Physician vs Nurse Practitioner?
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- Опубликовано: 21 авг 2024
- Physicians and nurse practitioners work together in almost all clinical settings to help patients! In my GI office, I work with 3 awesome NPs who evaluate and treat patients. This allows me to see more people, allows my patients to have shorter follow up time if needed, and lets me do more procedures for patients who urgently need them! Thanks to Courtnery from @nursesofinstagram for joining me in this collab!
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If you have dosing questions, please ask pharmacists rather than APPs. They are the experts and always superhelpful.
right??? like we have excellent pharmacists RIGHT THERE
@@chicagogirl4everanda pharmacists FTW all the way
You are absolutely right! I have done that so many times while working in hospital. Y’all are a wealth of information. That’s what you trained for.
Some doctors order wrong too and the pharmacist gets all the anger from the patient when they pick it up
Missed the point of the video
I'm pro team, and experience is great, but arguing a nurse practitioner is equivalent to a physician is false. We can respect physician extenders without doing a discourtesy to other physicians and the patients who want them by perpetuating falsehoods of equivalency.
you want the APRN with 30 years experience or the resident? Give me the NP or the PA that have been around the block and knows their shit over a cocky or inexperienced doc.
@@voidpunkprincess Another falsehood of equivalency. Tell me, would you rather bring your incredibly complex and sick child to an NP with 15 years of experience, or a physician with 15 years of experience?
@@voidpunkprincess Do you want the APRN with 30 years experience or the MD with 30 years experience?
@@voidpunkprincess you mean the PA or NP being cocky and inexperienced
@chrisflados220 I agree completely. As a nurse, I have worked with a ton of cocky doctors but, honestly, anyone can be cocky and I've seen it in all areas from carers to docs . I've seen unhelpful pride in myself that has gotten in the way, before.
It's important for everyone in the healthcare field to recognize the importance of the team and to put ego aside for the sake of the patient.
I don't, at all, think Dr. Schmidt was saying NP's are the same as docs - only trying to help patients understand that they're a helpful part of the system and their knowledge is absolutely needed.
What a sellout. This is obviously untrue. It’s funny how many doctors will decide mid-levels are amazing once they’re attendings in a field where having NPs see their patients increases their income.
I swear I saw this exact comment on r/Residency. Seems like a LOT of residents were triggered by this…
@@ComfyChaos they are VERY triggered! I’ve never seen such hate for a group of ppl who just go to school and fill a position. It’s that need to kick down thing I guess
@@JanuaryjenkinsJust like the residents are kicked around by attendings. A pervasive and toxic culture of bullying and punching down. Really sad.
@@ComfyChaosresidents haven’t been all burned out by the system yet so some of them still care about the well being of the patient, but don’t worry soon enough they will be attendings and learn that it’s just a job and highering a bunch of NPs increases your income
@@Januaryjenkins calling midlevels people who "just go to school and fill a position" is quite something
First thing I genuinely disagree with you on, and this is coming from a nurse. We both know that the educational background from nursing school and medical school is vastly different. Sure an experienced NP could be a good provider, but not when it comes to complex cases/patients (even in this case, they are more familiar with algorithms rather than why, mostly due to education [not going to med school]). Making it seem as if an NP and physician are similar is very misleading and honestly a little dangerous. A physician with a DO or MD degree are the same, an NP is still a nurse (despite higher education).
Tell me, if your child was incredibly sick, would you rather have them see a physician with 10 years of experience, or a nurse practitioner with 10 years of experience. We both know the answer to that lol.
NPs and PAs can definitely function well as physician extenders / assistants / support, but definitely not as sole providers. We're getting pretty close to a reality where only the "higher class" will be able to see physicians while the rest of the "lower class" citizens will only be able to afford to see NP's and PA's.
As a physician, I’d rather me or my child be seen by a well trained NP with good clinical skills than an MD with substandard training or clinical skills (poorly trained and non-US residency and / or someone who has practiced tooo long and isnt keeping up with current knowledge/treatments.)
Stating an NP is a nurse is also incredibly misleading. That’s like saying a resident is a medical student. Of course I would rather my family member would see a physician, just like I’d rather they see the best physician in the country. Not every patient can see the top physician in the country, nor can they all see a physician. Maybe we should work to change that going forward but in the current climate, we need NPs to help take care of these patients
except that the training for NPs is very unregulated with tons of degree-mills being opened up to train new-grad nursing students. yes there are some NPs out there who have great experience but that is far from universal. NPs can play a vital role in patient follow-up if they are under direct supervision of a physician, but implying they are on the same level as a doctor just opens the door for them to have clinical independence which is unsafe and dangerous to patients. @@Doc_Schmidt
@@misteratoz I chose who was avaialable: NP I could see in July versus doctors who didn’t take tricare remote or weren’t open for new patients for the next 4 months.
He got through IM residency and GI fellowship just to not know Entecavir dosing? He wasn’t capable of looking up that information on his own to build a personal decision that is evidence based to treat? And didn’t know his cirrhosis patient was decompensated?
The example this sets is that highly trained physicians can’t look up even an UpToDate article’s worth of information and just accept a dosing recommendation blindly. If you aren’t vetting information on an hourly basis, that is negligent.
I think you missed the point. That in the day to day the NP can have more working knowledge compared to someone with overall less time in that specific specialty.
@@lijohnyoutube101 oof this is very wrong.
@@justsomeguy6730 You don’t think if you start at a practice as practicing physician even with a residency and fellowship that if a NP has been there for 10 years plus they are likely to know the cadence of their typical patients at a quicker recall?
To me that is what this is trying to demonstrate, its not the details of the example which doesn’t really matter but the concept of day to day experience versus a difference incoming experiences. There are complete commonalities in the overlap but not entirely the same.
Let’s say an attending arrives and has done 200 of something over 3 years but the PA has done 20,000 over 10 years. The PA will have quicker recall and automatic memory association.
To me it seems like you think it was about the specifics of the example ( and granted perhaps the example wasn’t ideal) but to me it was a conceptual point. It would have conveyed the same point if he had called it a yingalyang or a bidditybob.
@@lijohnyoutube101That’s not really true. Our knowledge bases are vastly different. As a physician, I have worked with midlevels who were practicing longer than me. They know what they know and what they have experienced and can be great at treating those things (which are usually the bread and butter and routine cases) but my fundamental knowledge is so much greater. That is why this video is a bit ridiculous. There’s no way a physician with the knowledge base he has would ask such a question. It makes no sense. I think it is very telling that many of the physicians commenting are not in agreement with this video.
@@lijohnyoutube101 Had the scenario been more like "Oh his insurance doesn't cover xyz... do you know what is an alternative drug that his insurance may cover since you have been working in this field for decades and you may know some older cheaper drugs?" sure.. but he's asking questions that should revoke his board certification
You need to rely on nurses to get your dosage right? They don't teach that to the GI fellows at Loyola? Honest question.
No, he said she has more experience with Hep B. Few doctors have everything memorized. They resort to resources, books, studies and colleagues. A nurse practitioner has a wider scope of practice then an RN but Has to work under a doctor.
Also, most RNs are quite familiar with proper dosages of meds, especially ones we’ve given to hundreds of patients at hospital or clinic or doctor’s office. While the pharmacist verifies any med orders from the medical provider, an RN often is able to spot an error in dosage or frequency or route before it gets to the patient. That’s part of our job; we can’t write or change prescriptions but we sure as heck won’t give wrong ones without double & triple checking everything.
