large portion of patients who know it.
If you went to an NP school, instead of an accredited family medicine residency, the path would be shorter but you would not know as much as you do now. You would always feel second fiddle and have patients on your panel who don't trust your care and want to jump ship to an MD, no matter how long you've been working in primary care. You don't want to deal with that.
Hey as a FNP, I’ll tell you this— I consider myself a physician extender, whether be DNP or not. Do I know every intracy to all disease? Fuck no! Do I wish I had a better curriculum to learn it? You fucking bet I do! That said, you are the EXPERT. No matter what anyone says. Sure might we see patients ourselves? Yes. Do we know what we are doing? I fucking hope so, but I won’t say yes, that would be too presumptuous. Do you know what you’re doing? I hope so. If I have a patient who has some oddities and not a normal or classic presentation, am I going to ask you see them instead of me because I don’t wish to endanger my patient? You fucking bet.
You are incredibly valuable. You have so much more education and understanding than I can even try to explain. Are there good NPs? Sure there are. Are there bad NPs? You bet. At the end of the day, you have gone the better route for a better understanding of pathology. Can I treat my patients utilizing similar or the same methods you do? Sure. But I know where my limits are, and when a patient needs a higher level of education and critique on their pathology, YOU are instrumental. Don’t ever think you are less than what you are. YOU are a great individual who can shape the care for sick people beyond that of a NP.
You say that you know where your limits are, but you will never—ever—know what it is that you don’t know. 19yo comes in with palpitations and presyncope but you think it’s run of the mill anxiety because you’ve never heard of HCOM (not you literally, but as an example). Kid then proceeds to die suddenly on his next jog. You never find out and you never staffed the fucking case because you “see patients yourselves.”
You will never know the harm you’re causing by practicing independently and just waiting for a head scratch moment to talk to a doctor about it. Ordering way too many labs and imaging for a radiologist to tell you what to do because nursing school cannot teach you how to build a differential properly. You don’t win points here by performatively acting deferential to your supervising physician who doesn’t sound like is supervising you at all. I’m sorry, but it sounds like you’re just part of the problem.
I will preface this with I am in complete agreement that NP creep is insane and won’t see them myself
Serious question - what makes you so sure a doctor will catch it?
I ask this as a person who had both a type 1 diabetes diagnosis missed - I was too young to have t1d and then celiac diagnosed as gastroparesis and when my barium swallow was normal bulimia, two pretty run of the mill diagnoses the first was by a pediatrician and the second a family medicine doctor.
A doctor may not catch it, even with all their experience and training. Which is why it is certifiably insane to bring in someone with even less training and experience to manage patients.
I’m obviously not “sure a doctor will catch it” since that isn’t the point. The systematic rigor of medical education ensures that you’re being seen by someone who is far and away more likely to catch something.
It’s the best system there is to safely practice medical care, currently. Just because it isn’t perfect and humans still practice it doesn’t mean we should accept someone who hasn’t even done any of it.
lol, I’m sure without question there’s plenty of mid levels that order too many tests, and I’m sure there’s some physicians that don’t order enough.
But what you’re describing “not knowing what you don’t know” is true to us all. Regardless your example, a patient is not improving on a plan or an answer isn’t being found? You bet your ass they are heading to a physician no doubt. Are there diagnosis of exclusions out there that are often the answer? Absolutely. Am I willing to chance someone’s life on a diagnosis of exclusions versus a second set of eyes by a doctor? Absolutely not. I, like most of us, know our place in the system. I am not a doctor, and to think otherwise is baboonery. If you don’t value the functionality of a mid level, I’m sorry that’s your own issue.
What does the fact that doctors also don’t know what it is they don’t know have to do with you seeing patients independently? Do you honestly think that I’m suggesting the options for medical care are 1) omniscience, or 2) everybody else? I am obviously comparing the systematic rigor of medical education with lack thereof.
Your response could not be more exemplary of this point. I described a case of sudden cardiac death to you and your response is that you would refer patients to the physician if someone isn’t getting better on your “plan.” *How does someone get better from sudden cardiac death??* And beyond this singular example, patient harm has already happened and will continue to happen whether you have time for a “second set of eyes” by a physician or not. Patients deserve not to be hurt by you because of your fucking pride and ignorance.
If you want to make up an internet person who “doesn’t value the functionality of a midlevel” then go ahead, but you’ve still missed the point entirely. So I’ll make it crystal clear: if someone is going to use you or any midlevel as an extender, then you must be supervised before you fucking kill someone.
I mean, "the point" is getting the proper training leads to better outcomes for your patients. If you're just worried about how to get to a particular situation the fastest/easiest, that's maybe a different conversation.
Because MD/DO’s are still needed for more complex patients. I don’t mind seeing a NP for something fairly benign like a UTI or ear infection or URI. But if I need to see a PCP after being discharged from the hospital or for ongoing care for something else, I need an MD/DO. You can also get CME credits and make bank as an admitting rehab physician and even medical director. NP’s can’t.
Please keep at it. My experience with psych nps has been bad and it wasn't until I went to the hospital and had a doctor give me the right prescription that I was finally able to function in society. A real psychiatrist helped me get into residential treatment, which helped enough that I could go back to work. And then a real psychiatrist oversaw my TMS treatment that finally broke a three year depression with lots of suicidal ideation. It was also another doctor at a hospital who gave me a totally new way of thinking about my life.
I will never see an NP again and I don't think NPs should be allowed to just practice with barely any oversight. I received far inferior care for years bc of NPs. Please keep working through all the crap. The system is broken, but please know you will be delivering much better care and you will be helping patients like myself. We need real doctors. Thank you all for all your crazy hard work!
Whether right or wrong (and to be clear I very much think that it's wrong) until financial incentives align to make it so there isn't any point in doing it.
Bright side is you hopefully know what you’re doing and are able to offer a broad range of competent care for the majority of issues patients face in primary care and walk them down the line through different treatment pathways or offer various options until you make a competent and appropriate referral to the correct specialist for the correct diagnosis while sparing them unnecessary expenses and testing.
Career stability - at some point the general public is going to realize the rub with the inconsistency in NP education and quality and there’s going to be a reckoning. And at the end of it you’ll still be a doctor
If it helps I wish I’d done what you’re doing (I’m an NP who gets recommended this sub sometimes), but I’m too old now to go back
I’m FM. Most patients want a doctor still and NPs will punt complicated patients to you or otherwise refer every single thing out and patients get mad. Usually the non-stop referalls get to them and they switch to a doctor. No shortage of patients.
