As an Rn for 43 + years I agree with you wholeheartedly! There are situations where I will agree to see an NP or PA, however whenever someone asks me about seeing one I always recommend an MD first, based upon their symptomology. I also will recommend a Specialist if they are not getting relief from their complaints!
As someone going from respiratory therapy to PA school, I definitely agree that things should always be overseen by an MD or DO. However, I don't see why so many doctors I see posting online don't want PAs doing certain procedures such as intubation. As an RRT intubation is something I will have experience with long before I start PA school. Do these doctors just not want to train their PAs, or is there some other reason? Obviously, it comes down to what the facility is ok with and laws first and foremost. However, I don't see why a physician who has a PA and trust them wouldn't want them to have some of the skills of the procedures that the MD or DO do within said specialty. Obviously, a cardiothoracic surgeon doesn't need to teach their PA how to completely do a surgery, but vein harvesting for bypass? Why not? It allows the MD or DO to focus more on the main problem if they teach their PAs to do some of the more mundane procedures. Which allows them to live up to their title as assistant that much more. Any thoughts on this?
Good points. Im a pre - PA student and I completely agree that, PA should have their work overseen by physicians (as is expected for the position), and that more complex cases be handled by a physician only, but it seems like PAs are well suited for everyday illness and injury, but the ppl in the comments (as usual with social media) take everything to extremes and are interpreting this as PAs shouldn't treat patients, which is kind of wild.
No doubt! The PAs that work alongside me are AMAZING! The key (and this goes for all clinicians regardless of the letters after one's name) is knowing what you don't know, and asking for help when you need it. 👊🏽
I'm so glad more physicians are talking publicly about this. I have been misdiagnosed by a nurse practitioner. She said I had rheumatoid arthritis. I went to a physician and he said I didn't have arthritis. I went to a second doctor and he said the same thing. I never went back to se another nurse practitioner or PA again. This misdiagnose made me think a lot about pursuing a career as an NP or PA. I thought about going to nursing school and then get my doctoral degree, but after that I decided to become a neuropsychologist. Still getting my master's and hope to get into a PhD. program after. Anyways, Thank you for talking about this. I would like to also tell people they can visit the Patients at Risk YT channel. Very informative. Take care everyone!
I went to a NP at a CVS walk-in clinic because I had a fever, night sweats, sore throat, white spots all over my throat and tongue and a ear infection. The nurse stuck a q-tip in my throat, didnt touch the back and it came up negative for strep. The NP came in and said I must have a viral infection and she couldnt do anything. A week later, I return, with the same problems, but now Im literally deaf in my ear, and a different NP looks at it and says, its clearly bacterial. I told her I was allergic to penicillin (hives) so she prescribed me amoxicillin. I took it, and now, in addition to all my other issues, my tongue is swollen and my skin feels like I have a sunburn. Im going to go to a physician because I've been sick for 3 weeks now.
Oh my! Go to the Dr. me too had the same issue and NP said Viral while Dr. said postnasal drip. HEENT Specialist Dr. said Nasal deviation and needs operation! So go ahead with a Doctor!
During an orthopedic visit, his PA came in and told me that aww it's really not anything to worry about and this particular doctor didn't check behind her or anything. To make a long story short, after a 2nd opinion from another Orthopedic doctor, I found that the issue was very serious and I got the right treatment. I believe that PA and NP should have another level of training especially when making diagnosis on patients they treat. If you don't feel like the diagnosis or level of treatment is right, seek a second opinion! We also have to advocate for ourselves when it comes to our health..Thanks Doc for the honest opinion and I appreciate your positivity
I found when working I was more cautious than my MD. Like someone coming from another hospital to see us with a long cardiac history, their cardiologist cleared them. I still wanted them to see one of our Cardiologist, so if their was a problem we had a team and a plan to call. My doctors were always like really ,then there would be a problem and he would say so glad you had them seen pre op. I can't tell you how often that happened.
I totally agree! CNP’s and PA’s are great providers, but an MD should be in charge over them. My son is an MD and I know how hard he studied and worked, 8 years past his undergrad work. I don’t know any mid level providers, that I’ve worked with, that have studied more than 2 years after undergrad and no residency, where the actual hands on learning begins. Thanks for addressing this in the practical way you have of doing so. 😉
Its good to know you have good ole fashioned values, ethics, and standards towards the care of al your patients - its a sin and a crime that many doctors do not adhere to providing the same lever of care which you and your team provide, ~ I believe you will always maintain such an excellent level of patient care ~ Keep going!
Is it ever thus!! It seems administrators are under the delusion that the bottom line of Health care must be in the black. PAs and NP are less expensive, but they don’t have the education and expertise that Dr’s have invested their lives in. Remember, If the water keeps dripping on the rock, it eventually changes it’s shape. We need to remember, we need Doctors and be grateful for what they give up to be there for us 24/7. We just need to keep the administrators aware of our needs and we can’t replace Drs. with PAs and NP. But. rather hire them in addition to Drs.
Most doctors won't come to rural areas. So mostly NPs and PAs provide care. Driving over an hour to see the nearest doctor can be problematic. Until the early 90s this area had between 1-5 doctors in each town. Now it's mostly NPs. The second part of this issue is that those on Medicaid and Medicare can't be seen by a doctor. As to about why I'm only being seen by the NP or PA and I'm told it's because I'm on Medicaid. Quite a bit of classicism going on there. Luckily they are really on top of things in regards to my healthcare. Except for pain treatment/management I don't have any complaints. WA state has closed the loopholes from the healthcare act and so it runs far more smoothly. In the past two years the bare minimum of care is why I'm still alive.
What you’re saying makes a lot of sense. But here in rural Iowa, it seems like we can’t get doctors to practice in our local Clinic. We have one physician who is approaching retirement and he only sees acute cases. The other patients are seen by a PA or CNP. So there’s that issue. With your friend’s father, wouldn’t have that slide gone to a lab or pathology for review?