@@KristenRowenPliskeNo they don't in 32 states as of january. If a doctor needs to ask someone with more experience on a topic it'd be another doctor, not some NP.
@@Userext47Not really sure how experience can get deleted by location but sure...
@@bosstowndynamics5488 "no they don't" was in reference to the claim that NPs have to work under a doctor. They used to have that condition but they lobbied together with administrators to gain independent practice in 32 states so far. Administrators because they pay NPs less than doctors but that "cost saving" doesn't get passed on to the patient and NPs becuase they want to play doctor
@@KristenRowenPliske
So if i have doubts related to dosing, should i call a Pharmacist or an NP. Enlighten
A specialty and subspecialty trained physician and a board certified GI specialist can not do a simple Entecavir dosing. Interesting!
Remind me to never be this guy's patient
Smart enough to know about dosing the med but not smart enough to grok that this is a sketch for youtube and thus uses an example that laypeople can make inferences about for the purpose of dramatization. Interesting!
@@ItsAsparageeseat least you tried
If i had doubts about med dosing, i’d be calling the pharmacist, not NP
And if i as a new attending have doubts related to some case, i’d be calling the physician with 30 years of experience over the NP.
So yup another means of spreading misinformation to patients.
This scenario is applicable only if you’re the only physician alive in that area and rest all are NPs.
@@appu12101 So it's relevant in a post-apocalyptic healthcare scenario, I get it now. You never know, might come in handy one day!
Sorry...no. At my provider's clunic, there is no doctor present. Ever. They are all nurse practitioners. And if those practioners need a consult with a doctor, they send you home and you wait a day or two to get that opinion. That is, provided that the nurse practitioner actually communicated your question correctly to the doctor. While this is a cute skit, the fact is this is a cost cutting measure that puts patients at risk and muddies the practice of medicine.
I've had the same experience with doctors as well. I'm not here to bash doctors or nurse practitioners. They're both valuable members of a medical team in a medical system (and a medical education system) that is fraught with problems. Surgeons used to be barbers, but we've come a long way since then. Nursing is going through the same process of professionalization in an environment where the knowledge and experience they DO have is devalued and dismissed. I think Dr. Schmidt is trying to counteract that, not to say that nurses and doctors are identical. It's not a zero-sum game where providing a level of professional respect to the other professionals on the team means you are devaluing or disrespecting the doctors.
Your provider's clinic is engaging in cost cutting, but that's a very different statement to claiming that all NPs are cost cutting measures
@@erininabox Nurses are already professionals. And I respect them. The fact is that Nurse Practitioners exist because there is a shortage of doctors, particularly in rural areas of the US. So PAs and NPs were created to fill that need. But for-profit healthcare organizations use them to cut costs in places that have plenty of physicians. Period. That is a fact.
@lisaboban thats not really accurate to the history of nurse practitioners. Really that goes back to the late 1800s before nursing regulations. But yes rural populations were a large part of it.
I read somewhere about an NP missing all the neurological signs of pre-eclampsia, and prescribing the mother antibiotics and sending her home. Fortunately the mother got a second opinion from a medical doctor and she and her baby did not die.
Loll we all know there is no equivalency between physicians and NPs. Really? A board certified GI specialist can’t dose a medication? If anything this says more about his clinical acumen than anything else.
It is normal to occasionally forget a dosing for a drug that a physician or provider presumably rarely orders, especially since it is something that can be easily checked online.
Do not forget, it was the PATIENT who requested a doctor ---the person/people upon your livelihood depends!
Sure. Patients also sometimes request men because they think women are incompetent as a sex, refuse doctors for racist reasons, etc. So like. What of it?
Ultimately many US medical providers’ livelihoods depends on the Centers for Medicare and Medicaid. When CMS reimbursement is cut off a hospital can end up closing within months (if not days). Check Becker’s Hospital Review for examples of this.
They can request all they want. If there’s no physician available; you’ll be letting yourself rot out. 😊
Remember, the patient doesn't know any better about what or who a nurse practitioners is. In order words, this is an ignorant patient.
When I was in college, a nurse practitioner prescribed me ativan daily as a sleep aid for YEARS. I was young and naive so I just trusted how she practiced medicine. I begged her for ambien when I realized couldn't fall asleep without the ativan and she refused, I would try 3-4 benadryl and not fall asleep. She tried to switch me to gabapentin and trazodone "to help me sleep better" (no mention of risks of benzo withdrawal). Getting off of the ativan was one of the hardest things I've ever done, I thought I'd never feel normal again.
No love for mid-levels but I know many psycs who do that regularly today. Good that you're off it
Dude that's insane. Adivan is what we use to sedate violent psych patients. She did the equivalent of hunting deer with a rocket launcher...
Actually, Ativan works amazingly well for patients who can't tolerate the side effects of Ambien.
But is prescribing Ativan for chronic use as first line of treatment standard of care?@@Stayhydrated736
@@Stayhydrated736 read the original comment again. where did OP mention they had problems tolerating ambien? you're comment is irrelevant to the central point OP was trying to make, which is the fact that she prescribed him/her a benzo for long term use... which, not even mentioning the possibility of side effects, has a shit ton of abuse potential. any med student with even a rudimentary understanding of pharmacology would not do something as irresponsible as what that NP did
wtf is this? GI specialist shouldn't need to refer to a NP
Of course physicians have the superior training, as I said in the video. The point of this video is that properly trained NPs can still offer capable, valuable care under supervision of a physician. Perhaps my own positive experience with NPs and PAs has skewed my thinking but often in GI settings, NPs can hyper focus on certain aspects of the outpatient setting (IBS or Hep B treatment for example) and over time gain a lot of experience and expertise in that area (in some cases, even being able to remind highly trained physicians of nuances that you would likely forget if you’re not treating certain diseases on a daily or weekly business). The buck of course stops with the physician as it is ultimately their patient but trying to discredit NPs to the point of banning the profession is just silly and a disservice to the medical field. We need NPs (and I’ll admit we need them to practice appropriately and within their scope) and they need us
@@Doc_SchmidtI think you mean to say you need NPs to generate more revenue. There is nothing in particular they can provide better than a PA or resident
@@JoshDanielGuitar seeing more patients generates more revenue, so yes you are correct
,YOU MEAN TO TELL ME THAT SCIENCE AND MEDICAL RESEARCH CHANGES AND HAS NEW DISCOVERIES EVERY DAY?? AND DOCTORS CANNOT RETAIN EVERY SINGLE PIECE OF INFORMATION THEY HAVE READ?? OMGGGGGGG
@@misteratoz ohhhhh, that’s why a lot of ppl are crying in the comments. You feel like NPs will replace physicians in hospitals 😂😂 bless y’all little hearts
Love this idealized presentation, ignoring the hordes of unsupervised midlevels
Who are you calling a mid level?
You, apparently.
@@jennakhivkapratt8751unqualified providers who dont go to medical school
@@jennakhivkapratt8751 -- midlevel was the term back when NPs had actual bedside nursing experience and went to quality schools, not the 100% acceptance rate online mills that focus their curricula on nursing lobbying and advocacy rather than actual patient care. I understand that nurse practitioners don't practice "medicine"...but most people don't, so when they slap a "Doctor" up in a clinical setting, most laypersons think they're seeing a physician, not a "Doctor of NURSING PRACTICE".