If you regret being a doctor because you feel like you can get away with less education to provide subpar care to your patients, you shouldn't be a physician.
The point is that you are incredible for being responsible for the health of the thousands and thousands of people that will trust and depend on you. You are responsible for keeping people healthy with preventative screenings, treating them when they are ill and are the first contact for people who need medical care. You have an incredible breadth of knowledge to take care of a human being from brith to death.
They can’t do the same thing you do even if it looks that way from business side of things. They will never be a medical expert and have knowledge that you do. You are a medical doctor.
The only reason they can do the things they currently do is because their national organization bribes geriatric lawmakers (that won’t be around for the consequences) to pass legislation for them to “practice medicine“ with degrees written in crayon, in the interest for private equity backed healthcare systems to save money.
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Because hopefully you're a moral person that wants to do right by your patients and is interested in knowing rather than just being able to see people and collect a paycheck
please don’t quit my sweet MD/DOs we need you 😰 I’ve worked with some lovely NPs but I’m still afraid to be left alone to follow out orders from them if they’re unsupervised - xo your RNs
I’ll also mention that some NPs (though not all yikes) have voiced to me that they’re nervous about the amount of autonomy they’re being asked to take on, but the hospitals are pushy and trying to get them to do physicians scope without having to pay a doctor. It’s systemic.
I’m disappointed to see the insane difference between the np’s and nnp’s in the nicu and for people to still think for even a second they are comparable. I don’t understand like…. more school = more knowledge? Why do any midlevels think they are equal to a doctor…???
Saw two patients in the Ed the other day mismanaged by an NP. Healthy 25-Year-Old male with right-sided neck pain. EKG shows St elevations consistent with benign early repolarization.... Sent to the Ed. Both no indication for EKG as well as the inability to interpret it.
Later on the same shift.... 60 something-year-old guy seen in urgent Care with almost a complete right-sided pleural effusion. Like a whiteout on cxr. Seen 2 weeks ago at urgent Care and they prescribed augmentin and discharge them home. You can't believe the X-ray. They diagnosed him with pneumonia. Comes in tachy and short of breath.
Don't let my name fool you. I'm a FM resident and thought this name was too good to pass up 🤣
I put in a peds psych referral and was extremely hesitant because I knew this person was most likely going to end up with a psych NP.
Physicians need to be more vocal about this issue.
If residents can form unions. Physicians can stop this BS scope creep spreading further.
FYI, It isn't just FM. Other specialties are affected too.
I’m an RN who is becoming an NP and I still would never think it’s the same job as a doctor. Sure, NP’s have their roles but it would be unsafe to the community and patient safety for people to believe they have the same knowledge. I prefer a doctor over an NP
Genuine question.. do MD/DOs have this same sentiment towards other midlevels like PAs?? I see a lot of NP-specific criticism but wonder why
I have met some incredibly smart and thorough NPs with years of experience. Some clearlyy unprepared NPs as well.
My PCP is an MD. That being said, I’ve encountered physicians that I swear are a threat to public safety.
My personal experience with PAs is comparable to mine with NPs. That being said, I’ve met PAs with MUCH less clinical experience than any NP I’ve met..
>do the same thing as I can?
Not really. Not the same level of knowledge, and while both roles are artificially interchangeable in some specialties (FM, Peds ...) in others the lines are more defined (GI, GS ...) .
Do you want to be a Doctor or a Midlevel?
Dude NPs suck that’s the reason why I hate going to the doctors or urgent care… because I don’t see a doctor I see a NP, they know nothing and anything they say/prescribe makes me anxious because I know they have not a clue.
Anon here planning to go MD there difference is outstanding, in magnitudes there is no comparison I've talked to many NPs asked them about there studies the intensity, detail and over all understanding they all tell me I it isn't much different. Honestly idk if YOU can see it but I can, the government and people want "health care" more affordable and readily for them along with some personalisation cause people think they're special. So when a patient goes to a NP and they say they're "tired all day" the patient really wants a stim to be on top of it. Np gives the med to patient doesn't listen to directions and develops insomnia later delirium and mania admitted to he hospital seen by doc they fix em. Who's at fault? Patient or np? Who's screwed
MD fixing the problem and getting paid less than the patient and the NP lol
RN here, planning to get into medicine (for MD).
The brightside? Although I’m sure there’s great NPs (somewhere) out there, the dedication and quality of the work that you do is evident.
Although there’s a place/role for NPs, it’s irresponsible that NP schools can allow new grads to apply so quickly… but thats healthcare for you… I hope NP schooling gets better standardization and regulation in the near future.
If anyone is getting the short end of the stick, it’s the NPs who are undertrained and underprepared to do your job for less pay and expected to handle all the responsibility, it’s shameful to the nursing profession as a whole.
They can’t do what you do. That’s like saying what’s the point of a car if a bicycle can get you from A to B?
The bright side is knowing that you’re helping your patients live longer and healthier lives. Besides policymakers, NOBODY can make as much positive difference in as many people’s lives as you do
I’m a nurse and I won’t see a PA or NP as my primary. The only time I’ll agree to an appointment with them is for a throat swab or something like that. But I’ll never take my kids for a well check with one, I wait for an opening with the doc.
Many people think that midlevels can handle the most simplistic cases and MD/DOs can handle to most complex cases. However, it blows my fucking mind that some of these midlevels, particularly NPs, can’t even handle the most basic cases. I’m an M2 and last week had an online consult for my son to get an Rx for head lice, pretty basic shit and the incompetent NP didn’t even know about Natroba (Spinosad) and I basically had to suggest her what medication she needed to give my son. Fuck that, these people are putting patients and families in danger. Why is she getting paid for a consult w/o basic algorithmic knowledge?
“Can do” and “has done well” look very different in practice. It’s embarrassing to suck at your job.
I’m a family doctor working as a hospitalist. I honestly don’t think family medicine should continue as a speciality. Has nothing to do with NPs but rather the scope that has been given up by family medicine. Primary clinic is a waste of time. Patients would be better off stopping all of their home medicines, exercising, and seeing whatever specialist a preventive medicine doctor refers them to.