That is a problem, for sure. Hopefully the one physician in your area is involved (at least behind the scenes) in the cases the NPs/PAs see. Regarding my friend’s dad, the slide was actually misread by the in-house pathologist in the practice. The PA, who saw my friend’s dad, should have considered a possible mis-diagnosis, particular in the context of a dark-skinned patient getting a sun-induced skin cancer (which is possible, but quite rare). Fortunately, I was able to intervene and right the ship. 🙏🏽
@@DrMudgil thank you for clarifying that! Cytology is something I'm not trained in. I'll look at slides when I get the chance cause I'm addicted to learning stuff but Micro lab was during my post-bacc years (I think it was the George H W Bush presidency),
I think it depends on your background, I worked over 30 yrs in critical care as an RN in a 1000 bed hosp. Then went to school , still as a CNP in critical care. When an RN works 1 yr and then goes to NP school they do not have enough experience to function alone. Same as an intern or somtimes a resident.
We don't have PA's and very few NP's in Australia. You always get to see the doctor, however specialists are notorious for "room hopping", having several patients on the go. This type of thing cannot be good for patient care as most times the specialist is obviously trying to move on to the next room!
I see an amazing NP. However she work in conjunction with a fantastic MD. I has always believed that a NP is their to assist the Doc, not replace them.
As someone is competing my undergrad and has a strong interest in medicine and healthcare. At first I thought I could start my own nurse practitioner practice in one of the states that allow it but after taking a look at the education provided it is not enough especially on the nurse practitioner side. I still feel like even if I attended a residency program and completed a fellowship that I wouldn’t be adequately trained and not be able to provide the level of care needed that patient deserves. I think NP and PA do have a place but it should be in urgent care roles or outpatient roles and doctors should be monitoring those cases and should focus on the complex cases and in patients.
I demand to see the doctor and not a pa or anyone else. When I'm paying for ❤ care i expect the top of experience and knowledge. I'm a Registered nurse and i can't replace a doctor; neither can anyone else who's not qualify for the category.
@@DrMudgil many rural areas can not attract a physician, CNP and PA can run clinic and do a fine job. I worked as a CNP under a physician but was pretty independent.
Bit of a story. I am finishing up my undergrad and am intending to go to Medical School. During my sophmore year I was working part time at a hotel as a busboy. I like to talk to guests I so I usually start a conversation. I met a couple of cool doctors but one interaction sticks out to me. I was advising a female guest regarding cool bars and places to eat . The guest chooses to pick a bar thats a block away. Since its night time and shes alone I offer if she needs someone to walk her to the bar (the hotel was in a bad part of town). She agrees and we start walking. I mention something about going through Organic Chemistry since I want to go to med school. She lights up and states that she's a physician in x state. I get back to the lobby and I google her name mrs smith DO, nothing comes up, Mrs Smith MD, still nothing. Finally I just google her name and the medical field she told me. She was a NP, not a doctor. Such an odd interaction. All the physicians I know are extremely humble and only use the Doc title in a clinical setting.
I understand what you’re saying. However, I have gotten better health care from NA/PAs than some of my doctors. I see a PA for my aftercare from breast cancer. I like her so much better than the doctor I am technically assigned to.
I totally agree with this video. I don’t know how anyone can think a np or pa is as qualified as an md. I recently had a cnpa give me a hard time because I wanted an md. I asked her by looking at me what could be a problem with being sedated. She had no idea that red heads have different needs. No way was she touching me.
This is My Rule #1 KNOW WHAT YOU DO NOT KNOW. I tell any medical or nursing (BSN or MSN) student that comes my way.... because it does apply to all students.
I have been seeing a Dermatologist for years and I have had many things removed, but I had a cancer spot on the side of my nose that was not a good thing and I ended up having to have my face cut from the corner of my eye to my smile line and nearly 50 stitches I have had many basil cell spots taken off and all because I worked in Phila. at the time and we could hop a train to the beach every weekend, for next to nothing, way back then. I am so aware of things on my skin and am usually correct about what is and what isn't something I need to see my Dermatologist about. One day I was visiting my sister and this was about 10 years ago and told her she needed to get to a dermatologist. She had not ever been to one. She had a very uneven mole on her back. I made her go to the Dermatologist and it was cancer and had metastasized and she ended up having to go back the second time only to find that she had another one that was exactly the same. I could almost put my entire fist in the hole. She is now 80 years old and still going, but the doctor told her I saved her life by being able to identify what was happening. I am 78 and the legs I once had, I was proud of, but no more. Why people do not take care with all the knowledge out there is so sad. Sorry, this is so long, cut your passion for what you do is so great and I will be keeping up with you for sure.
A lot of NPs can do exactly what you have described in this video. In fact, I’ve done it several times myself in the past three months… and I’ve also had patients tell me that I gave them a more thorough assessment than a psychiatrist ever has… whats happening in healthcare is that we get job offers with zero training or support from other MDs and corporate companies… so they want us to do these things in order to have a jobs. I am without a job because I have contracts I was offered that were unsafe. MDs wrote the medical parts of those contracts. If every MD was willing to train up an NP, we could be better, much better, but it is a VERY rare, sometimes impossible task to find the opportunity for training that your PA got from you. Very rare any MD is willing to do this, they would rather train other MDs up. We have been duped. FEEL BAD FOR US 😂
Well said! PAs are a key part of my team, but the mentoring/training is absolutely essential. In fact, I much prefer working alongside the PAs I invest in than many MDs. 🙏🏽
@@DrMudgil I regret choosing NP school over PA because I wanted to be a PA all along but just did not realize it. I have decided to LEAVE nursing because it’s so messed up. Im going to become a family court mediator and make $400k working only 1600 hours a year. Lol. So the lack of training and support I have received from MDs and corporate companies has caused me to leave the profession. I made that decision after a video was posted bulkying NPs on TH-cam. Its called “Patients at Risk” and it blames US for being the bastard children no one wants anything to do with. Wish I had known this before going $138k in debt to become an NP. Too late to go to PA school. Maxed out on my loans. Isn’t this sad!??? Had to become a nurse because I went through a divorce then got fed right into the funnel of doom. As a PSYCH NP, my mental health has been destroyed since I became a nurse. We are the modern day slaves.
I found that most MDs do not want to mentor NPs and they just throw them into the fire just so they can see more patients. I refuse to work with MDs like that. Needless to say, I haven't worked so much in NP practice. If more NPs got proper mentoring from their collaborating MD, it would be a win win for both parties, the MDs and the NPs.
I'm suffering from a sinus infection, I have them twice a year. NP refused me antibiotics said it's not infection. So can't wait for my DO to get back. So I can be treated.
