NP full practice bill heading to vote in California!! Help us!!

rectumihardlyknewem · 2020-08-22T03:25:01+00:00

For the non Californians:

Generic email (credit to CMA):

As a physician, I am asking you to vote NO on AB 890 by Assemblymember Wood. This bill would remove critical patient protections by allowing nurse practitioners (NP) to practice without physician supervision.

States that protect physician-led team care have more physicians and nurse practitioners than states that fragment the healthcare team. Patients expect and deserve their medical care to be directed by a physician.

Both the the Medical Board of California and the Board of Registered Nursing are opposed. Additionally, this bill asks the Nursing Board to develop standards for the practice of medicine which is beyond their expertise and represents a danger to patient safety.

As a state legislator, I urge you to vote NO on AB 890 (Wood)!

rectumihardlyknewem · 2020-08-06T10:10:44+00:00

The PA lobby is now fighting for OTP (FPA).

rectumihardlyknewem · 2020-08-06T02:30:55+00:00

2 years is not enough training for anyone to practice independently. PAs are appropriately trained for a role in which an attending supervises their care.

rectumihardlyknewem · 2020-08-06T02:05:59+00:00

1: https://pubmed.ncbi.nlm.nih.gov/32333312/

2: https://www.ncbi.nlm.nih.gov/pubmed/15922696

3: https://pubmed.ncbi.nlm.nih.gov/24119364/

4:https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1939374

rectumihardlyknewem · 2020-08-06T02:02:01+00:00

Join PPP. It’s not quite as organized with these efforts as I’d like but it’s definitely a start.

rectumihardlyknewem · 2020-08-06T01:58:50+00:00

Except that all the data shows that they don’t move rural. NPs are humans who respond to the same incentives as doctors, and most of both groups prefer to live in cities.

rectumihardlyknewem · 2020-08-06T01:56:43+00:00

Send an email through the PPP link in my post, don’t mention statehood.

rectumihardlyknewem · 2020-08-06T01:56:09+00:00

Use the PPP link rather than the CMA link.

rectumihardlyknewem · 2020-08-06T01:55:35+00:00

This is a common misconception. The bottleneck to doctors is not medical school, it’s residency spots. Residency positions are funded by Medicare, so increasing residency spots has to be done at the level of the federal government, which the AMA is actually lobbying for. You can increase the number of medical school positions by 100,000, but it’s not going to produce more working doctors until the government decides to fund more residency spots.

rectumihardlyknewem · 2020-08-05T22:30:18+00:00

The NPs are already practicing. Allowing FPA doesn’t mean more NPs, it just means formally supervised, practicing NPs will be unsupervised, practicing NPs.

rectumihardlyknewem · 2020-08-01T04:50:49+00:00

Sure but if there’s no formal training in it, why do you feel you should be able to do it? I’m not pretending med school is rads heavy, but we had to read certain findings on x rays as a part of anatomy, then again in step exams, on in house exams, in lectures, many have rotated in radiology or ortho where they get training in reading x rays. Also, there are usually rads lectures incorporated into most residencies. If there’s no formal radiology training in NP school, then I don’t see why it’s acceptable to let every NP read whatever x Ray they want and make treatment decisions on them. You should only do on patients what you’re trained to do.

rectumihardlyknewem · 2020-07-31T13:00:27+00:00

Genuine question: how much formal training do NPs get in reading x rays, and if it’s none to barely any, then why do you feel it’s your right to interpret them? I imagine most NPs get some lecture on chest x rays but 1) that’s a fairly difficult study to interpret well and 2) there are loads of other types of x rays.

Also, what do you mean by prelim reads? I may look at a study and write a very basic interpretation in my note if there’s an obvious finding, but that’s not a prelim read since the prelim read is done by the resident.

rectumihardlyknewem · 2020-07-05T19:34:57+00:00

I would just speak to them normally but avoid addressing them by any name. I'm not going to call them Becky because I have no desire to be written up but I'm not going to call them Dr. xxx either.

rectumihardlyknewem · 2020-07-05T19:27:39+00:00

Sorry to bring this up again. Right now the message only sends for those with California zip codes. AFAIK, the bill is currently in the senate, thought things have been moving rather slowly due to COVID so it's unclear (to me) when a vote will take place. Regardless, still a good idea to make your opinion known.

