<p>^ In the big picture, it’s not just about whether YOUR patient (seems to) benefit. It’s also about whether MOST patients benefit, in a significant way, in controlled, double blinded studies. I think THAT is where the financial rubber meets the road.</p>
<p>"Effectiveness VS Efficacy: Effective treatment provides positive results in a usual or routine care condition that may or may not be controlled for research purposes but may be controlled in the sense of specific activities are undertaken to increase the likelihood of positive results. Effectiveness studies use real-world clinicians and clients, and clients who have multiple diagnoses or needs. In contrast, Efficacious treatment provides positive results in a controlled experimental research trial. A study that shows a treatment approach to be “efficacious” means that the study produced good outcomes, which were identified in advance, in a controlled experimental trial, often in highly constrained conditions. Translating efficacious practices to routine practice settings to produce effective results is one of the more challenging issues of evidence-based practice. "</p>
<p>or</p>
<p>“Efficacy and Effectiveness Evaluation:A Behavior Research Example”</p>
<p>False - the studies the NPs like to throw around for this are massively flawed. Have you seen the curriculum for some NP programs? Its laughable. </p>
<p>Better diagnosticians? Really?</p>
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<p>I disagree. There simply isn’t a replacement for the tens of thousands of hours that go into training a physician. Hell, some residency programs (especially the surgeons) are talking about lengthening their residency due to the recent hour restrictions.</p>
<p>^ I think what IS true, is that many patients prefer to see them.</p>
<p>I also think that most of the time, any additional morbidity or mortality that results, is probably outweighed by the cost savings, even if additional costs for additional prescriptions and testing is included. </p>
<p>NOT the same, but I also think that the morbidity and mortality of just not doing ANYTHING is probably outweighed by the cost savings. One difference (not the only one), is that patients do not prefer this.</p>
<p>Further muddying the waters, NPs will soon have to get the higher degree a Doctor of Nurse Practioner DNP, rather than a MNP. Will they be Dr. Nurse or Nurse-doctors?</p>
<p>“The training should be more vocational in nature - like nursing - starting in undergrad. Then there could be a year of two of a residence/training program.”</p>
<p>I prefer my doctors to have a broader perspective and a diverse array of critical thinking skills. Good doctors need far more than technical and diagnostic skills.</p>
<p>Receiving a loan is never income; paying debt is never deductible. Interest expense is always deductible. The cost of the equipment is depreciable, and current provisions of the Code are very generous, allowing most companies to write off their equipment in full the year of purchase.</p>
<p>Ex: Buy equipment for $60,000; take a loan for the same amount. The $60,000 is not income. The $60,000 (through current “bonus” depreciation or Sec. 179) can be written off in full the year of purchase. As the loan is repaid, the repayments are not deductible as an expense. That’s ok, because the deduction comes through the depreciation, and under the rules currently in effect–that’s a much better current tax benefit than getting them over the life of the loan.</p>
<p>GT-sorry for what has happened to you. I hope you had a good CPA, because it doesn’t appear correct. A S corp has the same deductions available as a sole proprietor, and is usually cheaper, because one doesn’t pay FICA on all the earnings.</p>
<p>Nurse prac–our experiences have not been good. They have either a) not diagnosed what was going on, or b) been way over cautious and CYA, sending us immediately to a specialist, (who we knew and trust). Specialist thought the NP really overblew everything. Has happened to us several times, different family members and different NPs.</p>
<p>H’s niece has been a RN for 2 years. She is now working on her NP–on-line. This kind of floored us. Appears it is very common. H’s dr. appt costs the same as a visit with the NP in that office. If I’m paying dr. rate, I want the experience the dr. has that got him his MD. I think medicine is going to rationing though, and most of us are going to have to see NPs first and jump through hoops to get to a dr. Maybe that’s b/c we’re in an underserved rural area.</p>
<p>Thanks HImom and sryrstress, we fired our accountant and have a new one. </p>
<p>I prefer for my care providers to have a broader perspective and a diverse array of critical thinking skills as well. However, I find that doctors don’t have a corner on that market. My patients see me because I care and good at what I do. I am busy because I have long-term relationships with my patients and I have a great word of mouth reputation. They all have the ability to see a physician if they want, but they choose me, not because I’m a NP but because I have excellent diagnostic and critical thinking skills. Plus, I care about their health. I lead the Quality Improvement in our clinic and we have won awards for being in the top 10% in quality of care. Myself and the PA I work with have much better numbers than the physicians we work with. In fact, I’ve been selected by area primary care providers (MDs, PAs, and NPs) to chair a community wide quality improvement effort. Perhaps no one else wanted the job, but I’ve dedicated my practice career to quality improvement efforts and documented my results. </p>
<p>I suspect studies that show NPs and PAs have better or as good quality of care as a physician may be flawed, but I haven’t seen numbers that disprove those studies. Clinical research is difficult and they can’t be placebo controlled. </p>
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<p>Sounds like an assumption.</p>
<p>For some reason, medical discussions on this forum tends to regress into criticisms of PAs and NPs and sometimes MDs. I don’t know why. The original topic was about doctors being broke. Family Practices in my area are. The doctors, or the NPs and PAs for that matter, are not. They are all making a fine living. DH has a PHD in English. He’s broke.</p>
<p>I agree, getting an NP online is very scary. This has been what has prompted the movement for the DNP. I’ll probably get one as I like school. But I certainly wouldn’t expect more money or status.</p>
<p>The trend towards large medical groups with PAs and NPs as the primary care giver is troublesome because these groups have replaced the office RNs and LPNs with MAs. Im sorry but a MA + NP/PA is not the same as the RN + MD.</p>
<p>“I also think that most of the time, any additional morbidity or mortality that results, is probably outweighed by the cost savings, even if additional costs for additional prescriptions and testing is included.
