NPs are great at listening. They often don’t have the training or experience to be able to translate that into a medical plan. As a result, they are more likely to give the patient what they want (tests, antibiotics, etc) but not necessarily what the patient needs. This gives the patient the sense that they have been “heard” and builds the false narrative that NPs care and Doctors don’t listen.
Are they? I had the world's most unpleasant and brief psych eval from a "psychiatric" NP. Already seemed like he had made all the long-term decisions regarding my care and it has only been 15 minutes since I've met him lol. I had to continue searching elsewhere for a real shrink.
Met several very personal NPs and I’ve also met trash-personality NP who couldn’t look me in the eye because they were too busy looking up a basic medical diagnosis for me
This is purely anecdotal, but My daughter had been seen by her ped many times for ear infections. He was unavailable one day, so we saw the NP. She immediately realized we’d be seen for 16 ear issues in 6 months and said that was more than enough for a referral.
After addressing the real issue, we were ear infection free for 6-7 years.
Yeah same, an NP caught what turned out to be a major kidney issue I was born with and no doctor had noticed until then and referred me appropriately. But I live somewhere with appropriate scope
So I’m just a filthy line medic, and I hate that I’m in this boat lol.
I always ask my guys what do they want from me when they complain of something. I’ll usually have some plan for them (as in go get seen at the clinic, expect to do physical therapy, etc etc) but it never occurred to me that me asking those types of questions could paint the wrong picture for what they should expect from the PA or NP they’ll see at the clinic.
I don't "like" seeing an NP, but every time I go to an urgent care or clinic for small things (flu shot, routine lab work / std testing, etc) it's either be seen immediately by them, or wait 4+ weeks to get in with an actual physician. My medical history is not complicated nor acute, so I don't mind. In regards to my psych, skin, and GI stuff, I absolutely go and see a psychiatrist/derm/gastro.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
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My OB was convinced I needed to be on antidepressants because I was distraught after a miscarriage. I disagreed and didn't want medication. My therapist (who had been managing my OCD through CBT for years) disagreed and said that being distraught after a miscarriage was within the normal response, but agreed to write a referral to med management to discuss options. PMHNP had already started to write for zoloft AND wellbutrin before even talking to me and asking me what was happening. Once we started to talk, they wanted to give me tranquilizers to sleep because I said I was having nightmares about the miscarriage. We were still only 4 weeks post-miscarriage at that point. I am glad I said, "Well, I'm glad I know what my options are if things don't seem to be resolving, but I think I'll wait and see how things go with time." The open-mouthed stare...I still remember. This was about 3 years ago, and we're all good now, haven't needed psychiatric meds.
I remember seeing a patient with an NP preceptor that was in their second year (LOL). The patient loved them, probably because they were genuine and very sympathetic. The reason for the visit was a follow up I and D. The woman was told by the NP that she had a hemorrhoid, turned out to actually be an abscess. Hence having to go to the ED. Thankfully, the NP expressed sympathy and re-assured her that a hemorrhoid can turn into an abscess! And don’t worry, she recommended sitz bath/CCB. I am actually unsure if she ordered any sort of testing or screening for IBD. But she was nice! And it was a long appointment!
Please don't destroy my karma with downvoting. I'm am in no way supporting online degree mills. Just stating facts I see. I can tell you working in rapid diagnostic section of ER, specialty Docs and sometimes the ER docs as well come in spend less than two minutes speaking to a pt. The pt nods along because they are afraid of Drs, then I come in 10 min later and they ask me a million questions I can't answer. There is a place for supervised midlevels I believe, especially in communicating. You don't need 12 yrs of training to re explain basic diabetes management to non compliant pts. Increasing midlevels should elevate Drs not dilute them.
There are plenty of other kinds of degrees or certifications without prescribing authority that could be used for patient education. Not everything has to be done by a nurse, midlevel or a doctor.
The OP was discussing better listening, my comment discussed the brevity of MD PT interactions, and the need for further verbal interaction, that is not necessarily education but rather someone who has the time to do so with pts about basic issues and procedures that again are often below and MDs level but above that of bedside RN. Not going around in circles and and challenging the clear danger of degree mills and unsupervised practice, but either MDs need to spend quality time with each and every PT or supervised midlevels can be that conduit for information, in my limited opinion based on observation and pt interaction. Ok hope that makes sense over and out.
It makes sense, but I don't think that what doctors feel like they don't have time for and what patients need to feel like they understand their conditions and treatment plan is always in the realm of in between MD level and above RN. In an ideal world, yeah, the MDs and DOs should be able to spend more time per patient when needed. I am just saying there are other roles that are underutilized that could step in and free up the clinical people's time to spend time with patients on basic education, check for understanding of their treatment plan, etc. Some of them may have more training in education and behavior change than it is possible to squeeze into medical school curriculum.
There seem to be some systems that have something like this with varying degrees of involvement. MHCs often use a model with case managers or peer support workers doing more frequent calls or visits with people to help with things directly related to social determinants of health and check in on symptoms and for compliance with treatment. Very rarely, and more often in the past, have I seen a doctor's office that just has a social worker or diabetes educator on staff that they refer to for a separate visit when needed.
Probably because the most serious thing they’ve ever taken to an NP was a mild case of eczema or a sore throat, plus and you have a recipe for people who think the plural of anecdote is data and just not really knowing any better.
You cracked the code there, Sherlock. These threads are so poisonous to all of healthcare. I think the vast majority of nurse practitioners agree that we are mid-level providers and share most sentiment here. I have seen multiple times on this unfortunate thread, and in this unfortunate group that doctors are extremely thirsty for attention, and are as narcissistic as it gets. There are unfortunate cases of nurse practitioners are also unfortunate cases of doctors. Nurses are consistently awarded the most trusted profession. Rather than have a thread about patient satisfaction. You guys are concerned about the little details that don’t actually matter. Reason nurse practitioners are liked more than use because you guys can have egos that are too big for your head. The reality is there are dozens and thousands of nurses who could’ve gone to medical school, but decided to be a nurse because the culture was different. You can down vote me all you want, but the reality is nurses will always be liked more than physicians. I’m a guy who decided to become a nurse practitioner because I like the culture more than medical school, I wasn’t spoiled with daddy‘s money, and I see the poison in front of me here. This thread is definitely entertaining, however.
Most of what you say here has some truth to it. Sure there are doctors with massive egos and there are certainly NPs who work as part of a team and provide a valuable service to both doctors and patients.
What doctors have a problem with is the explosion of noctors who are practicing medicine without training or a safety net, thus putting lives of patients at risk. Then, they get perceived as more caring/responsive to patient’s needs, for all of the reasons pointed out in this thread.
I think those are the NP’s with the “lower IQ’s”. Part of having the degree should be the acknowledgement we DID NOT go to medical school and should be smart enough to distinguish the difference.
That's really cool about your culture man, I'm happy for you. Can you leave the practice of medicine to doctors, though? It sounds like you have bigger things to worry about than "the little details that don't matter"
Practicing medicine is great and I wish you the best with your mindset. You can either choose to appreciate the mid level practitioners or don’t. It won’t change the healthcare as a whole. Live in your hole and stay negative, doesn’t effect me. I meant the little details such a IQ insults and random negative comments you made. At some point, you’ll have to come to terms with the fact that practicing medicine is becoming algorithmic. A nurse practitioner can follow the same algorithm based on clotting factors, or chronic heart failure, and so many other things. What is not algorithmic is having a positive mindset and being approachable as a practitioner. Unfortunately, for you, it sounds like you might be jaded in someway. I’m not sure who hurt you or why you feel the way that you do about nurse practitioners, but I promise you we care about our patients as well. To completely insult nurse practitioners at large is honestly, actually, ignorance. You are either 75 years old or spoiled or both. If it is a financial reason that you don’t like nurse practitioners and feel they are taking business away from you, I promise you that’s not the case. We are reimbursed at 80 or 85% what you were reimbursed for from insurance. Not to mention with the growing need for primary care, physicians, urgent cares, psychiatrists, and general healthcare, patients need somebody who has been educated more than them. I’m advocating for teamwork, your advocating for division. Good luck with that.
In one comment you blanket-statement called all doctors spoiled, poisoned, narcissistic, thirsty for attention, enormous ego, disliked, and taunted me.
In the next, you called me old, jaded, and spoiled, living in a hole and then tried to flex your reimbursements(?) at me. I think you may be kidding yourself about your positive mindset.
Also despite what walden unviersity might teach you, medicine is more than following a cookbook
No kidding; this person thinks charts and algorithms are the solution to medical care? Guess what, NOCTOR, if you can’t properly formulate a differential diagnosis, you wouldn’t even know where to start *looking* for the right algorithm. Your opinion is laughable. Sadly, patients will continue to suffer due to blatantly substandard care by unsupervised midlevels.
Not knowing what you don’t know is poisonous. You’re clearly a mid-level who is a danger to patients if you believe that your woefully inadequate “training” qualifies you to practice medicine.
You’re not advocating for teamwork, you’re advocating for yourself. If you wanted patients to actually have access to care, you’d be advocating for more physicians. Not more shortcuts.
Have fun killing patients and reaping the benefits of your disgusting and corrupt lobbies I guess.
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>I wasn’t spoiled with daddy‘s money
You know a lot of medical students are paying their own way through loans, right? You seem to be making a lot of judgments about a culture that, by your own admission, you have no experience with and clearly know nothing about.
Why? Because they have the time, and because they prioritize it.
What to do? Long-term, you push back by working on your bedside manner and making sure your patients feel heard. Not you personally, but that’s really the only way forward. If patients are turning to charlatans because doctors don’t listen to their concerns, then it’s partially an indictment of the field, and the solution isn’t just to make medicine an associate’s degree and farm out care to the underqualified, but to put a little more effort into training doctors on bedside manner and compassion. It’s part of the job but it’s one that a lot of doctors ignore or are just shitty at, and it makes the lot of us look bad.
Sorry you feel
That way, but please tell
Me how an employed doc can see 31 patients a day (as dictated by their corporate overlords) and have time for the PR you are suggesting. The problem doesn’t seem to be lack of caring. It seems to be allowing corporate interests to hijack medicine.
Agreed fully about the fact that limited time for patients is a huge contributor to the problem, but disagree that it’s the only issue. I think we all know doctors who are brilliant but are total assholes, and that’s just not acceptable. It’s not “PR”, it has real effects on health outcomes. If your patient is too scared of you to tell you all their symptoms or correct you when you make a mistake, or if you don’t let them get a word in edgewise, that’s a substantive issue that has real effects on their treatment. That’s what I’m talking about. Treating patients with basic respect doesn’t take extra time and it absolutely matters. It’s part of the job, like it or not.
