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> This is a good thing for standard of care: it's a chain of accountability. This is classism in action. There’s no reason a nurse practitioner can’t bear lega

> This is a good thing for standard of care: it's a chain of accountability. This is classism in action. There’s no reason a nurse practitioner can’t bear legal responsibility for their actions. As long as it’s unambiguous who is the responsible party whether they are a physician, nurse or physiotherapist there’s a chain of accountability.

imglorp 4y ago
Not disagreeing that you need to enable all levels of provider, that's not what I'm saying. I also agree all levels of provider should have an easy career path to the top. The point is there's a system requirement for interfacing one provider to the next, so that if you're receiving a handoff from someone else you know they prepared the patient for the next guy. There's also a malpractice/liability component.
kurupt213 4y ago
NPs don’t have near the experience of a doctor (who needs something like 8,000+ hours of supervised experience before they can practice unsupervised). You are saying a NP is the equivalent of an attending physician, which is absurd.
- barry-cotter 4y ago
  Saying an attending physician and a nurse practitioner are in every way similar would seem unlikely, given the radically different environments they work in. When we compare outcomes they look as good or better than physicians but that’s not to say they can completely replace them. > A meta-analysis of nurse practitioners and nurse midwives in primary care > This meta-analysis was an evaluation of patient outcomes of nurse practitioners (NPs) and nurse midwives (NMs), compared with those of physicians, in primary care. The sample included 38 NP and 15 NM studies. Thirty-three outcomes were analyzed. In studies that employed randomization to provider, greater patient compliance with treatment recommendations was shown with NPs than with physicians. In studies that controlled for patient risk in ways other than randomization, patient satisfaction and resolution of pathological conditions were greater for NP patients. NPs were equivalent to MDs on most other variables in controlled studies. In studies that controlled for patient risk, NMs used less technology and analgesia than did physicians in intrapartum care of obstetric patients. NMs achieved neonatal outcomes equivalent to those of physicians. Limitations in data from primary studies precluded answering questions of why and under what conditions these outcomes apply and whether these services are cost-effective. https://pubmed.ncbi.nlm.nih.gov/7501486/ https://pubmed.ncbi.nlm.nih.gov/7501486/

imglorp 4y ago

Not disagreeing that you need to enable all levels of provider, that's not what I'm saying. I also agree all levels of provider should have an easy career path to the top. The point is there's a system requirement for interfacing one provider to the next, so that if you're receiving a handoff from someone else you know they prepared the patient for the next guy. There's also a malpractice/liability component.

kurupt213 4y ago

NPs don’t have near the experience of a doctor (who needs something like 8,000+ hours of supervised experience before they can practice unsupervised). You are saying a NP is the equivalent of an attending physician, which is absurd.

barry-cotter 4y ago
Saying an attending physician and a nurse practitioner are in every way similar would seem unlikely, given the radically different environments they work in. When we compare outcomes they look as good or better than physicians but that’s not to say they can completely replace them. > A meta-analysis of nurse practitioners and nurse midwives in primary care > This meta-analysis was an evaluation of patient outcomes of nurse practitioners (NPs) and nurse midwives (NMs), compared with those of physicians, in primary care. The sample included 38 NP and 15 NM studies. Thirty-three outcomes were analyzed. In studies that employed randomization to provider, greater patient compliance with treatment recommendations was shown with NPs than with physicians. In studies that controlled for patient risk in ways other than randomization, patient satisfaction and resolution of pathological conditions were greater for NP patients. NPs were equivalent to MDs on most other variables in controlled studies. In studies that controlled for patient risk, NMs used less technology and analgesia than did physicians in intrapartum care of obstetric patients. NMs achieved neonatal outcomes equivalent to those of physicians. Limitations in data from primary studies precluded answering questions of why and under what conditions these outcomes apply and whether these services are cost-effective. https://pubmed.ncbi.nlm.nih.gov/7501486/ https://pubmed.ncbi.nlm.nih.gov/7501486/