NPs have about 3 to 5% of the training of a physician. They "shadow" rather than have to actually gain clinical experience via a grueling residency (and possibly fellowship).
Note how studies that compare physicians to NPs reveal how NPs cost more, as they order more tests and get things wrong. Except for the studies that slyly don't point out that the more complex cases are directed toward the physician and the NPs get the easy, simple ones.
Patients are getting ripped off. For most current NPs, the term should be "bottom-level".
the NP is a midlevel lol@@jennakhivkapratt8751
I do not get the point of this video, besides the obvious pandering.
Are you telling me all medical school, residency and fellowship training has not prepared you to become an independent practitioner? or at least when in doubt, reach out to someone with similar or more training for a more in-depth answer?
Someone with 2 months of shadowing experience can definitely help your gastroenterologist treat Hep B 😂
Im a CT/ Rad tech. My experience is mid levels have very little training regarding radiology. Its takes a few years working experience before they even know what exams to order and how to order them correctly.
Same here. I have had a PA tell me straight out that they did not know what background radiation equivalencies were or how much radiation an xray gives vs a CT. I have had one say they ordered xrays and CTs on the same body part at the same time because they don't know how to read CTs, and while they were going to wait for the radiologist to read the CT, they wanted something that would make them look like they could read it. Not that they were going to read it, they wanted to look like they could read it. And this was a PA, who had much more training compared to an NP.
It doesn't matter if supposedly they are under doctors. I have seen too many doctors not bother even glancing over anything they do whatsoever. I have gone to the ER doctor, whose name was on everything, only to be told that wasn't their patient and they don't know anything about it, it's the midlevel's. And that is at least in a hospital where a doctor is at least on site. Many clinics and such now don't have doctors on site. Some don't even have them where they can be contacted.
I've had mid-levels literally scream at me about "how dare we question them," when asking about an order. Not a one has ever even heard about Image Gently, Image Wisely, and only a couple have ever known about ALARA, all very important radiologic safety related items in the USA.
Also, NPs have been pushing at a federal and state level to be able to read their own x-rays, you know, something that takes a radiologist 12 years of school/training/residency/fellowship? The ASRT and other radiologic science bodies have been fighting them about it for years now.
All this to say that I agree with you, @scootiemcpootie, and I disagree with this video and the message it is sending.
Came here to say this, they typically order the wrong tests
@@MsAwesome6814 and that's why hospitals love them! $$$
How is that any different than doctors? Also if you think radiology is bad in what is ordered…. You might want to strike up a conversation with pharmacy!
Physicians don’t get much training in radiology until residency either.
Sad to see you sell out the profession you worked so hard for
NPs hop from specialty to specialty all the time and cross cover in areas they have no experience in. I always refuse to see NPs.
Correct! Anyone with HALF A BRAIN would avoid NPs/PAs/ at any cost. They're walking death traps. DEMAND A PHYSICIAN.
No they don't hop from speciality to speciality! They have to have at least 5000 hrs in the area of speciality and post graduate education also as well as their masters
@@angelfiremimosa I mean, this is just false.
I specifically seek out Nps over doctors because I find them to be more competent and far less likely to have a god complex
I hope you never have any regrets down the road when you realize you'd have been healthier and better with a real doctor taking care of you and screening for serious medical conditions! @@octupleentendre
As a GI fellow, I was a big fan of yours. We’ve interacted a few times on your IG.
But this is disappointing. The generation of docs before us sold our soul to midlevels. So to see a doc of our generation, right after he becomes an attending and benefits from cost cutting measures of midlevels, simp to appease them is disheartening.
Why not advocate for the thousands of unmatched med students, who go into debt, much more qualified than a mid level, to practice in the same way. This is a totally different issue, I know.
But as soon as you become an attending, seeing a video like this… makes you look like a sellout. Lost a lot of respect for you. You know you don’t need an NP to dose meds, but you belittle yourself for clicks and popularity, while pushing the AANP agenda. Patients will ultimately suffer, but as long as you get to dual bill makes it okay.
It’s frankly insulting that you think I’m suddenly making this because I’m now an attending. I work with NPs but I don’t make money off of them because I’m a salaried employee. I’m disappointed my colleagues aren’t able to appreciate any nuance to the situation. Sure there are many negatives in the NP landscape currently but that doesn’t mean there aren’t some positives in working with NPs and I decided to make a video highlighting the benefits/positives of an NP interaction. If you’re so offended by one video that you cannot support my videos, so be it. I appreciate the support up to this point
Correct! Not only does he likely make money from NPs and other midlevels, but no doubt their lobbyists paid him to make this video!
@@user-yt3ze8wl2w just like big Pharma pays me for all my vaccine videos?
@@Doc_Schmidt The guy you replied to is without a doubt a bot LOL (regarding making money from midlevel's).
I don't know how much drug companies pay you, nor do I care. You've already shown your true colors, though, so I wouldn't be surprised if you take their golfing trips, free meals, etc. @@Doc_Schmidt
Has to be one of the most shameful sellout videos I've seen recently from a doctor. No wonder medicine is going down the hole.
What did he sell ??
The point of the degree is to guarantee a level of training and board certification at minimum. All MD/DO's have passed USMLE step 1/2/3, as well as ABIM or ACG boards. There's a guarantee that they will have been exposed to, and are required to continue updating their medical knowledge for the patients. The same is not true for NP's who can simply transfer fields, at which point this is built simply on trust rather than oversight.
They don’t have to have the same level of training but to state “can just transfer fields” is Bull. Granted, their programs are NOT the same length or intensity of residency, but they get to punt complex things up the chain.
An MD/DO is NOT a guarantee of someone being good at their job. Some people who have passed their boards are straight up terrible.
You think NPs can just transfer without further education or exams specific to that field? And you think there is no continued education? 🤣🤣
Edit: the kicker is you typed this on a device you could use to do actual research 💀💀
@@Januaryjenkins What required exams or standardized education does a FNP need to do when transferring from say, FM into Nephro? The answer is none. The supervising physician can offer their own "training" but there's nothing required by their nursing body or law.
yeah, the "further education" being an online module or two and a test a high schooler can pass@@Januaryjenkins
@@Januaryjenkinscringe
The AANP and the AAPA (the organizations for NPs and PAs respectively) have been lobbying to have NPs and PAs working independently despite their lower level of training. As mid-level providers, they are invaluable in helping address the common diseases, but when a case is more uncommon or complex, their training doesn't cover it. This is a patient safety problem if they are able to practice independently. A video like this may apply a false equivalence, and to paraphrase Dr. Jabbar of Med School Insiders from his Doctor vs NP vs PA video, the current climate prioritizing emotions over facts is a problem, as while humans are equal, we are not all equally trained nor equally capable. The scope of practice creep must be stopped.
If a Level II NICU has to transfer a patient to a Level 3 or 4 unit because they don't have the experience to handle the case, do those doctors have to give up independent practice? If a family medicine doc refers a patient to a specialist, do they have to give up independent practice because the symptomatic evaluation falls outside their experience and training?
@@abydosianchulac2 Everyone must do what they're trained for. The fact is that NPs and PAs have far less education of the human body by at least 5 years, and their foundation isn't as strong. But they do learn a lot that can be applied, but it isn't enough to practice without oversight.
