The Sunday Times Week In Review section contained this nifty letter:
To the Editor:
Thank you for bringing attention to the growing problem of access to primary care in Massachusetts. The problem has been worsened by our universal health care initiative, which was missing a strategy to increase the number of providers to serve the increase in patient load.
Your article, however, focused on increasing the number of doctors to solve the primary care shortage. Nurse practitioners have been filling this role for more than three decades by providing the best in health care.
We are the future of primary care. Make an appointment. We’re open.
Robb Stenson West Falmouth, Mass., April 7, 2008
What universe am I living in? The buffoon can’t be serious! It’s just not possible. Nurse Practitioners are the future of primary care? They are providing the BEST in health care? No one, and I mean NO one in their right mind could believe such a thing. Not even Robb Stenson (and by the way, why the two ‘b’s? Does that stand for BIG BUFFOON??) asks to see an NP OVER a doctor! That’s right! I don’t see any NP hospitals and people clamoring to see NP’s INSTEAD of doctors! They are ANCILLARIES!!! Did they forget that?
It truly makes me just want to give up. Can Internal Medicine be devalued any further? Why do I teach it to med students, when apparently NP’s are the future anyway? And they wonder why students don’t want to pursue a career in IM. Jackasses like Robb Stenson apparently feel they are better than IM doctors and they have a tenth of the training.
I give up. The Apocalypse of Medicine is surely upon us.
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One angry doctor will be saying it all on film.
Hate to tell you this- but I am currently pregnant and am choosing to see a NP rather than my OB/GYN. I like her better, she listens to me, and her schedule is not so jam packed that she has more time to spend on exams.
I couldn'd agree with you more Angry Doctor. I am a pharmacist with about 16 yrs of hospital experience. NP's, PA's, NMW, and whatever other people that they take off of the street and give prescriptive authority to are one of the biggest problems in healthcare. That, and lowering the nursing standard's so that every knothead with a GED can spend 2 yrs or less at the local community college, and suddenly they are an R.N. No common sense, no critical thinking skills, but they are suddenly Florence Nightingale.
I had to laugh at "anonymous". If I said that, I would want to be anonymous also. Lets see, I go to the NP, because her schedule is not jam packed. My truck has been running badly, and my mechanic is real busy. Maybe I should make an appointment with my gardner to look at it...he isn't very busy.
I have to wonder how you have so much time to write in your blog... my son just started his practice and he doesn't have time to even call his mother
Maybe the NPs are not the arrogant know-it-alls some MDs are. I work with them, and I'd much rather deal with NPs as a whole. Sure there are excellent MDs and crappy NPs. Doesn't a good NP know when to consult with their preceptor? If that is the case, I do not NEED and MD for many of my complaints. To be honest, I am capable of figuring out what's wrong with myself (sinus infection for the
50th time, etc)
I am here as I am doing some research in the apocalypse, and I have stumbled on to this site which has little to do, at least explicitly (but perhaps implicitly) with what I seek. I feel compelled to comment, as a doctor (non-practicing) and (practicing) researcher, Angry Doctor must have some esteem issues as he readily attacks the "quackos" and substandard practitioners of his profession such as NPs like some vigilante out for justice rather than being concerned about his own practice and his own knowledge about medical subjects that he obviously gets from Readers Digest-like versions of second-rate journals financed in large part by the pharma field and the Mephistopheles-like pharmaceutical reps who most likely line his pockets. And all of this leads to a real large sense of self-importance. I'd like the Doc to put up his CV against mine, especially the work he has put in AFTER med school, where the cast majority of U.S. MDs coast with regard to keeping up with cutting-edge research or understanding the full complexities of issues in the field rather than picking some sort of extreme simplistic position to glorify himself (and those who follow his exploits). To wit, if the Apathetic Apothecary really did his homework and actually tracked his scrips to see who was prescribing the majority of chic but risky, expensive and completely ineffective drug cocktails of the day, some of which that have barely passed clinical trials and, when they have, have most likely done so in nefarious fashion (based on objective evidence in celebrated cases). Just ask the pharm companies what the top 10 drugs are (in sales, in dollars, in prescriptions) by treatment categories and you will be surprised. Rather that all the bluster, why don't you spend some time focusing on what Galen and Hippocrates sought as they established the profession of medicine? If you wish to blog in your free time, by all means, but don't patronize those of us who actually KNOW, and don't think you will get away with this laziness, like the rest of the life you live, presumably, in a practice that has you, rather than being a critical thinker, acting like an automaton like most of the profession is wont to do, today. This behavior, dear sir, is the REAL sign of the apocalypse, which, sad to say, is the only opinion contained in this response. You are just like the rest of them. And for those who who will boast that I remain anonymous and therefore should be discounted--read your history. I, as I said, will put my CV up against any of you, but will remain anonymous as it would not be worth the effort in terms of moving an extremist from his position nor can I claim a desire for personal adulation that others seem to crave. I write for the sake of catharsis, mainly; a response to living in the greedy, crooked, SELF-ish world in which we live.
Wow, what a rant. I'm an NP and being a - gasp - "ANCILLARY" is an extremely useful role. I off-load the non-complicated patients for my MDs so that they can take the complicated patients. Not infrequently, those patients prefer to see me. Our relationship is collaborative not competitive.
I have worked with incredible NPs and crappy MDs and vice versa. You can have all the booklarnin' in the world and still make a bad call. Arrogance doesn't generally help improve your thinking process.
I thought I liked your blog (at first) Oh I'm a male LPN. and your a asshole. I'm with the other Anonymous writer posted on July 22. Were you beet up as a kid and now you have your MD...