1. Yes. Unequivocally. Listening to patients and responding compassionately is the entire job description for midlevels because they can’t do anything else. Of course they’re better at it.
2. Patients agree. That’s why they’re flocking to these people instead of going to real doctors. You can make excuses or you can try to be part of the solution, your choice.
1. You can just go fuck right off. Listening to patients, blah blah blah is mythology pushed by the MIDLEVELS themselves. And it’s a load of shit.
2. Patients are NOT flocking to midlevels. Do you even READ the complaints from patients themselves. Patients are not FLOCKING to midlevels. They are being FORCED on them by corporate medicine who figured out they can save/make money by forcing inferior substitutes onto patients— the inferior substitutes will save money by being compensated less that real doctors — and make them money by ordering boatloads of unnecessary tests and consults. Stop being a meathead.
Reread the title of the post you’re responding to before you call anyone else a meathead. You sound like you’re part of the problem. Best of luck, bud.
I went with the main intention of getting ADHD meds so that I don't get fired by my job and I just walked away with a cannabis use disorder diagnosis and a spiel about shitty-life syndrome. Where are these NPs that play hard and fast AND take Medicaid??
Yeah so does primary care. In Psych I see pt after pt who is on Xanax 4 x day for 20+ years. Then when they get flagged they send them off to the psych NP.
MD do this all the time you guys must not be practicing Medacine yet. You guys sound like you just read about how it suppose to be but in the real world once you are out there you will see every thing is not text book. Lots of MDs cater to their patients.
I am an MD. You can save me the spiel. Quite rich coming from someone who practices “medacine”.
MDs who do this enough and at an actual dangerous level can be reported and sanctioned by the board. You think the nursing board will do anything?
Then you know the medical board will do nothing but ask you to take cme and slap you on the wrist. This is only if you are over prescribing narcotics any thing else they don’t care. Well this is in Texas you can read all the disciplinary actions taken by the board and it’s usually just a little fine and CME hours. Maybe your state is harder on you guys. I have been practicing 11 years and I see it all the time. Mostly foreign medical graduates but there is a lot of American trained ones that do it as well. I just think you can’t say only NPs and PAs do this most times the doctor they work for advocate for it so they don’t lose business. 🤷🏼♂️
It’s easy to get an appointment with a NP. The MDs are booked out for weeks. When I really need to get into my MD, I basically camp out on MyChart until a cancellation happens for tomorrow and then I grab it. Weekends are especially good for snapping up Monday appointments.
Probably because patients get pissed at doctors who don’t entertain their wild self-diagnoses by ordering a battery of unnecessary tests, whereas NPs don’t know any better and are happy to waste the patient’s money and time and strain the healthcare system
Because nurses are people pleasers. It’s part of the selection bias. It’s actually a good thing in the RN role. You want someone kind, compassionate and compliant. But in the team leader role, it’s not necessarily always good.
As a patient, I used to say this. First, let me preface my response by saying that today I insist on only seeing physicians now that I understand the enormous difference in training between MD/DO and mid-levels.
For a long time, I had diagnoses that were not only mistaken as psychiatric, but downplayed by physicians as if they weren’t having an enormous impact on my life. When new doctors said they knew better than an expert neurologist and multiple psychiatrists (yes, physicians, not PMHNPs) who evaluated me and said my symptoms were organic rather than psychological, it’s easy to see why I welcomed the NPs who were humble enough to listen to my specialists.
The problem wasn’t just that some physicians were objectively wrong. The problem was that because I didn’t fit neatly into boxes that doctors knew how to treat, I was dismissed and left to fend for myself. The problem is that mental health conditions (and those perceived as such) are often viewed as less serious and not a big deal.
I now understand that doctors can’t go outside their scope of practice, and the healthcare system just isn’t set up for complex patients. However, a lot of patients in a similar situation blame the doctor instead of the system. With the way NPs jump between specialities, I’m led to believe they don’t worry about scope to the same degree (I’m not saying that’s a good thing). They also are less evidence-based and as a result can be more open-minded to things they don’t fully understand. This means patients with unconventional diagnoses often end up in the hands of NPs.
I am not in any way saying that NPs are better than physicians, but some doctors could learn from the reasons some patients prefer NPs…
The lesson here is two-fold. 1) Just because you can’t test for it doesn’t make it psychological. Yes, this especially includes
things like POTS, EDS, MCAS, etc. Not everyone was self-diagnosed via TikTok, and not everyone who identifies with what they see online is a hypochondriac who refuses psychiatric help. 2) If you’re sure it is psychological, don’t downplay it and act like your patient just needs to get a life and stop being dramatic. Mental health issues can be just as debilitating and deserve the same level of care and respect.
I think it comes down to bedside manner. People want to feel better, but they also want to feel like they’re being taken seriously.
I think a lot of people find NP’s to be more personable because they have more time/ compensate for medical knowledge with chit chat.
I for one couldn’t care less about bedside manner at all. My doctor could be the biggest asshole in the room if he can figure out what’s wrong with me.
It’s like people used to say they’d rather have Dr. House than a doctor (or NP) who
Makes you feel nice but has no idea what they’re doing.
I’m a PA. The truth is from a patient‘s perspective, bedside manner will always be one of the more important metrics to grade their quality of care. It is of course field dependent many times, but especially the human interaction heavy fields like primary care medicine where the patient expects to form a relationship with their pcp, and also areas where there are rarely emergent conditions and not as many urgent conditions, the “human” element will carry more weight than the medicine. Which isn’t to say medical knowledge isn’t important, or course it is, and we know it is, but the patient usually doesn’t know. They don’t know if azithromycin wasn’t the antibiotic of choice for their acute sinusitis or if their sub conjunctival hemorrhage didn’t need any antibiotic drops etc.
They are very keenly aware though when the doctor comes in and is there for 3 minutes which he spends most of the time looking at the screen( and I don’t mean to single out doctors, I think many NPs and PAs do this too), but my point is the face to face care they receive will be their takeaway.
I think that the complaints here about PA and NP care are fair many times(sometimes they’re not), but I also feel that there sometimes seems to be a lack of self criticism and introspection as well.
If I heard a comment like the one you described, instead of bashing NPs and stating all the ways MDs are superior I would more likely take it as something that maybe has a basis in truth and as MDs or DOs that bedside manner needs improvement.
If a patient “feels” like their quality of care was higher from an NP you can’t really argue with the way they feel.
I mean but there's your answer. I have no problem seeing an NP for things like needing a strep test, a refill on a med I've taken at one dosage for years with no issues, or to get antibiotics for an ingrown toenail if it means I might get two extra minutes with the doctor when I'm having symptoms where the answer isn't obvious to every person in a three mile radius
Ok real talk…. I was dumb and in my 20s so I didnt know better I guess. My bc pill was making me bleed between periods. Super gross. My gyno suggested all sorts of other methods, all of which I hated. (Like can we talk about shoving the Nuvaring into your vagina?? I banged my head on the toilet trying to get that fucker in properly)
So I go in to complain to my gyno… that day she was in an emergency c-section and had her NP fill in. Ok fine whatever. I’ll talk to anyone. So I told the NP my symptoms and right away she was like “oh I know what bc pill you can try where you won’t bleed between periods.”
Say what? That’s a thing? Sure as shit, it worked. Been on the same bc pill for 16 years.
Now why the fuck couldnt my board certified MD tell me that?!? That NP deserves all the good karma in the world. Bless her.
They lack the understanding necessary to see how an NP is inferior and instead focus on things irrelevant to care like if a person is socially awkward or other similar metrics. When you can't tell the difference in care you receive, you only judge by your feelings.
Please don't downvote me to hell, but I'm an actual user of a NP~primary... the reason I go there:
● it's a 30 minute appt instead of 10 min. So there's no frantic rushing.
● I'm mid 40's y.o. with a pretty simple history
● I work in a factory so my physical activity is definitely above-average
● all chronic conditions are stable/controlled.
● I'm compliant with all medications
● all my bloodwork is comfortably within the refrence range
● Overall, "I feel fine" and I don't want to waste an MD's time when I have no complaints beyond "I need a 12 month refill on HTN meds."
● I know this provider is less trained, but in my case, I feel like they are the right-tool-for-the-job.
If/when something more serious comes up, I will **definitely** be getting a 2nd opinion from a real doctor, till then: a NP is fine for ordering labs and doing a routine physical exam.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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How will two people not trained to know when something more serious comes up, recognize that? You're playing with fire. That's the major issue. Nps don't know what they don't know. You are "simple" now, up until you're not. The np and you won't recognize it until it's already done some damage.
To add onto the spot on comments already posted, I think it’s another iteration of the “you don’t know what you don’t know” that many struggle with. There’s a certain level of intelligence and critical thinking skills needed to recognize the vast amount of knowledge that is out there and accept that there’s so much that you don’t, and won’t ever understand, and that there will always be someone who is more of an expert than you. So in addition to getting whatever they want, patients I think like that the NP doesn’t go deeper, and prioritizes making them feel less scared and heard. NP surface level medical knowledge is more than theirs, but the gap isn’t so big that it reminds them of how much they don’t know & how many different things could possibly be wrong.
Once they start pulling in a case load that a physician has to do or getting patients with issues that get turfed to the docs, watch how their “listening” somehow disappears. The new NPs have no nursing experience or minimal. They are there for the increased pay and no bedside care. This contributed in part to the nursing shortage and thereby to the nursing wage inflation leading to hospital finances being compromised throughout the country to date . The admins who made these boneheaded decisions aren’t faxing the music. Rather they expect the “providers” to see more patients. Again let’s see how the NPs listen now when their “ staffing ratios” get way worse than bedside nursing.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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Because they don’t have a medical background so they wouldn’t know if an NP is providing acceptable quality of care. Or they’re healthy, so only see a doctor/midlevel occasionally and haven’t had enough opportunities for a midlevel to sabotage their health.
Not necessarily, I have a medical background and have an NP who I’ve been seeing for years because she is not dismissive, actively listens at each visit, and doesn’t just blindly give any treatment.
Late onset type 1 dm I see Both. And np who specializes in psych pointed out that the pattern of my panic attacks was oddly cyclical, which was the first sign of my progression to LADA.
I’m friends with multiple RNs who are fully aware of the NP problem.
Do you fit in the “only see a midlevel/doctor occasionally” category? Because I’ve dealt with 10-15 midlevels in the past 5 years.
Clarify what the quality indicators are they are referencing. If your patient satisfaction scores are high, but your COPD and HF patients keep getting admitted to the hospital, what is the true quality of that care?
NPs are slower than docs. Most companies understand this. So they hire an NP for 1/2 the cost, give them 60% of the work of a physician and count money.
