[NPInfo] My Reply........To Shelby

Thu Sep 6 10:24:36 PDT 2007

I must admit that I agree with Dave. I have felt for many years now that our value (in the health care environment, to decisionmakers) is that we constitute "cheap doctors." The first time I said this to a colleague, she was shocked, and insisted we are valuable because we are so"caring" and "spend time with patients." 

We all like to think we are special and that there is something that sets us apart as a profession. Actually, I take back the "we," because like Dave, I am really not sure there is something different, except that our scope of practice is more limited. It took me many years to see this reality.

I have seen enough caring doctors and uncaring NPs to know that it isn't fair to make broad generalizations on that basis. I have seen excellent patient education being done by doctors, especially the baby boomer generation of docs and younger, so I don't think NPs can really claim to be superior in that way, although we may once have been, in the 1970's and 1980's.

As for being cost-efficient: I don't think that has ever been demonstrated, though people have tried. It would have to be a well-designed very lengthy longitudinal study with a very large sample. And "spending more time with patients" is not cost-efficient. 

As for caring for the underserved: there are probably as many doctors caring for the underserved and rural populations as there are NP's. It all boils down to whether or not you can support yourself with a particular type of practice. If I were a specialist with 4 years of med school, 3 years of residency, one or more years of specialty residency and a year or two of fellowship training, and the loan payments to show for it, not to mention the overhead (including expensive office equipment to amortize), I doubt I would work for peanuts.

Bottom line: I think our value is that we are inexpensive: our education, our "care & feeding" (license and certification fees and malpractice premiums, etc.) and the fact that we are available for a salary and if we work for a business, they don't have to share any profits with us if they don't want to. They can give us all the lousy hours MD's don't want to work and all the scut work MD's don't want to do. Hospitals--same thing. NP's are the new "house staff" since residents/interns aren't allowed to work 120 hour weeks anymore, or whatever ungodly hours they used to work.

Finally: if we are special, I think the public will tell us how. I don't think we should have to mount a PR campaign or deliberately strive to define ourselves according to some attribute or another. What we are will be obvious enough.

Acquiring and using political power would be a better goal.

. The 
> question is
> who will care? Insurance companies don't. They only care about 
> paying us the
> least possible.
> Health planners don't, they want to have the same quality as 
> docs at a
> lesser cost.
> The government does and does not as they are faced with the same 
> problemsthat the insurance industry faces. How to get most from 
> a buck.
> And WE hold ourselves up to providing the same level of care 
> that physicians
> do (remember the NP article in JAMA). On one hand we strive to 
> show we are
> as good and on the other hand we ARE different. Either we are 
> trying to be
> them or we are not. A central question for both professions.
> So that leaves most of us needing to do what most have trouble doing,
> keeping up with the day to day advances in medicine. We need to 
> do that to
> be as good. We do that with less journals and many less 
> resources than
> physicians have, and we do it well.
> Do we both want to do what physicians do? Yes.
> Do we both want to be different? Yes.
> Do we want to document that difference? Yes.
> Do we both want to be different in the SAME WAY? I think so but 
> who really
> knows?
> All interesting questions.
> Thank you for bringing them up.
> Love and peace,
> Dave
> 
> 
> 
> 
> 
> 
> On 9/4/07 10:49 PM, "mmhelgert46 at comcast.net" 
> wrote:
> 
> > OK.....we need to have this dialogue ....Physician Assistants 
> must have a
> > physician at arms length( either by phone or in the building) 
> So says the
> > Board of Medicine in each and every state ....I don't see any 
> other way around
> > this one....NP's in various states need a variety of similar 
> settings called
> > preceptors, physician consultants...and other combinations of 
> these types of
> > practices. Some states are very independent...such as Oregon 
> (my state)
> > 
> > My question will always be...what are we doing that makes us 
> different, unique
> > and stand apart ?...what's the niche we fill? and what we are 
> doing about
> > making this happen. It still makes little difference if 
> physicians are "at the
> > top of the food chain"...this is not my concern...my concern 
> is what are we
> > doing to set ourselves apart from this? this is the task that 
> faces us right
> > now...this point in history when health care is in 
> shambles...it is a perfect
> > opportunity to make it happen for all of us.......not continue 
> discussing> physicians.......what makes us different then they 
> are?...if we can't even
> > figure this out...we're doomed. The dialogue cannot continue 
> along the lines
> > of "we are cheaper"...that's old and it doesn't quite 
> describe us....money
> > should never be in the description........
> > 
> > This is the part...where it gets really tough...'cuz I'm 
> describing a
> > professional...and that brings up the DNP program and that whole
> > issue..........which is the future......and this is where we 
> take our rightful
> > place shoulder to shoulder with all other 
> professionals....such as lawyers,
> > physicians, CPA...to name a few......we set the standards, describe
> > educationally what we need, we provide the statements that the 
> public must
> > see...and this must happen so we don't go the way of the 
> dinosaurs...Meg> 
> > _______________________________________________
> > NPInfo mailing list
> > NPInfo at nurse.net
> > http://lists.nurse.net/mailman/listinfo/npinfo
> > *****************************
> 
> _______________________________________________
> NPInfo mailing list
> NPInfo at nurse.net
> http://lists.nurse.net/mailman/listinfo/npinfo
> *****************************
> 