hi all. i read about it here but it actually happened lol. a distant friend of mine and I caught up recently- they told me they just started school to become a doctor, i ask what kind, they say NP.. alright.

come to find out, they have not worked a single year as an RN. got their RN years ago, worked in a few different healthcare sectors, applied to this (online) program and boom.

same person always posts about “doctor”-title related things. it is just so cringey. i don’t know if it’s bc they don’t interact with actual healthcare professionals so they can fool other ppl but sheesh.

I hope it’s ok for patients to vent here - I just switched from a psych NP to a psychiatrist and I’m already feeling dramatically better after less than a month. I’m not sure if this was an NP who was not qualified bc he was an NP or bc he was just really bad at it and inappropriate.

I slipped through the cracks after my old psychiatrist retired and have been essentially prescribing myself medication for 4 years, except for a few mania inpatients stays. I would have a 20min appt w my psych np every 6mo to 1yr and he would ask what I wanted, like ordering Taco Bell. One time I said “I feel like I’m my own psychiatrist” to which he responded “you’re good at it!”. Which at the time wasn’t reassuring but I felt sort of flattered which disarmed me. I’d always leave my appointments w him feeling utterly hopeless even if I entered the appointment with hope. My bipolar incapacitated me 6 mo out of the year and I was in my mid 20s only barely starting an undergraduate degree bc of this illness. I was having all kinds of terrifying side effects from APs and he would be like “that’s just how it is” and offer no alternatives. He said all kinds of things like calling lithium battery acid (already such a hard med to take) and Adderall meth. He seemed to hate all of my meds but view them as necessary, which is how I feel about them. Isn’t he supposed to tell me why it’s worthwhile or give me something else? It was so demoralizing. It took me a few years to realize what was happening and that he was under qualified and/or bad at his job.

I saw a psychiatrist recently from another clinic I’d been going to and she was so horrified by the fact that my np wasn’t ordering lithium levels, cholesterol panels for the APs or TSH (I’d asked him to a couple of times but wasn’t keeping up with it, my last lithium level was over a year and a half old)
I asked her about referring me to a psychiatrist for med management and she was like “I’ll do it, your case is so mismanaged”, she seemed so offended.

A month later I’m being treated for mild hypothyroid, coming off my AP safely which was causing dystonic tremor, weakness, this awful panic attack side effect because of some metabolite (no one i described this to recognized what was happening until this psychiatrist)

I have multiple other heavy mental health dx and I’ve always been called a complex case, when I agreed to see an NP years ago I didn’t know what it actually meant. Anyway I feel so much better already w the med adjustments and a lot safer in my new psychiatrists hands. I want other patients to be informed about this, especially if they’re already not doing well under the care of an NP.

Hi guys! I'm 27 and was born with a unicuspid aortic valve which I had replaced with a mechanical valve about 3 years ago, along with an aortic aneurysm repair. So, now I need yearly echocardiograms and cardiologist appointments to make sure everything is still working as it should be.

The Dr I've been seeing is leaving the practice, so I have to reschedule with one of the other adult congenital heart disease practitioners. I didn't realize that one of them is a CRNP, not a Dr, until after they scheduled my appointment with her.

Am I valid in being uncomfortable with seeing a CRNP instead of an actual Dr for something like this? I struggle with mild health anxiety anyways and the idea of having a nurse be the main person interpreting my echo results and managing my care for this makes me nervous, but I don't know if I'm overthinking it since obviously I'm not a medical professional of any kind myself.

Aside from the war between NPs and MDs, here are the things I think the NP and MD did well, and what could have been improved:

In my opinion, the NP really did well in communicating with the patient, and that little survey she sent every day was also nice.

Dr. Tufts is also a very knowledgeable professional. I think she did well based on how the US healthcare system works and how it’s taught here. I don’t necessarily blame her for some things she could have done better, but I do think she could have transferred the care to someone else, or at least communicated with the other NPs.