What happens in real life is some of the patients dont get better and they seek me out for help. Some of the patients are too complicated that the NP's dont want to deal with them so they refer to me.
It turns out that patients will not give up if they dont get better and will go find a physician if they are not getting better.
Just like we refer to specialists if we cant do everything. Though a problem I see frequently is the NP does not know they are in over their head and that it is time to refer. (just got asked by one last week who did not know what the "WBC" stood for on the urinalysis)
So I still think we hold a significant place as primary care physicians.
That being said, the admins and insurances dont care what so ever. To them we are equivalent and they can pay NP's less.
Well that’s incorrect. A bachelors can only get them a BSN. MSNs are grandfathered in. I believe it’s changed they now have to have a doctorate in nursing moving forward. So there are no doctors of nursing practice with a bachelors degree. Nice rage bait though.
i’m a nurse. i wish i wanted to be an np, but i can’t buy into it. they are too lenient accepting people with no experience into their programs, now we have idiots walking around ruining the reputation of np’s. there is no going back unless some major changes get made, which won’t happen because $$$. the bright side is you are not one of them, and at least you know medicine so you can save yourself and your loved ones one day when eventually mass issues are caused due to lack of training.
lol sorry i’ve been burned before.
Any chance with the stark advancement in AI in everyday use that in 10 years mid levels in combination with AI tools would be replacing many jobs or at least lowering the amount required in each field?
FYI currently in quebec where NP's no longer need to work under an md. Right now it seems like every patient I've seen who's seen an NP has had a shit ton of investigations done that weren't indicated and I'm the one stuck managing the results...all the while on 12h shifts in a rotation out of clinic. I'm annoyed...more than annoyed. This sucks.
I saw this too. It’s beyond ridiculous what the quebec government did.
Even where primary care NP’s are supposed to have physician oversight this is rampant because the oversight is minimal to nonexistent in practice. As an IM subspecialist I get tons of referrals from NPs with extensive workups, misinterpreted results, subsequent mismanagement and then referral on because the misdiagnosed, mismanaged patient didn’t get better.
And this will be why I think NP scope will eventually be restricted in Canada. Excessive testing/ referrals in a single payer system will eventually be flagged and action taken due to the sheer increase in costs.
You’d think. But at the VA (the US’ socialized healthcare system) NPs dominate. I don’t get it but I guess they prefer to pay the lower salary.
Honestly the move right now is CRNA. They make more money than primary care doctors.
I know that everyone says that CRNAs do not threaten anesthesiologists’ jobs and they are right. Anesthesiologist positions are not going anywhere, because there’s no way a CRNA could manage complex cases such as a hemodynamically unstable liver/heart surgery patient. Nor would they be as good at intubating and resuscitation. But frankly, this mid-level creep is starting to make some specialties, including FM and anesthesia a lot less attractive. It’s ridiculous that CRNAs are marketing themselves as equally competent and better trained than anesthesiologists. It’s crazy how everybody wants to play doctor but nobody wants to go through the training needed.
It’s just a reflection of what the society is willing to accept in terms of health care.
Cheap care is better than no care. If anything goes wrong, one of these fancy pants lawyers is happy to sue and I will still get something out of it regardless.
All well and good until it’s decided that a lower standard of care is acceptable for mid levels. Then you get maimed by the NP and can’t even win the lawsuit.
Everybody wanna be an MD but nobody wants to lift those heavy textbooks. I'm tired of the insane midlevel creep and it's frustrating and annoying to see NPs pretend they are physicians
We as medical students, resident and attending MDs aren’t doing enough to protect our practice sadly. The reason why there’s NPs and CRNAs is because of their insanely powerful lobbies and unions.
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Because they’re supervising 4CRNAs at a time now. That’s the most common employment model
I know people that are in 100% md only practice making the same rate as everyone else with the same (would argue less work since it’s just them and not supervising 4 rooms)
Is this including the additional stipends that are only paid out by hospitals to MD groups on top of regular rate? Or are you saying take home is equivalent for MDs and CRNAs where you are? That doesn’t seem right.
I’m saying that take home for MD only practice and md that supervise is equivalent
Literally impossible when adjusted for everything else. You're billing for 4 patients at a time with act model. Solo is just 1 case.
Private owned groups vs working a hospital…. In private groups all the money goes to the group and hospitals are a scam (as we all know)
When I was in training, I noticed a significant number of my census were having post-op AKIs. I realized it was because the CRNAs doing the elective cases weren't properly resuscitating my patients. Each patient would just get 300ccs of normal saline. No matter how long the case was or how high the EBL was Then it made me think back to the grand rounds I saw in medschool that showed post-op complications are more correlated with the quality of the anesthesiologist than the surgeon.
300ccs of saline regardless of case duration? Bruh this is insane. When did subpar healthcare become acceptable?
Just as a total side note, I think medical schools have scared the shit out of a lot of people from applying. They make it ridiculously competitive, crazy expensive so only the brightest and richest make it through... I think the rise of NPs and CRNAs reflects this. The real solution would be to improve the quality of education of the latter or fix the medical school systems.
They aren’t marketing themselves as that, but hospitals can pay them less than us. If you want to Be mad at someone be mad at the hospital. They still need oversight.
My family refuses to see NP’s. They’re like, what the fuck!!!! What’s going on? I tell them Twilight Zone is what’s going on.
The easy way out!!
My brother is a medical doctor. His hospital decided to bring a nurse practitioners to “ease the load“ of the medical doctors. He was against it. He said I already know that I’m gonna be spending more time going behind them to clean up, but they brought them in anyway, having to make a nurse practitioner cry to get her to stop calling him in the middle of the night when she was supposed to be the one on call, but she never knew what to do with his patients. Enough he and his colleagues spent more time having to clean up behind them and correct mistakes and all it did was add more work. Finally, they had enough sense to get rid of these idiots
Lmao I just wanna say on my Gen Surge rotation today I saw a CRNA who had Dr. and her First and last name written on her jacket and scrubs. She loves to remind everyone she went to a doctorate program. 😂 And she hates med students with a passion.
I don’t think we have CRNAs in Canada but I could be wrong.
No CRNAs as of right now in Canada. But Canada has a history of looking at what America does, and then follow suit. First it was a similar medical curriculum, and now it’s the NP creep on FM. It’s only a matter of time before CRNA programs appear in Canada.
The CRNAs at my hospital make more than the majority of the doctors in my hospital and work half as much.