They know the boundaries in which they work. Seeing the directions insurance companies are going, they have been pushed to work outside their own scope of practice. Even when quite skilled and knowledgeable, they still practice under the supervision of the MD. On the flip side, some MD's have become complacent, disconnected and disinterested in patient care and are satisfied abdicating to those NP's & PA's. You are a much more conscientious doctor who actually cares for his patients.
The docs I roll with love their patients as much as I do and provide them with outstanding care. Unfortunately, there are always some bad seeds in every profession.
My (soon to be ex☹️) primary Doc has both a great PA and NP. Sometimes I would spend more time with the PA than my doc, but that's OK... I know they collaborate. I've been going to them for more than 15 years and see them as a team. It's obvious that they work well together and have alot of respect for each other. I'm staying with the practice after my doctor leaves because of the PA, even though I'm not too enamoured of the other doctors in the practice. It's a little unnerving to hope that this new partnership will work out.😵 BTW, I'm sorry for your patient's loss of his son, and I'm glad you stepped in and corrected your friend's dad's diagnosis... Thank goodness you and your expertise were there for him!👍
@@DrMudgil 💚me too... thanks, Doc. I have to admit I am worried...☹️ I do understand where you're coming from... I've experienced too many instances where the doctor overused PAs and NPs to improve their bottom line💰💲🤑
I managed medical clinics in LA for many years. I have worked with many PAs and NPs over the years. Without exception the PAs and NPs gave superior quality of care, patient education and excellent bedside manners, sometimes better than the MDs and DOs. I was glad over the years to see that the restrictions on the NPs in writing prescriptions and working independently (under a physician's review) have been lightened. Yes, I think that their work should be reviewed with peer review, media directors and/or State Boards but so should the physicians' work with valid complaints not being dismissed or hidden. I also worked with physicians who were motivated only by money/profits rather than quality medical care or compassion for sick people.
There are some AMAZING PAs and NPs and some downright lousy docs out there, I don’t disagree with that. I can virtually guarantee you, though, the wonderful PAs and NPs you describe were trained by and/or worked under the supervision of some amazing docs, who cared about their patients and ensured their team did too! 😉
Thank you for replying! While I agree with you that the PAs and NPs probably got excellent technical/clinical training from their teaching and supervising physicians, but not necessarily bedside manner or patient education.
@@DrMudgil 💓👍🏽 You see, after working with so many doctors over the years, and following your videos, I know without seeing you in person that you have those qualities. 😉
I’m curious if, in those examples you gave, it was a PA or NP making the misdiagnosis? I would be surprised if so, given there is usually a pathologist involved (a role a mid level cannot fill).
The issue here is identifying when a pathology report and what you see clinically are discordant. The patient was under the care of PA, who referred the patient for surgery. The story didn’t add up, which is why I had my buddy send me the slides to review.
You are the finest human being and doctor, and you KNOW I've been watching your programs, and READ your books. I live in Ohio and my days of going to the Dermatoloigist here because you get seen and talked to by at PT or MA. THE DOC YOU FEEL IS IN SUCH A HURRY TO GET OUT TO OF YOUR ROOM TO SEE OTHERS AND I DON'T LIKE IT. Makes me nervous. I'VE HAVE 70 CUTS AND SCARS. If I didn't make sense I'm sorry but do your research and.pick the best....DR MUDGIL IS THE BEST❤️❤️
Boy, this is a bold post...You're absolutely correct in many aspects, but there seems to be a bit of a discredit to advanced practicing providers or as you call them mid levels. Many have several years of experience prior to entering their profession, like a EMT-paramedic that has intubated, performed chest tubes, and done resuscitation, whereas a resident physician has not experienced that.
No doubt! Nothing beats experience. I learned more from the wonderful ICU nurses during my intern year than any doc! This post is more about the vast use of NPs and PAs as a patient’s primary provider, many of whom have little or none of the life-experience you astutely mention.
@@DrMudgil training is certainly different. I’m a primary care NP. I did 4 years of undergrad. I was an RN for 10 years in both critical care and urgent care. I did 3 years of grad school and 1 year of primary care NP residency. I felt very ready and safe to treat patients in primary care independently. Certainly could not work as a specialist independently. But in primary care… absolutely! Training is not all the same for all NPs. But by the same token, it’s not all the same for all MDs/DOs. Many train internationally where they only do 4 years of school (instead of 4 undergrad 4 med school) come here, pass boards, get into fam med residency and work completely independently without anyone questioning whether they should or not. We have many foreign trained physicians in fam med because of the shortage. Certainly, the training is not the same for all physicians in that sense. Just something to think about.
My Drs office always books me with the nurse practitioner, and the PA has prescribed me a medication for high cholesterol besides the one I was already taking. No I did not even pay to have it filled.
I get what you're saying but corporations dont care. The reality is that companies have realized it's cheaper to pay a bunch of NPs to do general care and start shaving off hospitalists and other primary care doctors. And the numbers en masse still back it up as well. While I agree that they will never have the same level of knowledge medicine nowadays is about making as much money for the shareholders as possible and cutting cots as much as possible. You pay an NP 130k and that worker is happy and you can save well over 100k that you'd have to pay a primary care physician. It's simply a numbers game atp
Say it mid level providers they hate to be called that. It bugs me after we go to school to get our MD degree that others think they can do the same as us.
What the point of having a physician assistant? If you pretty much dictating and caring out all the order you could do that with your Medical assistant
My physician assistants are a hugely important part of my care team and operate virtually independently after undergoing extensive training by my side. That being said, I still review and sign off on every treatment plan. My hand touches every patient seen in my practices, but I couldn’t do what I do without the wonderful PAs on my team!
NPs describe projects they did in their program as similar to something you would do in middle school, like a poster project on handwashing. Many arrange their own practicum hours, and there is no regulation regarding how they may describe themselves as a specialist. So an NP student who helped change bedding in the cardiac unit can call herself an "NP Cardiac Specialist". I'm an ex-nurse. I left due to the corruption and lack of education. (Ask a nurse what the "nursing diagnosis" of "imbalanced energy field" means.) There is an enormous push from the nursing organizations to get "many letters" behind their names. There is a massive amount of time, money and energy invested into making nursing look academic without the academics. Look into an NP program, and you'll likely find that the majority of the courses are about leadership, politics or Philosophy. Maybe one course per semester has a medical word in the name, like Pharmacology, but it will only scratch the surface. You might find the TH-cam channel "Patients at Risk" interesting.
