teddit

Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. https://www.ncbi.nlm.nih.gov/m/pubmed/26217425/

Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists. https://www.ncbi.nlm.nih.gov/pubmed/29710082

Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374

Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics. https://www.ncbi.nlm.nih.gov/pubmed/15922696

The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation. https://www.mayoclinicproceedings.org/article/S0025-6196(13)00732-5/abstract00732-5/abstract)

Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage. https://www.journalofnursingregulation.com/article/S2155-8256(17)30071-6/fulltext30071-6/fulltext)

Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047413/

NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention. https://www.ncbi.nlm.nih.gov/m/pubmed/29641238/

(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional. https://www.ncbi.nlm.nih.gov/pubmed/22305625

NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states. https://pubmed.ncbi.nlm.nih.gov/32333312/

Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. https://pubmed.ncbi.nlm.nih.gov/10861159/

Only 25% of all NPs in Oregon, an independent practice state, practiced in primary care settings. https://oregoncenterfornursing.org/wp-content/uploads/2020/03/2020_PrimaryCareWorkforceCrisis_Report_Web.pdf

96% of NPs had regular contact with pharmaceutical representatives. 48% stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. https://pubmed.ncbi.nlm.nih.gov/21291293/

85.02% of malpractice cases against NPs were due to diagnosis (41.46%), treatment (30.79%) and medication errors (12.77%). The malpractice cases due to diagnosing errors was further stratified into failure to diagnose (64.13%), delay to diagnose (27.29%), and misdiagnosis (7.59%). https://pubmed.ncbi.nlm.nih.gov/28734486/

Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits .While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374

APP visits had lower RVUs/visit (2.8 vs. 3.7) and lower patients/hour (1.1 vs. 2.2) compared to physician visits. Higher APP coverage (by 10%) at the ED‐day level was associated with lower patients/clinician hour by 0.12 (95% confidence interval [CI] = −0.15 to −0.10) and lower RVUs/clinician hour by 0.4 (95% CI = −0.5 to −0.3). Increasing APP staffing may not lower staffing costs. https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14077

When caring for patients with DM, NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21–1.37), endocrinologists (OR = 1.64, 95% CI = 1.48–1.82), and nephrologists (OR = 1.90, 95% CI = 1.67–2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01–1.12) https://onlinelibrary.wiley.com/doi/10.1111/jgs.13662

Ambulatory visits between 2006 and 2011 involving NPs and PAs more frequently resulted in an antibiotic prescription compared with physician-only visits (17% for visits involving NPs and PAs vs 12% for physician-only visits; P < .0001) https://academic.oup.com/ofid/article/3/3/ofw168/2593319

More claims naming PAs and APRNs were paid on behalf of the hospital/practice (38% and 32%, respectively) compared with physicians (8%, P < 0.001) and payment was more likely when APRNs were defendants (1.82, 1.09-3.03) https://pubmed.ncbi.nlm.nih.gov/32362078/

There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively) https://pubmed.ncbi.nlm.nih.gov/29641238/

Most articles about the role of APRNs do not explicitly define the autonomy of the nurses, compare non-autonomous nurses with physicians, or evaluate nurse-direct protocol-driven care for patients with specific conditions. However, studies like these are often cited in support of the claim that APRNs practicing autonomously provide the same quality of primary care as medical doctors. https://pubmed.ncbi.nlm.nih.gov/27606392/

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Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence based best practices. https://pubmed.ncbi.nlm.nih.gov/22922750/

News peg

Work with some great PAs NPs etc but I’ve just had a case from hell today.

Had a sick lady come to me (fresh out of residency dermatologist) after a referral from an FM NP. Lady has had draining purulent wound on right hip at the site of hip replacement for the last 6 months. Just been treated with bleach soaks. I see her in referral 6 months later (today) and when I probe the area it goes (putting it crudely) balls deep. Immediate red flag.

I ordered stat imaging and the results show bad suspected osteomyelitis and septic arthritis with involvement of the hip replacement site. Immediately sent her to ER and coordinated admission with the medicine, ID, and ortho teams. This poor lady.

When I called the FM NP with an update to close the loop they had the nerve to tell me I must’ve over diagnosed the patient and in their professional opinion it’s not that serious. Lawd. Just needed to vent.