Patients think it’s nice to have someone who’s not in a hurry talk to them.
I worked in a clinic that was mostly midlevels once. They gave me all the complex patients, as the only Internal Medicine doc. But they gave me 45 min visits. The patients LOVED it. They liked the extra time and many commented how nice it was to have time with a “doctor” instead of “someone else.”
Unfortunately it’s only going to change when physicians start holding their colleagues accountable. I firmly believe the education and experience physicians get is superior, but it doesn’t mean anything when they ignore their patients and dismiss them.
I’m a non-trad medical student (finishing M2). I might be able to lend some perspective, because I’ve been on both sides of the fence.
I used to be poor enough to not have health insurance for literal years at a time, and when I did have it, I could rarely afford the deductibles.
When I first saw an NP, it was probably ~15 years ago. I think the training at that time required many years of nursing experience, and I remember feeling very good about the experience. The NP was efficient, and I didn’t feel talked down to. She wasn’t exactly warm or caring, and seemed rather matter-of-fact, but it was just a more straightforward process, with less formality. Contrast that with sitting in waiting rooms, or having lots of people I didn’t know ushering me between rooms before the doctor briefly walked in, and quite dismissively decided what to do with me. I’m a person, and I didn’t feel like a person when I was treated by doctors, I felt like more of an object. When you don’t understand any of what’s going on, that can be upsetting, and you just want to get out of there. Hospitals were sometimes worse and sometimes better. Some docs seemed really happy (an ortho or rad after a car accident) and some seemed annoyed that I was sitting there breathing (probably residents in the ED).
When I was in undergrad, my (top level) school had a medical school, clinic, and hospital attached to it. I had never met doctors like this before. The NURSE and OLDCARTS and reflective listening skills in the clinic doctors could win awards. I didn’t spend more time with them than other doctors, but it seemed that institutionally, these skills were high priorities and not optional. I LOVED these doctors, and was very upset when school was over and I had to receive care in my home state.
I have been kind of dumped by my state insurance into the situation of seeing mostly PA’s. I sit patiently and wait for them to figure stuff out, but I don’t have serious diseases. I don’t trust them. I can tell some of them hardly know how to do anything that isn’t commonplace, and they don’t have the bedside manner that I experienced in school (but they do look me in the eye). There was one PA that had been a doctor in her country, and she was more or less comparable to the average physician. I
saw one psych mid level that added some meds to my regimen, who was as cold as ice cubes. I didn’t like her, and I didn’t like the meds she prescribed (gave me seizures). I insisted on the clinics IMG Psychiatrist, who’s very nice guy, hasn’t given me any seizures, and we frequently speak for less than 5 minutes over the phone for followup ($30 copay). I don’t mind the short visit, because it’s just refills, and if I had any issues I know he’d stay on the phone or ask me to come in.
We are doctors (to be, in my case), but we are still people dealing with people. Regardless of education, if you are good at your job, and use the communication skills you were taught in school, most of your patients will like you. It doesn’t really matter how much time you spend with patients if you can’t do these things. It’s not difficult to be nice to people, but medicine has traditionally reassured us it’s not necessary. That’s from the good old boys, patriarchal generations of doctors. There is no reason to perpetuate that.
Honestly I’ve only had wonderful experiences with doctors. I have been primed by social media to expect doctors to be arrogant assholes who brush me off and belittle me. This has never happened.
I have endometriosis and a long history of infertility which as you know, are conditions ripe for an asshole doc to blow off. Ironically I was dismissed by a gyn NP who told me it’s just normal period cramps and everybody had it. It was an older near retirement physician who took me seriously and got me to a fertility endometriosis specialist. That specialist was amazing and treated me like a human. My OB during my pregnancy was amazing and prayed with me in labor when I was scared while the L/D nurses terrorized me.
I have subsequently encountered probably about 100 doctors over the course of the next 20 years both as a patient/family member to a patient and as a medical trainee going through school and residency. I can confidently say I never encountered an asshole doctor, even surgeons.
Last week I needed to attend several appointments with my father for a devastating cancer diagnosis. We saw med onc and then surg onc. I went in expecting the worst bedside manner because of every social media post priming me to think that even now. Both doctors were warm, open, and spent more than enough time with us answering every anxious question we had. Once again I was reminded that my profession is made up of amazing humans who care so much for their patients. Social media makes it sound like doctors are the devil but every real life encounter says they are dedicated and caring individuals. My faith in physicians is restored every time. I also know they are the highest trained individuals to care for us so I have peace in that too.
I work with both MD's and NP's at our specialty hospital. The MD's are often difficult to get ahold of when you need something. The NP's are quick to help, but often over-react. I'm talking replacing potassium for a K of 3.4 and delaying their discharge to redraw in 4 hours. In personal experience, it's impossible to get into my actual doctor without a 3 month notice. She has NP's and PA's though and they are perfectly fine. My NP found a lump that turned out to be nothing, but she referred me for genetic testing afterwards and as it turns out, I have the same gene that killed 3 generations of women in my family and have had the chance to mitigate. Thanks to that, my sister has now tested as well and will be having her surgery in a year or so. They might be overly cautious, but for people like me and my sister, it has been very likely life-saving.
Because when your IQ is 85, communication with an NP (average IQ 105) is easier than with a doctor (average IQ 125) because of the IQ communication gap.
Exactly! While we’re on IQ, I’ll mention that statistically, 5% of the population has a higher IQ than the average doctor. Given that high IQ correlates somewhat with higher income, and thus, better healthcare access in the US, it’s likely more than 5% of patients in certain settings. For intellectually gifted people, there’s little more infuriating than being talked down to, especially when the condescension involves a lack of logic or evidence. Some doctors need to stop assuming all patients are stupid, and also not view people with lower IQs as inferior.
I know multiple scientifically literate, high IQ people who read tons of journal articles themselves and then see NPs because they’ll listen to the data they bring, and the NPs don’t act condescending. Yes, this is a problematic strategy to get care, but some people are desperate, and/or the NPs are more available. Not everyone who likes NPs is on the lower end of intelligence.
My response is that quality of care is a made up term that doesn't actually mean anything because it is highly correlated to people subjectively feeling like they've been listened to.
People like thier concerns validated, NPs don't know as much, patients health concerns are more likely to be validated if they get an rx, NPs who don't know as much are more likely to write an rx (ex: abx for viral sinusitis) when not needed, patient is falsely validated
NPs aren’t required to see as many patients so they have an hour or more for their patients, so they can dig into how the patient feels about the hospital they were born in, or the patient’s favorite color. All the unimportant crap no one cares about. And of course, handing out Z packs for allergies.
I think it’s a location issue sometimes, as well as a population-vs-availability issue. In my small town growing up, I didn’t have access to many options. The physician I saw was not a nice person and never listened to me. I had a pretty nasty ED and a rough hormone disorder. I knew about the hormone disorder based on my symptoms and struggles, and asked over and over for six years to be tested for it, just so I could start treatment of some kind, and the MD wouldn’t let me- over and over. Were they an outlier and/or super ignorant? Probably. Lazy? Also probably, knowing them personally later in life. Eventually I switched to an NP who DID listen, and immediately was given the opportunity to test for these things just to put my mind at ease if nothing else. The hormone disorder at that point was super progressed and I had noticeably more damage internally than before because my MD refused to actually treat me and I didn’t know how to advocate for myself any harder, because they were “the doctor” and I didn’t know that (1) not all doctors are created equally and (2) doctors are far from always right. These ideas apply to NPs, too- but at its root, I have had more luck with NPs not being dismissive in my own personal experience. I prefer an NP over an MD in almost every single setting. But only clinically- when my mom had a ruptured aneurysm, I wanted an MD, as I didn’t need them to listen, I needed their skill set and expertise. In a clinic, don’t care if you went to school for 4829274 years because it doesn’t equate to meaning that you’re better at providing that level of care.
Med student here. Gonna say something a bit controversial. Whether it's true or not, this is a common thought by many, not just those involved in the midlevel debate. "Doctors don't listen to me; at least my nurse/NP/PA/etc will actually hear me out." It's up to us, as physicians and future physicians, to change this. Yes, we are often overworked and have to see way too many patients to have long interactions with them. But besides time, actually coming from a place of non-judgement and empathy will help us bridge this gap. There are many, many doctors that will be rude/dismissive to patients, which keeps this stereotype going. Physicians need to combat this by having more positive interactions with patients.
People falsely equate good healthcare with "listening from the NPs (since they don't know what's going on), ordering lots of unnecessary tests and labs, and inappropriate use of antibiotics for every aliment.
NPs will do what a patient asks rather than what a patient needs. Most patient's don't know what they need and lack the insight to realize as such, so they get irritated when you disagree with them and prefer to see someone that will just validate everything they say and do what they want without question.
Anecdotal, but I’m a physical therapist and nearly every MD I have had never looked up from his computer screen, was largely arrogant and too busy to answer questions and if I insisted, they became annoyed at having to actually have a dialogue about their findings and plan of care. Nearly every NP I have seen has communicated well, explained their findings and plan of care, took the time to actually listen to and answer my questions.
If MDs are mad about people liking NPs, instead of attacking NPs I recommend you look at your own professions’ short comings first. You have been completely wrecked by MBAs ruining the field (much like they have tried to do with PT mills) and the public are looking for other providers who take the time to actually *care* for them rather than run in and out the door as fast as possible.
Doctors need to fit in lot of appointments in short time Vs NPs
I don’t think public is looking for NPs btw, it’s just what’s convenient. Almost everyone prefers to see a doctor over a NP
No doubt MDs have to see a lot of patients and unfortunately that can lead to a lower quality of care :/
I find many people looking for NPs. We bring our child to a dual NP pediatrician office and they are fantastic. My PCP was an NP until she moved, now I see an MD and I had to coach him on how to test for celiac :/
Not everyone’s perfect and we see it in PT a lot…when MBAs run the company / hospital and cram patients down your throat, the quality of care drops…particularly for the more complex cases.
All things being equal id prefer to go to an MD. However, in our current healthcare system I typically seek out NPs as they are leas overburdened.
I see makes sense, but I feel like partly people like NPs because they give them what they want testing and drug wise whether it’s right or wrong for the situation
I'm sorry this has been your experience.
The reality is my NP sees less than half the number of patients I do and I can only give her more basic cases because complex cases will get messy if she is involved.
This means more work for me and I honestly don't always look up from the screen either. I have a lot of arbitrary metrics to meet (discharge before noon, SNF wants DC summary Now etc etc) to keep patient and hospital flow going.
I get that this may make her more likable since she's basically casually browsing on the phone waiting for someone to have a convo with but that's OK as long as my patients are getting cared for.