Doc, I think CNPs and PAs are perfectly fine seeing patients but only for follow-up visits after an MD or DO has already seen the patient and diagnosed any issues. Even then they should immediately bring the actual physician in when there is a change or a new problem. I have been to many doctors due to being transferred often in my former job. Too many times I've been seen by the MD or DO on only the first visit. After that it's their PA or CNP every time. Now I see Dr. Cowan here in the Lancaster, OH area and I have never been seen by anyone other than him. I agree with you that only a doctor should be diagnosing and initiating a treatment plan. BTW, I was in NYC for the day last week. I arrived at Port Authority and wandered up to Bryant Park and showed my wife Time Square as it was only her 2nd time ever in NYC. Honestly I didn't know you were in NYC or I might have stopped in for a pic with the famous Doctor Mudgil, four-time Gold Medal winning Lypoma excision competition champion.
No doubt, Dave. PAs and NPs can be invaluable members of the healthcare team. My PA, Nick, is phenomenal and truly an extender of my services, BUT my hand still touches every patient he sees. Hope you and your wife had a wonderful day in NYC! Next time stop in to see The Doc! 😉
@@DrMudgil I have family in Sussex, NJ so we do get there now and then. If we do go to the city again, it would be an honor to meet you. Have a great day and as always, thanks for the inspiration you always provide to Get it done.
There’s some real issues with this commentary. I’m not sure this doctor knows what a PA is silly due to working with one. Likewise, the PA isn’t the physicianS assistant, they’re the physician assistant, there is a major difference. PAs are trained within their scope and can practice medicine at a level they and their team are comfortable with, anyone can miss issues on an exam, that’s not a uniquely strong issues within PA/ NP, rather it’s matter of training. You can have a PA which is highly trained and capable or an MD who just barely slides by and is generally under trained at using evidence based approaches, the most important thing is the PA work within their scope, stating that PA/ NP are infiltrating healthcare also created a stratification and competing view of medicine, and uses language which makes them sound incompetent alternatives to physicians This country’s healthcare system is rapidly developing and changing, the days where MDs and DOs were the sole medical providers may not be sustainable to address the needs of an ever growing underserved and aging population There is not competition needed here, all providers enter medicine for one reason which is to minimize and reduce human suffering, and care for those who need it the most, the PA is not a physicianS assistant, they are their own medical provider working in collaboration with the physician and care team.
Are you saying these two patients mentioned with incorrect diagnosis were due to an NP and/or PA? Because if it was misdiagnosed by an MD/DO then you use this as a point about NP/PA providers then that seems completely unethical to connect the two. Don’t get me wrong, I completely agree with having physician lead teams, however, Help us and support us so that we can do our best to help with the patient load. Just because some of us chose to not pursue MD/DO (and some have had the grades, MCAT score and experience to succeed there) doesn’t mean we don’t possess the ability to gain that knowledge to practice at extremely high and competent levels. How about we all stop fighting and do what we need to in order to become a healthy team and industry for the sake of the individuals out there.
If you can’t pursue MD/DO, then do what you can. People study 10 and more years to become a physician, but you just want to brag about being independent. Nurses are mid level, so be mid level, stop looking for some ways to become an independent care provider. THAT IS NOT RIGHT. Nurses are nurses, physicians are physicians. You just want to mess everything up for your own sake.
Did you even read my entire response and question to him or are you just responding out of habit from a place of disdain and preconceived notions about everyone under an entire career field? @@peterwinchester7929
“I trained him under my wing for two years.” Did you divinely inherit your medical knowledge or did someone pour into you while you studied? Was that residency not your time of training and exposing your lack of knowledge? You’re arrogant.
I’m just a jaded ICU nurse turned PA who trolls people on the internet 😂 Thanks for all that you do, doc. I agree, your training is unmatched and I hope we keep brilliant PHYSICIANS at the helm of medicine.
@@WilliamParnell-x1xICU nurses are the biggest bad asses around - I can’t tell you how many times they saved me and how much I learned from them during my intern year! 🙌🏽
As someone is competing my undergrad and has a strong interest in medicine and healthcare. At first I thought I could start my own nurse practitioner practice in one of the states that allow it but after taking a look at the education provided it is not enough especially on the nurse practitioner side. I still feel like even if I attended a residency program and completed a fellowship that I wouldn’t be adequately trained and not be able to provide the level of care needed that patient deserves. I think NP and PA do have a place but it should be in urgent care roles or outpatient roles and doctors should be monitoring those cases and should focus on the complex cases and in patients.
As an Rn for 43 + years I agree with you wholeheartedly! There are situations where I will agree to see an NP or PA, however whenever someone asks me about seeing one I always recommend an MD first, based upon their symptomology. I also will recommend a Specialist if they are not getting relief from their complaints!
RNs are angels walking the earth! Thank YOU for all you do! 🙏🏽
As someone going from respiratory therapy to PA school, I definitely agree that things should always be overseen by an MD or DO. However, I don't see why so many doctors I see posting online don't want PAs doing certain procedures such as intubation. As an RRT intubation is something I will have experience with long before I start PA school. Do these doctors just not want to train their PAs, or is there some other reason? Obviously, it comes down to what the facility is ok with and laws first and foremost. However, I don't see why a physician who has a PA and trust them wouldn't want them to have some of the skills of the procedures that the MD or DO do within said specialty. Obviously, a cardiothoracic surgeon doesn't need to teach their PA how to completely do a surgery, but vein harvesting for bypass? Why not? It allows the MD or DO to focus more on the main problem if they teach their PAs to do some of the more mundane procedures. Which allows them to live up to their title as assistant that much more. Any thoughts on this?
Good points. Im a pre - PA student and I completely agree that, PA should have their work overseen by physicians (as is expected for the position), and that more complex cases be handled by a physician only, but it seems like PAs are well suited for everyday illness and injury, but the ppl in the comments (as usual with social media) take everything to extremes and are interpreting this as PAs shouldn't treat patients, which is kind of wild.
