4 ms·

Keep in mind "provider" can mean someone with a 1.5 year online nurse practitioner degree that they got while working part time, with the majority of classes on

Keep in mind "provider" can mean someone with a 1.5 year online nurse practitioner degree that they got while working part time, with the majority of classes on "nursing theory." American healthcare is truly a mess.

ARandomerDude 6y ago
They can't practice without board certification or being supervised by an MD, and in some states both. It isn't like they can go to Bob's Online College and then it's a free-for-all after that.
- yhoneycomb 6y ago
  First of all "board certification" is completely meaningless in the context of nurse practitioners. They are "board certified" by the nursing board, with standards that are completely paltry compared to the standards set for actual medical doctors. Secondly, even for medical doctors "board certification" is largely an extortion scheme. Third - there are about 28 states where nurse practitioners can work independently of any supervising physician. Also, in many cases "supervision" is a joke, with the supervising physician hundreds of miles away and simply signing charts without reviewing them. > It isn't like they can go to Bob's Online College and then it's a free-for-all after that. It actually is, though. You would be very, very surprised.
  - ARandomerDude 6y ago
    > It actually is, though. You would be very, very surprised. My Dad became a board-certified FNP when I was in high school. I've seen enough of the books, the reading, the studying, the records reviews, the toil, and the anxiety to know you're wrong about this.
    - yhoneycomb 6y ago
      Your dad was likely trained in a time before the explosion of nurse practitioner diploma mills. Currently, certain nurse practitioner schools are better than others, but the fact remains that the minimum requirement for clinical training hours is 500. [1] That's literally 3 months working a 40-hr/week job. That's less than the number of hours Petsmart trains their dog groomers for (over 800). [2] Furthermore, many nurse practitioner schools are not even finding placements for their students, instead forcing them to beg others to take them on for what are mostly shadowing experiences. ---- [1] https://www.nccwebsite.org/content/documents/cms/2020323_final_statement_np_students_and_clinical_hours.pdf https://www.nccwebsite.org/content/documents/cms/2020323_fin... [2] https://services.petsmart.com/grooming https://services.petsmart.com/grooming
bhupy 6y ago
Pretty much all empirical evidence so far shows no statistically significant difference between outcomes and quality of care between PAs, NPs, and traditional MDs. "A meta-analysis of 38 studies, comparing a total of 33 patient outcomes of NPs with those of physicians, demonstrated that NP outcomes were equivalent to or greater than those of physicians. NP patients had higher levels of compliance with recommendations in studies where provider assignments were randomized and when other means to control patient risks were used. Patient satisfaction and the resolution of pathological conditions were greatest for NPs. NP and physician outcomes were equivalent on all other outcomes." https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice https://www.aanp.org/advocacy/advocacy-resource/position-sta... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/ https://pubmed.ncbi.nlm.nih.gov/28234756/ https://pubmed.ncbi.nlm.nih.gov/28234756/
- yhoneycomb 6y ago
  Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. https://www.ncbi.nlm.nih.gov/m/pubmed/26217425/ 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 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 https://jamanetwork.com/journals/jamainternalmedicine/fullar... 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 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 https://www.mayoclinicproceedings.org/article/S0025-6196(13)...) 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 https://www.journalofnursingregulation.com/article/S2155-825...) 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/ 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/ 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 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/ 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/ 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 https://oregoncenterfornursing.org/wp-content/uploads/2020/0... 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/ 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/ 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 https://jamanetwork.com/journals/jamainternalmedicine/fullar... 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 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 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 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/ 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/ https://pubmed.ncbi.nlm.nih.gov/29641238/ ------------------------------------------------------------------------------------------------------------------------------------------------ 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/ https://pubmed.ncbi.nlm.nih.gov/22922750/

ARandomerDude 6y ago

They can't practice without board certification or being supervised by an MD, and in some states both. It isn't like they can go to Bob's Online College and then it's a free-for-all after that.

yhoneycomb 6y ago
First of all "board certification" is completely meaningless in the context of nurse practitioners. They are "board certified" by the nursing board, with standards that are completely paltry compared to the standards set for actual medical doctors. Secondly, even for medical doctors "board certification" is largely an extortion scheme. Third - there are about 28 states where nurse practitioners can work independently of any supervising physician. Also, in many cases "supervision" is a joke, with the supervising physician hundreds of miles away and simply signing charts without reviewing them. > It isn't like they can go to Bob's Online College and then it's a free-for-all after that. It actually is, though. You would be very, very surprised.
- ARandomerDude 6y ago
  > It actually is, though. You would be very, very surprised. My Dad became a board-certified FNP when I was in high school. I've seen enough of the books, the reading, the studying, the records reviews, the toil, and the anxiety to know you're wrong about this.
  - yhoneycomb 6y ago
    Your dad was likely trained in a time before the explosion of nurse practitioner diploma mills. Currently, certain nurse practitioner schools are better than others, but the fact remains that the minimum requirement for clinical training hours is 500. [1] That's literally 3 months working a 40-hr/week job. That's less than the number of hours Petsmart trains their dog groomers for (over 800). [2] Furthermore, many nurse practitioner schools are not even finding placements for their students, instead forcing them to beg others to take them on for what are mostly shadowing experiences. ---- [1] https://www.nccwebsite.org/content/documents/cms/2020323_final_statement_np_students_and_clinical_hours.pdf https://www.nccwebsite.org/content/documents/cms/2020323_fin... [2] https://services.petsmart.com/grooming https://services.petsmart.com/grooming

bhupy 6y ago

Pretty much all empirical evidence so far shows no statistically significant difference between outcomes and quality of care between PAs, NPs, and traditional MDs. "A meta-analysis of 38 studies, comparing a total of 33 patient outcomes of NPs with those of physicians, demonstrated that NP outcomes were equivalent to or greater than those of physicians. NP patients had higher levels of compliance with recommendations in studies where provider assignments were randomized and when other means to control patient risks were used. Patient satisfaction and the resolution of pathological conditions were greatest for NPs. NP and physician outcomes were equivalent on all other outcomes." https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice https://www.aanp.org/advocacy/advocacy-resource/position-sta... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594520/ https://pubmed.ncbi.nlm.nih.gov/28234756/ https://pubmed.ncbi.nlm.nih.gov/28234756/

yhoneycomb 6y ago
Resident teams are economically more efficient than MLP teams and have higher patient satisfaction. https://www.ncbi.nlm.nih.gov/m/pubmed/26217425/ 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 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 https://jamanetwork.com/journals/jamainternalmedicine/fullar... 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 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 https://www.mayoclinicproceedings.org/article/S0025-6196(13)...) 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 https://www.journalofnursingregulation.com/article/S2155-825...) 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/ 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/ 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 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/ 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/ 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 https://oregoncenterfornursing.org/wp-content/uploads/2020/0... 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/ 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/ 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 https://jamanetwork.com/journals/jamainternalmedicine/fullar... 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 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 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 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/ 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/ https://pubmed.ncbi.nlm.nih.gov/29641238/ ------------------------------------------------------------------------------------------------------------------------------------------------ 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/ https://pubmed.ncbi.nlm.nih.gov/22922750/