In your opinion, should NPs continue to have their scope of practice and independence expanded? [question - other]

Physician here. I do think they should be expanded, but that doesn' t mean I'm not going to be snarky about it.

Doctors almost always have a Bachelors degree, four years of medical school (a doctorate), and 2-10 years of residency and fellowships.

Nurse Practitioner is effectively a 2 year masters degree (or a 3 year doctorate... which you can get online...) on top of a four year bachelors degree (Nursing degree).

As far as what I'd say is reasonable: in many states they can practice family medicine without supervision. I think the market can figure out surgeries--there's just no damn way liability insurers are going to allow a NP to practice, nor a hospital will allow them to participate in hospital call. I'm saying there doesn't really need to be a low against NPs doing surgeries, just throw them in jail for fraud if they say lie about their credentials (none of this "Doctor Nurse" bullshit) and get ready for the malpractice suits.

I have a lot of personal reservations about Nurse Practitioners in particular. Physician Assistants in my experience are a lot more consistent with the quality of their training. As a RN in this thread pointed out, nursing schools are a mixed bag and the NP degree from what I heard assumes you know little things like Anatomy from your undergrad....

First reason: That said, think of what a license is. Say a battlefield medic comes back from Iraq. His next door neighbor falls and breaks his arm, walks over and asks him to set the bone. He states his primary care refuses to do it and referred him to the emergency room. The medic sets the bone. I think it is morally repugnant to throw that medic or anyone else in jail or fine them for helping people, as long as they are upfront about their credentials.

Second reason: Everything is already fucked. We have naturepaths prescribing marijuana and testosterone to nearly everyone who walks through the door. I met an 18 year old who got marijuana for knee pain (I examined that knee, as an old man I envied that knee). I met a 28 year old man two weeks ago who got on T replacement... with IM testosterone, he told me he wishes to remain fertile and he never got a thorough endo w/u (if you don't know why that is shocking, congrats, apparently you could be a naturepath).

Not only that, but there are some shit doctors out there too that the state boards just let get away with anything. Though I'd say doctors generally are more consistent in quality, the quality control systems are far from perfect (check out that super-fun "Doctor Death" podcast series).

Getting back to NPs - they already have a ton of practice rights around the country, in many states functioning unsupervised doing all kinds of medicine it took me nearly a decade to learn (they must be real smart to do it in two!). That genie really isn't going back in the bottle.

The reality is, healthcare doesn't have a lot to do with population health outcomes (shocker for some, I realize). At least by broadening the practitioner field it will make it cheaper.

Third reason: Doctors receive too much training, and the regulations are horseshit. If a PA can start practicing after 2 years of school, doctors should be practicing in 3 at the most. However, they can't even practice after four! They get effectively a learner's permit and can't get a real license until they've completed a year of internship. That is total garbage. There is something called an Assistant Physician which is similar but IIRC they actually have fewer practice rights than a PA. LOL.

Medical school: The 2nd half of 4th year of medical school is BS. Graduate them early, do a mini internship as an Assistant Physician, then toss them into residency. Actual job experience will make residency directors so happy, some of these kids are entitled snowflakes.

Residency: 3 years of IM + 3 years cardiology + 2 years intervention fellowship to cath a heart? Hey people are removing entire colons in 5 years, how about that?

Anyway, just my two cents.

/r/healthcare Thread