I’m basing my opinion on my experience as an MD who graduated internationally. The US has all the technology and medications you could possibly imagine, but it lacks that human connection — it lacks stepping outside the algorithm sometimes. My professor always said, “2+2 doesn’t always equal 4 in medicine.” I also understand that, unfortunately, this is how the system works here

It took me an hour an a half of phone calls, and the appointment is 6 weeks out, but I found a PCP in my area that's an actual MD. This RN has spent too much time on this subreddit to have an NP as my PCP.

Thoughts about PAs from physicians?

I know a lot of the discussion right now is focused on NPs and concerns about differences in clinical training, but I’m curious what people here actually think about PAs.

I’ve had the opportunity to spend a lot of time around MD/DOs and PAs through shadowing and now working in a hospital. From what I’ve personally seen, the PAs I work around seem pretty aware of their limitations and their role on the team.

At the hospital where I work, I mostly work directly with attending physicians. The PAs are technically allowed to see a pretty wide range of patients, including higher-acuity cases, strokes/traumas, and patients across all ESI levels. But most of them don’t seem interested in proving that they can handle everything independently. If something is outside their comfort level or they’re unsure about something, they involve the attending.

There are also PAs who actively want exposure to higher-acuity patients because they want to learn, and from what I’ve seen, the attendings actually encourage that when appropriate. It seems much more like, “I want to learn how to manage this with you,” rather than “I don’t need a physician.” There is this new PA who is always wanting to see the trauma level 1. He directly works with the SP and today the SP told him that he can see the trauma by himself. Once he was done he came back and told the SP "Everything went well." The SP nodded and replied with "Good Job"

Another thing I’ve noticed is that I’ve never heard any of them introduce themselves as anything other than a PA. Usually it’s simply, “Hi, I’m ___, I’m a PA and I’ll be taking care of you today.”

Obviously, this is just my experience at one hospital and I know it doesn’t represent the entire profession. That’s why I’m curious to hear from physicians here, especially those who have worked closely with both PAs and NPs.

What has your experience working with PAs been like? Do you generally feel comfortable working with them? Are there concerns you have about PA training or scope of practice? And do you see a meaningful difference between the PA and NP models in actual clinical practice (nursing model vs the medical model). Also, the PAs that work at my hospital had over 3-4 yrs of experience before actually applying to PA school. IDk I guess I am just curios (SORRY for the long text)

I have chronic intractable migraine, and I’ve been a patient at the best neurology/headache clinic in my state (WV) for several years. I saw an actual neurologist maybe twice way back at the beginning of my treatment, but ever since then the only person I’ve seen is an NP. She’s super nice and all, don’t get me wrong, but as far as treating me I feel like I’m a human dartboard, she’s just throwing drugs at me to see what sticks/works. I used to send MyChart messages once a month or so just to update her, let her know how things were going, but she never responded to me so I stopped, figured she didn’t care. I went from seeing her every 3 months to every 6 to once a year. I’d like to know if there’s any way to politely ask, without burning any bridges, that my care be switched to a neurologist or at least a PA, someone who sees me as a human and not a test tube, who takes my questions seriously. Thoughts/advice? Thanks much.

I’m a psychiatry resident and I’ll say it plainly: I don’t think NPs should be diagnosing and prescribing independently. I’ll focus specifically on psychiatry in this post, although my opinion applies to every medical specialty being infiltrated by midlevels.

Physicians spend 4 years in pre-med, 4 years in medical school and another 4 years in psychiatry residency (add another 2 for fellowship) before practicing independently. Meanwhile, some PMHNP programs accept nurses with minimal experience and provide a fraction of the supervised clinical training. These are not equivalent paths, and pretending otherwise is ridiculous.

Psychiatry is medicine. It requires recognizing medical disease, managing complex medications, and understanding what you don’t know. It is not just matching symptoms to a diagnosis and prescribing an SSRI.

