Trauma Centers/Nurse Practitioners

Discussion in 'Too Hot for Swamp Gas' started by QGator2414, Apr 26, 2014.

  1. ArtDeco
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    ArtDeco Well-Known Member

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    To answer Q's question, the situation is really really complex, and it varies state to state. If we are talking about Florida, I would tell you that you should have no trouble seeing a licensed doctor anywhere in this state. If you are having an issue, maybe we should look at why you can't get in. Could it be that:
    1. The doctor is having to deal with more and more paperwork and has less time to see patients
    2. There are fewer and fewer practicing physicians because more are retiring or opting out of this mess
    3. We are reimbursing them so low that they'd rather sit at home or see less patients and pay "extenders" (PAs/NPs) to do their heavy lifting.
    I can tell you all 3 affect me. I'm relatively young, but I would quit tomorrow if I could. The paperwork is just simply ridiculous and it's getting worse. Electronic medical records have made things worse. Patients are so ungrateful nowadays and they generate absolutely no rapport with you. They simply go to whoever's cheapest or on their insurance plan. If Obama gave my 3,000 patients tomorrow the choice of (1) seeing the worst doctor in the state for free or (2) paying $50 a visit to see me, 2,900 would choose the free doc. I believe this is what Michi was referring to above. People are inherently not suited to judging their own health. It takes an objective, learned person to differentiate pathology from simple inconveniences. I'll post later, but IMO, NPs and PAs have definite roles, but aside from the most obvious areas of need (Mississippi Delta, etc.) they should always be supervised or under the tutelage of an experienced MD.
  2. HallGator
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    HallGator Administrator VIP Member

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    I've wrote on here before that I am totally sold on PAs. I have been seeing one for well over 15 years and have nothing but good things to say about him. If he thinks I need to see a specialist then he sends me to one just like the doctors I used to go to did. I can get into see him the same day I need treatment except for the weekend.

    I also have a specialist at Shands I see for a lung disease I've had from many years. He is also top notch in my book. I have no hesitation in seeing either a NP or a PA. I personally think they all compliment the medical profession.
    • Agree Agree x 1
  3. QGator2414
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    QGator2414 VIP Member

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    Art that is definitely the mindset that must be battled. We deal with it on our end of the healthcare industry with dentistry. Fortunately we have not been killed with as many extra burdens as you.

    But there are so many people that want to shop price and are willing to go to the corporate dental chains for a free exam and xray. I can tell you those corporations do not stay in business by these promotions. That "treatment coordinator" is there to get as many dollars out of the patient as possible after the treatment plan. But some will think that cheap "free" or "$1" visit is going to save them money. And it certainly can at times.

    That is just not the way we want to deliver dentistry. The corporations and even some small groups/practices have done a good job using the entitlement mentality of people to get them in their doors.

    A great quip I heard the other day..."There is no such thing as dental insurance. It is a benefit."
  4. ArtDeco
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    ArtDeco Well-Known Member

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    This sounds reasonable. I have been fortunate to know some very well educated and qualified PAs (and NPs, too), but unfortunately, we live in an era where quality seems less important than a warm body with a pulse. If you've got one you have a relationship with, or one who's been doing this awhile, that's great. I think the danger is when people go see someone off the street they've never known when they are ill. In my office, I have two types of visits- chronic followups for chronic conditions and sick visits. In my experience, all of my really really bad things I've diagnosed-lupus, heart attacks, pulmonary emboli- have all come from sick visits. So I'm a little reluctant to have people say, "I've got a headache, let me see whoever" because you need an experienced hand to know if you've just got a headache or if you've got a meningioma. IMO, the NPs and PAs would be better utilized seeing the regular followups, i.e. cases where the diagnosis has already been made, you just need a set list of things evaluated and questions asked.
  5. Dreamliner
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    Dreamliner Well-Known Member

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    Tell you what, when my then four-year old son came down with pneumonia, it was the NP's who took charge, worked him over and got him healthy. Yes, the doctor did waltz in from time to time, but for this potentially life-threatening occurrence, there was no need for a doctor.
  6. AzCatFan
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    AzCatFan Well-Known Member

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    This is the free market at work, right? If a NP or PA can give a person the drugs he wants at a cheaper cost, why should you force the customer to pay the MD premium? Of course, it speaks a problem the free market has with healthcare, and that's the fact that the commodity is the health of a human being. And we are reluctant to put a price tag on human life.

    On a more personal note, I prefer to see the NP, because I can get an appointment much quicker, and almost always know the issues. I see the doctor for a check-up every once in a while, but the majority of my visits center around ear problems. This time of the year, my left ear gets clogged and it's almost always the Eustachian tube. On rare occasion, it's a full fledged infection, but I can usually tell the difference. Either way, the NP is more than qualified to look in my ear and diagnose the problem and prescribe me the nose spray to help clear things up, or the antibiotics if infected (hasn't been infected in nearly 4 years). No need to see the doctor.
  7. QGator2414
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    QGator2414 VIP Member

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    No doubt we have not had a free market in healthcare. It is not a problem of the free market but the government not allowing it to operate in a much less regulated manner...

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