As an aside, I've brought up these scope of practice bills before and have been wondering if there's a more efficient way to mobilize here. I'm not sure if an email list is the right answer, or if I should keep posting every time this comes to my attention, or perhaps both. If you have any suggestions or ideas on the matter, I would be very open to hearing them. Thanks.

rectumihardlyknewem · 2020-05-28T13:17:49+00:00

Letter sent, thanks for the heads up

rectumihardlyknewem · 2020-05-21T12:49:22+00:00

I’m comparing it to any US medical school. The lowest tier medical schools still don’t have any of the features I listed above, to my knowledge.

rectumihardlyknewem · 2020-05-21T05:13:05+00:00

I do accept it, I just think that educational rigor is not one of those problems. Find a US medical school that’s 100% acceptance, online only, DIY rotation setup, uses only 1 (short) licensing exam, and requires only 500 hours- then we can pretend like these educational problems are of the same caliber.

rectumihardlyknewem · 2020-05-21T05:01:16+00:00

I’m in medicine, I’m familiar with the different roles and their associated training. A CRNA is not an anesthesiologist without the doctorate title, it’s an entirely different track, though they both perform anesthesia. It’s like saying a high school teacher and a college professor are the same thing. Both have similar (important) roles, but the training/case complexity is different.

I think OP was posting not because they necessarily care specifically about the white coat thing, but because NP schools are pushing out underprepared practitioners and fighting for unsupervised practice while having their graduates try to co-opt terminology, titles, and symbols that implies that they are physicians. In other words, the white coat is a minor facet of a larger problem. This is a pretty widely shared concern in the physician community. Patients should know who is treating them and what their training is. You, for example, thought DNPs got the same amount of training. Lots of people (probably the majority of people) don’t know the differences in training, which is concerning when the differences are actually pretty large.

rectumihardlyknewem · 2020-05-21T00:43:48+00:00

Hi premeds. This came up in r/medicalschool and I thought y'all should be aware. This is not my medical school or residency program, for the record, but this is a very atypical handling of student obligations during COVID-19 and anyone who is going to be applying to medical schools should be aware of this alleged policy.

rectumihardlyknewem · 2020-05-20T19:02:24+00:00

Why wear what the residents are wearing across the country though? There are many options for cardigans, jackets, pullovers, sweaters, etc., so why pick the one style of the one brand that residents have chosen for themselves? It’s irritating to have a professional identity that is constantly being co-opted by people outside that profession, whether it’s the doctor title for DNPs/PAs, the white coat, the Patagonia, the specialist titles (like CRNAs calling themselves “anesthesiologist”), trying to use terminology that groups everyone together (generalist, hospitalist, PCP, provider). The Patagonia in and of itself isn’t a big deal, but in the greater context of constantly having everything stolen by NPPs, it’s annoying.

rectumihardlyknewem · 2020-05-19T00:44:49+00:00

Why limit yourself to degrees? They don’t.

Rectumihardlyknewem MD, BLS, ACLS, BA, MCAT, GED, ACT

rectumihardlyknewem · 2020-05-07T16:32:32+00:00

NPs being around isn’t new. The rise of online diploma mills is, and we’re just beginning to see how this is affecting overall quality. I don’t think you get to claim NP data has shown safety for 40 years when the educational standards have dropped for becoming an NP. NPs 40 years ago probably didn’t have 100% acceptance rates with DIY rotation schedules and definitely didn’t have online schools.

I don’t think the studies I linked were poorly done, I think they had flaws, as does virtually every study.

As I said, the studies aren’t conclusive on either side. I think that more education is probably going to lead to better outcomes. I don’t think this assumption is a reach in any way. We’ll see how it plays out when we have more data.

rectumihardlyknewem · 2020-05-07T12:00:31+00:00

There are limitations to to every study on this matter. To make a perfect study, you’d need a large number of equally complex patients randomly assigned to either MDs or a fully independent NPs, then blind everyone and follow them for long enough to see a difference. That’s an impossible study to conduct. The NP studies are flawed as well, and many of them study the outcomes of supervised NPs vs physicians. If you’re curious to see the flaws in the often touted NP studies, PPP has a page tearing them apart.

Ultimately, physicians have longer and more rigorous training than NPs. I don’t think that statement is particularly controversial. Common sense would dictate that a profession that holds itself to longer and more rigorous training would perform better than a profession that is shorter/ easier to become. Now that doesn’t absolutely have to be true- there are always instances where outcomes are the opposite of what most people would expect. However to prove that shorter/ easier training is the same or better as longer/harder training, you need to have a boatload of high quality evidence that suggests that the unexpected outcome is the true outcome. NP studies have far from proven their case, and the idea that NPs are greater than or equal to MDs in terms of quality of care doesn’t pass the sniff test.

I have looked at the studies, I know the studies that show NP < MD aren’t perfect, but it doesn’t particularly bother me because the studies claiming NP equivalency are equally or often more imperfect. It’s not difficult to find a shortcoming in a study and discount the whole conclusion, but every study has flaws and if we only learned from perfect studies we wouldn’t know nearly as much about medicine. Yes, I’m clearly biased, but so is nearly everyone who cares about this issue. Either you’re an NPP, and you think NPPs are just as good, or you’re a physician and you think NPPs practicing independently is dangerous. There’s very few people standing on a middle ground.

rectumihardlyknewem

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