No doubt! The PAs that work alongside me are AMAZING! The key (and this goes for all clinicians regardless of the letters after one's name) is knowing what you don't know, and asking for help when you need it. 👊🏽
@@DrMudgil That's a great point and one that will prevent poor care. 👊🏻
I'm so glad more physicians are talking publicly about this. I have been misdiagnosed by a nurse practitioner. She said I had rheumatoid arthritis. I went to a physician and he said I didn't have arthritis. I went to a second doctor and he said the same thing. I never went back to se another nurse practitioner or PA again. This misdiagnose made me think a lot about pursuing a career as an NP or PA. I thought about going to nursing school and then get my doctoral degree, but after that I decided to become a neuropsychologist. Still getting my master's and hope to get into a PhD. program after. Anyways, Thank you for talking about this. I would like to also tell people they can visit the Patients at Risk YT channel. Very informative. Take care everyone!
NPs and PAs can be incredibly valuable members of a healthcare team, but they don't endure the same rigorous training as MDs.
I went to a NP at a CVS walk-in clinic because I had a fever, night sweats, sore throat, white spots all over my throat and tongue and a ear infection. The nurse stuck a q-tip in my throat, didnt touch the back and it came up negative for strep. The NP came in and said I must have a viral infection and she couldnt do anything. A week later, I return, with the same problems, but now Im literally deaf in my ear, and a different NP looks at it and says, its clearly bacterial. I told her I was allergic to penicillin (hives) so she prescribed me amoxicillin. I took it, and now, in addition to all my other issues, my tongue is swollen and my skin feels like I have a sunburn. Im going to go to a physician because I've been sick for 3 weeks now.
Oh my! Go to the Dr. me too had the same issue and NP said Viral while Dr. said postnasal drip. HEENT Specialist Dr. said Nasal deviation and needs operation! So go ahead with a Doctor!
During an orthopedic visit, his PA came in and told me that aww it's really not anything to worry about and this particular doctor didn't check behind her or anything. To make a long story short, after a 2nd opinion from another Orthopedic doctor, I found that the issue was very serious and I got the right treatment. I believe that PA and NP should have another level of training especially when making diagnosis on patients they treat. If you don't feel like the diagnosis or level of treatment is right, seek a second opinion! We also have to advocate for ourselves when it comes to our health..Thanks Doc for the honest opinion and I appreciate your positivity
You’re absolutely correct! We must all be our biggest advocates when it comes to our health AND it’s important to respect that “gut feeling” … 👊🏽
I found when working I was more cautious than my MD. Like someone coming from another hospital to see us with a long cardiac history, their cardiologist cleared them. I still wanted them to see one of our Cardiologist, so if their was a problem we had a team and a plan to call. My doctors were always like really ,then there would be a problem and he would say so glad you had them seen pre op. I can't tell you how often that happened.
I totally agree! CNP’s and PA’s are great providers, but an MD should be in charge over them. My son is an MD and I know how hard he studied and worked, 8 years past his undergrad work. I don’t know any mid level providers, that I’ve worked with, that have studied more than 2 years after undergrad and no residency, where the actual hands on learning begins. Thanks for addressing this in the practical way you have of doing so. 😉
Yes, ma’am! You hit the nail on the head! 🙏🏽
Its good to know you have good ole fashioned values, ethics, and standards towards the care of al your patients - its a sin and a crime that many doctors do not adhere to providing the same lever of care which you and your team provide, ~ I believe you will always maintain such an excellent level of patient care ~ Keep going!
That's what it's all about! Let's get it! 👊🏾
Is it ever thus!! It seems administrators are under the delusion that the bottom line of Health care must be in the black. PAs and NP are less expensive, but they don’t have the education and expertise that Dr’s have invested their lives in. Remember, If the water keeps dripping on the rock, it eventually changes it’s shape. We need to remember, we need Doctors and be grateful for what they give up to be there for us 24/7. We just need to keep the administrators aware of our needs and we can’t replace Drs. with PAs and NP. But. rather hire them in addition to Drs.
A M E N! 🙏🏽🙌🏽🙏🏽
So true 😮
Most doctors won't come to rural areas. So mostly NPs and PAs provide care. Driving over an hour to see the nearest doctor can be problematic. Until the early 90s this area had between 1-5 doctors in each town. Now it's mostly NPs.
The second part of this issue is that those on Medicaid and Medicare can't be seen by a doctor. As to about why I'm only being seen by the NP or PA and I'm told it's because I'm on Medicaid. Quite a bit of classicism going on there. Luckily they are really on top of things in regards to my healthcare. Except for pain treatment/management I don't have any complaints.
WA state has closed the loopholes from the healthcare act and so it runs far more smoothly. In the past two years the bare minimum of care is why I'm still alive.
THANK YOU!!! Thank you Doctor for explaining this to people.
👊🏽👊🏽👊🏽
What you’re saying makes a lot of sense. But here in rural Iowa, it seems like we can’t get doctors to practice in our local Clinic. We have one physician who is approaching retirement and he only sees acute cases. The other patients are seen by a PA or CNP. So there’s that issue. With your friend’s father, wouldn’t have that slide gone to a lab or pathology for review?
That is a problem, for sure. Hopefully the one physician in your area is involved (at least behind the scenes) in the cases the NPs/PAs see.
Regarding my friend’s dad, the slide was actually misread by the in-house pathologist in the practice. The PA, who saw my friend’s dad, should have considered a possible mis-diagnosis, particular in the context of a dark-skinned patient getting a sun-induced skin cancer (which is possible, but quite rare). Fortunately, I was able to intervene and right the ship. 🙏🏽
@@DrMudgil thank you for clarifying that! Cytology is something I'm not trained in. I'll look at slides when I get the chance cause I'm addicted to learning stuff but Micro lab was during my post-bacc years (I think it was the George H W Bush presidency),
@@AirdrieReed 👊🏽👊🏽👊🏽
I think it depends on your background, I worked over 30 yrs in critical care as an RN in a 1000 bed hosp. Then went to school , still as a CNP in critical care. When an RN works 1 yr and then goes to NP school they do not have enough experience to function alone. Same as an intern or somtimes a resident.
We don't have PA's and very few NP's in Australia. You always get to see the doctor, however specialists are notorious for "room hopping", having several patients on the go. This type of thing cannot be good for patient care as most times the specialist is obviously trying to move on to the next room!
That’s not ideal at all. Healthcare issues are a problem all over our planet!
@@DrMudgil they certainly are unfortunately!
Thank God for Drs like you. Have a great weekend.
🙏🏽🙏🏽🙏🏽
I see an amazing NP. However she work in conjunction with a fantastic MD. I has always believed that a NP is their to assist the Doc, not replace them.
