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California AB 890 allows NPs to practice radiology
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RN, BSN, APRN, DNP, 1st grade perfect attendance, under 8 soccer participation…
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here is their leader – politically and in letters
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Quote from texas rads
RN, BSN, APRN, DNP, 1st grade perfect attendance, under 8 soccer participation…
You left off “FOS”.
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Quote from Theforce111
Quote from brickydragon
Well, I put my money where my mouth is and joined Physicians for Patient Protection.
Kudos.. In the end that is all that matters. We can post and complain to each other all we want here but only money talks in politics.
And really – $129/year is peanuts. Calculate in your head how many minutes of your work time you have to donate to earn this. (don’t forget – use gross income, it’s deductible.) I think it is worth it to do something effective to oppose this. -
Quote from Picasso01
I dont understand thishow can NPs interpret diagnostic procedures?!! What???
first – they can’t “interpret”. they have absolutely zero training
second – I have learned that whether they can do a specific task is actually irrelevant. What matters is whether they can get it pushed through a legislature.
two cases came to my attention yesterday”
1) a Family NP who has a patient who is one month old and is yellow. She doesn’t know what to do and was asking opinions on Facebook
2) a psych NP who had a 4 year old child who was talking to an imaginary friend. The NP said she was schizophrenic and put her on an anti-psychotic.I am telling you there is an unending supply of these horrible stories. absolutely…. unending….
nursing leadership doesn’t respond appropriately by working for better education/training… they respond by trying to hide the stories.-
I think that what is going on with the Noctor invasion is absolutely horrible. That said, I do not see how this devolution is any less surprising or expected given the downward spiral our country has been on these past decades … culminating in the farce that is our current president with his clown car of enablers and toadies.
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Quote from diagnostic.radiologist
I think that what is going on with the Noctor invasion is absolutely horrible. That said, I do not see how this devolution is any less surprising or expected given the downward spiral our country has been on these past decades … culminating in the farce that is our current president with his clown car of enablers and toadies.
This is happening in California State Assembly, not exactly a Trump stronghold.
They want this: [link=https://www.medscape.com/slideshow/2019-international-compensation-report-6011814#2]https://www.medscape.com/slideshow/2019-international-compensation-report-6011814#2[/link]Tbh I agree.
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You can see why this site, and medicine in general, have gone straight to Hades.
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There is an extreme demand for in person care healthcare professionals. I would say extreme because when I moved to CA, I could not find a single MD under my health plan for the next 6 months ! They offered a NP and I refused. Granted that I didn’t have an emergency but was trying to establish primary health care provider for myself, what would other people in similar situation do who are not doctors themselves? For cough and cold, headache, migraine, stomach upset, diarrhea, vomiting (patients need prescriptions for meds)…they would see ANY health care professional who can write prescriptions and that is where the inroads have been made by Non doctors over the course of years.
Another example…My friend had floaters in the eye and was scared to death and could not find an appointment with an ophthalmologist for 2 months unless she went to the ED. She ended up seeing a NP ophthalmologist and had a great experience according to her. I don’t see this happening with Rads unless the studies are backlogged ( imagine a CT not being read in 3 days ), so Dr. Shaffers effort is absolutely commendable. Show us the need for more Non radiologists to read the study …if there are backlogs. I don’t think it exists. The backlogs continue to exist for in person care though and that fight may be a bit tricky as prescriptions are needed for even minor ailments.-
Quote from RADD2010
Show us the need for more Non radiologists to read the study …if there are backlogs. I don’t think it exists. The backlogs continue to exist for in person care though and that fight may be a bit tricky as prescriptions are needed for even minor ailments.
The need is that rads make 600k right now and the number needs to come down to 150k. We (government) want to start providing healthcare to everyone but in order to make it economically feasible the artificial supply side restrictions need to come down. Take it as you want but this is the driving force behind these changes. Radiology is a small piece of the entire pie but it’s the same fundamental pattern everywhere else that’s driving total costs up – rent-seeking stifling supply & efficiency.
[link=https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/]https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/[/link]
[link=https://www.medscape.com/slideshow/2019-international-compensation-report-6011814#2]https://www.medscape.com/slideshow/2019-international-compensation-report-6011814#2[/link]-
I think the efforts should be to produce more radiologists then, with proper training. The radiologist has to look at all organs even on a chest X ray…MSK, Heart, Lung, portion of bowel. It is NOT a problem focused study like seeing a patient for cough or headache.