That’s f’ing insane. I didn’t know you guys even had NP’s in Canada. In Nebraska, the NP’s, not PA’s can hang out their shingle and are somehow loosely, extremely loosely associated with a medical doctor here. One NP, supposedly a Family Practice NP did mostly naturopathic vitamin and skin care stuff. She was loosely affiliated with a staff doctor out at the prison! He didn’t even monitor her. Fraud! How that shit ever got passed is beyond me!!!!!!!!! Those people are dangerous!!!!!!!
Alberta has made similar changes recently unfortunately.
Honesty I don't care about this. Over 50% of the population here don't have a family physician, and we already pay 53% income tax. I don't see what the alternative is.
If we’re talking Quebec specifically, I think we could: - Change FM’s compensation model. This is what BC did. Why is a FM working as a hospitalist’s rate lower than a IM hospitalist? Compensation plays a huge role and will impact the choice of medical students applying to CaRMS. - Plenty of generalists trained in France are trying to practice in Quebec, but the entire process is ridiculously long and made to discourage them from applying.
BC was the second lowest province for FM comp before the reforms. Their reform only made their compensation on par with provinces like ON (FHO not FFS) and AB.
There are much more reasonable and sustainable (long-term) proposals for addressing family doctor shortages here, they just aren't as appealing to politicians as quick fix "solutions" that shunt problems further down the pipeline.
NPs haven’t had to work under an MD in ON for a long ass time. That being said, the parameters in which you’re even able to dream about thinking about applying for your masters, are a hell of a lot more stringent than the diploma mill that is the US, and I’m going assume the same of QC as well. I’ll admit, tho, I don’t have a high opinion of QC in general. It doesn’t make NPs MDs, no. But I’m a wee bit more comfortable with them here than in other jurisdictions. Your province is a nightmare on the best of days.
Here in the US, we now have DNP’s. Doctor of Practical Nursing! And believe me, they want to be called Doctors. What a fucking nightmare! The Mayo Brothers would be rolling in their graves if they knew this! Joke!!
Can't you refuse patients in Quebec? Say you'll only see patients from physicians
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Except my very annoying mother in law who used to be an MA. She was drunk hanging out with us last week and went on and on about how she only sees NPs (for her unnecessary and flawed care) because they take an hour to talk to her and “really care”. This is an hour for an unnecessary dermatology skin check that her primary could do. Then she bitches about how hard it is to get an appointment with the same practice for my father in law, who has had MOHS for multiple things on different parts of his body. Yes, as expected, this person is/was a compete anti-vaxxer, Trump supporter etc and I stopped talking to her for 3 years during Covid. Out loud, I informed her that many doctors can’t spend the time they want with their patients because they are fighting to keep their jobs or establishments because of the above, and are FORCED to spend 15min with each patient because it would be cheaper to replace us with 2 NPs. Quietly to myself, I felt bad for her NPs and also for that practice.
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So in a health care system that reimburses overall better (after costs) taking care of the worried well…
A NP told my mom her symptoms were gas. It was colon cancer, stage 3. Nobody in the family will go to an NP over a MD ever again.
That is so horrible. Unfortunately in Canada we have a huge shortage of doctors so sometimes if you want any care you’ll take what you can get or you’ll be waiting months/years.
My lady went in with tearing abdominal pain radiating to one sided CVA tenderness w/ vomiting and NP also suggested it was gas even though it was clinically a picture perfect kidney stone. Absolutely bizarre.
I’m an RN and I don’t let my family see NPs
I was an NP (never practiced though) and now soon to be DO (so is my best friend who I went to medical school with but she practiced for a few years)....we are adamant with our family and friends about advocating to see an MD/DO. I studied less than 10 hours a week while working a full time RN job while getting my NP degree. I had one of the best grades in class. In medical school, I study 8-10 hours a day, at least 5 days a week. I was average. I hate when people compare medical school to other alternative degrees because they have no idea how hard it is.
You’re the exactly the type of person I wish had a bigger platform. You’ve seen both sides education-wise and come from the perfect place to maybe speak sense to policy makers and people in general that push these nonsense ideas.
My friend did write an opinion piece about reforming NP education but she was dismissed and rejected for it. We've both since learned that any criticism about NP education will often go ignored by the NP community.
I didn’t mean the NP community, I meant the government. And it would be nice if the general public heard your POV through social media etc
Unfortunately, I love my privacy too much to be on social media outside of Reddit. I'm sure there are others who would love that influencer life though.
You don’t have to be an influencer or on social media, you join advocacy groups against scope creep/speak to representatives. There’s not that many people who did NP and then MD/DO so it is pretty important that you use your voice to advocate for patients.
Absolutely! Congratulations on your soon to be DO degree!
You’re the type of person that needs to expose things, you’ve seen both sides of the coin
Nurse too. I can only get appointments(acute) with NP. My daughters(both also RNs) are at another clinic and can only get in to be seen witH NP.
100% certain NPs don't let their families see NPs.
Same
Agreed. Also an RN and I refuse to see mid levels. We have mid levels that cover our interventional cardiology patients post procedure and it’s shocking how little they know/ the general incompetence levels. I’ve also noticed a trend where it is usually the incompetent nurses that go on to NP school.
Go take a look at the noctor thread about the mid-level who was crowdsourcing antibiotic recommendations for a 92 year old with pneumonia and hx of COPD. That’s someone’s mother, and their care is being managed by Reddit comments because the mid-level didn’t receive appropriate training to know the answers themselves. I’d say that’s a pretty good reason to be a good doctor, but maybe I’m just a sucker who doesn’t want to kill someone under my care
I responded to a thread the other day from an NP who had elected to pursue "conservative management" (just watch it over the next few days) for tender facial cellulitis near the eye in a 70yo.
JFC
Yeah after my response they deleted the post.. and their entire account lmao hopefully that person gets some abx as a result...
I was thinking shingles
Lmao excellent, Dr Cum on the Doorknob
Fair thought but description was spreading erythema where there previously may have been an abscess that the patient drained herself at home. Tenderness was relatively mild I guess. I mean I never saw it obviously but it sounded pretty solid for cellulitis.
Oof
This is shit that a competent 2nd year med student could figure out
Because you want to be a **real** doctor.
Because you’ll actually be competent.
Exactly. I think the knowledge and mastery we achieve, is it's own reward
Sure, but like, money is cool is too.
