Geriatricians are internists who complete additional fellowship training in caring for elderly patients, who often have complex combinations of multiple chronic and acute medical conditions. Ironically, although geriatricians have additional training, they typically earn less than internists, because geriatric patients are often on Medicare health insurance, which provides lower financial reimbursements than many private insurers. Therefore, there is not much incentive for physicians to specialize in geriatrics, which is intensifying the shortage.
On the other hand, another AMA top story covers the latest developments on the nursing front. Advanced practice nurses are seeking to expand their scope of practice in at least 24 states. New legislature would legally allow nurses more freedom and authority to prescribe narcotics, and also to lead a patient care team, in states where doctors are now legally required to take the lead and supervise the team. Several states already allow prescribing and practice authority to advanced practice nurses.
I found it interesting that one doctor quoted in the article cites that giving nurses the additional freedom and independence they seek could “put patients’ safety at risk”. I’m confused! Maybe I’m oversimplifying the situation, but from a patient’s point of view: wouldn’t a complete lack of caregivers be a much greater risk to patients than being treated by a qualified, highly trained, and experienced advanced practice nurse? Then again, analysts are also predicting that the nation is also poised for a severe nursing shortage as well! (More on that later!) What is a patient to do?
What are your thoughts? Will expanding the scope of advanced practice nurses help to alleviate the physician shortage? Feel free to comment here, or in the health careers forum! We look forward to hearing from you. . .
In recently recruiting with a leading hospitalist mangement company, I experienced, first-hand, the increasing demand for both advanced practice nurses and physician assistants. This demand is in direct response to the difficulty in finding internal medicine physicians to fill the ever increasing number of open positions.
Many hospitalist groups today, are filling their open hospitalists positions with these mid-levels, because, quite honestly, some help is better than none.
Craig
The point that people are missing is that nurses are attempting to circumvent the process of going to medical school and residency training in order to practice medicine INDEPENDENTLY and without being under the jusrisdiction of state medical boards. These people are not so highly trained as you might think. They want to be equal to physicians with 1/4 of the training if that. The gen public is so naive and will believe anything these nurses say under the guise of increased patient access to care. In their attempt to claim equivalence and fool the naive public, they are now getting Doctor of nursing practice,DNP, certification in order to confer the title “doctor”. What happened to knowing your role in the health care team. Why. when there is an even more dire nursing shortage looming over us,is there a push to mint all these nursing doctors. Money and prestige pure and simple. These DNP degrees are available online people. No residency either. They are trying to create a parallel health care system based on a sham degree. This is why physicians are outraged.
The AMA was outraged many years ago when Doctors of Optometry (8 years of schooling) wanted to use a handful of diagnostic agents when examining patients. They charged that Optometrists would be “practicing medicine without a license.”
Today, if you look at a PA’s license, it actually states they are practicing medicine. I’m sure NP’s are think they are too.
All of this started out as a way to improve access to basic care in inner city and isolated areas of the country. Once both groups got their foot in the door, they have demanded (and gotten) prescriptive authority and want to hang out their own shingle. The physician oversight that was supposed to be in place, rarely occurs.
The AMA has allowed this to happen because doctors can employee midlevels cheaper and reap the benefits of seeing alot more patients.
At issue to me is the increasing demands of both PA’s and NP’s for power and autonomy. Sure there are smart ones just like there are smart people in many jobs. The bottom line, though, is that did not go to medical school, did not do an internship and residency and therefore how can they have the depth and breadth of knowledge to “practice medicine”? Which ones will be pressured by the practice, the goal of money, or their ego to go beyond their abilities?
The AMA needs to step up and protect the American public. PA’s and NP’s should ONLY be allowed to do treat basic health problems, run preventative health programs, always have credible physician supervision nearby. They should not be allowed complete autonomy. MD’s and DO’s practice medicine….period.
What’s next? Maybe an NP or PA wants to do brain surgery?
If we need more doctors in internal medicine and geriatrics, let’s make it more attractive. We can start by giving scholarships to students who want to go into these areas of practice.
I’ve noticed our hospital losing alot of great bedside nurses to going on to get an NP degree so they can “practice medicine”.
Excellent bedside nurses are critical to your health as a patient. They are there 24/7 and pick up on the slightest changes that may alert a physician to problems.
The practice of nursing must be seen as a valuable profession. We can’t afford to lose good nurses who see being an NP as being better.
As a future FNP and current RN, I can not leave this page without leaving a comment. I could have gone to medical school but I chose nursing. NPs are taught to practice from the nursing model not the medical model and we are not trying to be physicians. If I had wanted to be a physician I would have gone to medical school. In fact, I am often asked why I didn’t go to medical school. My answer is because I chose a different approach. My patients know they can talk to and approach me and do so more than their physicians. I also am not arrogant enough to believe I can cure everything but smart enough to know that I can care for everyone. And if physicians are going to continue to specialize to make more money, what are we supposed to do for primary care? Leave it because we didn’t go to medical school? Forget about it because we didn’t complete a residency (which, as a side note, I have to politely suggest treatment too frequently at work)? No. We went back to school for a second degree to help solve the problem to care for America well and ill. And how can you call yourself an intelligent person and say someone should not go back for further education? And as physicians you trust nurses with your patients in their illest state in the hospital to catch symptoms, monitor vital signs, and assess while you can’t be there. But somehow with even more additional training using many of the same textbooks and guidelines you learn from NPs are not capable to care for patients? It simply does not add up.
I am not a doctor nor a NP.
I have been a RN for 30 years and I am only 50.
I have worked Surgical Intensive Care at a teaching hospital.
I also was a charge nurse and a bedside nurse.
I have also(unfortunately) been a patient many times.
I have help teach many medical student’s and resident’s how to do certain procedures that I have helped with numerous times with the attending’s of the medical student’s and resident’s.
It is not just exactly like you were taught in med. school.
Patient’s are not all the same.
I did not go to nursing school just for the money.
I wanted to actually help sick people.
I had a doctor offer to pay for my APN school and I had to grade point to go in to med. school if I wanted.
I wanted to help my poor ailing grandmother who was a diabetic and had to have her foot amputated and at the time I was able to get my Associate’s Degree in nursing so I did.
When I was sick and in the hospital,I did not care who helped me when I was vomitting.
I did have a medical student think it was beyond him to help give me an emesis basin,kleenex or even a trash care.
A nursing assitant had walked by and heard what the young man had said and came in quickly to help me.
You should have the want to help sick people before you allow dollar signs cloud your vision.
I believe nurses and doctor’s are on the same team no matter what.
Yes,I agree if you have finished med school,you deserve the respect.
Doctor’s have to be accountible to the AMA and all nurses are accountible to the state board of nursing.
I don’t think NP should ever be allowed to practice without a doctor’s backing them but they have had a lot of education too.
They do take alot of the pressure off of them by seeing patient’s that the doctor feels is not in a life threatening situation.
Nursing assistant’s,LPN’s,RN’s,NP,medical student’s,resident’s and attending’s are all on the same team and are very important to the healthcare system.
Believe it or not I am not sure how half of the people got into medical school. Doctors think it is so hard, however, I know some really dumb ones who need the expertise and assistance of a nurse. Doctors, residents, and medical students that have this “I’m the doctor, so I’m the boss” attitude have internal and self-esteem issues they need to deal with. If your job makes you who you are then you have completely missed the boat!!!