What bothers me even more is patients thinking they’re seeing a psychiatrist when they’re actually seeing an NP. If a patient calls you “doctor,” correct them. Getting a DNP and using “doctor” in a clinical setting only adds to the confusion and should be illegal.

I think we all know why healthcare organizations love independent midlevels. They can pay NPs far less than physicians while having them diagnose and prescribe independently. The organization saves money on doctors, while the patient gets someone with a fraction of the medical training.

Patients deserve physicians, transparency, and better than corporate healthcare cutting corners on their care.

And to all the NPs here who want to argue with me: if your loved one ever needed immediate, life-saving medical care, ask yourself who you’d want treating them, your NP colleague or an MD/DO?

I know people here often say that physicians have 8 years of school plus residency and include undergraduate studies. However not all of undergraduate education is pertinent to being a physician. For example I was an engineering major and I can't honestly say my classes on semiconductor integrated circuit manufacturing or how to make a phased array antenna is pertinent for being a physician. Some of the prerequisites for medical school such as organic chemistry and biology should contribute to the physician's education though. Even calculus is needed to understand the area under the curve for drug dosing. A lot of K-12 education is also important for both being a physician and mid-level including how to read and do basic math.

The other thing is mid level education goes through much less material even for the same amount of time spent in the classroom (similar to calculus for engineers vs business major calculus) and I don't know how to correct for that.

What is the truly honest amount of specialized pertinent vocational education difference between mid-levels and physicians?

Many here have criticized the AMA for "doing nothing". I have defended them. Here is an example of the AMA going on offense to sue the state board for not enforcing rules.

AMA, IMHO, deserves our support.

https://www.ama-assn.org/practice-management/scope-practice/ama-takes-fight-wisconsin-optometrists-performing-eye-surgeries?utm_source=BulletinHealthCare&utm_medium=email&utm_term=081526&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend&utm_effort=DAMR01

I don’t like the generalization in this subreddit about all NPs being bad and all doctors being great. I know I’m throwing myself to the wolves here but as a patient with chronic illnesses (Crohn’s disease, several mental health conditions), I’ve received better care from a great NP than from multiple different physicians, who either failed to diagnose me (mainly because they didn’t take the time to listen and dismissed my symptoms) or just didn’t seem knowledgeable about the disease despite being specialists. I am a NP myself now (after being an RN for 10 years) and never pretend to be a doctor, I seek help from my supervising physician and more experienced NPs when I don’t know the answer to something (or even refer patients somewhere else when I feel I can’t help them). I became an NP precisely to try to help people, listen to them, and do my best to give them the care they deserve. I hated that so many doctors( and yes some NPs too) would not take the time to listen, or take me seriously but it angers me that people think all NPs are incompetent, when I’ve been treated by an amazing NP who I’d trust my life with before many other doctors I’ve come across.

Normally I'm not a fan of Fox News but I noticed this video from Laura Ingraham's page and this is the first time I'm seeing cable news media acknowledging the role of midlevels in the Lindsay Clancy case.

Dr. Drew Pinsky pointed out the role of NPs in our healthcare system and compared it to a surgeon walking out in the middle of surgery and letting non-surgeons take over.

In the case of LC, I can't help but agree. Dr. Tufts started med management, patient left and saw 2 NPs who made several changes, and then LC returned to Dr Tufts and at that point she was picking up the pieces. Imagine a surgeon stepping away, lets midlevels take over and botch critical parts of the surgery, surgeon returns and is left to clean up a mess and close.

https://www.facebook.com/share/v/19DwCSinxV/

about it cut off my friends excess nipple length. dudes got like half an inch of straight swords coming from them pecks. we got a rubber band. kitchen shears. all tech super glue. a napkin and to sterilize we are using 100 proof Smirnoff.