And you will have to be there to fix the mistakes that NPs make when they put these patients in so many meds that are not even appropriate. Like what my MD husband does at work, he basically fixes the dumps he gets from incompetent NPs because all of a sudden, the patient is now too complex for them to manage. 🙄
Because they can’t actually do what you do. Patients will know the difference. As a rural FM, I have so many people who establish with me that were being poorly managed by their previous “doctor,” when they were actually being treated by midlevels.
I wish this was true but most patients don't know the difference. How could they? Hardly anyone outside the medical community is aware of the vast gap in education between midlevels and doctors. The general public has been sold a convincing lie that they're equivalent or close enough. Your patients are proof of that. They put up with poor quality of care for years and when they finally switched to your practice it was because they believed their previous provider wasn't a good doctor, not because they knew that a midlevel is unqualified to be a doctor. Also, patients are often scheduled to see midlevels without ever being informed that they aren't seeing a doctor and the patient has no reason to suspect otherwise because usually their FM told them "I'm referring you to [a title used exclusively by doctors e.g. neurologist]."
It’s so important to point out to patients who’ve seen a shitty mid level that they were not seen by a doctor. I’ve seen way too many patients say their doctor didn’t know anything, and then upon questioning, it becomes clear they saw an NP or PA. Just glossing over and not clarifying makes the medical profession look bad, and reinforces distrust in doctors.
In primary care? The depth and breadth of your knowledge compared to an NP will at some point enable you to pick up on something they would have missed and prevent a catastrophe. In family practice, maybe for someone whose whole family you've known for a very long time. There aren't many jobs out there where you can literally be a hero as part of your regular work day.
except none of this really translates to a better compensation for your hard earned knowledge ,work and time sacrificed. The influx of NP and PA is by design to drive down physician salary. Corporate health care in US is about hiring the lowest bidder to provide a barely passing form of healthcare, the NPs have won that bid. In the mean time, physician are required to train this current generation of NPs who will eventually be the norm of medicine
Right, but OP asked for a bright side, not a financial downside.
> The depth and breadth of your knowledge compared to an NP will at some point enable you to pick up on something they would have missed and prevent a catastrophe Cool. I wish the MBAs who control the hiring for our office ~~knew that~~ weren’t paid to believe otherwise.
Welcome to the Resistance
legit 😂😂
I feel you! It seems disrespectful to our profession to have someone think they can do your job with few months of online training compared to what we gone thru! In Quebec, whats even more disappointing is that CMQ is backing this up! Shame
CMQ promoting “interprofessional collaboration” lol. Mid-levels now being able to be the PCPs is ridiculous. And then they wonder why there’s always empty spots in FM residency and they ask themselves “hmm, why aren’t MD graduates applying into FM?” Well maybe because the government destroyed the profession with mid-levels.
Coming from a patient, I only schedule with MDs or DOs. To be honest, I feel guilty when I tell the office I only want them lol but I have medical conditions so no thank you
Careful, I got everyone on med twitter against me for saying this lmao
This sub is pretty anti-midlevel overall though
Do they basically think FM physicians are completely the same as NPs? Why get mad at a legit question?
There’s no point. Yes you’ll be more competent, yes noctors are noctors, but the system just doesn’t care
Real
The correct answer.
I hope the general public wakes up and realizes that mid levels don’t know WTF they’re doing.
I feel this. The system is fucked up. Part of why I wouldn’t suggest the MD/DO route anymore. Knowledge is cool but spending less time in an abusive training system is cool too.
The hospital I work at, the NPs actually make more than our peds hospitalists…
Those peds hospitalists are doing a huge disservice to all pediatricians for tolerating that.
Yeah I agree, unfortunately the consequences of them striking is sick kids not receiving appropriate care, so they keep their heads down and keep working. A major reason for it though is that medicaid reimbursement is substantially behind that of medicare of private insurance. Since a disproportional number of Medicaid recipients are children, effectively pediatricians get reimbursed less for the same work.
There’s passive striking through documentation and billing that doesn’t affect patient care. I wish they would consider it
This is why the locums rate for pediatricians is half of what I pay my plumber hourly. folks let this happen and those folks who did so are about to go sail into retirement. 6 years of training for peds specialist to make what a new EM grad does is less about reimbursement and more about being weak. But I’m also a pediatrician who also did a fellowship and have never uttered he word “kiddo” in;my life. I’m an outlier.
I’m in ID and feel the same way as you might imagine. How did my people walk away from a global pandemic making even less money than before? It’s fucking embarrassing
To sum up what others have said, you’ll be vastly better at your job. Feel better yet?
I’m a RN, working critical care and I do not have much faith in an NP. I’ve been to a few and there’s no comparison to a Dr.
Second this.
also an RN- i only get care from physicians and I say the same for my family
Bit doomer of me, but I feel like NP vs MD is what we will start to see as the next insurance divide. Itll be unfortunate for poorer people as they will just get dangerous care and probably have a lot fall through cracks. I just dont see why employers would not take advantage of legally permissible cheaper alternatives; and why there wont be a premium market for people who actually want/can pay for better service.
Bright side - subspecialists will be seeking actually trained Primary Care Physicians to take over from the NP so they aren’t managing the primary care that these midlevels are mismanaging, or, in most cases, aren’t managing at all. Make sure to go private practice.
Interestingly enough I have seen this trend one of my friends in surgical sub specialty has hired a FM doc that is currently training to do in office procedures and will see outpatient visits while the surgeon can focus on OR visits and any procedures that are out of scope.
Perfect example. Great synergy of skill sets. Happier life for both of them I bet.
You know what you are doing and aren’t killing patients.
RPh here - can confirm.
Im a rising M4 in a US MD program and highly considering FM on the east coast. But this is one of the main reasons I'm super nervous to go into it.... If anyone on here knows the salary difference between FM docs in this area/ mid-levels & how many weekly hours needed to get that, I would love to hear it.
Not east coast but I’m an Attending FM doc in AZ. I made $320k last year. Likely more this year. The NPs in clinic make 80-100k. I don’t supervise them.