It would be interesting to see how much of your graph money goes to the hospital / other admin and insurance industry ? To generalize 600 K money for all rads is false and misleading, haha . If that is the basis to push for more non MDs for reading studies, why confine it to just nurses ? Why not pharmacists, Amazon drivers, Nursing aides.
I am all for access to healthcare, but the people need to be qualified in my opinion. Just to bring the salaries down to cut healthcare costs seems like a strange approach, straight out of communist manifesto. -
Quote from avocado
The need is that rads make 600k right now and the number needs to come down to 150k. We (government) want to start providing healthcare to everyone but in order to make it economically feasible the artificial supply side restrictions need to come down. Take it as you want but this is the driving force behind these changes. Radiology is a small piece of the entire pie but it’s the same fundamental pattern everywhere else that’s driving total costs up – rent-seeking stifling supply & efficiency.
[link=https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/]https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/[/link]
[link=https://www.medscape.com/slideshow/2019-international-compensation-report-6011814#2]https://www.medscape.com/slideshow/2019-international-compensation-report-6011814#2[/link]
We EARNED that, Avacatroll, by going through a painful, rigorous selection process, [i]years[/i] of school, and even more [i]years[/i] of training. People trust their LIVES to our interpretations. Would you trust some NP who consults You-Tube videos for a life-or-death call on YOUR CHILD?
Your jealousy shows through like a search-light. Wassamatta…couldn’t get into medical school? Could you even get into (community) college?-
RADD2010 – I agree. Medical education needs to become free and loans forgiven. And people should go to med school directly, without college. This will happen sooner (if Senate goes blue in addition to Californians Pelosi & Kamala running House & WH) or later (if GOP keeps senate). Plus, in a sense, AB 890 is also expanding supply side of “radiologists”, economically speaking, leaving all superstitious titles and credentials aside.
Dalai – most care paid for in the US doesn’t involve a child’s life-or-death decisions. And salaries are determined by supply and demand, not somebody’s sense of entitlement or how much they EARNED it. There are PhDs who’ve been studying for 30 years, doesn’t mean they deserve any more pay than current scraps.
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Quote from avocado
Dalai – most care paid for in the US doesn’t involve a child’s life-or-death decisions. And salaries are determined by supply and demand, not somebody’s sense of entitlement or how much they EARNED it. There are PhDs who’ve been studying for 30 years, doesn’t mean they deserve any more pay than current scraps.
Health care is NOT a business like any other, although as we physicians continue to sell ourselves to MBA’s, it is headed that way. Clearly, you are NOT a physician, but some wannabe who couldn’t cut it and is jealous of what physicians have achieved. EVERY SINGLE STUDY we read has the potential to have a deadly finding. EVERY SINGLE ONE. So go back to whatever off-shore unaccredited school you went to and demand your money back.-
Where is this $600k salary? I will leave my job this second if its in a liveable city.
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Exactly. I don’t know where the medscape salary data from. Definitely donot see most radiologists earning that average salary. I think medscape number is the total yearly compensation, ie salary plus benefit.
I knew some people making 600k, they are working their butts off, crazy busy. Other specialties are more relaxed.
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150k? You want me to make a Walgreens pharmacist salary.
lol. Its honestly harmful to your agenda to be so extreme. If you want free healthcare and docs to make less , ok. I agree with shortening training and making med school free. Still, nobody will do the job for 150k. Try and sound reasonable. -
Corporate pharmacist is a far lower tier of hell than even the worst rp job
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You want radiologists to make 60% of what nurse anesthetist currently make? I would laugh uncontrollably and quit immediately If asked to do my job for anything close to 150 k. Let the noctors have at it, at that point. I am sure that would go swimmingly
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We all know that it’s a problem. Now we just need to think of how to deal with it and be more proactive. It’s only going to get worse if we ignore it and only complain.
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Quote from brickydragon
Where is this $600k salary? I will leave my job this second if its in a liveable city.
he is the consummate troll, he doesn’t know what he is saying, ignore/block
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I think 600k is gross underpay. For the value add to society Rads should be making 1M. Have to factor in the extra work and inflation and normalize it to prior years.