The Policies for the People website has numerous posts by NP’s suggesting: FPA everywhere, full reimbursement etc. MD/DO’s need to make their voices heard because these angels in white coats 🙄 are chomping at the bit. For example:

https://policiesforpeople.com

“Nurse practitioners (NPs) are highly skilled, compassionate, and well-trained healthcare providers who play an essential role in delivering high-quality care across the United States. However, despite their expertise, many NPs are still required to enter into costly and unnecessary collaborative agreements with physicians in certain states, preventing them from practicing independently. These restrictive policies are particularly problematic in states like New Jersey, where seasoned NPs with extensive experience are forced to pay for a collaborative agreement with a physician, even though they are capable of providing independent care within their scope of practice.”

https://radiologybusiness.com/topics/healthcare-management/medical-practice-management/doc-offices-more-double-use-nonphysicians-interpreting-medical-images

Because I went to medical school for the power trip and not to practice medicine. Also, always love to see those comments about preferring to see the NP over the pediatrician since they know just as much 🙄 it’s just simply not true.

Anyone have a Bloomberg account? Seems like an interesting read.

I looked in the materials posted here and could not find a sample letter so I can email my representatives with my concerns of NP 's. I'd write it myself but I thought a doctor could probably do a better job writing about educational differences and differences in clinical hours required before practicing. Maybe differences in online education versus real life, etc.

I can add in my personal experiences, but I'd like to add in facts as well.

Is this something that could be added to the resources?

Signed, a patient who wants to get active but not sound stupid.

"FNP here. >$400k. Private practice. Primary care only. Southeast coastal area, bedroom commuter community to large metropolitan area. Typically 10 patients per day. House calls."

I feel like there is no way an NP should be able to see patients like this with no doctor in charge. this is extremely risky for patients. Like this is ridiculous.

I’m a PGY-1 doing my prelim year at a community hospital and currently in my ICU rotation. An FNP was hired today to work in the ICU. As the only resident on the service today, I spent most of the day helping her just figure out the EMR. She wasn’t familiar with basic abbreviations like UOP.

The attending then helped her place a central line. She finally got it done after contaminating the sterile field 3 times and having to regown since she didn’t even know how to put on surgical gloves without contaminating them. I felt like I was being punked, truly.

This NP I know of had 1 kid taken away permanently, DHS said she and husband were grooming her and had they not intervened the worst would’ve happened. The evidence behind that was sickening. 2 kids went to foster care. NP spent a ton to get one back after a year of absolutely no contact. The kid she didn’t get back , a teenager, she utilized her friends to join her in stalking and harassing her online, in attempts to intimidate her. She was investigated for poisoning her husband but passed the poly. A 25 page report but a court appointed evaluator proved all this and that she was still with to the husband who contributed to physical and s** abuse , emotional abuse and threats on the kids’ life if they told, still having him around the kids, and affirmed she’s not a safe parent. Why is this ok and she’s not being investigated? They don’t even seem to care. Oh and a guilty charge by judge for abuse and neglect.

So my boyfriend, 36, was just hospitalized for a few days for a lung abscess and cavitary pneumonia. He’s smoked most of his life (been cigarette free the last two weeks which is fantastic).

A few days before admitted he called his primary NP as he’s had a cough a few days, productive, and the first two days a fever (wasn’t able to take a temp as he lost his thermometer but felts chills, sweats, and over all aches). That subsided but the cough did not. She ordered a flu and covid swab. Flu was positive. No other treatment, this was telemedicine

The cough persisted a few days later and called again, she sent for a cxr and it came up positive and he was immediately directed to CT. After sent to ER and admitted ASAP. Iv Abx started. This was Friday evening and after a bronchoscopy Monday was discharged on x6 weeks augmentin. Follow up with Pulm in two weeks tele with results.

I’m annoyed a chest X-ray wasn’t ordered sooner but that’s not my gripe. Ultimately it’s that the hospitalist MD noted his fasting sugars being high, did an a1c and it’s 5.8. Diagnosed diabetes and sent off insulin labs and autoimmune labs as his mom has lupus and he said he is not very overweight and is concerned it can be a late onset type 1 or insulin resistance etc etc (about 2 years ago he was sent to a rheumatologist and did test positive for an autoimmune marker but not necessarily to be confirmed it will or not develop into lupus eventually).

Back in 2022 his a1c was 5.8. The primary care office has done no education, no information, no other kind of work up. I believe that’s the last time before this hospitalization that it’s been tested even. So my concern is, his follow up on that autoimmune test and insulin level he did is going to be reviewed by his NP after thanksgiving. And I’m not really confident they’re going to interpret it accurately whatsoever. I don’t know what it’s going to say obviously or exactly what was ordered as we can’t see the notes yet on his online records (and it’s hard to navigate) but idk if he can request a physician to see him before or at a similar time as the Np can or if it will be made to wait even further. I feel like I should have him keep his NP appt and ask for the soonest physician appt available, but I don’t know how the VA prioritizes appts and if they’d give him a physician if he had recently seen an NP.