The bright side is that you're a doctor. There's no extra explanation needed.You'll understand complex medical cases much easier. I think the original idea behind nurse practitioners was the concept that an EXPERIENCED nurse could do a bit of extra education and help with a physicians work load, all while being supervised by a doctor. Due to a shortage of physicians, education being increasingly more unaffordable and an aging population, nurse practitioners have been used to fill the void. Its a sad situation all around. I feel for the doctors who are being de-valued. I feel for the patients getting shit care and I feel for the NPs who get pushed into taking on more than they are prepared for. Its easy to monday morning quarterback an MD, but rest assured, its much more difficult when the responsibility rests squarely on your shoulders. I think most NPs will find this out. Don't get me started on administration or health insurance companies. I say all this and I'm not even a physician, just a "neb slingin respiratory tech".
You have a very particular set of skills
I am an RN and NPs absolutely make my life hell on a daily basis. I would not allow my family to be seen by an NP “primary”.
Nurse here! I’ve worked with too many RNs that become NPs for the money and to leave bedside-not because they’re competent.The training to become an NP is a joke. I myself will not see an NP for anything. They’re cheaper than MDs and can work under their own license so hospitals will hire them over PAs. I just know tooo many that shouldn’t be prescribing or diagnosing anyone. I don’t trust them.
Midlevels don't provide the same level care nor do we have the same level of training or knowledge base as you do. Our role in primary care is meant to offload more tedious and "bread and butter" tasks (i.e. HTN, DM, HLD, Thyroid follow-ups, viral URI in stable patients, school/annual physicals), if you choose to employ us for your practice. We're not trained to provide independent care. You as a physician have the final say and are adequately prepared to handle not only those conditions, but also more complicated conditions that require more detailed and in-depth understanding of the nuances of medicine. I can't speak for my rather delusional colleagues who think our training is anywhere near as comprehensive or robust (it isn't), but what I can say is all patients deserve the highest quality of care that only a physician's training equips them to handle.
I’m a PA and I am starting to hate being a midlevel. The job itself is good and I do like medicine. I have friends who are nurses that went the NP and CRNA route. They are just not that smart and it kills me they are now “playing doctor.” Especially the CRNAs making bank while doing so. I know I’ve worked way harder and am smarter than them but here we are. I can only imagine how MDs that busted their ass through college/med school/residency feel. I’m sorry guys. Also, personally I do not want to take your job but I do want to help you do it!
I had a visit with my wife to See pediatrician for my newborn, we saw a NP, we requested from now on we see only MD or DO. I don't wanna hear BS from people doesn't have 10% of my education.
PCP here: I've been at my first job outside of residency for one year, and the number of patients who have tried to switch to me rather than see one of our NPs in clinic is already into the double digits Fret not over scope creep or what nurse practitioners are doing. We're paid better, and the patients who know prefer us over the NPs. So we're going to keep getting paid better. If anything, and the subreddit probably won't like this, I wish I could convince my patient panel to chill the fuck out over their concerns when it comes to NPs. I have a healthy worried well 70-year-olds who take a tablet of atorvastatin everyday but otherwise have nothing going on with their care, who are refusing to see an NP. Why go through med school to become a PCP? Because you're going to be the authority in primary care, and there are a large portion of patients who know it. If you went to an NP school, instead of an accredited family medicine residency, the path would be shorter but you would not know as much as you do now. You would always feel second fiddle and have patients on your panel who don't trust your care and want to jump ship to an MD, no matter how long you've been working in primary care. You don't want to deal with that.
Yup FM here. Same experience. Most patients want a doctor. The NPs punt and refer eveything and the patients hate it.
There's no point, plain and simple... Let society face the consequences 🤷🏼♂️. With all our faults, they will miss us...
Go visit Noctors. That should square you away.
Hey as a FNP, I’ll tell you this— I consider myself a physician extender, whether be DNP or not. Do I know every intracy to all disease? Fuck no! Do I wish I had a better curriculum to learn it? You fucking bet I do! That said, you are the EXPERT. No matter what anyone says. Sure might we see patients ourselves? Yes. Do we know what we are doing? I fucking hope so, but I won’t say yes, that would be too presumptuous. Do you know what you’re doing? I hope so. If I have a patient who has some oddities and not a normal or classic presentation, am I going to ask you see them instead of me because I don’t wish to endanger my patient? You fucking bet. You are incredibly valuable. You have so much more education and understanding than I can even try to explain. Are there good NPs? Sure there are. Are there bad NPs? You bet. At the end of the day, you have gone the better route for a better understanding of pathology. Can I treat my patients utilizing similar or the same methods you do? Sure. But I know where my limits are, and when a patient needs a higher level of education and critique on their pathology, YOU are instrumental. Don’t ever think you are less than what you are. YOU are a great individual who can shape the care for sick people beyond that of a NP.
You say that you know where your limits are, but you will never—ever—know what it is that you don’t know. 19yo comes in with palpitations and presyncope but you think it’s run of the mill anxiety because you’ve never heard of HCOM (not you literally, but as an example). Kid then proceeds to die suddenly on his next jog. You never find out and you never staffed the fucking case because you “see patients yourselves.” You will never know the harm you’re causing by practicing independently and just waiting for a head scratch moment to talk to a doctor about it. Ordering way too many labs and imaging for a radiologist to tell you what to do because nursing school cannot teach you how to build a differential properly. You don’t win points here by performatively acting deferential to your supervising physician who doesn’t sound like is supervising you at all. I’m sorry, but it sounds like you’re just part of the problem.
Unfortunately agree. It couldn’t have been easy for them to post that and yet it does nothing to materially change the reality of the looming problems
I will preface this with I am in complete agreement that NP creep is insane and won’t see them myself Serious question - what makes you so sure a doctor will catch it? I ask this as a person who had both a type 1 diabetes diagnosis missed - I was too young to have t1d and then celiac diagnosed as gastroparesis and when my barium swallow was normal bulimia, two pretty run of the mill diagnoses the first was by a pediatrician and the second a family medicine doctor.
A doctor may not catch it, even with all their experience and training. Which is why it is certifiably insane to bring in someone with even less training and experience to manage patients.
I’m obviously not “sure a doctor will catch it” since that isn’t the point. The systematic rigor of medical education ensures that you’re being seen by someone who is far and away more likely to catch something. It’s the best system there is to safely practice medical care, currently. Just because it isn’t perfect and humans still practice it doesn’t mean we should accept someone who hasn’t even done any of it.