Sacrifice your youth studying; burning the midnight oil during ugrad when your roommates are partying; studying every weekend in med school for Monday morning tests when your cohort is making $ and have weekends and evenings off to live life. Working crazy hours for low pay during Residency while starting families. By the time you “make it” to attending status, you have crazy debt and start the nonstop grind of what modern rads has become.
Now that I think of it, $1M isn’t enough. We need to stop defending attacks on our salaries that are depressed due to bloat from insurance/pharma/suits/corps in the system and ask for more.
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The biggest joke about all this “cost” non-sense is the government literally has the printer to digitally and physically print money. There is never a shortage. There is also no need to “raise” dollars via taxation or sell bonds to foreign countries or its citizens…the dollar was never created by anyone other than the US govt. For those that don’t understand how currency and the US dollar works it’s amusing seeing people argue about needing to tax more or pay people less to “pay” for all this stuff…sorry but that’s not how it works. Hopefully sooner rather than later the majority figure this out otherwise they continue falling for the same back and forth the government keeps telling them…it’s been going on for 100 years now so I doubt the masses will ever figure it out. “Oh no, look at the debt! How will we ever pay it off! I can’t believe how big the government budget is! We can’t afford it!” lol Literally same crap in newspapers 100 years ago.
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Quote from ChuckI
I think 600k is gross underpay. For the value add to society Rads should be making 1M. Have to factor in the extra work and inflation and normalize it to prior years.
Sacrifice your youth studying; burning the midnight oil during ugrad when your roommates are partying; studying every weekend in med school for Monday morning tests when your cohort is making $ and have weekends and evenings off to live life. Working crazy hours for low pay during Residency while starting families. By the time you “make it” to attending status, you have crazy debt and start the nonstop grind of what modern rads has become.
Now that I think of it, $1M isn’t enough. We need to stop defending attacks on our salaries that are depressed due to bloat from insurance/pharma/suits/corps in the system and ask for more.
amen!
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It is disheartening some folks fall prey to Avocado’s fallacious premise – that health care costs are the result of excessive physician salaries. Anybody with more than a passing familiarity with health care – and with a modicum of common sense – recognizes experienced physicians generally save money by avoiding unnecessary tests and procedures.
Notwithstanding Avocado’s protestations, the problem is not that people don’t get enough health care. But rather they get too much health care, without producing any meaningful benefit. A skilled physician knows when to counsel patients to stop wasting resources when there is no expected benefit. A midlevel generally does not.
Of course these cost savings are partly offset by some physicians practicing defensive medicine or unscrupulous physicians seeking to maximize billings (your local orthopod who owns his own magnet for example). But in my experience, these individuals are the exception and not the rule (the ER being a significant caveat regarding defensive medicine). And practicing CYA medicine is certainly more common amongst mid-levels than competent physicians.
A good analogy is a car mechanic. Take your car to a poorly trained mechanic and they will rack up a huge bill trying to diagnose and fix the problem. On the other hand, a skilled mechanic can often quickly determine the problem and save you considerable time and money.
Corporate entities and hospitals – not physicians – are the biggest source of wasteful health care resource allocation. Whether from profit motives (i.e. replacing skilled physicians with less skilled providers), bureaucratic inefficiency (how many pointless committees and nonproductive administrators does your hospital have?), or misguided regulatory burdens (i.e. inane policies to satisfy silly Joint Commission rules).
The poor management of hospitals is truly remarkable, and reminiscent of General Motors back in the 1980s. Ever met a hospital CEO who can tell you the operating costs of an OR room per hour? Or the material and labor costs for doing an appendectomy? I would be shocked if somebody has.-
I dont get why people keep entertaining the troll. He knows exactly what buttons to push to get people wound up. Today its ‘nurse practicioners are the future’ the next day is ‘AI is the future’ and in the next round ‘radiologists are overpaid’. Just ignore him and let him troll some other web board.
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Quote from 67ED5CC042435
Other physicians cannot reliably interpret imaging findings so I do not expect NPs or PAs to do so worth a damn.
I noticed our ER providers are great at interpreting their own imaging until I spend more than 30 minutes on dinner, then they turn into needy children who can’t look at a head CT themselves and start the discharge paperwork.-
How many rads are moving to California to start their own practice with a bunch of nurse practitioners? Or is there no point because rad partners and envision will already dominate that. Those high paid buyouts to private groups suddenly look like a great idea as they can be replaced with cheap nurse practitioners.
