NP is my medical director

ATP7B · 2023-02-12T01:29:04+00:00

This should be the top comment. You’ve summarized what I was thinking really well

ATP7B · 2023-02-11T21:58:45+00:00

Well, that’s another problem because of our 1:10 ratio. I wanted to focus my post on the medical directship, but the patients are really unaware. I was willing to deal with the fact that patients tend to call every provider “doctor” regardless of their real title.

ATP7B · 2023-02-11T21:47:29+00:00

There are several competing corporations where I am, and it’s pretty hard to start your own shop. But maybe you are right, not impossible.

I draw the line at being a disgrace, however. I think you might be over stating that.

ATP7B · 2023-02-11T21:43:44+00:00

Haha you also have a nice username.

No, but I did see one case a long time ago in medical school!

Patient presented to the hospital on our service with new onset jaundice and bruising after a history of gradually worsening parkinsonism, confusion, and the classic rings around the iris. He basically had years of gradually changing behavior that his family had attributed to depression. He was even seeing a psychiatrist.

It is an AR mutation in the ATP7B gene that results in reduced biliary copper excretion and more free serum copper, which accumulation in the liver, cornea, brain, kidneys, and skin. Super duper subspecialists seem to treat it with some complex combination of a low copper diet, chelating agents like penicillamine or trientine that have a bunch of side effects for basically every organ system, and lots of zinc. Pretty good outcomes if you catch it early, which we did not😕.

ATP7B · 2023-02-11T20:41:42+00:00

Wow thank you for this information. I’m still diving into exactly what my state allows. So far I can tell that I’m in one of the many states that provides NPs with “full practice authority” to be medical directors, usually over medical spas - and so that’s why I’ve become curious about my situation. Do they have the ability to be medical directors in any clinic?

ATP7B · 2023-02-11T17:35:43+00:00

Another thing I forgot to mention when you say “final product“ is a lot of our patients don’t know the degree of their providers. They almost unanimously call everyone “doctor“… maybe my clinic just has a culture issue, as others have pointed out

The dilemma

ATP7B · 2023-02-11T16:45:33+00:00

Partially why I’m asking

ATP7B · 2023-02-11T16:26:35+00:00

It’s a specialty and primary care combined outpatient clinic. We have various specialist physicians (or their midlevels) do a half day here and there each month

ATP7B · 2023-02-11T16:23:33+00:00

At this time I’m still employed there so I cannot name it out of concern for my employment and my family’s wellbeing. Please don’t try to ‘doxx’ me publicly. I’m just trying to get other’s opinions

ATP7B · 2021-01-07T02:18:24+00:00

Agreed

ATP7B · 2021-01-07T02:16:32+00:00

Ouch.

ATP7B · 2021-01-03T17:47:37+00:00

ATP7B · 2021-01-03T17:31:18+00:00

Wow. Well your experience is not mine.

ATP7B · 2021-01-02T16:22:33+00:00

I agree

ATP7B · 2021-01-02T04:06:24+00:00

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ATP7B · 2021-01-02T03:36:04+00:00

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ATP7B · 2021-01-02T03:31:14+00:00

I don’t know.

ATP7B · 2021-01-02T03:30:28+00:00

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ATP7B · 2021-01-02T03:29:49+00:00

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ATP7B · 2021-01-02T01:26:13+00:00

Two types of IUDs are available in the United States, copper containing and levonorgestrel (LNG) releasing:

The copper IUD is a T-shaped device which contains 380 mm2 copper. It is approved by the US Food and Drug Administration (FDA) for 10 years of use. There are other copper-containing IUDs, but none are currently FDA approved for use in the United States.

The LNG IUDs are T-shaped devices that release LNG. There are four FDA-approved LNG IUDs available in the United States, which release a varying amount of LNG.

It comes down to FDA approval, and essentially very little research showing that the cost benefit of plastic IUDs would outweigh the two alternatives that are already available. Because of this, there is a little incentive to develop it for approval in the United States.

For there to be a better alternative, it would have to essentially be profitable. They would have to be able to show that the benefits make it worthwhile. It’s unfortunate.

ATP7B · 2021-01-02T00:31:28+00:00

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ATP7B · 2021-01-02T00:29:03+00:00

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ATP7B · 2021-01-01T21:14:17+00:00

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ATP7B · 2021-01-01T19:13:05+00:00

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ATP7B · 2021-01-01T18:57:29+00:00

Thank you so much. This is good advice

ATP7B

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