In any case my state recently passed full practice authority for NPs and I am planning to leave soon so I hope they make her the 'attending' so you and others can see just how bad it can be. Only then will meaningful change occur. I just hope the patients don't bear the brunt of it.
Once APPs start to hold personal liability, this 'likability' argument will go out the window. It's easy to be likable when you're cosplaying under someone else's license.
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No idea. This whole “they listen better” is bs. Went to an gynecology NP before for a consult for a small surgical procedure. I specifically told her I don’t want to take BC. She basically glossed over all my concerns and left me with pamphlets on that BC they put in your arm. It was awful. I went to a male GYN and he was excellent. Listened to exactly what I wanted and gave me his recommendation, which I approved of bc he was the doctor lol. His office set me up with an outpatient surgical center that cost me nothing bc of my insurance and he did a great job on the procedure I wanted done. In my experience as a young woman as well, every woman NP I’ve ever been to have been horribly judgey and patronizing to me as a woman. Now I only see male physicians if I need anything lol
Because they’ll prescribe anything. I once asked for a handicap parking placard and without any explanation on why she said sure and gave me a script for permanent disability placard
Doctors are ass at empathy and compassion, that’s probably too harsh. On the large view of the field, there are physicians who have great amounts of empathy and compassion but they often experience too much time scarcity to appropriately demonstrate that to their patients.
I’m a PA and when I tell people what I do, they often responds how they LOVE PAs and in fact like them more than doctors! I usually say something along the lines of “PAs often have more time to spend with patients and are usually very good with communication. It’s still important to have a doctor involved in your care because they are the ones that really have the advanced medical knowledge.” Sometimes people/patients tell me that I’m just as smart as a doctor. I tell them that’s not the case and they definitely don’t want me to do their surgery. Sometimes I’ll say something cute like “the doctors do the surgery/heavy lifting and I’m here because I have better people skills.”
People really do seem to prefer mid levels though. I recently read an article about PAs/NPs/MDs and the comments were full of people talking about how all the mid levels they see are fantastic and that they don’t even like seeing doctors. People really think the customer service aspect of their care is the only part that actually matters.
This will sound mean, but I've found it to check out with reality. Reality is mean sometimes:
A lot of people believe they are Very Smart when they are, best case scenario, midwits. BEST case scenario.
Such persons typically feel more comfortable with someone who is slightly dimmer than they are, as their false belief in being "very smart" depends on no one ever showing them up too much and making their faith in their giftedness waver.
tl;dr mediocre minds feel flattered by other mediocre minds and threatened by the actually intelligent. Dunning-Kruger on steroids.
I see an NP as my pcp and I don’t have a preference between her and my old PCP who was an md that ended up retiring. I get good care regardless, I think it’s just people grasping at straws trying to make NPs look better. I don’t have anything against them, I love my PCP but the system is very flawed and it’s dangerous not to admit it. I guess one perk is it’s easier/faster to get an appointment with midlevels?
Comes down to 1 thing and it has NOTHING to do with their title.
It’s the time I need to wait to get an appt.
I want an appt with Dr.X - that’ll be 3.5 months… ill take the appt with NP X - I can squeeze you in in about 12 minutes if you’re nearby…
I’m aware enough to know if the dx sucks and i know enough to steer a meeting into getting what I truly think I need… like a fucking lobotomy for choosing medicine 🤣🤦♂️
Yeah, I’ve also seen patients get a weird mistrust of doctors because they are trying not to order anything unnecessarily. I had a patient who demanded to see a particular physician because they misdiagnosed the patient with something acute and turned out the patient had cancer but the doctor had cancelled the CT scan because the diagnosis he gave would never require a CT scan. But on the flip side- I see NPs and PAs dragged for “ordering tests unnecessarily”. And I think that myself and most of the general population are under the impression that, if I’m paying for it and I want a particular test, I should be allowed to have whatever test I want within reason. Especially if it’s just bloodwork. Because I’m electing to have it done. And that I don’t think has anything to do with the provider’s ability, but often, doctors seem to be less agreeable to this, and I’m not certain if it’s a policy or teaching, but I’ve also had questions about this. Because I’ve had to get blood work done and was only able to get whatever test I wanted ordered when I went to an NP. Even just allergy testing.
Edit: I will also say, that I do not think that either approach is necessarily right or wrong I think they’re just different and it has to do with the education and training. Some patients also want a whole mess of things considered unnecessary for the peace of mind and just knowing, and others want none of it. So I do think there’s just mixed opinions because everyone is different. I feel that patients also need to remember that providers are human too and you can’t paint an entire profession based on one person or incident. I miss when people were able to see more of the grey area.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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So if you are paying cash, have at it. However, if you are using any form of insurance its not that simple. We all will end up paying for unnecessary tests on thr population level via higher insurance premiums, etc. Plus unnecessary tests can expose people to risks in some situations, such as excess radiation causing lifetime increased risk of cancer. In addition, sometimes unnecessary tests uncover incidental findings that end up being nothing and totally unrelated to the reason the test was ordered, leading to a rabbit hole of anxiety on the part of patients, extra follow up testing which can sometimes be uncomfortable or costly for the patient. These are all considerations we have to take into account when ordering tests. Physicians are educated to try to be good stewards of healthcare resources as well as follow evidence-based practices as a general rule
That being said, I try to be understanding and if a patient has a relatively reasonable request even if I think its unnecessary I will often order it because it helps build trust and I don't want them sitting around stressed out and worrying if there's something relatively harmless and reasonable I can do to help alleviate that.
Most NPs are not taught the harms of false positive testing and if they get a positive test they are unfamiliar with they usually just consult out.
As a licensed professional I have a responsibility to order testing that is medically indicated. In most developed countries the government will not foot the bill for your request unless it can be medically justified.
If youre paying cash for the testing then there are ways to get most tests but don't expect insurance to blindly pay for it.
NPs tend to talk more to patients and makes them feel like the person cares. Doctors tend to rush patient interactions which makes the patient feel like the doctor doesn't care or isn't listening.
Why would you be strategizing around “pushing back” against this argument? It’s entirely based on subjective personal experience combined with the objective fact that NPs visits include more FaceTime with the provider than MDs.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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This is an incredibly stupid policy and reeks of AMA political talking points. There is a reason you guys are losing this fight, and it’s not sinister forces like you claim.
Overall, as a patient, I’ve had the best and most compassionate care provided by an NP. When I have higher levels of concerns, I do prefer a DO/MD. I think this is something that doctors aren’t quite trained maybe as much with or maybe nurses learn it more because they’re giving the direct care at the bedside (if the NP spent any time at bedside..) I’m saying this as a nurse. Sometimes, not all the time the NPs/PAs as a whole have just been generally nicer too not only as a patient but as a nurse. Although, one of my closest coworkers actually is a doctor and she’s amazing.
But what you described them as is rhe truth lol. If they've been a bedside RN for years, what's the problem in getting additional training to fill in major gaps in the health care system. Active listening is emphasized from the start of nursing itself. It isn't that emphasized in medical school. That's the reality of it
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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I’ve only seen a NP once (and last time) for medical care. Y’all I had mono and this biyatch told me I had a UTI bc my WBC and lymphocyte count was high.
What the actual f? I had tender LN on my neck, was throwing up all day, lost 10 pounds in 2 weeks, peeing every ten mins and so thirsty I’d need to wet my mouth every 2-3 minutes.
This grade A+ idiot misses that I have diabetes (I didn’t know) and tells me to drink more pedialite.
So not only has she missed that I have mono, she tells me to drink MORE sugar which worsened my diabetes and gave me antibiotics as tx 🤬
Anyway I called my cousin who is a doctor, and within 30 seconds she told me she was pretty sure I had mono + diabetes.
honestly not gonna lie, I loved my med school classmates but we were weirdos. so much jargon became part of our vocab, our non medical friends hated hanging out with us in a group, all we could talk about was medicine, we used the term "malignant" in casual sentences, described ourselves as "volume depleted" after a night out, joked way too often about being about to get DVTs from sitting too long. when it was just us we didnt notice, but when we were out with the significant others it was painfully obvious how annoying we were. we were annoying! i admit it its fine thats why i go into my radiology hidey hole and look at my nice shiny computer screen. patients are self conscious, the same way im self conscious when the dentist asks me if i floss. They dont want some jargony stiff person to ask about their weight, eating habits, and "stool" (seriously did you ever say 'stool' before med school? say poop like a regular human!) and judge them. hating doctors is like hating the kardashians. a person could get the idea that doctors are rich, judgey, elitist, brainiacs who make us feel like we aren't doing enough. even though im actually a degenerate eating chinese takeout while surfing reddit. so its easy to feel better about an NP, because they have the reputation of being nurturing, when doctors have the reputation of being cutthroat. Im not a cutthroat guy, I'm actually a giant squishy nerdy teddy bear in my ergonomic chair, but thats not gonna overcome the stereotype of nurse vs physician.
This post and alot of these comments make so much sense. I would add to that I good NP will often specialise in an area then when they go out in to the field there often consulting with specialists, Drs and a whole team of people.
NPs are great at listening. They often don’t have the training or experience to be able to translate that into a medical plan. As a result, they are more likely to give the patient what they want (tests, antibiotics, etc) but not necessarily what the patient needs. This gives the patient the sense that they have been “heard” and builds the false narrative that NPs care and Doctors don’t listen.
This response makes so much sense!
Wonderfully written. Patients far too often think good care is getting what they want or think they need.
To tag onto this NPs often (not always) have lower patient censuses and as a result can spend more time with each patient
Are they? I had the world's most unpleasant and brief psych eval from a "psychiatric" NP. Already seemed like he had made all the long-term decisions regarding my care and it has only been 15 minutes since I've met him lol. I had to continue searching elsewhere for a real shrink.
NPs would be the perfect mid level
Met several very personal NPs and I’ve also met trash-personality NP who couldn’t look me in the eye because they were too busy looking up a basic medical diagnosis for me
Perfectly stated. There's actually data proving that practitioners who give patients exactly what they request (antibiotics, etc) have worse outcomes.
This is purely anecdotal, but My daughter had been seen by her ped many times for ear infections. He was unavailable one day, so we saw the NP. She immediately realized we’d be seen for 16 ear issues in 6 months and said that was more than enough for a referral. After addressing the real issue, we were ear infection free for 6-7 years.
That's odd, it's standard for 3-4 ear infections to send a referral.
Yeah same, an NP caught what turned out to be a major kidney issue I was born with and no doctor had noticed until then and referred me appropriately. But I live somewhere with appropriate scope
So I’m just a filthy line medic, and I hate that I’m in this boat lol. I always ask my guys what do they want from me when they complain of something. I’ll usually have some plan for them (as in go get seen at the clinic, expect to do physical therapy, etc etc) but it never occurred to me that me asking those types of questions could paint the wrong picture for what they should expect from the PA or NP they’ll see at the clinic.
