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

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  • VagabondMD
    replied




    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 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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  • mkintx
    replied


    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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  • legobikes
    replied
    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.

    Leave a comment:


  • snowcanyon
    replied
    What administrators and CMS fail to account for is the general laziness and lack of work ethic endemic to mid-levels.That's why they became...mid-levels. Not many of these folks want to do anything aside from punch a clock from 9-5, M-F, which just isn't how medicine works. They can't work fast, they can't work efficiently, and they won't work when they don't want to. This alone will limit their penetration. And boy does it make precepting them ************************.

    Patients love them, though, because they give them whatever they want, like a live action Dr. Google.

    Leave a comment:


  • jm129
    replied
    so let's make screening criteria for ourselves....

     

    here are "my two cents"...

    - must have at least 5-7 years of nursing experience in a specific specialty

    - have completed NP education from a reputed program, certainly not online

     

    Leave a comment:


  • The White Coat Investor
    replied
    This trend is not solely limited to APCs. There are lots of medical schools where the students basically have to line up their own rotations. Many of these are Caribbean schools or DO schools, but even USUHS has this to a certain degree.

    I really think it's poor form for a school to charge tens of thousands in tuition and then not make sure there are top notch clinical rotations lined up as part of that education.

    Leave a comment:


  • Lordosis
    replied




    I disagree.

    Imo the concept of nursing “experience” is vastly overrated.

    I’m not sure how the current state of nursing really prepares them to diagnose and treat. Sure it’s some exposure to a handful of things but I really don’t thing the carryover is that significant. Most are also in completely different settings (outpatient, specialty) as well.

    We’ve had better luck with fresh ones that are trained up . That’s probably anecdotal

    I think it just comes down to the individual and they type of direct supervision they get in their early NP years.
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    I see your point.  I think a lot has to do with the individual.

    Either way there has to be training.  Not online classes and thrown together shadowing.

     

    Leave a comment:


  • StateOfMyHead
    replied




    They will take over primary care at least for majority of people on Medicare/medicaid. People with private insurance will be able to see docs.

    I would be very leery about going into primary care now.

    Above statements are predictions, not what I consider ideal. Docs are foolish, unable to organize and thusly allow this crap to proliferate. Being replaced by online degrees, it’s pretty pathetic tbh.
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    This is happening in my area in many specialties including neuro, gyn and derm. The wait list for a physician is 4-6 months or longer but there are plenty of PA/NP openings...thank you but I will wait. I'm hanging on to my sweet spot age physicians, 45-55yo range with a death grip. It has become an interesting lesson in adherence to recommended treatment as I am now more diligent about staying connected and attending the routine checks for fear of losing my "spot" with a physician.

    Leave a comment:


  • Zaphod
    replied
    Its a yogi berra situation, the ones that are good are the same ones that realize they have no business practicing independently.

    That said, I think there is a front line very low acuity role that would be helpful, but thats not how america works. We didnt sit down and figure out how to best complement the system and address shortfalls, they just put up mills and put them out there in the world.

    Leave a comment:


  • SValleyMD
    replied
    I disagree.

    Imo the concept of nursing “experience” is vastly overrated.

    I’m not sure how the current state of nursing really prepares them to diagnose and treat. Sure it’s some exposure to a handful of things but I really don’t thing the carryover is that significant. Most are also in completely different settings (outpatient, specialty) as well.

    We’ve had better luck with fresh ones that are trained up . That’s probably anecdotal

    I think it just comes down to the individual and they type of direct supervision they get in their early NP years.

    Leave a comment:


  • Lordosis
    replied


    No self respecting physician should be allowing any of these people to rotate with them.
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    The point I am trying to make is that there are really 2 types.  I have worked with a few "good" NPs.  They know what they don't know.  Always it is one with real nursing experience prior to getting the advanced degree.  They also seem to correlate with the ones who do not go rouge and start practicing in a specialty they do not really understand.

    I think there is a place for midlevels in healthcare.  Just not the online degree, no experience, no supervision kind.

    Leave a comment:


  • Dilaudidopenia
    replied




    Just the other day I found out that a nurse that I know from our hospital is getting an NP degree.  She has about 10 years experience already.  I asked her if it has been hard securing rotations and she told me that it was not for her because of her experience she could draw on the physicians that worked with her on the floors.  She did say without prompting that her classmates with no experience are having a much more difficult time.
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    No self respecting physician should be allowing any of these people to rotate with them.

    Leave a comment:


  • highdoseamox
    replied
    Here, this should save her a week or two: peds urgent care for mid levels who usually see adults:

    Cough: chest X-ray, azithro (bronchitis or “cover for pertussis”)
    Fever: full labs, chest X-ray, rocephin (pending blood culture results)
    Bronchiolitis: chest X-ray, steroids, tons of albuterol, and diagnose intercurrent otitis so you can throw some abx on as well
    Diarrhea: full labs, plain film or abdominal ultrasound
    Not sure what the pathology is: high dose amox





    Leave a comment:


  • G
    replied




    I have wonderful news! NP2B has secured a rotation in the health center associated with a public school system that is operated by PNPs. I am confident that in her six weeks there she will get the equivalent training of a three year pediatrics residency and will enter the job market on a nearly equal footing to compete with the practicing pediatricians in the community. Hooray!
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    thanks for the "guffaw"...I believe that's the right word for what I just did.

    I actually injured myself today rolling my eyes after listening to a neuro NP spout unsolicited advice in the ER.  pediatrics, stroke neurology...such a waste on all that useless education!

    Leave a comment:


  • Lordosis
    replied
    Just the other day I found out that a nurse that I know from our hospital is getting an NP degree.  She has about 10 years experience already.  I asked her if it has been hard securing rotations and she told me that it was not for her because of her experience she could draw on the physicians that worked with her on the floors.  She did say without prompting that her classmates with no experience are having a much more difficult time.

    Leave a comment:

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