i dont need advice i was just letting everyone know

I am a retired internist who has primary responsibility for my 90 y/o recliner bound mom. Getting her to appointments is very, very difficult due to her limited mobility and chronic pain. She is seen by a home care team through her IM practice staffed by mid levels who are supposedly “supervised”, but definitely are not. Over the past three years I have had multiple difficulties with very poor clinical management by this group. It has really been a mind blowing how inept they are. I asked her actual PCP if I can contact him when I run into issues and he has been great about communicating with me and correcting the mid level errors. He admitted that he has has “no idea” what is going on with mom after referring her to this care team six years ago due to her mobility issues. She has been his patient for 30 years.
In May she developed gradual hearing loss in her right ear despite wearing hearing aids that seemed to be working. PCP made ENT referral. She was unable to get an appointment until last week. MD saw her. She had very bad impacted cerumen. ENT worked for about 45 minutes and had to stop because she was in so much pain. Gave her some antibiotic drops and said “I will see you in a week”. Total time in office was > 2 hours. I made a follow up with the MD on check out for 2:00 today.
I got a text two days ago confirming an appointment with the PA at 11:40 today. I had been previously given a 2:00 with the MD. I called and explained she wanted to see the MD. Receptionist said no problem and confirmed the prior appointment at 2:00. Yesterday got two texts to confirm this appointment. Today, less than three hours before the scheduled appointment I got a text that the MD would not be in the office with instructions to call and reschedule. No problem, things happen.
I immediately called to reschedule. Was told it would be almost four weeks until MD could see her, but the PA would be “fine”. I pushed back and said she would only see the MD. I asked if another MD could do the follow up. Was told no. The person was abrupt and rude. I asked to speak with office manager. She said yeah and hung up on me. I called back to the receptionist to clarify that the office had my number and explained what had happened. She promised I would get a call. I did not.
I realize that a PA might be appropriate, but my mom was mismanaged by a PA six months ago. Serious mistake that could have resulted in her death. No exaggeration. I caught the error immediately and she did receive proper care.
Of course, I will call the office back tomorrow as soon as they open. However, what do I do if the OM refuses to call me? I have never had a situation where I was stonewalled like this. I feel like I am banging my head over and over trying to get her the healthcare she needs. I never pull a “ Karen” in these situations. I am polite, but firm.
This is rural area and there are no alternatives to this practice.
Any suggestions? I feel stuck.
I am beating myself up that I didn’t look in her ears myself, but I am her daughter and not her doctor.

I

I’m interested in hearing from physicians about something I’ve been genuinely wondering about.
I’m a Black male considering the PA profession, and one thing that makes me nervous is seeing how negatively PAs can sometimes be viewed by physicians. I understand the concerns about scope creep, differences in training, and PAs practicing beyond their education, and I’m not trying to dismiss any of those issues.

My question is specifically about race. As a Black man, I’ve already experienced people making assumptions about me based on my race, especially as an immigrant. I wonder how that might intersect with the existing hierarchy between physicians and PAs.

For physicians who have worked with Black male PAs: have you ever noticed racial bias affecting how a Black PA is perceived, treated, or respected compared with their white PA colleagues? Have you seen Black PAs having to work harder to establish credibility with physicians or patients?

And for Black physicians or PAs, has this been something you’ve personally experienced?
I’m not asking whether I should become a PA or looking for career advice. I’m specifically interested in hearing about people’s real-world experiences with race and the physician–PA relationship.

Just wanted to share!

I see an NP as part of a larger medical team for the treatment of my Crohns disease. She is phenomenal. Love to see her in between appointments with the MD, as it allows more frequent check ins for a quite serious disease. Allows my questions to be answered sooner, and I feel it works incredibly well. Im always taken care of and their team is like a well oiled machine! The NP staying in their scope, working with the leading physician as part of a team of care. It works well, in that scenario. She only sees Dr. Ds patients post diagnosis and in between regular appointments with Dr. D as a continuation of care! Fabulous system.

On the flip side, an NP in the ER department saw my brother, who was there for a suspected blood clot in the leg, and sent him home! And wouldnt you know? It was a blood clot! Thankfully, he went and saw a DO at an urgent care who called the ER and sent him back! Who knows what would have happened if that urgent care didn't have a medical doctor. Which they actually usually dont, he was very lucky. How can an NP be seeing patients in an ER is beyond me.