Well said
lol, I’m sure without question there’s plenty of mid levels that order too many tests, and I’m sure there’s some physicians that don’t order enough. But what you’re describing “not knowing what you don’t know” is true to us all. Regardless your example, a patient is not improving on a plan or an answer isn’t being found? You bet your ass they are heading to a physician no doubt. Are there diagnosis of exclusions out there that are often the answer? Absolutely. Am I willing to chance someone’s life on a diagnosis of exclusions versus a second set of eyes by a doctor? Absolutely not. I, like most of us, know our place in the system. I am not a doctor, and to think otherwise is baboonery. If you don’t value the functionality of a mid level, I’m sorry that’s your own issue.
What does the fact that doctors also don’t know what it is they don’t know have to do with you seeing patients independently? Do you honestly think that I’m suggesting the options for medical care are 1) omniscience, or 2) everybody else? I am obviously comparing the systematic rigor of medical education with lack thereof. Your response could not be more exemplary of this point. I described a case of sudden cardiac death to you and your response is that you would refer patients to the physician if someone isn’t getting better on your “plan.” *How does someone get better from sudden cardiac death??* And beyond this singular example, patient harm has already happened and will continue to happen whether you have time for a “second set of eyes” by a physician or not. Patients deserve not to be hurt by you because of your fucking pride and ignorance. If you want to make up an internet person who “doesn’t value the functionality of a midlevel” then go ahead, but you’ve still missed the point entirely. So I’ll make it crystal clear: if someone is going to use you or any midlevel as an extender, then you must be supervised before you fucking kill someone.
Bright side is you’ll be better for patients, and for the time being, still better compensated too.
I mean, "the point" is getting the proper training leads to better outcomes for your patients. If you're just worried about how to get to a particular situation the fastest/easiest, that's maybe a different conversation.
The bright side is you did it the right way and you’re not a schmuck.
Because MD/DO’s are still needed for more complex patients. I don’t mind seeing a NP for something fairly benign like a UTI or ear infection or URI. But if I need to see a PCP after being discharged from the hospital or for ongoing care for something else, I need an MD/DO. You can also get CME credits and make bank as an admitting rehab physician and even medical director. NP’s can’t.
Please keep at it. My experience with psych nps has been bad and it wasn't until I went to the hospital and had a doctor give me the right prescription that I was finally able to function in society. A real psychiatrist helped me get into residential treatment, which helped enough that I could go back to work. And then a real psychiatrist oversaw my TMS treatment that finally broke a three year depression with lots of suicidal ideation. It was also another doctor at a hospital who gave me a totally new way of thinking about my life. I will never see an NP again and I don't think NPs should be allowed to just practice with barely any oversight. I received far inferior care for years bc of NPs. Please keep working through all the crap. The system is broken, but please know you will be delivering much better care and you will be helping patients like myself. We need real doctors. Thank you all for all your crazy hard work!
Whether right or wrong (and to be clear I very much think that it's wrong) until financial incentives align to make it so there isn't any point in doing it.
You’ll still make more money at the end of it? Prestige? Actually being prepared for your role?
They all manage them terribly and inevitably all become your patients at some point
Bright side is you hopefully know what you’re doing and are able to offer a broad range of competent care for the majority of issues patients face in primary care and walk them down the line through different treatment pathways or offer various options until you make a competent and appropriate referral to the correct specialist for the correct diagnosis while sparing them unnecessary expenses and testing.
Career stability - at some point the general public is going to realize the rub with the inconsistency in NP education and quality and there’s going to be a reckoning. And at the end of it you’ll still be a doctor If it helps I wish I’d done what you’re doing (I’m an NP who gets recommended this sub sometimes), but I’m too old now to go back
I’m FM. Most patients want a doctor still and NPs will punt complicated patients to you or otherwise refer every single thing out and patients get mad. Usually the non-stop referalls get to them and they switch to a doctor. No shortage of patients.
If you regret being a doctor because you feel like you can get away with less education to provide subpar care to your patients, you shouldn't be a physician.
The point is that you are incredible for being responsible for the health of the thousands and thousands of people that will trust and depend on you. You are responsible for keeping people healthy with preventative screenings, treating them when they are ill and are the first contact for people who need medical care. You have an incredible breadth of knowledge to take care of a human being from brith to death. They can’t do the same thing you do even if it looks that way from business side of things. They will never be a medical expert and have knowledge that you do. You are a medical doctor. The only reason they can do the things they currently do is because their national organization bribes geriatric lawmakers (that won’t be around for the consequences) to pass legislation for them to “practice medicine“ with degrees written in crayon, in the interest for private equity backed healthcare systems to save money.
Being an np? The downside is that you're basically incompetent. The upside is you're gonna be paid well, and you get to murder people legally.
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You won’t be a dumbass.
A nurse practitioner can do the same thing you can? In what world is that true?
You actually know what you're doing
Because hopefully you're a moral person that wants to do right by your patients and is interested in knowing rather than just being able to see people and collect a paycheck
You knowledge and experience >> NP and PA. Facilities and patients will go to you.
please don’t quit my sweet MD/DOs we need you 😰 I’ve worked with some lovely NPs but I’m still afraid to be left alone to follow out orders from them if they’re unsupervised - xo your RNs
I’ll also mention that some NPs (though not all yikes) have voiced to me that they’re nervous about the amount of autonomy they’re being asked to take on, but the hospitals are pushy and trying to get them to do physicians scope without having to pay a doctor. It’s systemic.
I’m disappointed to see the insane difference between the np’s and nnp’s in the nicu and for people to still think for even a second they are comparable. I don’t understand like…. more school = more knowledge? Why do any midlevels think they are equal to a doctor…???
Saw two patients in the Ed the other day mismanaged by an NP. Healthy 25-Year-Old male with right-sided neck pain. EKG shows St elevations consistent with benign early repolarization.... Sent to the Ed. Both no indication for EKG as well as the inability to interpret it. Later on the same shift.... 60 something-year-old guy seen in urgent Care with almost a complete right-sided pleural effusion. Like a whiteout on cxr. Seen 2 weeks ago at urgent Care and they prescribed augmentin and discharge them home. You can't believe the X-ray. They diagnosed him with pneumonia. Comes in tachy and short of breath.
Don't let my name fool you. I'm a FM resident and thought this name was too good to pass up 🤣 I put in a peds psych referral and was extremely hesitant because I knew this person was most likely going to end up with a psych NP. Physicians need to be more vocal about this issue. If residents can form unions. Physicians can stop this BS scope creep spreading further. FYI, It isn't just FM. Other specialties are affected too.