Teamwork makes the dream work! My PA Nick is a HUGELY important part of my team! 😉
As someone is competing my undergrad and has a strong interest in medicine and healthcare. At first I thought I could start my own nurse practitioner practice in one of the states that allow it but after taking a look at the education provided it is not enough especially on the nurse practitioner side. I still feel like even if I attended a residency program and completed a fellowship that I wouldn’t be adequately trained and not be able to provide the level of care needed that patient deserves. I think NP and PA do have a place but it should be in urgent care roles or outpatient roles and doctors should be monitoring those cases and should focus on the complex cases and in patients.
I demand to see the doctor and not a pa or anyone else. When I'm paying for ❤ care i expect the top of experience and knowledge. I'm a Registered nurse and i can't replace a doctor; neither can anyone else who's not qualify for the category.
No doubt! RNs are real world angels, though! Saved my ass many a time when I was an intern! Thank you all YOU do! 😉
Many states PA and CNP are able to practice independently also able to prescribe
If it’s under the oversight of an MD, as part of a healthcare team, that’s okay. The problem is that’s typically not the reality, which is unfortunate
That’s dangerous 😢
@@DrMudgil many rural areas can not attract a physician, CNP and PA can run clinic and do a fine job. I worked as a CNP under a physician but was pretty independent.
Bit of a story. I am finishing up my undergrad and am intending to go to Medical School. During my sophmore year I was working part time at a hotel as a busboy. I like to talk to guests I so I usually start a conversation. I met a couple of cool doctors but one interaction sticks out to me.
I was advising a female guest regarding cool bars and places to eat . The guest chooses to pick a bar thats a block away. Since its night time and shes alone I offer if she needs someone to walk her to the bar (the hotel was in a bad part of town). She agrees and we start walking. I mention something about going through Organic Chemistry since I want to go to med school. She lights up and states that she's a physician in x state. I get back to the lobby and I google her name mrs smith DO, nothing comes up, Mrs Smith MD, still nothing. Finally I just google her name and the medical field she told me. She was a NP, not a doctor.
Such an odd interaction. All the physicians I know are extremely humble and only use the Doc title in a clinical setting.
Classic! I find that chiropractors and optometrists love dropping the “Dr” title too! 😂
I have always thought that very thing. Sometimes it’s almost impossible to see the doctor. Makes me a little uneasy for sure.
Makes me uneasy too!
I understand what you’re saying. However, I have gotten better health care from NA/PAs than some of my doctors. I see a PA for my aftercare from breast cancer. I like her so much better than the doctor I am technically assigned to.
No doubt! There are some AMAZING PAs and NPs out there, like my PA, Nick! The key is knowing what you don't know, which is a hard thing to teach! ;)
I totally agree with you!
I totally agree with this video. I don’t know how anyone can think a np or pa is as qualified as an md. I recently had a cnpa give me a hard time because I wanted an md. I asked her by looking at me what could be a problem with being sedated. She had no idea that red heads have different needs. No way was she touching me.
This is My Rule #1 KNOW WHAT YOU DO NOT KNOW.
I tell any medical or nursing (BSN or MSN) student that comes my way.... because it does apply to all students.
Yes, indeed! 👊🏾
I have been seeing a Dermatologist for years and I have had many things removed, but I had a cancer spot on the side of my nose that was not a good thing and I ended up having to have my face cut from the corner of my eye to my smile line and nearly 50 stitches I have had many basil cell spots taken off and all because I worked in Phila. at the time and we could hop a train to the beach every weekend, for next to nothing, way back then. I am so aware of things on my skin and am usually correct about what is and what isn't something I need to see my Dermatologist about. One day I was visiting my sister and this was about 10 years ago and told her she needed to get to a dermatologist. She had not ever been to one. She had a very uneven mole on her back. I made her go to the Dermatologist and it was cancer and had metastasized and she ended up having to go back the second time only to find that she had another one that was exactly the same. I could almost put my entire fist in the hole. She is now 80 years old and still going, but the doctor told her I saved her life by being able to identify what was happening. I am 78 and the legs I once had, I was proud of, but no more. Why people do not take care with all the knowledge out there is so sad. Sorry, this is so long, cut your passion for what you do is so great and I will be keeping up with you for sure.
Your sister is lucky to have you! Thank you for sharing! 🙏🏽
A lot of NPs can do exactly what you have described in this video. In fact, I’ve done it several times myself in the past three months… and I’ve also had patients tell me that I gave them a more thorough assessment than a psychiatrist ever has… whats happening in healthcare is that we get job offers with zero training or support from other MDs and corporate companies… so they want us to do these things in order to have a jobs. I am without a job because I have contracts I was offered that were unsafe. MDs wrote the medical parts of those contracts. If every MD was willing to train up an NP, we could be better, much better, but it is a VERY rare, sometimes impossible task to find the opportunity for training that your PA got from you. Very rare any MD is willing to do this, they would rather train other MDs up. We have been duped. FEEL BAD FOR US 😂
Well said! PAs are a key part of my team, but the mentoring/training is absolutely essential. In fact, I much prefer working alongside the PAs I invest in than many MDs. 🙏🏽
@@DrMudgil I regret choosing NP school over PA because I wanted to be a PA all along but just did not realize it. I have decided to LEAVE nursing because it’s so messed up. Im going to become a family court mediator and make $400k working only 1600 hours a year. Lol. So the lack of training and support I have received from MDs and corporate companies has caused me to leave the profession. I made that decision after a video was posted bulkying NPs on TH-cam. Its called “Patients at Risk” and it blames US for being the bastard children no one wants anything to do with. Wish I had known this before going $138k in debt to become an NP. Too late to go to PA school. Maxed out on my loans. Isn’t this sad!??? Had to become a nurse because I went through a divorce then got fed right into the funnel of doom. As a PSYCH NP, my mental health has been destroyed since I became a nurse. We are the modern day slaves.
I found that most MDs do not want to mentor NPs and they just throw them into the fire just so they can see more patients. I refuse to work with MDs like that. Needless to say, I haven't worked so much in NP practice. If more NPs got proper mentoring from their collaborating MD, it would be a win win for both parties, the MDs and the NPs.
I'm suffering from a sinus infection, I have them twice a year. NP refused me antibiotics said it's not infection. So can't wait for my DO to get back. So I can be treated.
They know the boundaries in which they work. Seeing the directions insurance companies are going, they have been pushed to work outside their own scope of practice.