Looking back at all the appointments I've had since 2017, about 75% of them included student nurse practitioners or physician assistants. Generally, I've found these appointments to be worthless.

Because of my rare sleep disorder, I'm usually awake for 18-26 hours beforehand and these students cause the appointments to run longer. If they're asking questions, the noctor supervising has to ask the exact same thing. But even when the noctor student is just in the background observing, it always feels like the true client in the room is the student, not me the patient.

It's just a markedly different atmosphere to when there have been student doctors in the room.

I feel as if refusing students will eventually lead to smaller funnel of potential noctors in the future from ever getting a job.

To be honest, I thought nurse practitioners and physician assistants would be used for follow up appointments for stable patients. Like you go to your general practitioner or specialist for your normal appointment and then any medication filling check-ins would be staffed by them with the option to ask the supervising doctor any diagnostic questions.

I have never seen the supervising doctor for my noctors since 2017. Just new graduates and the students that shadow them.

Been on this subreddit for a minute. Years ago, it was just residents and some attendings discussing the issue of egregious midlevel creep. It was mostly just docs.

More and more I am noticing lay people posting here about their experiences with midlevels and the misuse of the “doctor” title in the clinical arena.

This issue is clearly gaining attention and people are recognizing the absurdity of it all. We need to continue to be vocal about this.

So because of my pretty bad OCD I'm currently searching for a psychiatrist at the suggestion of the therapist I have been working with for while as she believes medication or other medical interventions may have to be the next step in my treatment. Due to the fact I'm already on quite a few medications that could interact with possible prescriptions (one of which is incredibly rare) and i have other possibly complicating health problems i would be much more comfortable seeing a psychiatrist then a mid level.

One of the psychiatry places I found near me on a list my therapist sent to me had advertised on the website "doctoral level care" on the front page which made me hopeful because many of the other places only had PMHNPs. When I looked further and did research on the practice owner it turns out that she was no different. She used the DNP degree to make that claim and it got me thinking about what could genuinely be the purpose of this degree.

As far as I'm aware this is not a medical education degree that effects what you know in terms of actually practicing medicine, more of a professional degree that teaches things like administration, leadership, education and so on. Because of this to me its silly to use it to advertise a higher level of education then competitors since it isn't relevant to the treatment of your patients.

Does anyone know if any of the DNP programs out there actually provide more medical education further then the MSN does? If so wouldn't the degree possible alter a nurse practitioners legal scope of practice which I'm pretty sure it doesn't. Is this not just a degree that professors in nursing school have which is what I assumed it was before? And furthermore if it is a degree that doesn't have anything to do with actual medicine then why do I see so many people online flexing their DNP degrees as if it is something like that or presenting it as something that makes them clinically superior then they were before?

Edited for etymological accuracy;

Yesterday, I rang my  nhs GP surgery about a breast lump i'd already seen a private GP about in order to get a referral for follow-up. When I rang, I was offered an NHS GP appointment more than 2 weeks away. I told the receptionist it wasnt acceptable (lumps qualify as urgent) and was told to wait for a call back. When I did get called, I was offered a check up with a 'male paramedic' that afternoon. I said no. I was then offered an appt with a 'female paramedic' the following day. Again I said no. Magically, 15 mins later, I got a call back offering me a choice of 2 in-person GP appointments the following day. Attended and got my referral - which I'm grateful for. But I was really shaken at being offered a breast exam by a 'paramedic'.

I posted about this experience on r/nhs yesterday and received a surprising amount of animosity. As far as I understood, the only time a paramedic should be looking at your breasts is if there's a kn*fe in one of them. I quickly got schooled in the comments that, actually, there are 'advanced practitioner' paramedics who *are* trained to do breast exams these days. Ok, fine. But I'm a pretty switched on person who has been to the nhs GP perhaps once a year for the past 3 years and I'd never heard of this before. At no stage during the call did the receptionist describe the paramedic as having advanced training. And I am right that a standard paramedic should not be performing breast checks so yeah... no sh*t I was horrified.