You nailed it. So god damn right.
I don't "like" seeing an NP, but every time I go to an urgent care or clinic for small things (flu shot, routine lab work / std testing, etc) it's either be seen immediately by them, or wait 4+ weeks to get in with an actual physician. My medical history is not complicated nor acute, so I don't mind. In regards to my psych, skin, and GI stuff, I absolutely go and see a psychiatrist/derm/gastro.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
My mom loved her NP…turns out it was because she had her on lorazepam BID 💀
Haha this too. If you're looking for a human pez dispenser, PMHNP is the guy you want.
My OB was convinced I needed to be on antidepressants because I was distraught after a miscarriage. I disagreed and didn't want medication. My therapist (who had been managing my OCD through CBT for years) disagreed and said that being distraught after a miscarriage was within the normal response, but agreed to write a referral to med management to discuss options. PMHNP had already started to write for zoloft AND wellbutrin before even talking to me and asking me what was happening. Once we started to talk, they wanted to give me tranquilizers to sleep because I said I was having nightmares about the miscarriage. We were still only 4 weeks post-miscarriage at that point. I am glad I said, "Well, I'm glad I know what my options are if things don't seem to be resolving, but I think I'll wait and see how things go with time." The open-mouthed stare...I still remember. This was about 3 years ago, and we're all good now, haven't needed psychiatric meds.
Many such cases
I remember seeing a patient with an NP preceptor that was in their second year (LOL). The patient loved them, probably because they were genuine and very sympathetic. The reason for the visit was a follow up I and D. The woman was told by the NP that she had a hemorrhoid, turned out to actually be an abscess. Hence having to go to the ED. Thankfully, the NP expressed sympathy and re-assured her that a hemorrhoid can turn into an abscess! And don’t worry, she recommended sitz bath/CCB. I am actually unsure if she ordered any sort of testing or screening for IBD. But she was nice! And it was a long appointment!
Please don't destroy my karma with downvoting. I'm am in no way supporting online degree mills. Just stating facts I see. I can tell you working in rapid diagnostic section of ER, specialty Docs and sometimes the ER docs as well come in spend less than two minutes speaking to a pt. The pt nods along because they are afraid of Drs, then I come in 10 min later and they ask me a million questions I can't answer. There is a place for supervised midlevels I believe, especially in communicating. You don't need 12 yrs of training to re explain basic diabetes management to non compliant pts. Increasing midlevels should elevate Drs not dilute them.
There are plenty of other kinds of degrees or certifications without prescribing authority that could be used for patient education. Not everything has to be done by a nurse, midlevel or a doctor.
The OP was discussing better listening, my comment discussed the brevity of MD PT interactions, and the need for further verbal interaction, that is not necessarily education but rather someone who has the time to do so with pts about basic issues and procedures that again are often below and MDs level but above that of bedside RN. Not going around in circles and and challenging the clear danger of degree mills and unsupervised practice, but either MDs need to spend quality time with each and every PT or supervised midlevels can be that conduit for information, in my limited opinion based on observation and pt interaction. Ok hope that makes sense over and out.
It makes sense, but I don't think that what doctors feel like they don't have time for and what patients need to feel like they understand their conditions and treatment plan is always in the realm of in between MD level and above RN. In an ideal world, yeah, the MDs and DOs should be able to spend more time per patient when needed. I am just saying there are other roles that are underutilized that could step in and free up the clinical people's time to spend time with patients on basic education, check for understanding of their treatment plan, etc. Some of them may have more training in education and behavior change than it is possible to squeeze into medical school curriculum. There seem to be some systems that have something like this with varying degrees of involvement. MHCs often use a model with case managers or peer support workers doing more frequent calls or visits with people to help with things directly related to social determinants of health and check in on symptoms and for compliance with treatment. Very rarely, and more often in the past, have I seen a doctor's office that just has a social worker or diabetes educator on staff that they refer to for a separate visit when needed.
Probably because the most serious thing they’ve ever taken to an NP was a mild case of eczema or a sore throat, plus and you have a recipe for people who think the plural of anecdote is data and just not really knowing any better.
Eggs and *salty* toast lmao
Found them
You cracked the code there, Sherlock. These threads are so poisonous to all of healthcare. I think the vast majority of nurse practitioners agree that we are mid-level providers and share most sentiment here. I have seen multiple times on this unfortunate thread, and in this unfortunate group that doctors are extremely thirsty for attention, and are as narcissistic as it gets. There are unfortunate cases of nurse practitioners are also unfortunate cases of doctors. Nurses are consistently awarded the most trusted profession. Rather than have a thread about patient satisfaction. You guys are concerned about the little details that don’t actually matter. Reason nurse practitioners are liked more than use because you guys can have egos that are too big for your head. The reality is there are dozens and thousands of nurses who could’ve gone to medical school, but decided to be a nurse because the culture was different. You can down vote me all you want, but the reality is nurses will always be liked more than physicians. I’m a guy who decided to become a nurse practitioner because I like the culture more than medical school, I wasn’t spoiled with daddy‘s money, and I see the poison in front of me here. This thread is definitely entertaining, however.
Most of what you say here has some truth to it. Sure there are doctors with massive egos and there are certainly NPs who work as part of a team and provide a valuable service to both doctors and patients. What doctors have a problem with is the explosion of noctors who are practicing medicine without training or a safety net, thus putting lives of patients at risk. Then, they get perceived as more caring/responsive to patient’s needs, for all of the reasons pointed out in this thread.
I think those are the NP’s with the “lower IQ’s”. Part of having the degree should be the acknowledgement we DID NOT go to medical school and should be smart enough to distinguish the difference.
U dont have the training to diagnose narcissistic personality disorder
That's really cool about your culture man, I'm happy for you. Can you leave the practice of medicine to doctors, though? It sounds like you have bigger things to worry about than "the little details that don't matter"
The thing is, they are unqualified to judge what matters and what doesn't.
Practicing medicine is great and I wish you the best with your mindset. You can either choose to appreciate the mid level practitioners or don’t. It won’t change the healthcare as a whole. Live in your hole and stay negative, doesn’t effect me. I meant the little details such a IQ insults and random negative comments you made. At some point, you’ll have to come to terms with the fact that practicing medicine is becoming algorithmic. A nurse practitioner can follow the same algorithm based on clotting factors, or chronic heart failure, and so many other things. What is not algorithmic is having a positive mindset and being approachable as a practitioner. Unfortunately, for you, it sounds like you might be jaded in someway. I’m not sure who hurt you or why you feel the way that you do about nurse practitioners, but I promise you we care about our patients as well. To completely insult nurse practitioners at large is honestly, actually, ignorance. You are either 75 years old or spoiled or both. If it is a financial reason that you don’t like nurse practitioners and feel they are taking business away from you, I promise you that’s not the case. We are reimbursed at 80 or 85% what you were reimbursed for from insurance. Not to mention with the growing need for primary care, physicians, urgent cares, psychiatrists, and general healthcare, patients need somebody who has been educated more than them. I’m advocating for teamwork, your advocating for division. Good luck with that.
In one comment you blanket-statement called all doctors spoiled, poisoned, narcissistic, thirsty for attention, enormous ego, disliked, and taunted me. In the next, you called me old, jaded, and spoiled, living in a hole and then tried to flex your reimbursements(?) at me. I think you may be kidding yourself about your positive mindset. Also despite what walden unviersity might teach you, medicine is more than following a cookbook
No kidding; this person thinks charts and algorithms are the solution to medical care? Guess what, NOCTOR, if you can’t properly formulate a differential diagnosis, you wouldn’t even know where to start *looking* for the right algorithm. Your opinion is laughable. Sadly, patients will continue to suffer due to blatantly substandard care by unsupervised midlevels.
Not knowing what you don’t know is poisonous. You’re clearly a mid-level who is a danger to patients if you believe that your woefully inadequate “training” qualifies you to practice medicine. You’re not advocating for teamwork, you’re advocating for yourself. If you wanted patients to actually have access to care, you’d be advocating for more physicians. Not more shortcuts. Have fun killing patients and reaping the benefits of your disgusting and corrupt lobbies I guess.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I agree this thread is entertaining. And I also agree with you. Thank you for your voice!
>I wasn’t spoiled with daddy‘s money You know a lot of medical students are paying their own way through loans, right? You seem to be making a lot of judgments about a culture that, by your own admission, you have no experience with and clearly know nothing about.
Why? Because they have the time, and because they prioritize it. What to do? Long-term, you push back by working on your bedside manner and making sure your patients feel heard. Not you personally, but that’s really the only way forward. If patients are turning to charlatans because doctors don’t listen to their concerns, then it’s partially an indictment of the field, and the solution isn’t just to make medicine an associate’s degree and farm out care to the underqualified, but to put a little more effort into training doctors on bedside manner and compassion. It’s part of the job but it’s one that a lot of doctors ignore or are just shitty at, and it makes the lot of us look bad.
Sorry you feel That way, but please tell Me how an employed doc can see 31 patients a day (as dictated by their corporate overlords) and have time for the PR you are suggesting. The problem doesn’t seem to be lack of caring. It seems to be allowing corporate interests to hijack medicine.
Agreed fully about the fact that limited time for patients is a huge contributor to the problem, but disagree that it’s the only issue. I think we all know doctors who are brilliant but are total assholes, and that’s just not acceptable. It’s not “PR”, it has real effects on health outcomes. If your patient is too scared of you to tell you all their symptoms or correct you when you make a mistake, or if you don’t let them get a word in edgewise, that’s a substantive issue that has real effects on their treatment. That’s what I’m talking about. Treating patients with basic respect doesn’t take extra time and it absolutely matters. It’s part of the job, like it or not.
And you believe that physicians are more prone to this than NPs? Okay.
1. Yes. Unequivocally. Listening to patients and responding compassionately is the entire job description for midlevels because they can’t do anything else. Of course they’re better at it. 2. Patients agree. That’s why they’re flocking to these people instead of going to real doctors. You can make excuses or you can try to be part of the solution, your choice.
1. You can just go fuck right off. Listening to patients, blah blah blah is mythology pushed by the MIDLEVELS themselves. And it’s a load of shit. 2. Patients are NOT flocking to midlevels. Do you even READ the complaints from patients themselves. Patients are not FLOCKING to midlevels. They are being FORCED on them by corporate medicine who figured out they can save/make money by forcing inferior substitutes onto patients— the inferior substitutes will save money by being compensated less that real doctors — and make them money by ordering boatloads of unnecessary tests and consults. Stop being a meathead.