The AAPA does not advocate for independence. They’re advocating for optimal TEAM practice-aka: working in close relationships with physicians and allowing a collaborative approach to determining the scope of the PA, rather than having the states determine individual scopes. Under no circumstances has the AAPA tried to obtain independent practice for PAs. And please don’t compare our training to that of NPs. They are vastly different.
@@abydosianchulac2there is a difference between lacking knowledge versus not having the available tools to treat a patient. I transfer patients to get a surgery from a specialized surgeon that doesn’t practice in my area or to put a patient in ecmo that I don’t have. It isn’t about competence but getting them to the right place. NP aren’t even competent to differentiate similar disorders which means they don’t create comprehensive treatment plans. They are incompetent, so your point is off and frankly you are a moron. Probably a midlevel yourself so I’m not surprised you don’t have the insight to realize the difference
No wonder his co fellows at SLU spoke poorly of him.
“Are you trying to get a rise out of me, Agent Kujan?”
I’d like to know more
When I moved to a new area no doctors who accepted my insurance were accepting new patients. I went with a nurse practitioner and I could not be happier. Come to find out that for years she was the nurse practitioner at my orthopedic surgeon's office so they all know her and speak very very highly of her. She's around my age and is very easy to talk to. I really like her and I am so glad I decided to try a nurse practitioner. She's not a doctor and does not pretend to be. But she is a highly trained skilled professional and I would recommend her to anyone.
I've had a very good experience with my NP, too! They're good!
I bet Loyola is proud to have you out here saying you don't even know which labs to order for Hep B. Solid representation.
Actually if you watch again, you’ll see I ordered the correct labs on my own. Loyola is very proud of me, thanks for asking!
"@@Doc_Schmidt Hey, I'm about to start Jenkins on Entecavir. You treat a lot more Hep B than I do. What do you usually check before switching?" My mistake, you know how to order a BMP but either dont know how to apply the results or are too lazy to chart prep a new consult and fail to know something as basic as their kidney function/active asities. Glad they're proud.
Just quit man. You screwed this up. Take a minute to reflect before you lose more of your (doctor) base of fans. @@Doc_Schmidt
@@EdwardKerplumplin oh hush
@@sctc2494no you hush. the commenter is right
Some of the comments here have been harsh, but the truth is that the job of making a diagnosis and prescribing medications should be for a physician, not a nurse.
Interestingly, the same people who make laws allowing non-physicians to practice medicine, would NEVER allow a paralegal to practice law for any reason.
Are we referring to an RN or a Nurse Practitioner, because they are vastly different! A nurse, should never diagnose patients. However, a Nurse Practitioner is more than qualified to make the call. It takes YEARS of education to become a nurse practitioner, and it’s no cakewalk. I wish people would educate themselves a little more…
@@jeanpierre9539 the standard is a PHYSICIAN who should make diagnoses and prescribe medications. Someone who graduated from a medical school. That the USA cuts corners to save costs, does not make it right!
Paralegals have years of experience shadowing attorneys, and can make the right calls based on the pattern recognition. Do you think that lawyers will ever allow them acquire the "training" to start representing clients without going to law school? What is wrong is wrong.
@@blessed_one_ That is your opinion, and obviously it holds no weight. 🙂
@@jeanpierre9539 hahaha Americans can let nurses continue treating them. That nonsense doesn't happen in sane countries. America is going downhill in healthcare and many other areas. Whatever works for them though, their lawmakers can continue destroying the country. It is NOT a nurse's place to diagnose and treat a patient. Common sense.
I understand the point you’re trying to make here, but it does your argument no favors when you contrive something very easy to ask the NP to help with. Like, you’re a board certified GI doc, it doesn’t ring true that you’d need an NP to help dose a very common medication. And if you needed a subject matter expert, the relevant one would be a pharmacist.
I appreciate that there are individual NPs who take the initiative to learn a lot, but the patient character in this skit is not wrong to worry that seeing an NP could mean being evaluated by someone with very little experience, certainly far less than a doctor would need for an equivalent level of independence. Until the NP field gets its act together and implements rigorous standards, all docs like you can reasonably do is vouch for individual NPs that you personally know.
My experience with nurse practitioners has been okay at best. I took my partner to PP to get switch to the depo shot from minipill, they saw two NPs. First one said you couldn’t take the minipill until the depo kicks in (completely false), second said we could for a week. They ended up seeing an endocrinologist a week later who immediately said it was perfectly okay to even take the minipill alongside the depo shot when spotting occurs to stop it. Way better experience with her. Not saying all NPs are bad, just not happy to get 2 completely different answers from NPs at the same practice, who should have birth control as their bread and butter since it’s PP! Endo was way more helpful.
NPs/PAs/midlevels are usually very substandard in general, if unsupervised (as it sounds here), they're even worse -- straight up dangerous!
Agree…saw an NP in women’s health who completely missed my as I now know…very common cancer symptoms! Sent me home with an antibiotic. Delayed my treatment a whole year…..My spouse saw one in a mental health hospital and was prescribed a ton of meds that included dangerous drug interactions. Took his psychiatrist weeks to ween him off! I will never see one for anything more than flu.
I went to a doctor with swollen eye, swollen face and eye discharge. The doctor said it was the FLU. I called and went to my PCP - a nurse practitioner, it was an eye infection. I could’ve been waking around without an eye for the rest of my life or WORSE! Not saying all doctors are bad, but we have to be realistic…there are some pretty uneducated ones out there. I’ll stick to who I trust!
Definitely lost some respect for you here. We don’t collaborate as equals and portraying it as such is irresponsible. Some NP’s are good, many are not and that is honestly where we are at due to their lack of standardization. Either way we do not collaborate as equals
@@thekaren1111 ok Karen, literally it’s based on education. Not to mention you are 100% evaluating based on customer service and no other meaningful metric.
@@joshb2686 Providing good customer service means connecting empathetically to a customer's/patient's needs to make sure they're fully taken care of. I'd dare say there's a pretty strong correlation between a medical practitioner's "customer service" skills/bedside manner and their ability to hear their patient's complaint fully without jumping to the easiest conclusion. Been around doctors and medical professionals all my life - family, friends, and my own providers - and the ones with the worst outcomes were always the ones who thought themselves above others, including their colleagues.
@@abydosianchulac2medicine and customer service are separate things
He didnt ask for your respect! Shut your mouth.
Fan from the UK here. I like your videos. I think this one is a miss I'm afraid.
We have similar, if not worse issues when it comes to scope creep, except my understanding is that here in the UK the PA expansion is the worst issue (where you guys across the pond are having more issues with NP scope creep).
Doctors self denigrating themselves to NPs/PAs in private, at the workplace, as a joke, is fine. I do the same with PA colleagues here. The same is not true of public videos - people are liable to actually believe doctors are as incompetent as your character is +/- actually needs hand-holding from NPs/PAs.
The reality is any competent gastroenterology registrar or consultant (UK equivalents to your US grades) would not need to ask a PA or NP any of the questions you just did.
Midlevels, especially NP, are persons with extremely limited training (compared to doctors) who are employed by a healthcare system because they are cheaper than doctors. Initially, they were to work under the close supervision of doctors, but that has changed, and they have pushed for and won independent practice, leading to worse patient outcomes.
Making the danger worse is that instead of being trained in one specialty, they are allowed to after their minimal training switch specialties on a whim and get a job in a different field. Some are great and stay in a field for their whole careers and stay in their scope, but that GI NP coulda been a psych NP last week and just decided to switch jobs and now dabble in GI because it looks fun.
