5 ms·

Board differences in medical field have been interesting to watch. For instance NP and PA have very similar skills, but the nursing board goes to bat for nurse

• trillic 2y ago
  Just last week I saw an NP, PA - someone with both degrees, didn’t understand why they’d have both. This makes sense now.
• n8henrie 2y ago
  Can you explain what you mean about doctors sabotaging PAs? In what way? And which doctors are to blame?
  • ty6853 2y ago
    In some states dragging their feet on supporting independent practice and chaining them to more onerous doctor oversight/collaboration requirements vs NP. I'm referring to doctors with/of influence in the medical board. NP are under the nursing board so doctors are less entrenched in their influence.
    • Aurornis 2y ago
      Letting NPs practice independently as doctors is increasingly viewed as a mistake, not a model that should be emulated more widely. There are a lot of problems coming out of the fact that NPs are now basically practicing medicine in parallel with doctors despite vastly different education and training experience. Many patients don’t even understand the difference. It doesn’t matter for common things like a simple sprain or common cold usually, but cases of medication overprescribing (think antibiotics for colds, etc) are commonly traced back to NPs and specialists will complain about the deluge of incorrect referrals from NPs who don’t know what they’re doing. One example: I heard a specialist explain that they had to stop taking referrals for Ehlers-Danlos evaluation from NPs because the local NPs were referring people at impossibly high rates due to misdiagnosis. Ehlers-Danlos has become a popular (though incorrect) TikTok diagnosis for vague symptoms and rather than push back, many local NPs were running with it. Social media is full of people who are convinced they have Ehlers-Danlos and a lot of NPs were leaning into the trend instead of realizing that it’s not real.
    • n8henrie 2y ago
      > I'm referring to doctors with/of influence in the medical board. So your unqualified statement refers to a specific and very small proportion of doctors. I'm extremely grateful that APCs have independent practice in my system. There is way too much work to be done compared to the number of physicians available to do it. The "working under a doctor" model seems to be mostly encouraged by the administrators, as this puts impossibly high liability on the physician (who is forced to "oversee" a dozen or more APCs). No thank you.
• Aurornis 2y ago
  > but the nursing board goes to bat for nurses allowing independent practice while doctors have chosen in some states to sabotage PAs The way Nurse Practitioners are allowed to practice independently now is a contentious topic in the field because they’re now operating essentially as doctors, but with much less education and hands-on training. The original idea was that NPs could handle a subset of simple and routine issues and leave the more complex issues for fully trained doctors. The current situation has NPs and doctors performing the same functions but with very different training, while patients are mostly unaware that there’s a difference. It’s a common complaint on forums like /r/medicine because doctors are seeing a rapidly growing number of patients who have gotten bad advice or prescriptions from overconfident NPs, especially in states where NPs can prescribe controlled substances. Going the NP route is also the preferred direction for people who want to practice alternative medicine but have a prescription pad, leading a lot of patients unknowingly into the hands of NPs who actually shun large parts of traditional medicine. Common problems around here are NPs who prescribe antibiotics on demand, some times dangerously powerful ones for extended periods of time. NPs writing long-term benzo prescriptions as first line treatment for anxiety (very bad practice) has created a mess of dependent patients who didn’t know what they were getting into, who end up back at fully trained providers who need to taper them off for sometimes as long as a year. So it’s not as simple as medical licensing boards being mean. There are some very real problems with the current double standard of training between NPs and doctors.
  • sarchertech 2y ago
    NP education is basically the Wild West. Much of it is practical training under a doctor, but unlike residency there is very little oversight and standardization.
  • orwin 2y ago
    In my country, you can be reimbursed on substance prescribed by a nurse (or any medical practitioner, including physical therapist) if its effect is proved, but only doctors can prescribe regulated substances, and this kind of prescription are typically monitored (and stats are made on those prescriptions. Why, i don't know yet, we set up the big data infrastructure like 5 years ago, so probably nothing yet). And there is another tier of regulated substance that you can only be prescribed at a hospital (rarely-used antibiotics, you must stay under surveillance while you take them to avoid creating resistance), and another tier that can only be prescribed by a specialist (methadone, lithium, probably a ton of others), but i would hope this is the same in the US.
• derbOac 2y ago
  I'm a bit disturbed and/or upset about the way licensing issues in the US are often covered. Typically you see an article like this, in a news outlet that's aiming for financially motivated and/or well-off individuals, complaining about licensing for beauticians and doing a hand-wavy thing about medical professionals. The argument is "beauticians don't need licenses but all this other stuff is fine." The problem with this is while it's true that beauticians don't cause the same damage as a medical provider (usually), they also don't have the same financial impact on the US economy as a whole. We don't hear people complaining about haircut costs, we hear people complaining about healthcare and higher education costs. When it does get discussed, it seems like those discussions are always targeting those who threaten the status quo, and there's very little discussion of underlying issues. So for example, you have pieces complaining about NP or PAs replacing doctors in clinics, ignoring the fact that it's not the NP or PA degrees necessarily, it's that you're taking people out of a 2 year program and putting them directly into practice with no residency or training program. Similar things play out with other provider types, where there's a lot of FUD and playing on stereotypes without discussing actual training backgrounds encountered within degrees, or the requirements that are actually necessary to complete tasks. If you look at current MD programs, many of them are pushing hard to go to a 1.5 year coursework, 2.5 year clinical training model, followed by residency. Compare that to a PA program that is what? 1.5 years of coursework followed by clinical training. Many PA programs now also require licensed healthcare practice before you even enter the program too. So it's really hard for me to accept the argument that PAs + 6 years of supervised training aren't similar to an MD + 4 years of supervised training. You can extend this to all sorts of aspects of the medical system. Many medications that are now prescribed really don't actually require prescriptions, especially some of those that someone has been taking for years. Others could be overseen by a pharmacist (probably better in many cases than a physician), or a psychologist, dentist, or optometrist with the right additional training. The idea that provider skills in a given area are only ever possibly obtained by the MD degree model is preposterous to me. Sure, there are probably some domains where this is currently true, but there's a lot of domains where it's not. These discussions need to stop treating healthcare as if licensing is a totally different issue there — although it is probably in terms of risks but also in terms of costs, the fundamental problems are the same. I could go on and on. Even among MDs, the specialty and subspecialty accreditation requirements can be grossly excessive and unnecessary. Conversely, there's also the fact that MDs sometimes are making decisions that they're not actually trained to deal with because their degree gives them a kind of blanket legal authority. Everyone has anecdotes about poor care, but I can say the same just about any type of provider I've had contact with. I can think of grossly irresponsible care that I've had from physicians, where we've been saved in a sense by PAs, RNs, or NPs. I can also think of cases where the MDs were great, and the PAs, RNs, and NPs didn't know what they were talking about. Healthcare licensing is a complete mess and it is a major unrecognized source of increased healthcare costs. Even with all of the push to deregulate, I don't see it being addressed effectively anytime soon because the discussion gets so distorted and because it often feels like the way it bubbles up into public consciousness is through bad actors leveraging deregulation for undesirable reasons.
• amadeuspagel 2y ago
  > If you are a licensed professional and your profession doesn't own the board, what often ends up happening is competing professions under the board sabotage each other. From The System of Professions: > By focusing on parallels in organizational development, students of the professions lost sight of a fundamental fact of professional life—interprofessional competition. Control of knowledge and its application means dominating outsiders who attack that control. Control without competition is trivial. Study of organizational forms can indeed show how certain occupations control their knowledge and its application. But it cannot tell why those forms emerge when they do or why they sometimes succeed and sometimes fail. Only the study of competition can accomplish that.