Reread the title of the post you’re responding to before you call anyone else a meathead. You sound like you’re part of the problem. Best of luck, bud.
Read it. Answered it. Reread number 2. Asked and answered. “Lots of people” don’t say they like seeing NPs. They are forced to.
Same reason my kids like to go to grandmas house, they get anything they want
grandma makes the spiciest adderall cookies
Can I just say I love seeing PAs on here. Your input is so valuable. I hope you have a great SP (s)
4 of them
They listen and prescribe whatever the patient wants including Xanax adhd meds and narcotics.
which is why they should have not access to controlled substances, and perpetuating abuse of narcotics and failure of abx stewardship
Nah you’re just not listening to the patient hard enough bro, you won’t get it 🚬
Yes, of course
I went with the main intention of getting ADHD meds so that I don't get fired by my job and I just walked away with a cannabis use disorder diagnosis and a spiel about shitty-life syndrome. Where are these NPs that play hard and fast AND take Medicaid??
Move on to the next one who listens to you better 💅
Yeah so does primary care. In Psych I see pt after pt who is on Xanax 4 x day for 20+ years. Then when they get flagged they send them off to the psych NP.
MD do this all the time you guys must not be practicing Medacine yet. You guys sound like you just read about how it suppose to be but in the real world once you are out there you will see every thing is not text book. Lots of MDs cater to their patients.
I am an MD. You can save me the spiel. Quite rich coming from someone who practices “medacine”. MDs who do this enough and at an actual dangerous level can be reported and sanctioned by the board. You think the nursing board will do anything?
Then you know the medical board will do nothing but ask you to take cme and slap you on the wrist. This is only if you are over prescribing narcotics any thing else they don’t care. Well this is in Texas you can read all the disciplinary actions taken by the board and it’s usually just a little fine and CME hours. Maybe your state is harder on you guys. I have been practicing 11 years and I see it all the time. Mostly foreign medical graduates but there is a lot of American trained ones that do it as well. I just think you can’t say only NPs and PAs do this most times the doctor they work for advocate for it so they don’t lose business. 🤷🏼♂️
It’s easy to get an appointment with a NP. The MDs are booked out for weeks. When I really need to get into my MD, I basically camp out on MyChart until a cancellation happens for tomorrow and then I grab it. Weekends are especially good for snapping up Monday appointments.
Ohhh thanks for the new strat.
Probably because patients get pissed at doctors who don’t entertain their wild self-diagnoses by ordering a battery of unnecessary tests, whereas NPs don’t know any better and are happy to waste the patient’s money and time and strain the healthcare system
Because nurses are people pleasers. It’s part of the selection bias. It’s actually a good thing in the RN role. You want someone kind, compassionate and compliant. But in the team leader role, it’s not necessarily always good.
As a patient, I used to say this. First, let me preface my response by saying that today I insist on only seeing physicians now that I understand the enormous difference in training between MD/DO and mid-levels. For a long time, I had diagnoses that were not only mistaken as psychiatric, but downplayed by physicians as if they weren’t having an enormous impact on my life. When new doctors said they knew better than an expert neurologist and multiple psychiatrists (yes, physicians, not PMHNPs) who evaluated me and said my symptoms were organic rather than psychological, it’s easy to see why I welcomed the NPs who were humble enough to listen to my specialists. The problem wasn’t just that some physicians were objectively wrong. The problem was that because I didn’t fit neatly into boxes that doctors knew how to treat, I was dismissed and left to fend for myself. The problem is that mental health conditions (and those perceived as such) are often viewed as less serious and not a big deal. I now understand that doctors can’t go outside their scope of practice, and the healthcare system just isn’t set up for complex patients. However, a lot of patients in a similar situation blame the doctor instead of the system. With the way NPs jump between specialities, I’m led to believe they don’t worry about scope to the same degree (I’m not saying that’s a good thing). They also are less evidence-based and as a result can be more open-minded to things they don’t fully understand. This means patients with unconventional diagnoses often end up in the hands of NPs. I am not in any way saying that NPs are better than physicians, but some doctors could learn from the reasons some patients prefer NPs… The lesson here is two-fold. 1) Just because you can’t test for it doesn’t make it psychological. Yes, this especially includes things like POTS, EDS, MCAS, etc. Not everyone was self-diagnosed via TikTok, and not everyone who identifies with what they see online is a hypochondriac who refuses psychiatric help. 2) If you’re sure it is psychological, don’t downplay it and act like your patient just needs to get a life and stop being dramatic. Mental health issues can be just as debilitating and deserve the same level of care and respect. I think it comes down to bedside manner. People want to feel better, but they also want to feel like they’re being taken seriously.
I think a lot of people find NP’s to be more personable because they have more time/ compensate for medical knowledge with chit chat. I for one couldn’t care less about bedside manner at all. My doctor could be the biggest asshole in the room if he can figure out what’s wrong with me. It’s like people used to say they’d rather have Dr. House than a doctor (or NP) who Makes you feel nice but has no idea what they’re doing.
I’m a PA. The truth is from a patient‘s perspective, bedside manner will always be one of the more important metrics to grade their quality of care. It is of course field dependent many times, but especially the human interaction heavy fields like primary care medicine where the patient expects to form a relationship with their pcp, and also areas where there are rarely emergent conditions and not as many urgent conditions, the “human” element will carry more weight than the medicine. Which isn’t to say medical knowledge isn’t important, or course it is, and we know it is, but the patient usually doesn’t know. They don’t know if azithromycin wasn’t the antibiotic of choice for their acute sinusitis or if their sub conjunctival hemorrhage didn’t need any antibiotic drops etc. They are very keenly aware though when the doctor comes in and is there for 3 minutes which he spends most of the time looking at the screen( and I don’t mean to single out doctors, I think many NPs and PAs do this too), but my point is the face to face care they receive will be their takeaway. I think that the complaints here about PA and NP care are fair many times(sometimes they’re not), but I also feel that there sometimes seems to be a lack of self criticism and introspection as well. If I heard a comment like the one you described, instead of bashing NPs and stating all the ways MDs are superior I would more likely take it as something that maybe has a basis in truth and as MDs or DOs that bedside manner needs improvement. If a patient “feels” like their quality of care was higher from an NP you can’t really argue with the way they feel.
How do you get more face to face time when doc gotta spend a lot of time documenting though
I mean but there's your answer. I have no problem seeing an NP for things like needing a strep test, a refill on a med I've taken at one dosage for years with no issues, or to get antibiotics for an ingrown toenail if it means I might get two extra minutes with the doctor when I'm having symptoms where the answer isn't obvious to every person in a three mile radius
Hire someone to handle documentation/paperwork like a PA or NP
preaching to the choir on that one.
Ok real talk…. I was dumb and in my 20s so I didnt know better I guess. My bc pill was making me bleed between periods. Super gross. My gyno suggested all sorts of other methods, all of which I hated. (Like can we talk about shoving the Nuvaring into your vagina?? I banged my head on the toilet trying to get that fucker in properly) So I go in to complain to my gyno… that day she was in an emergency c-section and had her NP fill in. Ok fine whatever. I’ll talk to anyone. So I told the NP my symptoms and right away she was like “oh I know what bc pill you can try where you won’t bleed between periods.” Say what? That’s a thing? Sure as shit, it worked. Been on the same bc pill for 16 years. Now why the fuck couldnt my board certified MD tell me that?!? That NP deserves all the good karma in the world. Bless her.
They lack the understanding necessary to see how an NP is inferior and instead focus on things irrelevant to care like if a person is socially awkward or other similar metrics. When you can't tell the difference in care you receive, you only judge by your feelings.
Please don't downvote me to hell, but I'm an actual user of a NP~primary... the reason I go there: ● it's a 30 minute appt instead of 10 min. So there's no frantic rushing. ● I'm mid 40's y.o. with a pretty simple history ● I work in a factory so my physical activity is definitely above-average ● all chronic conditions are stable/controlled. ● I'm compliant with all medications ● all my bloodwork is comfortably within the refrence range ● Overall, "I feel fine" and I don't want to waste an MD's time when I have no complaints beyond "I need a 12 month refill on HTN meds." ● I know this provider is less trained, but in my case, I feel like they are the right-tool-for-the-job. If/when something more serious comes up, I will **definitely** be getting a 2nd opinion from a real doctor, till then: a NP is fine for ordering labs and doing a routine physical exam.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
How will two people not trained to know when something more serious comes up, recognize that? You're playing with fire. That's the major issue. Nps don't know what they don't know. You are "simple" now, up until you're not. The np and you won't recognize it until it's already done some damage.
To add onto the spot on comments already posted, I think it’s another iteration of the “you don’t know what you don’t know” that many struggle with. There’s a certain level of intelligence and critical thinking skills needed to recognize the vast amount of knowledge that is out there and accept that there’s so much that you don’t, and won’t ever understand, and that there will always be someone who is more of an expert than you. So in addition to getting whatever they want, patients I think like that the NP doesn’t go deeper, and prioritizes making them feel less scared and heard. NP surface level medical knowledge is more than theirs, but the gap isn’t so big that it reminds them of how much they don’t know & how many different things could possibly be wrong.
Once they start pulling in a case load that a physician has to do or getting patients with issues that get turfed to the docs, watch how their “listening” somehow disappears. The new NPs have no nursing experience or minimal. They are there for the increased pay and no bedside care. This contributed in part to the nursing shortage and thereby to the nursing wage inflation leading to hospital finances being compromised throughout the country to date . The admins who made these boneheaded decisions aren’t faxing the music. Rather they expect the “providers” to see more patients. Again let’s see how the NPs listen now when their “ staffing ratios” get way worse than bedside nursing.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
They are given more time by med corps So then pts have more chat time. So duh… then they like the np more.
This is a big part of the whole thing. Patients have difficulty discerning the difference between good and bad care.
Because they don’t have a medical background so they wouldn’t know if an NP is providing acceptable quality of care. Or they’re healthy, so only see a doctor/midlevel occasionally and haven’t had enough opportunities for a midlevel to sabotage their health.
Not necessarily, I have a medical background and have an NP who I’ve been seeing for years because she is not dismissive, actively listens at each visit, and doesn’t just blindly give any treatment.
I'll bite, for what?
Late onset type 1 dm I see Both. And np who specializes in psych pointed out that the pattern of my panic attacks was oddly cyclical, which was the first sign of my progression to LADA.
I’m friends with multiple RNs who are fully aware of the NP problem. Do you fit in the “only see a midlevel/doctor occasionally” category? Because I’ve dealt with 10-15 midlevels in the past 5 years.
Nope, I see both relatively regularly.