Him asking for info from someone else isn't the problem. Its his incomplete and false explanation as to what an NP is and is not.
NPs have to pick a specialty and they go to school learning that specialty. They can't just switch on a whim.
@LydJaGillers this is (mostly) factually inaccurate. Both NP and PA can switch specialties at any time. NP may need to get additional certification to such from adult to peds, but within the relm of their patient population, they can switch in-between subspecialty from GI to neuro to nephro etc
Very well said
@@LydJaGillers -- there is no such thing as a "Dermatology NP" but see how many claim to be that. It's ridiculous. A "certification" to switch specialties? Ridiculous.
completely wrong. They can and do switch on a whim. I've seen it constantly. They get very vague generalized training and then just do whatever specialty they want. Doctors actually get specific years long training in a certain specialty and cannot just change specialties on the fly.@@LydJaGillers
"The MAs and CNAs in my clinic have been working here longer than I have and have a lot of first-hand experience. I ask them for advice all the time." That's how you sound.
What an idiotic comparison.
First hand experience doing what?
@@psychiatricallyinclined 500 hours of training lol
@@Doc_SchmidtYou’ve already lost the debate, Dr. Schmidt.
@@SteveAustin-ru5krplease don’t insult real doctors by giving him that honorific
This to me is like saying a line cook is just as capable as a chef in the food industry. Maybe here and there, but as a whole it's just not true.
Exactly. there is no way you would let a flight attendant or junior officer fly a plane in place of a pilot. Why should medicine be any different?
Yeah this ain’t it chief
Sick daughter?
Oh Please. Stop right there.
There may had been a good intention of starting NPs at some point of time but right now its all how to increase profitability for hospitals and groups. 8 out of 10 NP won’t be your “practiced years and under supervision”. They will be from online diploma mill, today FNP, tomorrow aesthetic derm clinic NP just collecting checks. No oversight, no concern. But hey at the end it will keep practices making money.
Shameful that you painted this one sided story in your video.
Yeah this isn't a good look. I've repeatedly seen NPs not even have a clue about basic physiology. Doing things like using silver nitrate to close an actively draining cellulitis...
I don't trust an NP at all who doesn't have gray hair 😂. They are a way for hospital admins to make money while delivering online-degree care.
Sure but with that attitude I also have to remind you that per JAMA, US physician diagnostic accuracy ranges from 5.8-55% depending on case difficulty due to overconfidence and failure to consult research and peers, so your 20% odds of finding a clinically experienced NP might not be too bad in that light..... now go do your CME :p
@@alakaniWhich paper is that? I am not doubting you. I am a radiologist and I just think that 5.8-55% is too high of a number so I want to critically appraise that article :p
@@alakani does 5.8% diagnostic accuracy even make sense? If that was even ballpark correct, people would have like a 90% fatality rate from life threatening diseases. Either think critically or cite the article next time please. For those numbers to be even close there have to be some major caveats.
Especially the aesthetic derm NP, they just want money for as little school as possible, “I’m practically a doctor with less school” Ive heard many say it
Really ruined it with this one. Look harder why your peers are rolling their eyes at you. Before you defend this anymore, really take a break and look inwards.
Bro what?! What's the point of residency and fellowship?! This guy is simping for the mid levels and inflating their already huge ego
Of course physicians have the superior training, as I said in the video. The point of this video is that properly trained NPs can still offer capable, valuable care under supervision of a physician. Perhaps my own positive experience with NPs and PAs has skewed my thinking but often in GI settings, NPs can hyper focus on certain aspects of the outpatient setting (IBS or Hep B treatment for example) and over time gain a lot of experience and expertise in that area (in some cases, even being able to remind highly trained physicians of nuances that you would likely forget if you’re not treating certain diseases on a daily or weekly business). The buck of course stops with the physician as it is ultimately their patient but trying to discredit NPs to the point of banning the profession is just silly and a disservice to the medical field. We need NPs (and I’ll admit we need them to practice appropriately and within their scope) and they need us
Let's see that same spirit when they obtain privileges to start scoping lol, don't worry it won't be long @@Doc_Schmidt
@@Doc_Schmidt The problem is that they don't ACTUALLY think they need you.
I love how a direct phone call turned into “I ran into them out there”
And how he owned her contribution to the fool's care without giving her credit...
@@yellowrose0910 i think that stems from the probability that he wouldn’t have accepted the doctors word if he told him that the NP was the one who had the idea.
@TheClonetruper Yeah but that's the point: use this as a teaching moment to stifle his ignorance. Or choose to continue the prejudice. Because mid-levels are members of the team to be appreciated. Not every patient requires a specialist (neurosurgeon, cardiologist, ortho); that's why we have GPs/PCPs. Similarly not every patient requires a GP; that's why we have mid-levels. They're well sufficient for many problems and patients. It's just arrogance and conceit for physicians to belittle mid-levels. They're used to working with residents and in a lot of ways (depending on the jurisdiction) there's not much difference.
Shame on you Doc Schmidt
Wow. I’m glad your decade of training with physicians to become a physician wasn’t enough and you have to ask an NP for help as if you're equals. Good to know though that if I ever go to your GI clinic, that you’ll ask an NP for help regarding my condition and not another physician.
Thanks for watching. Sorry you’re upset
@@Doc_Schmidt You are sorry, indeed.
@@user-yt3ze8wl2w nice one
@@Doc_SchmidtYou don’t believe your own words, IMO, Dr. Schmidt. You work with these providers, we get it.
Just stating the truth. Glad you agree.
Are we really simping for NPs now?
How to tank your standing with your colleagues 101. Tough to see.
Ah yes, respect aka simping 😅
I can't wait for Loyola to respond to this. How embarrassing for Ben.
@@Doc_Schmidtrespect? You either can’t tell when they are making major mistakes which is about 70% if the time in my experience, or you aren’t even checking up on their work and have no idea what is happening. In both scenarios you don’t look good at all. I respect my colleagues, I don’t respect NP when it comes to practicing medicine, they aren’t even comparable to an intern. I only consult people I respect for advice on difficult medical problems, if I’m unsure about it, no NP is going to be close to the mark.
Dropped the ball on this one..
This video is very misleading and frankly really dangerous… MD’s and NP’s are NOT equivalent, they may work and collaborate on the same team. Despite the disgraceful trend of physicians being replaced by NP’s, if you or someone you care about have a serious medical issue make sure you are seen by a PHYSICIAN.
On behalf of all physicians, this is BS and I’m quite disgusted by this video coming from an MD. For every NP who knows what they’re doing and refers to the physician in a timely manner when needed, there are 50 more who are overconfident and lack knowledge. The “collaboration” between an MD and NP in their respective fields is completely one-directional, as the knowledge and skill gap is astonishingly large. I have known NPs who have worked in a field for >10 years and seem to be quite good at what they do, but as soon as they exit their safe “bread and butter” territory, the lack of training becomes disturbingly apparent. I encourage everyone to be seen by a physician, MD or DO.
@@doctorpostingit hasn't even been up for more than 12 hrs. Unless this is a reupload, it just looks like you just made that up? Through I could be wrong 😕
@nughoul you are wrong. There is a vibrant group for physicans on Reddit which has been actively discussing this post. Most if not all comments are scathing critiques
@@TusharSingh-zh5tq yeah uh... if it was an actual irl or organized (owned) website group I'd say that would be trustworthy to say this group is mad, But a reddit group?
