Issues Concerning the PA/NP in the ED | EM & Acute Care Course
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- เผยแพร่เมื่อ 7 ก.ค. 2024
- Issues Concerning the PA/NP in the ED by David Glaser, MD
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I’m probably too young and haven’t been a PA long enough to really have merit in the fight. But I take the approach of I don’t care what I’m called as long as I’m paid and I can have intellectual space that isn’t harshly infringed on. I’m well aware that we don’t learn the same amount that physicians do nor should we attempt to compare ourselves. I just want my colleagues to view me as a competent provider, regardless of want the initials besides my name are, or what the title is. But again I’m too fresh in the field to share this viewpoint at a conference, TH-cam is the perfect place.
Most of the physicians I have met are very accepting or even glad to work with a PA
Ps are following the path of NPs, lobbying to practice medicine independently just like a physician. That is what MDs have a problem with. Not PAs
I always wait for your videos as they are so informative and effective. Thank you for always sharing the correct information. Keep posting.
Medical school graduates have hundreds of hours of hands on medical training and have passed the USMLE exams which far exceeds the medical training obtained in NP school.
No shit
No kidding ! In many community and rural ED they have single coverage by PA or NP and won’t hire a licensed MD who is 1 to 2 months short on residency ( even if the MD has many years experience in at a different ED ). Medicare, Medicaid, insurance companies say the MD is competent, as he/she has cleared the USMLEs, over one to two years residency training and many additional years of independent practice.
No one has provided a reasoning for it.
@@anantpchandel3321 here’s the reason: Doctors as a group are snobs that eat their own, NPs are loyal to each other and organized
Unmatched medical graduate with all USMLEs passed cannot even touch a patient
@@maxoreilly2698NP’s are loyal to eachother but not to their spouses. Hoooooly crap I have heard so much cheating story nightmares in my school 😂
Can you give someone a Nitro if they are having chest pain with hyperacute t-waves in leads 2,3,aVF? (if they have a hx of a inferior MI w/RVI)
inferior STEMIs and nitro are not a good combination. tends to make them dangerously hypotensive.
@JP. How many years medical schooling does a FNP have, how many years training do they have ?
FNP graduates have zero years in medical school. Also zero months, weeks or days
@@maxoreilly2698what if the have 10+ years of experience n the field? Experience > School
@@lucypher5200then they probably are able to identify patterns better (practice empirically) than a new grad doctor but considering how much doctors learn in their initial 1-2 years in residency, I would wager on trusting MD/DO after residency no matter how much experience the NP/PA has. Ideally I want to see both and get opinions from both. Experience doesn’t always mean better than training. If I need an intubation, I want a paramedic, not an EMT. If I want surgery, and I had to choose between the 4th or 5th year surgical resident or a first assist PA that has done the job for 30 years, taking the resident. Regardless, pharmacists are smarter than all other providers in my experience so 😅
@@xaviergarcia7965 gotta agree with you on that. fast response I know. I’m on my phone ATM
@@lucypher5200 experience is valuable. Without the comprehensive foundation that medical school provides experience teaches a random collection of algorithms with poor understanding of the underlying pathology, in other words the “what” is there but not the “why”
A medical school graduate would work directly under a physician, even though they have vastly more medical education and training training than a newly minted NP from an online program and 500 hours of medical clinicals in hot pursuit of FPA
Everyone says MD/DO vs NP/PA, but the real question is….all of them vs Pharm.D 😮💨😳
There has been a certifying "test" for NPs in emergency medicine since 2013. I'm not sure how you could miss our ENP board certification? Done through the AANP-CB and AAENP organizations. This alone made me stop listening.
And how is this test compared to tests taken by physicians or even medical students. Because you know anyone can make up a test.
@@barneylinux Nice try at diversion. Did anyone discuss test comparison? No. Is anyone comparing providers? No. The speaker said that NPs did not have a EM specialty and board certification. He spoke in error. Don't be so insecure. The world does not revolve around you.
I love this. I’ve been an ER nurse for 20 years. I’m also a family nurse practitioner certified- The reason I am still working in the ER As an RN is because I am back in school for my psych certification. I’m not even kidding you when I tell you the physicians want me to see the patient first so I can tell them what’s going on with the patient and diagnose the patient for them- yes as an RN. They love working with me- because I do the work for them. Lol. My ER doctor didn’t even know that iron deficiency causes RLS or the clozapine can cause agranulocytosis- I had to tell them to order labs- my ER docs ask for my suggestions all the time. ER docs are not the end all be all. Just so everyone knows.
@@MC-ij7yw yeah this sounds believable.
@@barneylinux Nurse does the work , Doctor gets the pay. Sounds about right
No other profession has the rigor medical school has to prepare one for their profession. None ! 4+++ years of grueling work, that tests your physical and mental stamina, (hell, getting into medical school is tough !). USMLEs Steps 1, 2 & 3 plus residency and boards?! It is no joke. Even if NPs and PAs can handle routine cases, there will come a time when they can’t handle the complexity of some cases. Why ? Simply because it was not included in the duration of their training. It’s simple math ! An experienced NP and PA may be comparable to some doctors over time, but even then, a damn good physician is a life-long learner, so will an NP or PA ever catch up ?