Sounds like an assumption”</p>
<p>Maybe, but it seemed to be what was happening with a huge HMO I worked for, for 10 years, and I kept thinking the birds would come home to roosts…and they never did! I mean the HMO got sued from time to time, but you had to sign away some of your rights to sue to be a member, and it all seemed to work out. Looks like I was wrong. It CAN work.</p>
<p>So doctors don’t have to go broke. Just join a big group, treat it like a Job", work regular hours, and “supervise” a bunch of folks who provide the care.</p>
<p>I suspect that where it is going. But in my community at least, all the reimbursement models we looked at (we interviewed about 8 companies) all reimbursed for physician productivity in which the physician needed to see the patients. </p>
<p>BTW, I don’t think PAs and NPs save money as I don’t think salaries are a primary driver of health care costs. If your HMO feels that way, they are indeed short-sighted. There just aren’t enough physicians interested in primary care. There is also a shortage of PAs interested in primary care. They also want the larger reimbursements that specialty practice provides as well. That is what needs to be fixed.</p>
If a new doctor with, say, 175K debt takes this kind of job, and is not a specialist, can (s)he still pay off the debt in 15-20 years without sacrificing the living standard significantly? What might be the starting salary of a very young doctor who has completed his/her residency and is newly hired by such a large group as an employee? 120K a year before tax? (I am really ignorant about this.)</p>
<p>Husbands reimbursement is tied to productivity, but there is some money for supervising others as well, and their productivity seems to affect HIS.</p>
<p>I think that there is room in the “healthcare party” for a lot of different professions. The problem is that many of those professional organizations have no interest in working together but instead want to work “by themselves” which hurts the patient in the long run.</p>
<p>This sounds similar to the debate amongst nurses regarding BSN prepared nurses vs. ADN nurses. They take the same licensing exam to become RNs. The pro-ADN camp says they are better nurses because they have more clinical training and the BSNs just have extra “fluff” and “book learning, which means nothing.” The BSNs like to tout their extra education as giving them “a broader perspective and a diverse array of critical thinking skills.” And on and on…</p>
<p>Doesn’t really contribute much to the current discussion; sorry. It just rang a bell when I read that.</p>
<p>I agree that this is an unfortunate direction of the thread, but it is a natural progression of the topic of cost-savings in medicine and someone inevitably pulls out that they think NPs/PAs are as good or better at practicing medicine than physicians, the implication being that they are a replacement for physicians. The problem is that the professions were and always will be physician extenders. The PA’s understand this - they train in the medical model, operate under the state Board of Medicine, and in their national professional guidelines state that they have and always will operate under a physician’s license. My bone to pick with the NPs is that they don’t. There is a push (as evidenced by the DNP requirement among other things) for complete independance to practice medicine, despite ludicrous educational standards, being trained in the nursing model, and in many states being licensed by the Board of Nursing. </p>
<p>I sincerely apologize if I’ve offended anyone here. I am just expressing my opinion and trying to back it up.</p>
<p>1 out of 73 people in my town of 28,000 are doctors (and I think I know almost all of them) and I can assure you none of them are going broke. But they do love to complain, like my friend who was whining that her DH’s income was $15K a month less than 5 years ago. And this hasn’t changed her life style one iota - even while putting 3 kids through college full pay. And don’t get me started on the friend whose DH is a plastic surgeon.</p>
<p>I haven’t researched those DNP programs, but they are not programs that allow you to practice as a Nurse Practitioner in which your need more specific certification with required courses in pharmacology, medical diagnostics, and medical treatment. The addition of a DNP to such certification is being proposed. </p>
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<p>In my state, many PA’s run their own practice. Our state practice laws require some physician supervision, but that physician does not need to be on site. PA programs where created by physicians to be physician extenders, but PA leadership is also talking about name changes (physician associate has been proposed) to remove the “extender” implication. </p>
<p>Of course you’re allowed your opinion Icarus and I don’t get offended easily. We need physicians and I don’t think they can be replaced with NP/PAs. But, a physician’s expertise is wasted with spending time with many routine medical conditions and NP/PAs are useful. Patients deserve a medical team for their care.</p>
<p>Oh my goodness. One of my dearest friends is an NP and that’s cool but after several in our family have experienced inept diagnoses and prescriptions from NPs we simply refuse to be seen by them. There are certainly some not-so-good physicians out there but if it’s my health I want to see an MD and not a mega-nurse. There is a big difference.</p>
<p>And as for physician salaries, I guess in my world view I have less of a problem with physicians earning a lot then say, real estate agents or insurance agents or administrators at colleges or people who move around other people’s money. And I also never understood why lawyers should earn a lot.</p>