They really should have specified reddit because it's really left field. It's "physician groups" v.s "a reddit group with physicians in mind" and they said plural, so I assumed it was actually multiple different groups.
I’m not inclined to take any advice from someone with an ableist slur in their username.
@@thekaren1111 Let's imagine you spend a decade dedicating your life to something. You dedicate every single day to learning everything you can, so that you can be an expert in the field. Some days you work for 18 hours, and that's just a normal day. After completing all this training, you come into work one day and see a 21-year-old who just finished two years of online classes. They mention that they worked full-time and had kids while taking these classes. How can they possibly learn anything like this? Unsurprisingly you notice that their knowledge is lacking, their hands-on skills are abhorrent, yet somehow they are more confident than you are.
Welcome to the world of midlevels in medicine. If you could see it from our perspective, this video would be shocking to you as well.
If an NP is supervised, sure. But, they do not have the same scope of practice and should be referring to a physician for more complex cases. But how often does an NP at a Urgent Care refer versus just giving a ZithroMedrol pack?
Now, I completely agree that we need NPs to extend our physician resources, and many are perfectly capable of being a PCP, but we shouldn't pretend they are equals.
What a sellout with the false equivalencies here. If he's really exchanging ideas like this with an NP, I would never go to him because he's obviously lacking in medical knowledge
So anyone who doesn’t know every single bit of information off the top of their head is incompetent?
@Doc_Schmidt you really needed an NP to tell you medicines should be renally dosed if there's elevated creatinine, like in the video?
@@CitizenofDystopia that’s not what happens in the video
@@Doc_Schmidt You are 100% a sellout and a disgrace to the medical profession. I have unsubscribed. Hope none of my doctors in the present or future have the attitude you do surrounding midlevels. They are incredibly dangerous and undereducated. It's a shame I'm replying to you with this, but I had to. Why don't you stand up for the exhausted medical students, residents, and fellows who are underpaid and overworked instead? Nursing is nursing, even if they're an NP, DNP, or some other quack who tries to be a doctor without the education.
You won't be consulting the NP in the future when they take your job because the hospital administrator you work for wants to save a quick buck. Your job isn't safe--no one's is.
@@min_g2608 how is he a sellout?! You people need to grow tf up!
ew ... I guess you had to focus on your residency more than "comedy sketches "
I don't understand this comment
Pretty disappointed by this video. Have followed you since the start of your vids but you have really just done a disrespect to your profession and colleagues.
I don’t really know much about different types of nurses. So I can say for me it feels like I don’t know if the nurse got a 2 year certificate like one who who beauty school and now works at great clips or did it for a year and is ready to quit. I do know doctor has way more education and trust that they are more dedicated
Nursing comes in levels. Nurse Practitioners (also called Advanced Registered Nurse Practitioners or ARNP's) have a 3-4 year Masters degree. Doctors do a 4 year medical school program, followed by Residency of 3-7 years depending on the specialty. NP's generally have to work under the supervision of a licensed physician, just like residents do.
@@erininaboxa NP degree is not 3-4 years. It is 2 years after getting a BSN. Doctors have about 12 years of education until they’re making real money and practicing independently. Not even close to the same thing.
@@erininaboxAlso I can’t tell you the last time I saw an NP and a doctor was anywhere in sight, maybe a phone call or two while he’s overseeing 5 other clinics.
@@MsAwesome6814 The ones I researched when trying to decide if I wanted to go that route were all 3-4 years long. You should base your criticism on facts rather than anecdotes and grudges. Even when the program is shorter, it's still a Masters degree, not a community college certificate. And to be fair, the work those nurses do at the 2-year certificate level is also valuable and important. Also not the same as a doctor, but not less valuable or necessary.
3-4 years? LOL you can literally become a NP with zero background in nursing, online, part time, in 2 years @@erininabox
Gotta admit, my experiences with and opinions of NPs are mostly bad.
They are not comparable to doctors but they are overconfident and entitled enough to pretend to be equivalent and most do not actually seek doctor input cause their arrogance (or maybe insecurity?) leads them to believe they don't need it. And then the patient suffers the consequences.
I do try to avoid NPs whenever possible in favor of seeing a doctor instead, as is my fucking right as a patient. I don't care how that makes a nurse feel. Their training simply is not remotely the same and it shows. It's dangerous.
Imagine being a GI doc and not know if your patient has decompensated liver failure or not. Yikes.
It's just an example to illustrate a point. Doctors occasionally forget details about their job just like any other professional. Luckily most doctors have teams to support them and help prevent things from falling through the cracks
@@Doc_Schmidtit means you don’t know your patient. I destroy residents who are this careless. How did you get this far in medicine? Are you happy with your midlevel oversight? Does she sign off on all your notes? Do you ask her permission to scope patients? You are an embarrassment to this profession
I sill prefer a doctor. The copay is the same
Did you seriously call a midlevel regarding med dosing? Buddy, that's below intern-level....
It’s google level
@@Doc_Schmidt Exactly, so why would you need to consult the NP instead of google lol. better yet, why have an NP at all if we can just google (considering thats the depth of their knowledge base, probably)
With people as prideful as you, no wonder healthcare system is in trouble. That you would try to shame a physician for seeking guidance from an experienced colleague in healthcare is unfortunate on your part.
Constructive feedback. I think this video woulda been ignored by the physicians as just irritating rather than infuriating if a few things had been done different.
1. You named it physician vs nurse practitioner which leads me to believe you wanted to stir up drama. Did you seriously not realize that title would prime your physician base to feel the need to defend the profession before even watching. You had to know this is a huge problem and strong opinions with this topic.
2. Big issue was starting the skit by discouraging a patient from trying to see someone with the training and education he prefers and further enforcing the message that the patient woulda been better off with the NP because you didn't know something you really shoulda been able to handle on your own. Im not against getting help from whoever the hell can help you but this sequence of events were giving a terrible message. Theres no way you didn't know physicians are pushing for patients to seek clarity in who they are seeing, undetstand what it means and speak up about who they want. You could have even had the patient give an example of a bad experience he had with a midlevel and said "yes, unfortunately that can happen. Im lucky in my group coutney has been practicing GI medicine her whole career and in our practice we work closely together incase she hasn't seen something before, i know that's not always the case but it is here so try not to worry if you sometimes do see Courtney"
3. A better example of "collaboration" woulda been something like getting a call from a pharmacist informing you that the patients insurance didn't cover a med and saying to the NP next to you.. "hey I'm unfamiliar with what med this insurance company covers, what have you had success getting covered?" And then maybe even having the phamacist help with dosing.
4. Making it clear that this has been YOUR experience with SPECIFIC NPs and it is not true of all NP. For example when the patients said "what if i had something she hasnt seen?" You said the NP doesnt work independently. This may be true IN YOUR CLINIC but it is just factually wrong for most states and is one of the biggest issues physicians have with midlevels.
Remember, please demand a physician always! Mid levels are a joke and unsafe! Demand real doctors for you and your family, not those playing dress-up! @@thekaren1111
I’d prefer a physician. The NP didactics and clinicals aren’t near to that of an MD. NPs have a place in PCP offices, alas, as advanced practitioners in specialty offices: it’s a big NO for me. You can be as ameliorating as you’d like, given you work with them. The NP is an answer to staffing problems.