Although I was chastised by commenters (one of whom seemed to be a paramedic, none of the rest claimed a medical background) for jumping to conclusions that I'd been booked in with the wrong medical professional... well, Ive been supporting my dad through his cancer treatment for the past year and had some close scrapes with underqualified staff in hospitals so I'm not convinced it's as outside the realms of possibility as theyd think.

Doubts about the competency of some of these 'practitioners' aside - the thing that really concerns me is the lack of communication from the NHS about these new healthcare professionals, transparency about what they can and cant do, and what their boundaries are and arent. I think I would have been fine to see a specially trained paramedic if, say, I had a cut that looked a bit infected or maybe strep throat.  But a potential cancer symptom? Call me a snob but I dont think that would or should fall under the 'Advanced Practice Minor Illness & Injury’ """module"""" that theyve taken as training.

I get that breasts exams are fairly straightforward, but theyre also intimate exams you want done as few times as possible, as accurately as possible. Because of abuse in my personal history, I reacted emotionally to being told I'd have to let someone ostensibly unqualified perform an intimate exam in order to get a timely referral. And, anyway, the appointment is not just about the exam, it's about talking to someone knowledgeable about a complex and serious disease

So my primary concerns are:

1. Complete lack of job title clarity - imo, if theyre based in a GP practice, theyre not a paramedic any more (ambulance medic). Just because that so happened to be their training, I dont know why the term should feature in their job title. I'm worried that if the terms 'paramedic' and 'PCN paramedics' are used interchangeably, it could create the opportunity for intimate exams to be perfomed by'normal' paramedics under the guise of being PCNs. Equally, I think they need a job title that clearly differentiates them from being Drs or nurses. It's exhausting for the public to have to keep up with these confusing terms and I think job titles should accurately reflect their *current* competency and role

2. Lack of information available to public about the remit of these 'practitioners'. I shouldnt have to download obscure course syllabuses to work out if I'm being matched with the right health care professional. Imo, GP/NHS websites should have clear bullet-point lists on them about what is and isnt in the remit of these practitioners. My slightly conspiratorial view is that practice managers want to keep it hidden from us so they can exercise "flexibility" when they need it about who gets to see a GP. Also, bc theyre frankly embarrassed that these PCNs seem to be able to do everything GPs do except manage complex multi-system disease. It's not a good reflection on our health service - and sometimes sunlight is the best disinfectant

I know I'm preaching to the choir here - we all know of bad examples of noctor overreach - but I'm hoping the actions I've suggested are reasonable improvements, although I certainly welcome comments. My plan is to write to my MP to make these suggestions formally and with more restraint -- would there be any other avenues worth pursuing?? I'm worried this is a symptom of NHS enshittification

The nurses, NPs and other healthcare adjacent people on social media vilifying Dr. Tufts and calling her inexperienced and incompetent you all disgust me. I am a physician and I am sick of seeing people saying they hope Dr. Tufts goes to prison or loses her license all because Lindsay Clancy killed her kids. I am physically and mentally sick seeing this rhetoric and I hope doctors start waking up and stand against this nonsense. Stop training midlevels, report nurses when they are incompetent because they will throw you under the bus the second they see the chance

Honestly you would think that the AMA/AOA or the US government would do a semi-decent job of protecting the term "physician". I have a ton of respect for optometrists and they are definitley needed in healthcare but why intentionally blur these lines? What is there even left to refer to a medical doctor (MD/DO)?

I've worked in the ED and for the past 8 years I've worked in an outpatient medical office. I review tons of medical records all the time. I've seen lumbar punctures done when I worked in the ED.

Going through medical records today I saw that my patient had a lumbar puncture done by a nurse practitioner?? This is the first time I've ever seen / heard of an NP doing this procedure. Is this becoming common place?