Even when quite skilled and knowledgeable, they still practice under the supervision of the MD.
On the flip side, some MD's have become complacent, disconnected and disinterested in patient care and are satisfied abdicating to those NP's & PA's.
You are a much more conscientious doctor who actually cares for his patients.
The docs I roll with love their patients as much as I do and provide them with outstanding care. Unfortunately, there are always some bad seeds in every profession.
My (soon to be ex☹️) primary Doc has both a great PA and NP. Sometimes I would spend more time with the PA than my doc, but that's OK... I know they collaborate. I've been going to them for more than 15 years and see them as a team. It's obvious that they work well together and have alot of respect for each other. I'm staying with the practice after my doctor leaves because of the PA, even though I'm not too enamoured of the other doctors in the practice. It's a little unnerving to hope that this new partnership will work out.😵 BTW, I'm sorry for your patient's loss of his son, and I'm glad you stepped in and corrected your friend's dad's diagnosis... Thank goodness you and your expertise were there for him!👍
It sounds like the PA you see is part of an awesome team! That’s what it’s all about. Hopefully the practice can keep that going! 🙏🏽
@@DrMudgil 💚me too... thanks, Doc. I have to admit I am worried...☹️ I do understand where you're coming from... I've experienced too many instances where the doctor overused PAs and NPs to improve their bottom line💰💲🤑
Great information dr m thank you so much for sharing 😊
You're most welcome! ;)
I managed medical clinics in LA for many years. I have worked with many PAs and NPs over the years. Without exception the PAs and NPs gave superior quality of care, patient education and excellent bedside manners, sometimes better than the MDs and DOs. I was glad over the years to see that the restrictions on the NPs in writing prescriptions and working independently (under a physician's review) have been lightened. Yes, I think that their work should be reviewed with peer review, media directors and/or State Boards but so should the physicians' work with valid complaints not being dismissed or hidden. I also worked with physicians who were motivated only by money/profits rather than quality medical care or compassion for sick people.
There are some AMAZING PAs and NPs and some downright lousy docs out there, I don’t disagree with that. I can virtually guarantee you, though, the wonderful PAs and NPs you describe were trained by and/or worked under the supervision of some amazing docs, who cared about their patients and ensured their team did too! 😉
Thank you for replying! While I agree with you that the PAs and NPs probably got excellent technical/clinical training from their teaching and supervising physicians, but not necessarily bedside manner or patient education.
@@janicestayshich9108 Those are qualities of being a good human! 🙌🏽
@@DrMudgil 💓👍🏽 You see, after working with so many doctors over the years, and following your videos, I know without seeing you in person that you have those qualities. 😉
@@janicestayshich9108 🙏🏽❤️🙏🏽
I’m curious if, in those examples you gave, it was a PA or NP making the misdiagnosis? I would be surprised if so, given there is usually a pathologist involved (a role a mid level cannot fill).
The issue here is identifying when a pathology report and what you see clinically are discordant. The patient was under the care of PA, who referred the patient for surgery. The story didn’t add up, which is why I had my buddy send me the slides to review.
You are the finest human being and doctor, and you KNOW I've been watching your programs, and READ your books. I live in Ohio and my days of going to the Dermatoloigist here because you get seen and talked to by at PT or MA. THE DOC YOU FEEL IS IN SUCH A HURRY TO GET OUT TO OF YOUR ROOM TO SEE OTHERS AND I DON'T LIKE IT. Makes me nervous. I'VE HAVE 70 CUTS AND SCARS. If I didn't make sense I'm sorry but do your research and.pick the best....DR MUDGIL IS THE BEST❤️❤️
You’re very kind. Thank you! 🙏🏽
Nice photo! Makes you look heaps younger!👍
Boy, this is a bold post...You're absolutely correct in many aspects, but there seems to be a bit of a discredit to advanced practicing providers or as you call them mid levels. Many have several years of experience prior to entering their profession, like a EMT-paramedic that has intubated, performed chest tubes, and done resuscitation, whereas a resident physician has not experienced that.
No doubt! Nothing beats experience. I learned more from the wonderful ICU nurses during my intern year than any doc! This post is more about the vast use of NPs and PAs as a patient’s primary provider, many of whom have little or none of the life-experience you astutely mention.
@@DrMudgil training is certainly different.
I’m a primary care NP. I did 4 years of undergrad. I was an RN for 10 years in both critical care and urgent care. I did 3 years of grad school and 1 year of primary care NP residency. I felt very ready and safe to treat patients in primary care independently. Certainly could not work as a specialist independently. But in primary care… absolutely!
Training is not all the same for all NPs. But by the same token, it’s not all the same for all MDs/DOs. Many train internationally where they only do 4 years of school (instead of 4 undergrad 4 med school) come here, pass boards, get into fam med residency and work completely independently without anyone questioning whether they should or not.
We have many foreign trained physicians in fam med because of the shortage. Certainly, the training is not the same for all physicians in that sense.
Just something to think about.
My Drs office always books me with the nurse practitioner, and the PA has prescribed me a medication for high cholesterol besides the one I was already taking. No I did not even pay to have it filled.
Hopefully the doc is overseeing things and will sort it out.
@@DrMudgil I have a scheduled appointment this month for the Doc.
I get what you're saying but corporations dont care. The reality is that companies have realized it's cheaper to pay a bunch of NPs to do general care and start shaving off hospitalists and other primary care doctors. And the numbers en masse still back it up as well. While I agree that they will never have the same level of knowledge medicine nowadays is about making as much money for the shareholders as possible and cutting cots as much as possible. You pay an NP 130k and that worker is happy and you can save well over 100k that you'd have to pay a primary care physician. It's simply a numbers game atp
No doubt - it’s all about numbers for hospital systems and private equity backed practices. Problem is, you get what you pay for …
Say it mid level providers they hate to be called that. It bugs me after we go to school to get our MD degree that others think they can do the same as us.
HMO Uptom uses many PAs 🤔 … but some of those PAs surprisingly know more than their MDs 😏
No doubt, there are some AMAZING PAs and some terrible docs out there.
This was my experience in managing medical clinics too!
What the point of having a physician assistant? If you pretty much dictating and caring out all the order you could do that with your Medical assistant
My physician assistants are a hugely important part of my care team and operate virtually independently after undergoing extensive training by my side. That being said, I still review and sign off on every treatment plan. My hand touches every patient seen in my practices, but I couldn’t do what I do without the wonderful PAs on my team!
but they have just as many letters as md. how can you be sure?