NP "didactics" are nonexistent (90% of their curriculum is on lobbying and advocacy) and their "clinicals" are 500 hours of shadowing
Man this is really embarrassing :/ to think you’re a doctor whose gone to medical school, residency, and fellowship is posting this
Has Loyola been notified? @@doctorposting
Down vote. Unsubscribing. Doctors for patients!! no more online NP, CNP… 😕
I wouldn’t recommend an online only NP either 😬
One of the places I brought elderly clients to the doctor abruptly resigned and they offered APRN'S instead. There were no more doctors on-site. Received a voicemail from my Dad that his side of the family had hemochromatosis before passing. Like to have blood analyzed and someone to review what they see. No one discusses things in depth which is hard if you are weak and tired alot.
So after 4 years of medical + 3 years of IM residency + GI fellowship you need to fall back on the knowledge of someone who may or may not have had RN experience + 1 year of “masters / doctorate level nursing training” +
Think of what the content of this skit actually entails. We don’t go to med school, IM residency and fellowship to memorize the dose of Entecavir. We learn concepts and physiology and pathology and medicines along with the knowledge of how to obtain minute details like doses. I’m not sure if you’re being intentionally obtuse but I’m certain you don’t have every dose or rare contraindication for EVERY medicine you EVER prescribe memorized such that you can prescribe them without any reference. I’m not sure why using a colleague like an NP or pharmacist who might prescribe or work with these meds far more often than you is any worse than looking it up in a database.
@@Doc_Schmidt I disagree with you.
And I think it is objectively better to fall back on a database than an NP. In addition the experience from the min 15,000-45,000 hours of clinical experience from medical school and residency I think would trump the usual NP. Especially now in days where many have no experience before NP “education”.
But your response was very eloquent. I appreciate your willingness to engage me.
Forgive the aggressive component to my first message. Have a good day.
@@Doc_Schmidt takes 1min to use UpToDate to look it up
@@Doc_Schmidtdude, you don’t look up prescribing guidelines for yourself? After looking up a medication dose three times you have it memorized, and why would you rely on an NP who has seen these rare disorders fewer times than you for prescribing information? I’m more horrified that you didn’t even check the patients chart before seeing them, so you didn’t even know they were decompensated and a nurse had to set you straight. My interns are better than that. How is it you didn’t learn the basics as a 3rd year med student?
Disappointing coming from a physician.
Collaboration with other providers like NPs is vital
you misspelled *nurses*@@Doc_Schmidt
Considering NPs to be the same as nurses is a fundamental misunderstanding of the situation and the healthcare system.@@MrMegladon9
@Doc_Schmidt 20 years ago, I would've agreed with you. But the recent "explosion" of the midlevel providers racing to autonomous practice, bypassing the years as a bedside RN as they used to, coupled with the rise of barely accredited online NP programs has turned a majority of NPs into a major liability. The research is finally starting to show their incompetence and the detriment to positive patient outcomes as compared to physicians. Credit for this is due to the ANA and AANP's lobbying efforts for nurses to achieve full practice autonomy, as they have now achieved in 26 states. Older physicians (and physicians like you) have FAILED to safeguard our practice and our patients. By putting out videos like this you are doing a tremendous disservice to patients, your peers, and the next generation of nurses. @Doc_Schmidt
Why don't you tell us what the "N" in "NP" stands for? @@Doc_Schmidt
And this is where I unsubscribe.(not that you care, I just can't support this) Seriously dude? If you get through a whole ass fellowship and still don't know as much as the PA/NP that means you're not a great physician...it does not mean the NP/PAs are just as good if not better. How dare you act like a physician and NP/PA knowledge base or education is equal. Physicians are working to prevent scope creep and protect patients from the damages mid-level providers are doing and against the fact that they are pushing for independent practice. Studies show that mid-level in the ED require more time, order more unnecessary tests costing the patient more, and have worse outcomes. Your comment of them not practicing independently relies on them recognizing they don't know something which failure to do so has led to patient deaths that I've seen first hand. Are there good PA/NP and bad MD/DO absolutely, but this is the exception.. not the rule.
This is correct. The overly negative first few sentences dilutes your message but, still correct.
@aweisen1 it is very negative,and I shoulda used more decorum but it's just infuriating to see potentially dangerous videos like this come from doc RUclipsrs while the general public don't know the truth. Yes mid-level spend more time which patients love but it doesn't lead to better outcomes and they aren't pressured to see as many patients. They get to piggy back off our medical licenses and put them at risk. Medical licenses that we sacrificed our youth for in 14 years of school and training and went into 400k debt for to just have some youtuber act like we are equivalent and dissuade patients from asking to see the real doctor.
@@doctorm4067 I agree. I am very concerned with the unintended consequences this video poses.
Yeah, this is major selling out. I'm disappointed in Doc Schmidt.
I gave you the benefit of the doubt so I came to check this video out myself.
Shame on you.
Oh and NPs have secured independent practice in 32 states so far, I hope you won't regret your decisions of belittling doctors for social media clout.
Sell out
Yeah this video isn’t gonna go over well
I"m Canadian and have a nurse practitioner for my provider. I receive excellent care from her and she's the first provider I've ever had that actually did a physical exam when I presented with complaints, took a full history, and listened to my complaints. She did all the testing and referrals to GI to get me diagnosed with my IBD vs the series of MD's who dismissed me as having hemorrhoids or just being anxious without investigating. She operates completely independently as a primary care provider with her own patients.
I wouldn't have guessed you'd be pandering to the MBAs in the C-suites.
Why are you trying to convince someone to take their sick daughter to an NP to save the hospital money?
Hey, hopefully they give you some of that sweet admin money right?
This speaks to the (poor) quality of your own clinical acumen
Because I don’t know the cirrhosis dose adjustment for Entecavir off the top of my head? 😅
@@Doc_SchmidtThanks for being a voice of reason. The outrage is telling. Do you think they also thought this was a real patient and not you in a wig?
@@psychiatricallyinclined Boot licking, really?
As a patient, I'm concerned by the general attitude I'm seeing from doctors in the comments here. From what I've seen with similar divisions of labor in other industries and areas of life, if time is of the essence, I want to be seen by someone with experience, regardless of education. If accuracy is more important than quick and decisive action and weird things are going on, I want to be seen by someone with education, regardless of experience. And if I'm dying of something totally baffling, I'd like to see the two working in parallel, either cross-checking each other hands on, or with the experienced one keeping me alive while the educated one hits the books to figure out what's going on. And what's scary as a patient is the acrimony that doctors are displaying towards NPs and the allegation they are making that the feeling seems to be mutual. I'd rather be seen by someone with neither education nor experience that could fall back on someone with just one of those factors than be seen by a pair of individuals with both education and experience that were constantly backbiting each other to the detriment of my care.
This is horribly dishonest and disturbing. NPs aren’t MDs. And the fact that you as a physician don’t know how to dose meds shows more about you than her.
You are doing a disservice to doctors when we are living in a time that care is jeopardized bc of scope creep. There is a place in medicine for everyone. But NPs have a role and that role isn’t to play doctor.
Let me know how it goes when you're transferred to the ICU and knocking on deaths doorstep, do you want the critical care physician or the nurse? Look inward, only you know that answer.
As a patient, from how such divisions of labor generally work in other industries, what I really want is a nurse practitioner taking care of keeping me alive while the physician hits the books looking for a root cause.
