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NP student cannot find pediatrician to agree to have her for 6 week preceptorship

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  • Beginning to see/notice some really awful calls from NPs... US, then CT neck of lymphadenopathy clearly associated with a new diagnosis of mononucleosis. I almost wish the radiologists around here were better gatekeepers.

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    • Beginning to see/notice some really awful calls from NPs… US, then CT neck of lymphadenopathy clearly associated with a new diagnosis of mononucleosis. I almost wish the radiologists around here were better gatekeepers.
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      I'm assuming you are in a state that allows NPs to practice without physician supervision, because otherwise I'd want the physician to actually supervise the NP and prevent this sort of misuse of healthcare.  The radiologists really can't be the gatekeepers here-- they can't second guess every order from a licensed practitioner.  And biopsies of lymph nodes in patient's with mono are a pathology nightmare. The patients are really the only ones who can complain about this, and they are being told they are getting extra special treatment from NPs, because an MD/DO would have just ignored their complaint of swollen nodes.  More is better, right??  Sigh.

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      • Beginning to see/notice some really awful calls from NPs… US, then CT neck of lymphadenopathy clearly associated with a new diagnosis of mononucleosis. I almost wish the radiologists around here were better gatekeepers.
        Click to expand...


        I would love to play the role of gatekeeper, but there are several problems with this:

        1. You say “gatekeeper”, while others might say “obstructionist”.

        2. The radiologist never has all of the requisite information and is not really ever trained or empowered to make imaging decisions (others than in breast imaging and a little bit in IR). We are very good, however, after the fact telling you that something was unnecessary or stupid.

        3. The financial incentives for radiologists, in the current fee-for-service environment, is for there to be no gatekeeper.

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