I don’t know why it has to be an either or mentality? Why can’t we have both? Any good NP/PA will recognize where their limits are, and will refer up accordingly. No one is saying NP’s/PA’s are here to replace and take every case from physicians. There are plenty of midlevel providers who continue education at the same standard as their physician counterparts, and who know much more than what they were originally trained in. I really don’t understand why this conversation is so dichotomous? Why can’t the two coexist and collaborate to provide the best possible care?
I will put my 12.5 years as an DNP/FNP against any New physician, because I was trained by some of the best NPs and M.D.s, and have learned much over the years. However, I agree that I would never put myself on the same level as an M.D. with the required level of training and comparable years of experience. The scope of practice is much greater for M.D.s and I avoid going outside of my scope as an NP. That is why we collaborate... it should be a given in health care anyway and not require signed documents. The Brick Mason doesn't have to have an architect's supervision. It's ridiculous. People who step outside of their scope should just be held accountable and it should not be anyone else's responsibility period!
@@TH-camGuy-dm7uy , you speak like an extremist.
FM-----> Neurosurgery. FM physicians do routine cases more frequently , that is why you say that. However, there are times when a FM physician has to do a work-up that is truly head-scratching that thank God the foundations in basic sceince (the first 2 years of medical) and USMLE Step1 solidifies that knowledge. For example, I have seen a FM physician work-up a patient with Gitelman Syndrome and it was a sight to see ! The biochemisrty and the pathophysiology knowledge need to tease that out from thiazide use and other differentials could only be provided by the in-depth, comprehensive knowledge medical school provides. Medical school is not nursing science. Nursing science is valuable but not the same.
There are doctors who refer patients because a case may be to complex for what they specifically studied. It’s no different then an ED Doctor sending a cardio patient to cardio because it is above their training. Don’t get me wrong doctors 100% train longer but that doesn’t make a DNP any less capable of diagnosing a cold then a family doctor. I think the real issue is both sides are insecure. MDs think DNPs want their job and DNPs think MDs think they’re “just a Nurse”. Both are usually untrue and both sides are projecting their own insecurities. DNPs go through rough training for less because they jump Immediately into their field with less scope. If I just wanna deliver babies I’ll be a midwife. But if I want to take care of the entire productive system Off a a woman I’d get an MD and become an OBGYN. Everyone needs to learn their role and relax. This topic is over discussed and tired.
@@CeceDeAnn MD/DOs are being replaced across the country by NPs.
NPs are fighting for and winning the privilege to practice medicine just like a physician but without the education and training of a physician.
As a result patients are being harmed like Alexis Ochoa and Betty Wattenberger.
The problem is if PA and NP practice alone, they will inevitably run into things they can't deal with. The patient can't on their own determine if their problem is something the PA or NP can deal with. I think the best thing is to always have a physician on site.
Also the fact that PAs or NPs tend to think they are the same as the physicians really speaks volumes, a classic case of "you don't know what you don't know. Humans have a lot of ego, and that can really blind them. Usually physician over consult but PAs or NPs under-consult because they think it's weakness to consult.
Even from what the people in the audience are saying, you can just tell that there is so much ego going around, one audience said that the physicians she works with are puzzled by the same things she is puzzled by(in other words, she is saying her level of knowledge is the same as them) another said the ER attending's input doesn't add to her knowledge, only the consultants add to her knowledge 😂🙄. Its honestly just egos flying around. Its the same with most professions for example lawyers and paralegals.
It would be awesome if every small rural CAH could have a residency trained EM physicians. That is simply unobtainable. FP physicians get very little ER training and generally suck in EM. So how are you going to fix it? Both PAs and NPs can be board certified in EM. Both have residency and fellowships in EM. I can handle and do ANYTHING a FP physician can in the ER. I can't tell you how often I've been called in from home to place a chest tube and intubate for FP physicians. My EM and critical care knowledge level is far above the standard FP physician.
So you keep speaking from your little box arrogance and ignorance of not knowing how we practice in rural America.
@@ctem-criticalcaretraumaeme791 I can promise you that any board certified FM physician in America can do a better job managing an ER than any "board certified" NP or PA. You simply don't seem to understand what kind of training even 4th medical student goes through much less a PGY1.
This is called the Dunning-Kruger effect.
@@barneylinux AND you would be a moron. What you say is simply not true. Those are the facts. YOU don't understand. I guess I'm imagining being called in to place chest tubes for FP physicians. Intubating? Central lines?
It's people like you that can't have a reasonable discussion. You are either a med student or a sub par insecure physician.
@@ctem-criticalcaretraumaeme791 imangine someone who thinks chest tubes and central lines are what make an ED physician. FYI, em and fm physicians have the highest step 3 board scores because they are trained in everything from OBS to Surgery. Please educate yourself in what is actually involved in making a doctor before spouting off whatever nonsense you intend to.
You can’t take a nurse and train them for a couple years with an online degree to turn them into a doctor.