On the flip side, how many are moving out of california for better medical care?-
I think NP’s will be most unprofitable in radiology. A practice would be lucky to squeeze 15RVU per day out of them. And, unlike radiologists, NP’s have employment options. When they feel overworked, they will just bolt to some urgent care.
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MY most recent information is that the offending language has NOT been removed from the bill.
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more reasons why we physicians need to stop this:
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Quote from Phil Shaffer
more reasons why we physicians need to stop this:
Yikes!
Not sure of which antibiotics to give immunocompromised cancer patients, in the COVID age, of all times. Wow. Just Wow. What are we doing here as a country.
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But I’m sure she was caring and empathetic enough to make up for her knowledge deficit!
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Quick way to fight back, thanks to California Medical Association. Got from an ER friend. Here’s a link to send an email to your CA reps and even request a phone call with them. I did it. Please other CA rads do it.
[link=https://www.cmadocs.org/ab-890]https://www.cmadocs.org/ab-890[/link]-
Thursday – PPP held a press conference.
[link=https://www.youtube.com/watch?feature=youtu.be&v=hKp9uGXEtbg&fbclid=IwAR2BHWt4FIsSNb1jga8DCEuvH0PlyCQYzzfL_hAfF8E0GPc82dCxxbk5DH4&app=desktop]https://www.youtube.com/w…bk5DH4&app=desktop[/link]If you are short of time (a virtual certainty) – watch the segment starting at 6:45. This is a segment by Rayne Thoman. She is an RN who was in an NP program, and tells us her experience in that system.
A few things stood out to me.
She tells us that her advanced psychopharmacology course had no actual instruction. It consisted of a study sheet of test questions. Then they had a test consisting of these questions and the test was open book. It sounds unbelievable, but the evidence is there.
Then, when Rayne started her clinical time with an MD psychiatrist, and had no idea what he was even talking about.
She filed complaints with the Board of Nursing, with the State Education department, and with the CCNE. This was a year ago, and to date, nothing has been done.
There is more… view the video.-
Phil-
I know it has been said here before but probably no enough. I want to personally thank you for all the time and effort you spend on this, which ends up helping us all out.
A lot of us, myself included, just put our heads in the sand and just assume that non physicians would never attempt to do or more importantly never be allowed to do what we do everyday. At the very least a lot of eyes are opened.
At the end of the day it should come down to adequate training and patient safety. If politics weren’t involved discussions like this would’t even be a thought.-
[link=https://www.cmadocs.org/ab-890]https://www.cmadocs.org/ab-890[/link]
If you live in California let your legislators know what you think.-
New language:
AB890Page34)Authorizes a certified NP to conduct an advanced assessmentand establish primary and differential diagnoses;order, perform, and interpret diagnostic procedures(but notprocedures using ionizing radiation unless the NP and facility are in compliance with the Radiation Control Law, not advanced diagnostic imaging, and not clinical laboratory procedures unless theNP ispermitted to do so under the Clinical Laboratory Improvement Act); prescribe, order, administer, dispense and furnish therapeutic measures and; after performing a physical examination, certify disability; and,delegate tasks to a medical assistant.
Good work to everyone who messaged legislators and other lobbying done by whoever. Not perfect but MUCH improved, right?
FYI I do not think this bill should be passed in any form. All physicians should be defended-
What’s considered “advanced diagnostic imaging?” Plain films are tough man. No way NPs are going to catch subtle fractures, bone lesions, pneumonias, pneumothoraces, bowel dilation, etc.
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Seem pretty arbitrary to me.
Personally, I consider any modality created after 1850 to be pretty advanced.-
AB890 passed. 27 YAY, 3 NAY.
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So what are the radiation control laws exactly? Can nps read xr or not? If not, then I guess they can just read US?
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Quote from 2BRads
So what are the radiation control laws exactly? Can nps read xr or not? If not, then I guess they can just read US?
Based on the phrasing, I believe the radiation control laws are in reference specifically to the procedures, not the diagnostic imaging.
