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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: i-node who wrote (25456)	3/11/2013 1:52:49 PM
From: Lane3	Read Replies (2) \| Respond to of 42652

If they're going to allow NPs to do this, I think some kind of real supervision ought to be required. I don't see why. States license people in various lines of work to practice their business. Without supervision. If they screw up, there are penalties and remedies. I don't see why NP's should be any different.

To: i-node who wrote (25456)	3/11/2013 2:17:30 PM
From: skinowski	Read Replies (1) \| Respond to of 42652

some of them might not fully comprehend the difference between the NP and the physician. She was pursuing a doctorate in Advanced Practice Nursing, or something like that. With that doctorate she would be legitimately called "Doctor". I think many of those "doctorate" programs are backdoors. I have mixed thoughts about mid level people taking over primary care medicine. I do know that people tend to rise to the occasion, so to speak. If a nurse is limited to routine nursing, that's all she will do. But if she finds herself in a situation when she must take responsibility, and diagnose problems, and prescribe treatments - yes, many intelligent, reasonably trained individuals would become fairly good at it. Maybe not as good as MD's, but for 90-95% of the situations good enough. That's why outcome statistics support using mid level personnel for primary care. Maybe not as good as MD's -- but unless your name is Dr. House, you can't survive taking care only of complex cases. There is one more catch - that when you approach a patient, you never know when the case may suddenly turn "complex". I submit that an MD would have a better chance of noticing when that happens. As a patient, personally, I'd stick with MDs. But - I digress. From your story one can't tell whether that NP was an unethical and greedy person, or perhaps she was forced to do some pill pushing "on the side" in order to survive in practice. People forget that NPs are under the same financial pressures as MDs. They still must pay their employee salaries, rents, etc. etc. Maybe some of their costs are somewhat lower, but their insurance rates may also be a bit lower. Many must be discovering that being in practice is no picnic... that not all that glitters is gold. In my experience, many, maybe most NPs and PAs at some point prefer to leave primary care, and work for specialists. IMO, for rural NPs it is unnecessary to have an MD sign off on every chart - but it would be reasonable to insist that they should have an established support arrangement with one or more MD's, who should be available whenever needed.