A premed student writes:
We see a trend that people are starting to say NP’s and CRNA’s, particularly in rural settings, are helping control costs while providing general care and limited anesthesia. I also see a trend that a lot of MD’s ad MD anesthesiologists are ranting that these types of advanced practice nurses are ruining general/family care and cannot and never will have the necessary training do to such a role without having been through med school - though not so much ranting about crna’s so long as they practice under an anesthesiologist and not solo.
So then nursing profession pumps out "Doctorate of Nursing Practice" to fill the void of internal medicine physicians.. though this is not a PhD role for academic/research settings.. it is for clinical settings. The AMA flips out again claiming ‘Dr. Nurse’ will confuse patients and cause problems.Do you think advanced practice nurses like crna, fnp, nnp, etc., are doing an adequate job for their scope of practice..? Calling in the md for exceptional or issues out of their scope?
What do you think of crnas practicing solo without an md.. this seems to be a ‘problem’ in rural areas.There is no doubt there is a shortage of health care professionals.. even down to lpns..
Being a medical professor and MD, what do you think?
The problem with advanced practice nurses is scope of practice. I have worked with NPs over the years. They can do a good job with straightforward problems. They often have problems when dealing with complexity. Unfortunately, one never knows when complexity will rear its head.
Their limited inpatient clinical experience means that they do not have the depth of experience in the spectrum of disease. This worries me.
When I was doing outpatient practice, we used a nurse practitioner for walk-ins and routine follow-ups. We eventually let her go and hired a part-time physician instead. The nurse practitioner too much longer to see the patients, needed significant supervision, and had mediocre judgement.
I strongly believe that this is a bad solution to generalist care. My blogging colleagues have previously blogged about this issue. I suspect that I will receive both attaboys and you are clueless comments.
Jared
May 9th, 2008 / 3:34 pm
So, this brings up an insolent question since I am from a farm background. Why do we ask this question and not state that it should be morally and ethically repugnant to not support MD’s/DO’s to go and set up a practice in rural areas which happen to be the ones where our food and raw materials come from. Since we can’t live without food, I’d probably want to keep the food producers in good medical care.
I’m just thinking aloud here, but it seems ludicrous to tell the guy who feeds you that he doesn’t deserve the same quality of care.