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Quote from frank the tank
Phil-
I know it has been said here before but probably no enough. I want to personally thank you for all the time and effort you spend on this, which ends up helping us all out.A lot of us, myself included, just put our heads in the sand and just assume that non physicians would never attempt to do or more importantly never be allowed to do what we do everyday. At the very least a lot of eyes are opened.
At the end of the day it should come down to adequate training and patient safety. If politics weren’t involved discussions like this would’t even be a thought.
Thanks –
For me though, it is something I just HAVE to do. I am so angry about patients being deceived and abused.
And it is not so much about politics – of the Rep/Dem kind.
IT IS $$$$$$
For CVS
For Insurance companies
For NPs.
most of all for hospitla corporations. They are evil, I am convinced.-
TBH – I almost wish the radiology stuff had been left in – sort of a poison pill.. .SO bad that the NPs trying to read Mammograms would cause a real crisis. That the media outlets could not ignore
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Seems like spending money on television advertising in California to alert the public would be more productive at this point.
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Quote from Mrdrsrow08
Seems like spending money on television advertising in California to alert the public would be more productive at this point.
we do not have enough to do that
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Quote from Phil Shaffer
TBH – I almost wish the radiology stuff had been left in – sort of a poison pill.. .SO bad that the NPs trying to read Mammograms would cause a real crisis. That the media outlets could not ignore
Let’s be honest. I read lots of mammo approaching a decade now. And close to 95% are normal. You can close your eyes and its you have a good chance that it will be normal (or nothing that will lead to serious consequences). The positive ones are usually not that subtle and a good radiologist is also capable of missing the subtle ones. And most of the ‘cancer’ that are really bad were picked up by the patients as ‘palpable lump’ or ‘felt something’ and we do the work up and bam the radiologist gets the ‘credit for picking up cancer’, when it fact it was the patient.
So for me, it isn’t so much a patient safety. Initially when they start out maybe, but if they’ve read 1000 screening mammas, which they could very well do in under a month, they will get better, just like anyone else.
I think for me, it is more about control. You want the right to do what I do, you need to go thru what I went thru.
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Youre just wrong about them picking it up as they go. To some extent, maybe. Maybe. But I get experienced PAs in the ED ordering DVT US with neg ddimer. When I ask why, they tell me moderate WELLS . When I go through the chart with them, they come up with a WELLS of 3, I show them its a -1. They still want it. The patient is really nervous. So we go talk to the patient. I explain that they could wait for another test for their anterior knee pain, but the lab work has shown they dont have DVT, and the other test is not likely to show why they have chronic knee pain, but the djd on X-ray may be the answer. They say so I dont need the other test, right? I say thats right. They smile and say ok, get me outta here.
Or , mind you, PAs with years of experience, ordering carotid Doppler after normal CTA, etc. Some of them, many of them, have such an insurmountable paucity of foundational understanding, and inverted sense of confidence, that They. Will. Not. Get. It.
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Quote from uncleduke
Youre just wrong about them picking it up as they go. To some extent, maybe. Maybe. But I get experienced PAs in the ED ordering DVT US with neg ddimer. When I ask why, they tell me moderate WELLS . When I go through the chart with them, they come up with a WELLS of 3, I show them its a -1. They still want it. The patient is really nervous. So we go talk to the patient. I explain that they could wait for another test for their anterior knee pain, but the lab work has shown they dont have DVT, and the other test is not likely to show why they have chronic knee pain, but the djd on X-ray may be the answer. They say so I dont need the other test, right? I say thats right. They smile and say ok, get me outta here.
Or , mind you, PAs with years of experience, ordering carotid Doppler after normal CTA, etc. Some of them, many of them, have such an insurmountable paucity of foundational understanding, and inverted sense of confidence, that They. Will. Not. Get. It.
You actually go over the chart with them? How do you have time to dictate cases?
Also, I see plenty of physicians who order carotid Doppler after normal CTAs. I dont think the PAs/NPs order a huge amount more than a physician would do. Look at the ED. They just click a button and a whole series of order gets placed. Do you think they are thinking about them? Plenty of knee jerk reaction orders come from physicians as well.
Look, I am not in support of PAs/NPs getting the right to do what physicians do, but I dont think that they are necessarily leading to more orders being sent. Initially they would just like a fresh physician out of training. But in time they should learn.