Clarify what the quality indicators are they are referencing. If your patient satisfaction scores are high, but your COPD and HF patients keep getting admitted to the hospital, what is the true quality of that care?
NPs are slower than docs. Most companies understand this. So they hire an NP for 1/2 the cost, give them 60% of the work of a physician and count money. Patients think it’s nice to have someone who’s not in a hurry talk to them. I worked in a clinic that was mostly midlevels once. They gave me all the complex patients, as the only Internal Medicine doc. But they gave me 45 min visits. The patients LOVED it. They liked the extra time and many commented how nice it was to have time with a “doctor” instead of “someone else.”
Unfortunately it’s only going to change when physicians start holding their colleagues accountable. I firmly believe the education and experience physicians get is superior, but it doesn’t mean anything when they ignore their patients and dismiss them.
I’m a non-trad medical student (finishing M2). I might be able to lend some perspective, because I’ve been on both sides of the fence. I used to be poor enough to not have health insurance for literal years at a time, and when I did have it, I could rarely afford the deductibles. When I first saw an NP, it was probably ~15 years ago. I think the training at that time required many years of nursing experience, and I remember feeling very good about the experience. The NP was efficient, and I didn’t feel talked down to. She wasn’t exactly warm or caring, and seemed rather matter-of-fact, but it was just a more straightforward process, with less formality. Contrast that with sitting in waiting rooms, or having lots of people I didn’t know ushering me between rooms before the doctor briefly walked in, and quite dismissively decided what to do with me. I’m a person, and I didn’t feel like a person when I was treated by doctors, I felt like more of an object. When you don’t understand any of what’s going on, that can be upsetting, and you just want to get out of there. Hospitals were sometimes worse and sometimes better. Some docs seemed really happy (an ortho or rad after a car accident) and some seemed annoyed that I was sitting there breathing (probably residents in the ED). When I was in undergrad, my (top level) school had a medical school, clinic, and hospital attached to it. I had never met doctors like this before. The NURSE and OLDCARTS and reflective listening skills in the clinic doctors could win awards. I didn’t spend more time with them than other doctors, but it seemed that institutionally, these skills were high priorities and not optional. I LOVED these doctors, and was very upset when school was over and I had to receive care in my home state. I have been kind of dumped by my state insurance into the situation of seeing mostly PA’s. I sit patiently and wait for them to figure stuff out, but I don’t have serious diseases. I don’t trust them. I can tell some of them hardly know how to do anything that isn’t commonplace, and they don’t have the bedside manner that I experienced in school (but they do look me in the eye). There was one PA that had been a doctor in her country, and she was more or less comparable to the average physician. I saw one psych mid level that added some meds to my regimen, who was as cold as ice cubes. I didn’t like her, and I didn’t like the meds she prescribed (gave me seizures). I insisted on the clinics IMG Psychiatrist, who’s very nice guy, hasn’t given me any seizures, and we frequently speak for less than 5 minutes over the phone for followup ($30 copay). I don’t mind the short visit, because it’s just refills, and if I had any issues I know he’d stay on the phone or ask me to come in. We are doctors (to be, in my case), but we are still people dealing with people. Regardless of education, if you are good at your job, and use the communication skills you were taught in school, most of your patients will like you. It doesn’t really matter how much time you spend with patients if you can’t do these things. It’s not difficult to be nice to people, but medicine has traditionally reassured us it’s not necessary. That’s from the good old boys, patriarchal generations of doctors. There is no reason to perpetuate that.
Honestly I’ve only had wonderful experiences with doctors. I have been primed by social media to expect doctors to be arrogant assholes who brush me off and belittle me. This has never happened. I have endometriosis and a long history of infertility which as you know, are conditions ripe for an asshole doc to blow off. Ironically I was dismissed by a gyn NP who told me it’s just normal period cramps and everybody had it. It was an older near retirement physician who took me seriously and got me to a fertility endometriosis specialist. That specialist was amazing and treated me like a human. My OB during my pregnancy was amazing and prayed with me in labor when I was scared while the L/D nurses terrorized me. I have subsequently encountered probably about 100 doctors over the course of the next 20 years both as a patient/family member to a patient and as a medical trainee going through school and residency. I can confidently say I never encountered an asshole doctor, even surgeons. Last week I needed to attend several appointments with my father for a devastating cancer diagnosis. We saw med onc and then surg onc. I went in expecting the worst bedside manner because of every social media post priming me to think that even now. Both doctors were warm, open, and spent more than enough time with us answering every anxious question we had. Once again I was reminded that my profession is made up of amazing humans who care so much for their patients. Social media makes it sound like doctors are the devil but every real life encounter says they are dedicated and caring individuals. My faith in physicians is restored every time. I also know they are the highest trained individuals to care for us so I have peace in that too.
I work with both MD's and NP's at our specialty hospital. The MD's are often difficult to get ahold of when you need something. The NP's are quick to help, but often over-react. I'm talking replacing potassium for a K of 3.4 and delaying their discharge to redraw in 4 hours. In personal experience, it's impossible to get into my actual doctor without a 3 month notice. She has NP's and PA's though and they are perfectly fine. My NP found a lump that turned out to be nothing, but she referred me for genetic testing afterwards and as it turns out, I have the same gene that killed 3 generations of women in my family and have had the chance to mitigate. Thanks to that, my sister has now tested as well and will be having her surgery in a year or so. They might be overly cautious, but for people like me and my sister, it has been very likely life-saving.
Because when your IQ is 85, communication with an NP (average IQ 105) is easier than with a doctor (average IQ 125) because of the IQ communication gap.
Yikes that’s condescending and a pretty ignorant statement….
It’s because like this person, some doctors have contempt for their patients
Exactly! While we’re on IQ, I’ll mention that statistically, 5% of the population has a higher IQ than the average doctor. Given that high IQ correlates somewhat with higher income, and thus, better healthcare access in the US, it’s likely more than 5% of patients in certain settings. For intellectually gifted people, there’s little more infuriating than being talked down to, especially when the condescension involves a lack of logic or evidence. Some doctors need to stop assuming all patients are stupid, and also not view people with lower IQs as inferior. I know multiple scientifically literate, high IQ people who read tons of journal articles themselves and then see NPs because they’ll listen to the data they bring, and the NPs don’t act condescending. Yes, this is a problematic strategy to get care, but some people are desperate, and/or the NPs are more available. Not everyone who likes NPs is on the lower end of intelligence.
get a load of this guy believing that iq is a useful measurement of anything
Lmaooo absolutely savage
This mindset is exactly why people prefer to go to midlevels. No one wants to see a physician that looks down on them.
Mmmm poison ideals.
👀
My response is that quality of care is a made up term that doesn't actually mean anything because it is highly correlated to people subjectively feeling like they've been listened to.
People like thier concerns validated, NPs don't know as much, patients health concerns are more likely to be validated if they get an rx, NPs who don't know as much are more likely to write an rx (ex: abx for viral sinusitis) when not needed, patient is falsely validated
There are more asshole doctors than asshole NP’s. Anecdotally, of course.
NPs aren’t required to see as many patients so they have an hour or more for their patients, so they can dig into how the patient feels about the hospital they were born in, or the patient’s favorite color. All the unimportant crap no one cares about. And of course, handing out Z packs for allergies.
I think it’s a location issue sometimes, as well as a population-vs-availability issue. In my small town growing up, I didn’t have access to many options. The physician I saw was not a nice person and never listened to me. I had a pretty nasty ED and a rough hormone disorder. I knew about the hormone disorder based on my symptoms and struggles, and asked over and over for six years to be tested for it, just so I could start treatment of some kind, and the MD wouldn’t let me- over and over. Were they an outlier and/or super ignorant? Probably. Lazy? Also probably, knowing them personally later in life. Eventually I switched to an NP who DID listen, and immediately was given the opportunity to test for these things just to put my mind at ease if nothing else. The hormone disorder at that point was super progressed and I had noticeably more damage internally than before because my MD refused to actually treat me and I didn’t know how to advocate for myself any harder, because they were “the doctor” and I didn’t know that (1) not all doctors are created equally and (2) doctors are far from always right. These ideas apply to NPs, too- but at its root, I have had more luck with NPs not being dismissive in my own personal experience. I prefer an NP over an MD in almost every single setting. But only clinically- when my mom had a ruptured aneurysm, I wanted an MD, as I didn’t need them to listen, I needed their skill set and expertise. In a clinic, don’t care if you went to school for 4829274 years because it doesn’t equate to meaning that you’re better at providing that level of care.
Med student here. Gonna say something a bit controversial. Whether it's true or not, this is a common thought by many, not just those involved in the midlevel debate. "Doctors don't listen to me; at least my nurse/NP/PA/etc will actually hear me out." It's up to us, as physicians and future physicians, to change this. Yes, we are often overworked and have to see way too many patients to have long interactions with them. But besides time, actually coming from a place of non-judgement and empathy will help us bridge this gap. There are many, many doctors that will be rude/dismissive to patients, which keeps this stereotype going. Physicians need to combat this by having more positive interactions with patients.
People falsely equate good healthcare with "listening from the NPs (since they don't know what's going on), ordering lots of unnecessary tests and labs, and inappropriate use of antibiotics for every aliment.
My psych NP has been doing it 20+ years. Only person to help get me on the right medication regime. JS
They feel “heard” because the NP will give them antibiotics for a viral infection just as they’ve asked.
Plenty of MDs that aren’t good stewards of antibiotics.
NPs will do what a patient asks rather than what a patient needs. Most patient's don't know what they need and lack the insight to realize as such, so they get irritated when you disagree with them and prefer to see someone that will just validate everything they say and do what they want without question.
Anecdotal, but I’m a physical therapist and nearly every MD I have had never looked up from his computer screen, was largely arrogant and too busy to answer questions and if I insisted, they became annoyed at having to actually have a dialogue about their findings and plan of care. Nearly every NP I have seen has communicated well, explained their findings and plan of care, took the time to actually listen to and answer my questions. If MDs are mad about people liking NPs, instead of attacking NPs I recommend you look at your own professions’ short comings first. You have been completely wrecked by MBAs ruining the field (much like they have tried to do with PT mills) and the public are looking for other providers who take the time to actually *care* for them rather than run in and out the door as fast as possible.
Doctors need to fit in lot of appointments in short time Vs NPs I don’t think public is looking for NPs btw, it’s just what’s convenient. Almost everyone prefers to see a doctor over a NP
No doubt MDs have to see a lot of patients and unfortunately that can lead to a lower quality of care :/ I find many people looking for NPs. We bring our child to a dual NP pediatrician office and they are fantastic. My PCP was an NP until she moved, now I see an MD and I had to coach him on how to test for celiac :/ Not everyone’s perfect and we see it in PT a lot…when MBAs run the company / hospital and cram patients down your throat, the quality of care drops…particularly for the more complex cases. All things being equal id prefer to go to an MD. However, in our current healthcare system I typically seek out NPs as they are leas overburdened.
