Expanded role of nurse practitioners

[MarkQ]

I work in the healthcare field as a pharmacist. There are a lot of variables which makes a direct answer of doctor or nurse practioner a hard question to answer. Nurse practioners have a roll in healthcare and are good for routine visits. If there is something complicated going on I would rather be seen by a doctor. Generally speaking, nurse practioners aren't under as much pressure to crank out the patient volume so if you see one you may get more time with them and they may be easier to get a hold of between visits if the need arises. Doctors have been thru more extensive training and may be better at diagnosing less common problems. However, doctors are generally under more pressure to crank thru the patients to cover overhead and therefore you may not get as much time with them and may not be able to talk directly with them between visits. Doctors may be more likely than a nurse practioner to brush off your concerns from being overworked. There is a hugh variation amongst all healthcare providers. A good nurse practioner may be better than a bad doctor.

 

[MadMonk]

Thoughtful response, MarkQ.

While I agree this could get political quickly, it doesn't have to.

I like my Primary NP (she is Hot, and Smart :love: )
I like my Doctor, who is pretty sharp, but he is not very pretty.
Both are very active with me. She comes in and gets all the data. He then comes in WITH HER, and they both work with me. I like that.

What I don't particularly care for is what I see with specialists. For instance, and this is common across the board, my Cardiologist's CP or PA comes in, asks a bunch of questions, writes scrips, etc.
Then I sit for 15 or 60 minutes, if I'm lucky, and then the doctor comes in. He smiles, says something irritating,
and then leaves. I suspect this is either a legal requirement, or something to do with charging the insurance company top dollar. A waste of my time, and causes me to have to juggle the rest of my life due to whatever insanity the specialist is playing taking entirely too much time.

If you wanted to get real technical, we could get into Pharmacists Prescribing Meds based on the Doc's diagnosis.
My understanding is that they know a hell of a lot more about drugs than the doctors do. My pharmacist has saved me from some serious reactions, etc., due to differant doctors prescribing all sorts of non compatible drugs (firm believer in having a good relationship with your pharmacist). I also would probably be less likely to get all these new expensive drugs that aren't any better to some older drugs that now have generic equivalents.

 

[MarkQ]

Thoughtful response, MarkQ.

While I agree this could get political quickly, it doesn't have to.

I like my Primary NP (she is Hot, and Smart :love: )
I like my Doctor, who is pretty sharp, but he is not very pretty.
Both are very active with me. She comes in and gets all the data. He then comes in WITH HER, and they both work with me. I like that.

What I don't particularly care for is what I see with specialists. For instance, and this is common across the board, my Cardiologist's CP or PA comes in, asks a bunch of questions, writes scrips, etc.
Then I sit for 15 or 60 minutes, if I'm lucky, and then the doctor comes in. He smiles, says something irritating,
and then leaves. I suspect this is either a legal requirement, or something to do with charging the insurance company top dollar. A waste of my time, and causes me to have to juggle the rest of my life due to whatever insanity the specialist is playing taking entirely too much time.

If you wanted to get real technical, we could get into Pharmacists Prescribing Meds based on the Doc's diagnosis.
My understanding is that they know a hell of a lot more about drugs than the doctors do. My pharmacist has saved me from some serious reactions, etc., due to differant doctors prescribing all sorts of non compatible drugs (firm believer in having a good relationship with your pharmacist). I also would probably be less likely to get all these new expensive drugs that aren't any better to some older drugs that now have generic equivalents.

You make a few interesting points here.

I have seen nurse practioners where I work working with a general practioner and then switch jobs and move to a specalist. The next week you get sent to a specalist and there's a good chance you will see the nurse practioner that just started working in that specality a little while ago. If you want to see the doctor you may have to wait months to get an appointment, but if you agree to see the nurse practioner you get in much sooner. Granted, the nurse practioner is in close contact with the doctor, but a lot of times they have very little specality training. A nurse practioner with experience in a specality can be good and most of them know when they can't handle something, but there is a learning curve there.

As a pharmacist the other thing I would change is outlawing television advertising of prescription medication. Like you mentioned a lot of times doctors don't know the drugs like we do. The drug companies advertise heavly to the patients and get them to go to the doctor and ask for the newest medication for a condition they think they have. A lot of the times an older generic drug will work just as well or better than the newer one. The overworked doctor not having the time to explain this to the patient just writes for what the patient wants. This drives up the cost of healthcare and specfically prescription drugs. To do this though would open up the whole freedom of speech argument.

 

[mmburtch]

I've seen both personally, and to the best of my knowledge received excellent care. I get the impression that NPs are trained specifically to fill vacancies in the Family Practice arena. I think after a supervised "residency" period, there is no reason they shouldn't be able to open their own practice.

 

[Rodrigo de Jerez]

What do you guys think?

I don't even know why you are asking this question. It is to easy to make this into a political argument. I also don't think the average medical consumer necessarily has the insight into what role a nurse practitioner should or should not have.