@@barneylinux Imagine someone who does not know what an example is. Imagine someone who can't admit they are wrong. Maybe when you get out of school and actually start working them you may realize what you don't know.
I'll be happy to teach you.
Speaking from a research perspective, in relation to primary care, there are several current studies that acknowledge equally effective care and outcomes from FNPs, as that of Family practice physicians.
Research Funded by nurse unions lmfao bruh those studies not reliable
@@TH-camGuy-dm7uy why you think they keep publishing studies but their main battle plan is lobbying politicians
@@_Death2islam360 let me guess, you’re a physician who doesn’t back what he say, or practices using evidence-based research. I say this because there are many studies proving what I quoted, as truth, AND they did not arise from nurse funding. Here is one -Chuan-Fen Liu et al. Health Serv Res. 2020 Apr. Now, have a nice day and go do your research.
@@TH-camGuy-dm7uy There is a desparate attempt to make family medicine/internal medicine practice seem easier than it is. It is NOT. a DNP does not equal MD and never will.
@@_Death2islam360 This part! If you spend more money "telling" the law you're good but there's no evidence you have approperiate or equal training, the name of your game is gaslighting the medical community. The name of your game is fake it til you make it. And I said that and I meant it.
1) Assistant Physicians (AP) are unmatched medical school graduates. APs in Missouri, like the Physician Assistant/Associate (PA) use collaborating (supervising) physicians. Therefore, the rules are similar to that of a PA. If someone went to medical school for 4 years, isn’t it plausible that they could be just as effective as a PA would be if they too have a supervising physician. Clearly, this gentleman doesn’t know much about APs.
2) Unmatched MDs need attending physicians to advocate for them, especially since they know what the medical school and the matching process is like.
3) I think it’s so wrong that attending physicians refuse to teach residents. Did they not take the Hippocratic Oath ? What do they think will happen to the profession if they continue to do that ? God forbid, one day they’re sick and need a damn good doctor. I hope they remember how they kept the knowledge to themselves. That’s just idiotic !
Does this rube not realize medical students have 3-5x more training than the best PA/NP programs? This is killing patients.
After 5 years on the job, most PAs can bridge that learning curve. Experience trumps any schooling. You can past tests all day long , I’ll take a 5 year NP over a new grad MD anyday of the week. Just cuz youre a doctor doesn’t mean you are competent while working. Ive seen PAs in my field I trust more than doctors. We have nurses in our ICU that the doctors ask advice from. Schooling only gets you so far. As long as people work within their training then there wont be as many issues. And if you have an issue with that, then come up with a solution for the physician shortage. The NPs and PAs can bridge the gap. Also research shows that NPs and PAs give safe, affordable care and that MDs prefer team based care. Aka working with PAs and NPs to consult and work with. As long as the PA/NP is willing to go to someone with more knowledge if they feel theyre in over their head, its the ideal format. Again, just cuz someones an MD doesn’t make them an expert in everything. There is a study that shows in an ICU they had a resident team and a team of PAs and NPs. The “midlevels” had lower mortality rates and shorter ICU stays. The research shows that Advanced Practice Providers can definitely be Primary Care Providers with the appropriate training and experience.
@@lucascooper3613 That is actually true and often a missed thought that is super under rated. Yes, the PA graduates 2-2.5 years in, the medical student still has about 6months to a year (depends on research length req. programs vary) during that time the PA already started seeing patients and started their training/residency. therefore once the medical student starts residency as an intern, the PA has already been seeing patients for about 2 years in that specialty. NPs are a bit more controversial because there isnt as standardized training
That’s a very bold statement. Do you have evidence to back it up? Or is it just your superior medical school education that allows a certain license to throw unsubstantiated allegations around? I missed that rotation in residency, I suppose.
@@nmanon4960 Do you think it would be wise to turn new 4th year medical students on patients? What could go wrong? They have more training than any mid level graduate at that point.
@@cm2973 the reality is way more nuanced. You know this. I would never turn a new graduate in any profession “on patients”. I don’t think that a newly graduated med student should be allowed to practice independently. I don’t believe that a PA or NP should be allowed to practice independently - EVER - in most acute care settings.
There are some settings where it might make sense to have less oversight - primary care is one example. MD primary care docs just send their patients to urgent care or ER most of the time, anyways…try and call to get in without having an appointment 6 weeks in advance!
What prevents an MD from practicing outside of their scope? Lawsuits? State boards? No - it is knowing what you don’t know. I don’t think that PAs and NPs are deficient in knowing what they don’t know. There are exceptions to everything, of course.
Honestly, With the rise of Artificial Intelligence, the standard procedures done by surgeons could soon be automated. Therefore, allowing mid level providers greater autonomy do to the fact that this technology can aid them In Surgery and other clinic necessities.
Lol
If that was the case, mid levels would be out of jobs
@@AmyStylinson Okay. We shall see
@@AmyStylinson Shit, once we get REAL artificial super intelligence, MD/DO's might be out matched by it. Kinda like how artificial intelligence is reading scans (better than radiologists). Though, obviously Doctors will be around FOREVER.
@@SithGod wouldn’t the useless role of mid levels be automated far before the vast knowledge of md’s?