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PED-EM-L  August 1998

PED-EM-L August 1998

Subject:

NP/PA in ED

From:

RICHERPA <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Tue, 11 Aug 1998 00:42:04 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (125 lines)

REPLY TO SMARCUS POSTING BELOW
 If the medical profession is being torn asunder, lets be adults and not
 blame NPs or PAs. MD salaries have decreased across the board because
of lower reimbursement for services across the board. I know of many ED
 physicians that are working at PA/NP salary levels because they are
 unboarded, can't open a practice of their own, less desireable to
 certain MD employers as compared to their EM boarded colleagues, are
 IMGs, and combinations of the above.
 Maybe someone should speak to an OB/GYN Laparoscopic surgeon who own's
 an 11 million $$ estate in Old Westbury(an extremely affluent
 residential community on Long Island) with a gas pump on his grounds,
as to why MD reimbursement is down.
 An internist on staff at a hospital I recently worked in was telling
 another MD(in a hall) how they are are "owners" in OXFORD & making
 profitable money, by reducing capitated monthly reimbursements to other
 downline internists & family pactitioners who care for Oxford patients.
 He should get SMarcus' posting.
 
 
> Marcus_Office wrote:
> >
> > This debate has gone on for years now and is not likely to stop.  Prior to
> > the Flexner report, almost anyone could call himself or herself a health
> > practitioner.  After an extensive study, it was decided to require a certain
> > minimum training to allow a person to practice medicine.  Thus the
> > requirement for formal medical schooling, licensing followed and then
> > specialization came along.  We are now moving away from the goal of Flexner.
> > It is unclear whether this is wise or not.  Will we have more snake oil
> > pushers or less?  Will a nurse or PA kill patients?  I doubt either will
> > happen.  We do pass rules requiring minimum skills to drive a car, to
> > install plumbing or to pull electrical wires, why should we allow someone
> > without the requisite education, training or experience treat humans?
> >
> > I do wonder what started all this.  Is it a gender war?  Is it the fact that
> > manufacturing jobs are not there anymore and we have become a service
> > economy with limited ideas for service delivery and health care has always
> > been so lucrative a market?
> >
> > As for use of physician extenders in general, doesn't there always have to
> > be ONE captain?  How can a ship, an army, a business run without one
> > commander?  If we are to develop a team approach to delivery of medical care
> > who will be the leader?  Under managed care some bureaucrat appears to be
> > that commander in chief, despite the claims of the companies otherwise how
> > many of you have not been up against a stupid decision which you had to
> > fight?  Will the PN insist on being the team leader?  What model will be
> > adopt?
> >
> > In a letter in Pediatrics several years ago, the Dean of the Rutgers
> > University Nursing School stated that PNs can do it better and cheaper than
> > MDs.  In a speech she gave that year she actually stated that nurses would
> > put the doctors out of business!  Some team!
> >
> > If we have not already lost it, we had better figure out how to regain
> > control. I only hope that in my lifetime I will see a rebirth of
> > professionalism in medicine.  I have a 20 year old daughter who would like
> > to go to medical school.  It will cost over $35,000 a year and she will lose
> > many years of income earning potential while she is in training.  At the end
> > of all that will she be any better off than a PN of PA economically?  Why go
> > through all of that?  will medicine become a profession only of the rich, or
> > the racial minorities (given scholarships and supplemental tutoring)?
> >
> > I do not have the answers and I apologize for pontification.  It bothers me
> > as I enter my "golden years" to see the profession that I loved and
> > respected being torn asunder.
> >
> > -----Original Message-----
> > From: Pediatric Emergency Medicine Discussion List
> > [mailto:[log in to unmask]]On Behalf Of Martin Oliver
> > Sent: Tuesday, July 14, 1998 12:26 AM
> > To: Multiple recipients of list PED-EM-L
> > Subject: Re: NP/PA in ED
> >
> > "Physician Assistants practice medicine under
> > supervision of a physician".
> >
> > Nurse Practitioners practice "advanced practice
> > nursing".
> >
> > PAs are trained in the "medical model", stressing
> > diagnosis and treatment of disease, while NPs are
> > trained in the "nursing model", stressing a more
> > holistic/psycho social approach.
> >
> > The bottom line is that, after about 7-10 years of
> > practice in a certain specialty, we all (MDs/NPs/PAs)
> > are equally capable (quick - what's the resting
> > membrane potential of gastrointestinal smooth muscle
> > cells?...yeah, I used to know it, too). I have the
> > studies around here somewhere that show that a PA
> > trained in a specialty (emergency medicine, peds,
> > neurology) is more capable than an MD who is not
> > trained in that specialty.
> >
> > I routinely assess, order labs, tap, order abx, then
> > call peds to admit or transfer to tertiary care. If
> > transferred, a NP usually picks the child up. A
> > hospital down the road uses NPs for the COBRA exam at
> > triage.
> >
> > This is certainly not intended to diminish the
> > neccesity of MDs. If my child developed a Wilms tumor,
> > I'd want a doc! But most (80%) of general medicine can
> > be handled by PAs/NPs.
> >
> > Martin Oliver, PA-C (and RN school grad a long time
> > ago)
> > Dept. of Emergency Medicine
> > Palomar Medical Center
> > Escondido CA
> >
> > For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
> >
> > For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
>
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

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