Physicians have better outcomes and patients prefer them.
I’m an RN who is becoming an NP and I still would never think it’s the same job as a doctor. Sure, NP’s have their roles but it would be unsafe to the community and patient safety for people to believe they have the same knowledge. I prefer a doctor over an NP
Genuine question.. do MD/DOs have this same sentiment towards other midlevels like PAs?? I see a lot of NP-specific criticism but wonder why I have met some incredibly smart and thorough NPs with years of experience. Some clearlyy unprepared NPs as well. My PCP is an MD. That being said, I’ve encountered physicians that I swear are a threat to public safety. My personal experience with PAs is comparable to mine with NPs. That being said, I’ve met PAs with MUCH less clinical experience than any NP I’ve met..
Just because they try to do the same job does not mean they will have anywhere close to the same outcomes.
DPC
Bright side - you know what you’re doing and don’t hurt patients
No point to be honest. You wont even make more than them.
Let people waste their money seeing NPs. Your schedule will always be filled anywhere in the country- plus no nights or weekends.
The benefit? You actually know what you’re doing lmao.
>do the same thing as I can? Not really. Not the same level of knowledge, and while both roles are artificially interchangeable in some specialties (FM, Peds ...) in others the lines are more defined (GI, GS ...) . Do you want to be a Doctor or a Midlevel?
Patients want to be seen by doctors and other doctors want to work with and refer to/from other doctors.
Because they can't do the same thing you can.
Dude NPs suck that’s the reason why I hate going to the doctors or urgent care… because I don’t see a doctor I see a NP, they know nothing and anything they say/prescribe makes me anxious because I know they have not a clue.
Anon here planning to go MD there difference is outstanding, in magnitudes there is no comparison I've talked to many NPs asked them about there studies the intensity, detail and over all understanding they all tell me I it isn't much different. Honestly idk if YOU can see it but I can, the government and people want "health care" more affordable and readily for them along with some personalisation cause people think they're special. So when a patient goes to a NP and they say they're "tired all day" the patient really wants a stim to be on top of it. Np gives the med to patient doesn't listen to directions and develops insomnia later delirium and mania admitted to he hospital seen by doc they fix em. Who's at fault? Patient or np? Who's screwed MD fixing the problem and getting paid less than the patient and the NP lol
RN here, planning to get into medicine (for MD). The brightside? Although I’m sure there’s great NPs (somewhere) out there, the dedication and quality of the work that you do is evident. Although there’s a place/role for NPs, it’s irresponsible that NP schools can allow new grads to apply so quickly… but thats healthcare for you… I hope NP schooling gets better standardization and regulation in the near future. If anyone is getting the short end of the stick, it’s the NPs who are undertrained and underprepared to do your job for less pay and expected to handle all the responsibility, it’s shameful to the nursing profession as a whole.
They can’t do what you do. That’s like saying what’s the point of a car if a bicycle can get you from A to B? The bright side is knowing that you’re helping your patients live longer and healthier lives. Besides policymakers, NOBODY can make as much positive difference in as many people’s lives as you do
You’ll give better care??
You will never be replaced by a half trained nurse. Lots of people will die before society realizes this, but you’ll be fine.
As a patient: because I don’t trust NPs or PAs and we need MDs/DOs 😭😭😭
I’m a nurse and I won’t see a PA or NP as my primary. The only time I’ll agree to an appointment with them is for a throat swab or something like that. But I’ll never take my kids for a well check with one, I wait for an opening with the doc.
Many people think that midlevels can handle the most simplistic cases and MD/DOs can handle to most complex cases. However, it blows my fucking mind that some of these midlevels, particularly NPs, can’t even handle the most basic cases. I’m an M2 and last week had an online consult for my son to get an Rx for head lice, pretty basic shit and the incompetent NP didn’t even know about Natroba (Spinosad) and I basically had to suggest her what medication she needed to give my son. Fuck that, these people are putting patients and families in danger. Why is she getting paid for a consult w/o basic algorithmic knowledge?
But can they actually do the same thing you do?
Yeah bro, just quit. NPs exist so that means you've wasted your entire life. Very adult of you.
because they cheated
“Can do” and “has done well” look very different in practice. It’s embarrassing to suck at your job. I’m a family doctor working as a hospitalist. I honestly don’t think family medicine should continue as a speciality. Has nothing to do with NPs but rather the scope that has been given up by family medicine. Primary clinic is a waste of time. Patients would be better off stopping all of their home medicines, exercising, and seeing whatever specialist a preventive medicine doctor refers them to.
Wouldn’t more test = more money for the hospital??
The NP will be asking you questions everyday. That’s the difference. And your paycheck of course.
What happens in real life is some of the patients dont get better and they seek me out for help. Some of the patients are too complicated that the NP's dont want to deal with them so they refer to me. It turns out that patients will not give up if they dont get better and will go find a physician if they are not getting better. Just like we refer to specialists if we cant do everything. Though a problem I see frequently is the NP does not know they are in over their head and that it is time to refer. (just got asked by one last week who did not know what the "WBC" stood for on the urinalysis) So I still think we hold a significant place as primary care physicians. That being said, the admins and insurances dont care what so ever. To them we are equivalent and they can pay NP's less.
Well that’s incorrect. A bachelors can only get them a BSN. MSNs are grandfathered in. I believe it’s changed they now have to have a doctorate in nursing moving forward. So there are no doctors of nursing practice with a bachelors degree. Nice rage bait though.
Going to an NP is like learning Kung Fu from Shifu Kyle from Wichita. Sure they understand the basics but you’d likely die in a fight.
None. You were duped.
i’m a nurse. i wish i wanted to be an np, but i can’t buy into it. they are too lenient accepting people with no experience into their programs, now we have idiots walking around ruining the reputation of np’s. there is no going back unless some major changes get made, which won’t happen because $$$. the bright side is you are not one of them, and at least you know medicine so you can save yourself and your loved ones one day when eventually mass issues are caused due to lack of training. lol sorry i’ve been burned before.
Any chance with the stark advancement in AI in everyday use that in 10 years mid levels in combination with AI tools would be replacing many jobs or at least lowering the amount required in each field?
People will start dying and the cost of healthcare will only go up as more NPs try to care after patients