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Quote from uncleduke
Youre just wrong about them picking it up as they go. To some extent, maybe. Maybe. But I get experienced PAs in the ED ordering DVT US with neg ddimer. When I ask why, they tell me moderate WELLS . When I go through the chart with them, they come up with a WELLS of 3, I show them its a -1. They still want it. The patient is really nervous. So we go talk to the patient. I explain that they could wait for another test for their anterior knee pain, but the lab work has shown they dont have DVT, and the other test is not likely to show why they have chronic knee pain, but the djd on X-ray may be the answer. They say so I dont need the other test, right? I say thats right. They smile and say ok, get me outta here.
Or , mind you, PAs with years of experience, ordering carotid Doppler after normal CTA, etc. Some of them, many of them, have such an insurmountable paucity of foundational understanding, and inverted sense of confidence, that They. Will. Not. Get. It.
Maybe years of looking at these images make seem easy to me personally. But I dont see why someone couldnt be trained to look at 2 sets of boobs and decide if there is asymmetry, skin thickening, unusual calcification or mass. They have old images to compare. If you read a 1000 of these you should get the hang of it. Now if youre talking about a head and neck MRI or complicated pancreatic CA case, thats a little different.
After working for nearly a decade, dictating thousands of cases, negative ultrasound DVT, negative head CTs, mammos, chest X-ray, DXA, any images scanned by a sonography (With work sheet of findings provided already) probably can be off loaded to PAs/NPs. Do I want them to do it? No. Mostly for my own financial and job security. Not because they couldnt learn this stuff.-
I have multiple examples of experienced NPs incapable of doing medicine. There are two effects. One is inadequate time in formal training. NO ONE lectures them on the work up of DVT/PE and then gives them an exam on it (That, if they fail, they fail).
2) they, unlike us, didn’t spend the nights up studying whatever was presented to them – 92% get their DNP WHILE WORKING FULL TIME. Their school is essentially an afterthought to them. They spend similar time learning how to care for patients that I spend on my hobby.So – not enough input.
Then – even with enough input many (most) just aren’t smart enough to understand or remember. It is not polite to say this, but it is true nonetheless. Most can’t pass MCATs, only 42% can pass step 3 (compared to 98% of physicians). You cannot take someone of average intelligence, and teach them how to be doctors. Just can not do it.
And, even if some DO pick it up on the job, what have they picked up? Only individual anecdotes, and these actually may be wrong, if they didn’t have the right person teaching them (say – another NP). I see them constantly saying things along the line of “antibiotic X is what you use for UTIs”. No discussion of how to diagnose UTI’s, no understanding of where the exceptions to the overly broad rule might lie.
This “education” is not systematic. It produces a person with massive holes in what they know, and they do not know where those deficiencies are.
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This is a thing I see with most doctors. We dont realize how smart we are. Spend all this time in medical school, residency, fellowship….literally everyone were around for a substantial amount of time has an IQ of 115+.
So you and everyone around you picks up advanced concepts like a 115+ IQ person can, and eventually one starts thinking its a normal thing. Its not.
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It is sort of like the military. You can be a regular army boot camp graduate, pull the trigger and kill the enemy. But you can also be a navy seal or special forces, where there is a high degree of selection process. In the end you can also pull the trigger and kill the enemy. The question is, who would you rather guard you, a regular army boot camp graduate with a gun or a special force soldier with a gun.
Just about anyone can get into a nursing school from high school and end up in an NP program. They would gladly take your money. But to get into medical school. Ah thats a different story. Sort of like special forces. Strict selection criteria and long, hard training.
Quote from Phil Shaffer
I have multiple examples of experienced NPs incapable of doing medicine. There are two effects. One is inadequate time in formal training. NO ONE lectures them on the work up of DVT/PE and then gives them an exam on it (That, if they fail, they fail).
2) they, unlike us, didn’t spend the nights up studying whatever was presented to them – 92% get their DNP WHILE WORKING FULL TIME. Their school is essentially an afterthought to them. They spend similar time learning how to care for patients that I spend on my hobby.So – not enough input.