Shilling for midlevels
Putting a physician and a NP side by side as equal is such disingenuous virtue signaling move. If it was that simple, nobody would spend 15 years in rigorous medical training. This clip is shameful and a disappointing
You’re not familiar with how to dose medications for hepatitis? It’s one thing to ask for experience on switching meds on patients. It’s another to show you can’t even look up a medication on UpToDate.
Come on dude, a med student could’ve done that. They teach that before med students start clerkships. How is a fellowship-trained GI specialist unfamiliar with that?
Lmao im sorry but my psychiatric NP misdiagnosed me with an extremely stigmatizing personality disorder after exactly ONE appointment so I do not think this is true in all cases.
Definitely not true in all cases. (Few things are)
@@Doc_Schmidt very fair, and to be clear i've also been treated by NPs who were great, but that experience definitely scared me off a bit from seeing one for my psychiatric care, specifically. She also abruptly dropped me as a patient over a minor miscommunication about billing (on her end, she said one thing and then did another) which definitely didn't help.
Wow, this is.. interesting. Either you are tremendously incompetent, poorly trained gastroenterologist, or an industry shill and you’ve taken the PA lobbyist dollar. Which one is it? Either way, pretty shameful.
Nobody can know everything all the time. We all use resources, whether that’s books, UpToDate or colleagues on our team. Not sure what’s shameful about that.
@@Doc_Schmidt if you have to ask why it’s shameful then you’re already a lost case I’m afraid. If you genuinely don’t know they answers to the questions you asked a PA, then you don’t know what you’re doing, and the person you are asking is worryingly incompetent based on what she asked you. I would be embarrassed in your position to ask a PA for clinical advice. I suppose you could ask something like “how do we get Mr A in for an urgent iron infusion?” but that’s it.
PAs can sometimes develop niche knowledge greater than a non-specialist in the area they work in, but this is not what you’re trying to show. You’re trying to show equivalency with an attending physician in the same speciality; it’s bollocks. You have an agenda. Shame on you.
unsubscribe
Sorry I disagree. NPs due to their limited formal training, can provide very limited care and would need close supervision. Even a seasoned NP cannot compare with most MDs. As an example, when I was a resident, I went to a GI clinic bc I needed one before a colonoscopy. I was seen by an NP in her 50s who has been working there for 10+ years. She made 2 major mistakes when explaining her rationale of doing things which showed even though she was taught what to order, she did not understand why she needed to order them.
In addition, I'm currently a fellow, and I have to say my worst consults and the rudest interactions were all from NPs and PAs who thought they are better than MD trainees.
I think our generation of doctors have not been taught to respect our self worth and the NPs have been taught they are equivalent to us. We should protect our own practice.
You should’ve kept this one in the archives. All you’re doing is spreading misinformation.
Oh I see. The stuff we're learning about in medical school actually does get used 🤔
sellout
Wow! Physicians and NPs are not equal. You are compromising patient safety by spreading misinformation. You made a joke of yourself and tried to drag all physicians in it. You lost so much respect from your colleagues. I know you want more subscribers and likes and hence spreading this misinformation. I used to enjoy your content but now after this video, you are not worth watching. Think what you did wrong before defending yourself. Unsubscribed!
how about when there is no doctor in the office, clinic or er and you have only the NP?
I think this video is on point. Talk to the NP if you feel they cant solve your problem then you ask for the MD but degrading the NP like they are inadequate is bs. Guy prob has heartburn
LOL if you need to ask a NP for management. you are not deserved to graduate from fellowship.
Good lord what a horrific video
While very much against the NP/PA being equal to MD/DO and OPPOSED to independent practice of mid-level practitioners, I think the point of this video is that physicians need to be open to all streams of information from other healthcare professionals in regards to patient care - including the NP (but not limited). So the point of the video should be applauded and well-received, just because doctors have xyz training they have to respect the input of others and create a cohesive work environment for all in order for the patient to benefit.
However, I do not agree with the presentation and it might be overtly pandering and creating a false equivalency. Everyone I know in medicine has stories regarding PA/NP mistakes, I worked with a PA myself that was unsure how to check a blood sugar and had to be taught by a medical student. I believe that we are becoming over-reliant on less trained "providers" to the point that some hospital executives are not adequately staffing physicians (not to mention the ridiculous barriers (financial, exams, time, geographic hazards) we place on American college and medical students).
Not to mention that almost no NP school offers didactic gastroenterological curriculum - nor are they licensed to practice gastroenterology by any medical board - nor are they tested regularly to ensure they are up to date on their knowledge of GI.
Not to mention the tremendous stress and sacrifice that US medical students go though - finding a medical school willing to accept them getting into 300k of debt at 7% interest rate, taking increasingly difficult exams with limited time to study (especially shelf exams and rotations), taking 9 hour + exams on a regular basis - then even after all that being unsure of whether you can be close to your family and loved ones for your medical training where you are paid less than minimum wage per time spent at work and also asked to study, do research and teach others. This is in contrast to the numerous NP schools (including online) that you equate to the same thing. No residency training is necessary for NPs the obviously cannot access MD residency programs (due to lack of USMLE exams) and have very few "1 year" programs that essentially are shadowing other midlevels - compared to at least 6 years in the respective MD training pathway that is far more involved.
Then finally you are lucky enough to be an attending, your parents are elderly and frail, your relationship may struggle, you may have age-related fertility issues and have to adjust your family expectations - not to mention the 300k at 7% is now 600k and preventing you from buying a home let alone the life you want to lead.
I think this is a good check your privilege moment from someone that pays attention to entecavir doses and am not the xth generation physician in my family. This video deserves correction and some mention of the struggle of medical training. Physician/medical student suicide is a real thing and the amount of work we place on them only to say that an NP with far less work/stress is equal is ridiculous, contributory, and dangerous.
Very well thought out comment, I appreciate the time you put into this and have to say I agree with everything.
I've used "ran into them I the hallway" to mean searched them down in the doctor's lounge to get the answer. Lol
Im my country nurses are lower on the food chain
Sad to know you got sold out too to the NP lobby, it's a shame that you're putting peoples lives at risk by downplaying the danger posed by midlevels
Nice of the Dr to defend this NP but sometimes you just want to see the dr.
And that's ok!
He makes the same $$$$$ regardless. @@Doc_Schmidt
Love the video
Unless you present with hemochromatosis and the gene test only tests as a carrier but you definitely get better after the blood draws. 🤷🏻♂️
You don’t deserve to be a physician if you seek advice from a nurse on medical management
It’s important to get input from everyone on the medical team when making a treatment decision
Yikes… I cannot believe you actually posted that. Unethical and disappointing.
Nurse practitioners are great if in a system that incorporates them so you still are in a room with your dr. I had one where alarming results were just shrugged off my the offf site dr and I was never able to ask for further test. My NPrs (they were the only ones in the building as the dr was across town where I was not permitted to go) always said “we will keep an eye on it” when I expressed concern. Because they not empowered me bough to be a primary.
This is GROSS!!! 🤮
What kind of NP knows dosing and adverse reactions to entecavir but has no understanding of how to read a mfin iron study??? If anything, this clip shows the massive disconnect between midlevel and physician training.
Sell out. Nice that you want to push economics of low supply of physicians and hire more midlevels.
And we're unsubscribing today.
Because of a single video I posted 10 months ago?
Nope. I want a Dr.
So much toxicity in the comments for a video essentially saying it's a team effort.