I apologize. Im just sooooo frickin sick of what this world has become. and no Im not suicidal. I just think your all morons. wait is that my ego, what ever feel free to psychoanalyze all you want, your still an ass :)
Another pharmacist. Couldn't agree more. We get more stupid scripts from NP's, PA's, ect. It drives me nuts. Give me a MD any day.
Are you kidding me? I've seen some local MDs writing for ridiculous amounts of controlled substances...Adderall, Norco, Percocet, Xanax, Soma...all for a single person. MD, NP, PA, RN, LPN....having letters behind your name doesn't mean you're intelligent.
The elevated status of NP's seems to be a problem with the supply of PCP's. Big Pharma is running out of cocky ego-inflated jackasses to make into their drug-pushing MD slaves.
You must be about near retirement. Most physicians that have this attitude toward mid-level practitioners are out-dated and simply don't understand the role of such providers. I am a physician assistant student who turned down acceptance to medical school because I investigated and realized PA's (and NP's) are more than qualified to do what we do. I chose PA school over medical school because of that reason as well as the fact that the lifestlye of a PA better suits me and my family. The only difference between a PA and an MD is time. We are taught using the "medical model" that MD's are taught using. We do the same course work and rotations, just in a shorter time. Time is valuable, don't get me wrong, and this is why our purpose is to be part of the health care team and offload the simpler cases from your busy day so that you can focus on complexities that we may or may not have caught in a more "difficult" patient.
Simply put, we couldn't exist without physicians and we respect them. Let me clarify, we respect the ones that earn respect and you sir, are far from that.
And yes, mid-level practitioners are the future of primary care. We are the future and we couldn't be there without our supervising physicians who will be there with us making it all possible.
As to the pharmacists on here; get a life. You can complain about mistakes MD's, DO's, PA's, and NP's make, but don't you forget that your job wouldn't exist if we were as knowledgeable as you are about pharmacology. We take pharmacology courses in our training, but that is only a small portion of our overall training. That is why your profession exists; your profession exists because pharmacology is so vast and large that it is impossible for us to learn it all with what we need to know to diagnose and treat patients. Again, we couldn't successfully practice without you and we respect your profession. If you are seriously going to complain everyday about us, you need to find a new job because you are there to make sure that the patients we see are safe with the prescriptions we give them.
Lose your ego problems and realize that healthcare is a team effort. Truly pathetic.
Before you start another ignorant diatribe against NPs you might want to do some research. There has never been a single study showing that care by NPs resulted in poorer outcomes than care by MDs. In fact, studies have shown that not only are outcomes similar, in many cases NPs provide greater patient satisfaction (see post by Anonymous). In the 11 states where NPs are allowed to practice independently, there has been NO increase in adverse events and NO increase in malpractice suits. Check out the Institute of Medicine's report: http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Scope%20of%20Practice%202010%20Brief.pdf
Angry doctor, perhaps you're so angry because you spent so many years in school, followed by years as somebody's bitch..I mean resident, and now you're up to your ass in student loan debt and malpractice insurance bills. Personally, I haven't spent one dime on tuition in becoming an NP due to the plethora of scholarships available to us. In addition, my malpractice insurance is approximately $1100 per year. So, who's the smart one? As for our supposedly inferior education, mine consists of a four year Bachelors degree and a two year Masters degree. And yes, I did take organic chemistry. Do you really think that your extra two years of grad school entitle you to such a sense of superiority? Give me a break. And Apathetic Apothecary, just because you guys decided to rename your Bachelors degree in Pharmacy a Doctorate doesn't mean you actually have additional knowledge. It's just degree inflation. You both need to put your big girl panties on and realize that NPs are here to stay and it would be in your best interest to learn to collaborate with us in a collegial manner rather than whine and cry about it.
Angry Doc: I am a nurse practitioner. Unfortunately I am not in colorectal surgery so I cannot remove the stick that is up your ass. However, if you want to compare penis size I would oblige you - you seem to think that with two letters after your name you are a demi-god. Tell me, do you hate DO's? Are they inferior to you and your "advanced learning" because they use a holistic model instead of an allopathic one? What about DPT's? Are you pissed they can prescribe cares? What about DPM's, DDS, DMD and OD's? Are all of these people inferior to you because their last name doesn't end in MD? If you're so butt hurt about two additional years of didactic work then relax, because more and more NP's are becoming DNP's and PhD's every year. What's that? You're still pissed because you spend 3 years in IM residency oh, I see, this residency (which is really just on-the-job training) is why you think you're so special. Well, if I am an RN in an ICU for 10 years, become an NP and work for 3 then guess what, I'll bet I know a hell of a lot more than a brand new doc - I would run circles around any PGY3. The fact is, NP's are fantastic at what they do. We have a specific scope of practice and we stay in it. If it's over our head, we refer. However, there are too many pompous ass MD's that think they can play God and end up doing more harm than good. The great MD's are the ones that can work in a team and recognize their own limitations. Today's medicine depends on collaboration. Apathetic Apothecary - you must be pissed about working in Wal-Mart for the past 20 years. You're just a pill counter and not the pharmaco-scientist you dreamed you'd be. Would you still be defending Angry Ass Doc if he let out a diatribe against Pharm D's that "Always try to chime in on grand rounds?" The asshole has a Messiah complex so bad you'll be his next target. Angry Doc loves to point out what he believes are short comings and weaknesses in other professions but, apparently he has none. So if you want to ask me to remove whatever's up your ass don't bother, you can just kiss mine!
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