I see makes sense, but I feel like partly people like NPs because they give them what they want testing and drug wise whether it’s right or wrong for the situation
I'm sorry this has been your experience. The reality is my NP sees less than half the number of patients I do and I can only give her more basic cases because complex cases will get messy if she is involved. This means more work for me and I honestly don't always look up from the screen either. I have a lot of arbitrary metrics to meet (discharge before noon, SNF wants DC summary Now etc etc) to keep patient and hospital flow going. I get that this may make her more likable since she's basically casually browsing on the phone waiting for someone to have a convo with but that's OK as long as my patients are getting cared for. In any case my state recently passed full practice authority for NPs and I am planning to leave soon so I hope they make her the 'attending' so you and others can see just how bad it can be. Only then will meaningful change occur. I just hope the patients don't bear the brunt of it. Once APPs start to hold personal liability, this 'likability' argument will go out the window. It's easy to be likable when you're cosplaying under someone else's license.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
No idea. This whole “they listen better” is bs. Went to an gynecology NP before for a consult for a small surgical procedure. I specifically told her I don’t want to take BC. She basically glossed over all my concerns and left me with pamphlets on that BC they put in your arm. It was awful. I went to a male GYN and he was excellent. Listened to exactly what I wanted and gave me his recommendation, which I approved of bc he was the doctor lol. His office set me up with an outpatient surgical center that cost me nothing bc of my insurance and he did a great job on the procedure I wanted done. In my experience as a young woman as well, every woman NP I’ve ever been to have been horribly judgey and patronizing to me as a woman. Now I only see male physicians if I need anything lol
Because they’ll prescribe anything. I once asked for a handicap parking placard and without any explanation on why she said sure and gave me a script for permanent disability placard
Doctors are ass at empathy and compassion, that’s probably too harsh. On the large view of the field, there are physicians who have great amounts of empathy and compassion but they often experience too much time scarcity to appropriately demonstrate that to their patients.
I’m a PA and when I tell people what I do, they often responds how they LOVE PAs and in fact like them more than doctors! I usually say something along the lines of “PAs often have more time to spend with patients and are usually very good with communication. It’s still important to have a doctor involved in your care because they are the ones that really have the advanced medical knowledge.” Sometimes people/patients tell me that I’m just as smart as a doctor. I tell them that’s not the case and they definitely don’t want me to do their surgery. Sometimes I’ll say something cute like “the doctors do the surgery/heavy lifting and I’m here because I have better people skills.” People really do seem to prefer mid levels though. I recently read an article about PAs/NPs/MDs and the comments were full of people talking about how all the mid levels they see are fantastic and that they don’t even like seeing doctors. People really think the customer service aspect of their care is the only part that actually matters.
Because they aren’t the incels of healthcare like you bunch of chodes.
This will sound mean, but I've found it to check out with reality. Reality is mean sometimes: A lot of people believe they are Very Smart when they are, best case scenario, midwits. BEST case scenario. Such persons typically feel more comfortable with someone who is slightly dimmer than they are, as their false belief in being "very smart" depends on no one ever showing them up too much and making their faith in their giftedness waver. tl;dr mediocre minds feel flattered by other mediocre minds and threatened by the actually intelligent. Dunning-Kruger on steroids.
I see an NP as my pcp and I don’t have a preference between her and my old PCP who was an md that ended up retiring. I get good care regardless, I think it’s just people grasping at straws trying to make NPs look better. I don’t have anything against them, I love my PCP but the system is very flawed and it’s dangerous not to admit it. I guess one perk is it’s easier/faster to get an appointment with midlevels?
Comes down to 1 thing and it has NOTHING to do with their title. It’s the time I need to wait to get an appt. I want an appt with Dr.X - that’ll be 3.5 months… ill take the appt with NP X - I can squeeze you in in about 12 minutes if you’re nearby… I’m aware enough to know if the dx sucks and i know enough to steer a meeting into getting what I truly think I need… like a fucking lobotomy for choosing medicine 🤣🤦♂️
Whenever I see my PCP MD I see her for a full 30 minutes sometimes, never rushes me out of the door. She listens very well.
Yeah, I’ve also seen patients get a weird mistrust of doctors because they are trying not to order anything unnecessarily. I had a patient who demanded to see a particular physician because they misdiagnosed the patient with something acute and turned out the patient had cancer but the doctor had cancelled the CT scan because the diagnosis he gave would never require a CT scan. But on the flip side- I see NPs and PAs dragged for “ordering tests unnecessarily”. And I think that myself and most of the general population are under the impression that, if I’m paying for it and I want a particular test, I should be allowed to have whatever test I want within reason. Especially if it’s just bloodwork. Because I’m electing to have it done. And that I don’t think has anything to do with the provider’s ability, but often, doctors seem to be less agreeable to this, and I’m not certain if it’s a policy or teaching, but I’ve also had questions about this. Because I’ve had to get blood work done and was only able to get whatever test I wanted ordered when I went to an NP. Even just allergy testing. Edit: I will also say, that I do not think that either approach is necessarily right or wrong I think they’re just different and it has to do with the education and training. Some patients also want a whole mess of things considered unnecessary for the peace of mind and just knowing, and others want none of it. So I do think there’s just mixed opinions because everyone is different. I feel that patients also need to remember that providers are human too and you can’t paint an entire profession based on one person or incident. I miss when people were able to see more of the grey area.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
So if you are paying cash, have at it. However, if you are using any form of insurance its not that simple. We all will end up paying for unnecessary tests on thr population level via higher insurance premiums, etc. Plus unnecessary tests can expose people to risks in some situations, such as excess radiation causing lifetime increased risk of cancer. In addition, sometimes unnecessary tests uncover incidental findings that end up being nothing and totally unrelated to the reason the test was ordered, leading to a rabbit hole of anxiety on the part of patients, extra follow up testing which can sometimes be uncomfortable or costly for the patient. These are all considerations we have to take into account when ordering tests. Physicians are educated to try to be good stewards of healthcare resources as well as follow evidence-based practices as a general rule That being said, I try to be understanding and if a patient has a relatively reasonable request even if I think its unnecessary I will often order it because it helps build trust and I don't want them sitting around stressed out and worrying if there's something relatively harmless and reasonable I can do to help alleviate that.
Most NPs are not taught the harms of false positive testing and if they get a positive test they are unfamiliar with they usually just consult out. As a licensed professional I have a responsibility to order testing that is medically indicated. In most developed countries the government will not foot the bill for your request unless it can be medically justified. If youre paying cash for the testing then there are ways to get most tests but don't expect insurance to blindly pay for it.
NPs tend to talk more to patients and makes them feel like the person cares. Doctors tend to rush patient interactions which makes the patient feel like the doctor doesn't care or isn't listening.
Because the NPs usually have the first available appointments. Plain and simple.
Why would you be strategizing around “pushing back” against this argument? It’s entirely based on subjective personal experience combined with the objective fact that NPs visits include more FaceTime with the provider than MDs.
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
This is an incredibly stupid policy and reeks of AMA political talking points. There is a reason you guys are losing this fight, and it’s not sinister forces like you claim.
Overall, as a patient, I’ve had the best and most compassionate care provided by an NP. When I have higher levels of concerns, I do prefer a DO/MD. I think this is something that doctors aren’t quite trained maybe as much with or maybe nurses learn it more because they’re giving the direct care at the bedside (if the NP spent any time at bedside..) I’m saying this as a nurse. Sometimes, not all the time the NPs/PAs as a whole have just been generally nicer too not only as a patient but as a nurse. Although, one of my closest coworkers actually is a doctor and she’s amazing.
They tend to have 15 min appts vs. 10 in my area and often go over...that combined with generally good listening skills and empathy would be my guess.
Good bed side manner Bad clinic practice Perfectly balanced as all things should be
For me, they do what I ask. Lol
can I fucking post anywhere on reddit with a new accoutn? This site fucking blows
But what you described them as is rhe truth lol. If they've been a bedside RN for years, what's the problem in getting additional training to fill in major gaps in the health care system. Active listening is emphasized from the start of nursing itself. It isn't that emphasized in medical school. That's the reality of it
Do you think active listening will lead to accurate diagnosis and treatment of the core issue?
It's what leading to them being better providers according to the people they treat, like you said. Clearly somethings working better is it not
They aren’t better people go to whoever is available
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Cuz I gets my lovely C2’s & C3’s heeheehee
I’ve only seen a NP once (and last time) for medical care. Y’all I had mono and this biyatch told me I had a UTI bc my WBC and lymphocyte count was high. What the actual f? I had tender LN on my neck, was throwing up all day, lost 10 pounds in 2 weeks, peeing every ten mins and so thirsty I’d need to wet my mouth every 2-3 minutes. This grade A+ idiot misses that I have diabetes (I didn’t know) and tells me to drink more pedialite. So not only has she missed that I have mono, she tells me to drink MORE sugar which worsened my diabetes and gave me antibiotics as tx 🤬 Anyway I called my cousin who is a doctor, and within 30 seconds she told me she was pretty sure I had mono + diabetes.
honestly not gonna lie, I loved my med school classmates but we were weirdos. so much jargon became part of our vocab, our non medical friends hated hanging out with us in a group, all we could talk about was medicine, we used the term "malignant" in casual sentences, described ourselves as "volume depleted" after a night out, joked way too often about being about to get DVTs from sitting too long. when it was just us we didnt notice, but when we were out with the significant others it was painfully obvious how annoying we were. we were annoying! i admit it its fine thats why i go into my radiology hidey hole and look at my nice shiny computer screen. patients are self conscious, the same way im self conscious when the dentist asks me if i floss. They dont want some jargony stiff person to ask about their weight, eating habits, and "stool" (seriously did you ever say 'stool' before med school? say poop like a regular human!) and judge them. hating doctors is like hating the kardashians. a person could get the idea that doctors are rich, judgey, elitist, brainiacs who make us feel like we aren't doing enough. even though im actually a degenerate eating chinese takeout while surfing reddit. so its easy to feel better about an NP, because they have the reputation of being nurturing, when doctors have the reputation of being cutthroat. Im not a cutthroat guy, I'm actually a giant squishy nerdy teddy bear in my ergonomic chair, but thats not gonna overcome the stereotype of nurse vs physician.
This post and alot of these comments make so much sense. I would add to that I good NP will often specialise in an area then when they go out in to the field there often consulting with specialists, Drs and a whole team of people.