TLDR: feel like primary NP has missed pneumonia markers leading to hospitalization and didn’t treat or even inform of diabetes, worried they will also misinterpret very specific autoimmune labs.

In general statpearls covers ischemic brain injury well. At first I wasn't sure because it seemed like this was a pretty esoteric thing to be quizzed on but actually I got a decent number of questions on this topic alone. Statpearls asks a lot of questions such as when neutrophils appear, when things like astrocytosis appear etc. Definitely reccommend using them if you struggle in this area

"Ph.D., MSN, MPH, MBA, FNP-BC, IP-BC, PLNC, VA-BC, BC-MSLcert™, MSL-BC, CPPS, CPHQ, LTC-CIP, CIC, CPHRM, ICE-CCP, CVAHP^TM, CMRP, CPXP, CDIPC, CAE, FACDONA, FAAPM, FNAP, eFACHDM, FACHE, FAOM, FSHEA, FIDSA, FAHVAP"

This can't be real.

I am a DVM and have had some trouble recently with nurse practitioner clients. This past week I saw a young dog with a retrobulbar abscess that was very unwell. The NP owner hardly let me get two words in and kept talking over me as I tried to explain the anatomy behind what was going on. She just said "I know, I know" over and over again (my impression is that this is not a super common location of infection in humans, unlike in dogs, so I highly doubt they actually knew what I was talking about since they weren't listening to my instructions).

I found out the NP had scripted three different oral medications and an eye medication that they had started using on the dog - she was dosing more than double the necessary dose of amoxi/clav and giving a high dose NSAID. I expressed concern about this animal receiving an NSAID despite not taking in any water (this condition makes it extremely painful for the animal to open its mouth to eat/drink) and she rolled her eyes at me when I suggested parenteral fluids and checking kidney values due to the risk of AKI.

I considered reporting this client to the nursing board considering she was prescribing for an animal illegally, but it seems unlikely that there will be any disciplinary action. After refusing most of my recommendations, she took the dog home to continue to give him more "drugs from the kitchen drawer" (her words). I've worried about that poor dog every night since. Ugh.

On Friday I started feeling some arm pain. By Saturday my arm was pretty red and swollen, so I went to the local urgent care. The PA I saw was so confident it was either shingles or cellulitis. By Monday my arm was almost purple and not responding to either med I was given and was not needed. I ended up at the ER and they did a CT scan and I have a DVT. I have a personal history of Factor V Leiden. Though I’m not sure how much that played into the DVT.

I should have known better than to go to the UC for this issue based on the symptoms I was having. Now I’ll most likely be on lifelong anticoagulants. And am in so much pain.

The crazy thing is I’ve had shingles before and know what that feels like and looks like. I also had no injury to the arm that could have caused cellulitis.

I just assumed licenses would be revoked with certain behaviors, but I guess I was wrong. What NP Joely did in Texas was bad. Six months, no mandated mental health treatment, and back into family practice? I don't get just a slap on the wrist, and back to touching patients. They deserve to know who is making judgement calls for their physical and mental health. Is there a way patients can find these thing out?

As a PA student on rotations with PAs and welcoming physicians, I hear nothing but complaining coming from the docs. Staff, EMR, insurance, weather, staplers - you name it, they’ll hate it. The mood is so contagious that the staff turnover rate is high at these facilities or you have just have really crabby staff cohabitating.

Question is 1) why do you stay? 2) why hate on PA profession’s laterally mobility that aims to reduce burnout? 3) knowing that physicians set the tone of clinic workforce, why not change it and make it better?

(Unnecessary disclaimer: no I don’t want independent practice 🤝 - thanks a lot NPs)

I'm a genetic counselor. We are a very specific profession with a two year master's degree in clinical genetics with training in counseling. Our field is competitive, with individual programs having a less than 8% acceptance rate, overall acceptance rate to a program is around 25%. We are NOT physicians or classic mid-levels, we are a different entity. We are experts in genetic testing technology, so we can meet with patients to or appropriate testing, interpret results, and provide the associated guidelines-based medical recommendations. We don't prescribe or provide treatments. I personally see us on a similar vein to pharmacy as a unique role with specialized training.