NPs describe projects they did in their program as similar to something you would do in middle school, like a poster project on handwashing. Many arrange their own practicum hours, and there is no regulation regarding how they may describe themselves as a specialist. So an NP student who helped change bedding in the cardiac unit can call herself an "NP Cardiac Specialist".
I'm an ex-nurse. I left due to the corruption and lack of education. (Ask a nurse what the "nursing diagnosis" of "imbalanced energy field" means.)
There is an enormous push from the nursing organizations to get "many letters" behind their names. There is a massive amount of time, money and energy invested into making nursing look academic without the academics. Look into an NP program, and you'll likely find that the majority of the courses are about leadership, politics or Philosophy. Maybe one course per semester has a medical word in the name, like Pharmacology, but it will only scratch the surface.
You might find the TH-cam channel "Patients at Risk" interesting.
Doc, I think CNPs and PAs are perfectly fine seeing patients but only for follow-up visits after an MD or DO has already seen the patient and diagnosed any issues. Even then they should immediately bring the actual physician in when there is a change or a new problem. I have been to many doctors due to being transferred often in my former job. Too many times I've been seen by the MD or DO on only the first visit. After that it's their PA or CNP every time. Now I see Dr. Cowan here in the Lancaster, OH area and I have never been seen by anyone other than him. I agree with you that only a doctor should be diagnosing and initiating a treatment plan. BTW, I was in NYC for the day last week.
I arrived at Port Authority and wandered up to Bryant Park and showed my wife Time Square as it was only her 2nd time ever in NYC. Honestly I didn't know you were in NYC or I might have stopped in for a pic with the famous Doctor Mudgil, four-time Gold Medal winning Lypoma excision competition champion.
No doubt, Dave. PAs and NPs can be invaluable members of the healthcare team. My PA, Nick, is phenomenal and truly an extender of my services, BUT my hand still touches every patient he sees. Hope you and your wife had a wonderful day in NYC! Next time stop in to see The Doc! 😉
@@DrMudgil I have family in Sussex, NJ so we do get there now and then. If we do go to the city again, it would be an honor to meet you. Have a great day and as always, thanks for the inspiration you always provide to Get it done.
There’s some real issues with this commentary.
I’m not sure this doctor knows what a PA is silly due to working with one. Likewise, the PA isn’t the physicianS assistant, they’re the physician assistant, there is a major difference.
PAs are trained within their scope and can practice medicine at a level they and their team are comfortable with, anyone can miss issues on an exam, that’s not a uniquely strong issues within PA/ NP, rather it’s matter of training.
You can have a PA which is highly trained and capable or an MD who just barely slides by and is generally under trained at using evidence based approaches, the most important thing is the PA work within their scope, stating that PA/ NP are infiltrating healthcare also created a stratification and competing view of medicine, and uses language which makes them sound incompetent alternatives to physicians
This country’s healthcare system is rapidly developing and changing, the days where MDs and DOs were the sole medical providers may not be sustainable to address the needs of an ever growing underserved and aging population
There is not competition needed here, all providers enter medicine for one reason which is to minimize and reduce human suffering, and care for those who need it the most, the PA is not a physicianS assistant, they are their own medical provider working in collaboration with the physician and care team.
PA and NP are not MD but we can sure make hell of money like one.........
And our scope is growing like it or not .....
When the motivation is money rather than providing patients the best care possible, the issue is obvious. 😉
Are you saying these two patients mentioned with incorrect diagnosis were due to an NP and/or PA? Because if it was misdiagnosed by an MD/DO then you use this as a point about NP/PA providers then that seems completely unethical to connect the two. Don’t get me wrong, I completely agree with having physician lead teams, however, Help us and support us so that we can do our best to help with the patient load. Just because some of us chose to not pursue MD/DO (and some have had the grades, MCAT score and experience to succeed there) doesn’t mean we don’t possess the ability to gain that knowledge to practice at extremely high and competent levels. How about we all stop fighting and do what we need to in order to become a healthy team and industry for the sake of the individuals out there.
If you can’t pursue MD/DO, then do what you can. People study 10 and more years to become a physician, but you just want to brag about being independent. Nurses are mid level, so be mid level, stop looking for some ways to become an independent care provider. THAT IS NOT RIGHT. Nurses are nurses, physicians are physicians. You just want to mess everything up for your own sake.
Did you even read my entire response and question to him or are you just responding out of habit from a place of disdain and preconceived notions about everyone under an entire career field? @@peterwinchester7929
please help i am stuck here
they have almost the same letters
Preach
“I trained him under my wing for two years.”
Did you divinely inherit your medical knowledge or did someone pour into you while you studied? Was that residency not your time of training and exposing your lack of knowledge? You’re arrogant.
The difference is my PA earned three times what I earned as a resident while working half the hours. 😉
I’m just a jaded ICU nurse turned PA who trolls people on the internet 😂 Thanks for all that you do, doc. I agree, your training is unmatched and I hope we keep brilliant PHYSICIANS at the helm of medicine.
@@WilliamParnell-x1xICU nurses are the biggest bad asses around - I can’t tell you how many times they saved me and how much I learned from them during my intern year! 🙌🏽
Very much so.
@@DrMudgil BINGO
so its really pay that bothers physicians; meanwhile you all have no clue how much RN's make and RT's make...
Kiero ver lo videos ya no te entiendo gracias
Now that is dangerous and true 😮
Hi Dr have a nice day
To you as well! ;)
That's correct!!! 0:😊
are DOs MDs?
DOs are DOs, MDs are MDs, PAs are PAs, and NPs are NPs … 😉
Now there are np/p to md programs...... Medicine is evolving and the education system is adapting........ Boo hoo hoo 😞😅
That’s terrific! The extra education is key! 🙏🏽
As someone is competing my undergrad and has a strong interest in medicine and healthcare. At first I thought I could start my own nurse practitioner practice in one of the states that allow it but after taking a look at the education provided it is not enough especially on the nurse practitioner side. I still feel like even if I attended a residency program and completed a fellowship that I wouldn’t be adequately trained and not be able to provide the level of care needed that patient deserves. I think NP and PA do have a place but it should be in urgent care roles or outpatient roles and doctors should be monitoring those cases and should focus on the complex cases and in patients.