So what spurs you to start such a thread? I think it is a squarely bad idea that will likely lead to little substantive discussion beyond, "This one time when I had Doctor X or Practitioner Y..."

Kid Montana obviously understands.

-Mark

I was curious what you guys thought. I read an online article regarding proposed policy changes in this regard in several states. It seemed as if all of the comments on the article were made by people with a political agenda ("doctors stink, nurses rule...etc"). I was wondering what you guys thought (I thought I'd get a less biased response from you guys).

And as for Kid Montana, stop pooping in my cereal!

I'll eat my words. I was wrong and I apologize.

-Mark

 

[Marco-Polo]

I've seen both, and I'd think it's a matter of expectations.

With respect to core knowledge, I think that primary care physicians have deeper/broader core knowledge from their clinical study (years 3/4 of medical school) and residency. Nurses/nurse practitioners have more applied training and in a different though related field.

What I want from my primary care physician is general health information, tracking (weight, bp, etc), nutritional and lifestyle counselling (which I will promptly proceed to ignore), management of long-term problems and diagnosis of short term ones. And, of course, referrals. I don't see a huge gap between that and a nurse's training. What's more, a nurse practitioner will likely be closer to training and more up to date. A-ok with me.

I'd encourage anyone reading this thread to read "Complications" and "Better", two books by the surgeon and writer Atul Gawande. Fascinating stuff.

 

[Humidor Minister]

I just thought I'd mention, one of my friends is a doctor. His medical practice insurance for his private practice is over $14000.00 a month (that is 14k). Doctors bare the burden of insurance. That in itself is a heavy hit. He says it's almost not worth it sometimes. I'd imagine he has to see as many patients as he can just to pay the bills. If they had to give patients as much time as a nurse does, there is no way they could survive in business. They both are very necessary to proper health care.

 

[grateful1]

I just thought I'd mention, one of my friends is a doctor. His medical practice insurance for his private practice is over $14000.00 a month (that is 14k). Doctors bare the burden of insurance. That in itself is a heavy hit. He says it's almost not worth it sometimes. I'd imagine he has to see as many patients as he can just to pay the bills. If they had to give patients as much time as a nurse does, there is no way they could survive in business. They both are very necessary to proper health care.

This is the main point of discussion as to why we will be seeing a Dr. (GP) shortage ensuing (not to mention the current legal changes..but I digress).

What you may find is that NP's and PA's will be seeing an increase in their insurance, should they be allowed more responsiblity.

 

[Humidor Minister]

We really have to wonder just how our health care system as a whole is going to transpire. Here is AZ my wife and I pay around 600.00 a month. I've heard of people in the eastern part of the country paying double that for just one person. What a mess.

 

[Yesi]

I just thought I'd mention, one of my friends is a doctor. His medical practice insurance for his private practice is over $14000.00 a month (that is 14k). Doctors bare the burden of insurance. That in itself is a heavy hit. He says it's almost not worth it sometimes. I'd imagine he has to see as many patients as he can just to pay the bills. If they had to give patients as much time as a nurse does, there is no way they could survive in business. They both are very necessary to proper health care.

I used to be a medical assistant to a doctor who was an Internist. His insurance was around the same amount, give or take a few thousand. His practice was always insanely busy and we were always double (and triple) booking patients. I know part of this had to do with the fact that he was a highly respected doctor. I also suspect that the reason he encouraged the influx of patients was just to cover the overhead. He was a great doctor, highly attentive to his patients, but worked non-stop and it seemed like sometimes he was just dragging through the day. I guess this explains one of many reasons I want to become a nurse, and not a doctor.

By the way, MDs/NPs are not the only ones who are facing these cost-cutting measurea in the health care industry. There was a reason why my old boss trained me to become a medical assistant instead of just hiring an LPN or RN. There's controversy in the nursing field about medical assistants replacing LPNs/RNs in doctor's offices and hospitals. The scary thing is, medical assistants aren't required to be certified or licensed in a lot of states.

Sorry, I didn't mean to stray from the original topic. My point is, if we don't take measures to fix the shortage - in ALL areas of medicine - there will be major repercussions.

 

[Humidor Minister]

The hospital where my wife works has a hiring freeze. In turn, they give the nurses more patients than they should. Sometimes 7 or more. Doesn't sound like much but there is a lot of responsibility they carry. A lot of meds that could easily get mixed up and other things that could easily be overlooked. It really is a stressful job. I couldn't do it. Give me power tools and a stack of wood any day. :thumbs:

 

[papabear]

I voted yes, that they should be able to practice independently. They have to be licensed by the state already, and are subject to malpractice suits and disciplinary action just as physicians are.

My primary provider is a Nurse Practitioner. I realize that she would be limited if a major problem arose (heaven forbid), and that she would have to refer me to a doctor or specialist in order to take care of that. She is currently in with a team of doctors, and one of them would see me first if she felt she needed help with something. I'm sure there are exceptions, but most NP's would be professional enough to recognize when they had a problem that they weren't equipped to handle. Even physicians have to sometimes refer patients to specialists for cases that are beyond their expertise.