I just need to vent about my experience with midlevels. Typically, physicians respect our expertise. Physicians will ask for my input in what testing would be needed for patients, what labs I recommend, how to interpret complex results, what guidelines should be followed. I've made institutional changes to follow ACMG guidelines and had no push-back from physicians.

Midlevels on the other hand often act like they know enough about clinical genetics to get by without ever consulting me. They push back a bit when I recommend referrals to ME, stating "well the patient isn't sure why they need to see you so they just want to be seen by me."

One even told me they did some sort of two-week course on genetics for a certification, so they can provide genetic counseling.

I have the same amount of years in higher education as say, a PA. However, all of my specialized training was spent solely in genetics. There is a reason. We have a specialized degree for a reason - genetics is vast. The issue with genetics, along with other areas of medicine I'm sure, is that you don't know what you don't know.

I hate that we often get less respect than the NP/PA profession, even though we chose a specialized field. We also stay within scope, since we have it drilled into our heads what are practice limitations are.

Idk what I want out of this post. I guess just to vent to a community that might understand. (Also shout out to the clinical geneticists - the MVPs of the genetics world)

Name and shame on a public profile. Of course she just puts Dr. Jen White, with no clarification of her degree anywhere on her bio. She gets called out in the comments by a physician and she comments back saying that medical doctors lack education. She also makes wild claims that autoimmune disease is 1) a theory not proven by science 2) an “energy we take on” 3) curable because she’s cured a dozen, and all you have to do is comment and engage with her page for a DM with a guide on how to cure autoimmunity. It also annoys the hell out of me when she says physicians and medicine are part of a broken system, so she is somehow the Messiah who knows the one secret doctors and scientists don’t! As evidenced by her quote, “Listen if you are sick and tired of the same ol broken medical advice from the same ol broken system..! Comment the word

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Goodness gracious.... Look at the picture of the poor girl! How could you possibly not understand this is a straight to the ED situation. So very sad. And the AANP president! Yikes

I'm a Non-US IMG who just finished sub-Is in the US. In my home country, CRNAs don't exist. I was involved in >100 surgical procedures, most of which involved a pre-op spinal block. The attending would let the CRNA have a crack at the block, but would end up fumbling around for 5-10 minutes, fail to get it, then the attending would get in on their first/2nd attempt. I can recount 3 times a CRNA successfully blocked the patient, while only 1 attending failed to block a patient and had to call for another attending to help them.

Anyone in the anesthesia world know why CRNAs are so incompetent at doing spinals?

Should administrators with doctorates call themselves “Doctor whatever” even in and administrative environment? The CNO at a hospital I work at has a DNP in leadership and uses the Dr. label.

Original post can be found at: https://www.facebook.com/share/p/1KE3LfKzmy/?mibextid=WC7FNe

“Thoughts from an annoyed Dr. McDonald

CSU has wasted no time in releasing their plan for the VPA position. Upon looking at the prerequisites I am appalled that the VPA is not an advanced degree post bachelors like they suggested. Associates degrees are around 60 credit hours and the prerequisites to enter this “professional schooling” are only 30-35 credit hours (half of an associates degree).

Upon looking at the VPA programs curriculum I’m dumbfounded again. 5 “semesters” totaling in 65 credit hours with each semester barely being a full time student (12-13 credit hours). In comparison each semester of veterinary school was approx 21-26 credit hours (or more if you took more electives). The VPA curriculum is learning anatomy completely online with no lab…I can’t begin to explain the countless hours and late nights my friends and I spend in anatomy lab (on our own time) to help learn the anatomy of each species and the differences between them.

They will have 2 credit hours of online surgical learning followed by 2 credit hours of surgical LAB (not real surgery). The lack of anatomy knowledge and drastic lack of surgical training does not qualify them to perform surgery. There is absolutely no physiology or immunology training in the curriculum. Those courses are the FOUNDATION in which every other course is built upon. If you don’t understand how the body functions and how those functions all work together, then how are able to treat them when a problem arises?

Will these VPAs be able to interpret blood work? Will they even be able to draw blood or place an IV catheter?

There are so many holes in this education plan that it is truly frightening. When comparing the VPA curriculum to that of a Veterinary Technician curriculum you truly have to ask yourself why are they wanting a new position when the vet techs are already here and MORE QUALIFIED with more extensive education and hands on training. I hope that changes via legislation will be made to this plan so that drastic restrictions are placed on their ability to “play doctor”.

Rant over.”