Then – even with enough input many (most) just aren’t smart enough to understand or remember. It is not polite to say this, but it is true nonetheless. Most can’t pass MCATs, only 42% can pass step 3 (compared to 98% of physicians). You cannot take someone of average intelligence, and teach them how to be doctors. Just can not do it.And, even if some DO pick it up on the job, what have they picked up? Only individual anecdotes, and these actually may be wrong, if they didn’t have the right person teaching them (say – another NP). I see them constantly saying things along the line of “antibiotic X is what you use for UTIs”. No discussion of how to diagnose UTI’s, no understanding of where the exceptions to the overly broad rule might lie.
This “education” is not systematic. It produces a person with massive holes in what they know, and they do not know where those deficiencies are.
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It may be that the facility needs a radiologist to sign off as the radiation safety officer so they can use radiation. I do not think this phrasing will prevent NPs from harming patients through constantly misinterpreting images.
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The amended verbiage I’m seeing now says, “For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient. A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).” In other words, what they can do now. Seems like they got rid of the whole “perform and interpret” parts.
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Thanks for the update! This is great news for all those with subtle lytic lesions out there etc.
Hopefully the bill gets fixed in other aspects so patients can actually be seen by someone with the appropriate training, but at least the imaging they get will be read well
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Was this a typo all along or did our leadership actually stand up for us?
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The redacted version makes it pretty clear that this wasn’t a typo. Whether or not the changes were made on a grassroots level or from leadership I do not know.
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I know (and really, you know) what that would look like
I know because I have seen their “H&P”s – basically they are presented a list of check boxes, and they check “normal” for them…In radiology -we know that computers can present lists of things that may be present. You check the boxes. The computer spits out verbiage that is similar in sound to a real radiology report.
whether it has any relation to what is on the film is not really important –
As one NP wrote “Knowing how to do an H&P is very important for billing.”
(I cannot make this stuff up)
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Right on cue, NP called up today to ask me if a tiny metallic FB in the chest wall (on XR, and I’d specified it was stable from old CT) could be an abscess.
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This is bad bad bad bad bad
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There are some horrible NPS for sure, but I will say a few that work in our ER are very good. They also know what they don’t know and are quick to transfer care to an MD/DO. Sad, but this does seem to be the exception.
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Here is an Unknown posted by a prominent NP – I say prominent because he is active in trying to improve their education – He knows it is bad. He aggressively promotes FPA. Obvious conflict there. And he is one of the “experienced” NPs who maintains the new crop of NPs coming out of diploma mills are damaging the profession for those, like him, who went to “good” schools and have been practicing for many years.
so here – he is playing professor and showing an unknown case to younger, inexperienced NPs.
His comment was “Xray called normal by radiologist”-
and here is his answer
Right clavicular fracture and two old rib fractures-
Yeah, he doesn’t know how to read X-rays. Even simple stuff.
The point is that he sees himself as superior to the Radiologist, makes no bones about it and he is dead wrong.Other cases the NPs quote which place themselves in positions of superiority to physicians are based on clinical cases they say they caught after the physician “missed” it.
In those cases, there is no hard record of the exam, what the patient said, etc.
IN this case there is a hard record.
This experienced self assure NP who is a champion for educational reform, needs to recognize that he himself does not know what he doesn’t knowwe have a case similar to a freshman calculus student thinking he caught the mistake in the astrophysics professor’s math, and celebrating his superiority all over social media.
Perfect example.-
AB890 passed today. 27 yay, 3 nay.
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Looks like they changed the bill to exclude NP interpreting studies.
For radiologic procedures, a nurse practitioner can order diagnostic procedures and utilize the findings or results in treating the patient.
A nurse practitioner may perform or interpret clinical laboratory procedures that they are permitted to perform under Section 1206 and under the federal Clinical Laboratory Improvement Act (CLIA).
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There are some ideas on how to combat this, and not just in California.
1) legislation to put them under Board of Medicine
2) legislation to make them really liable for their actions
3) combination of 1 and 2
4) attack the definition of “practice of medicine” and “practice of nursing”
5) Qui Tam actions against hospitals billing for their services inappropriately. (it appears this is very common)
6) Get the AMA, AOA more involved (in process)
7) one of the points the senators brought up most was serving rural areas. Now I am not so naive to think that these were their REAL concerns, after all, they had been lobbied hard by a large group of corporations, It IS about the money. nevertheless, provisions REQUIRING them to go to rural areas would be interesting. Further – legislation to make it very attractive for physicians to go rural would be helpful. Not the least of which, would be raising primary care reimbursement 50%. Wouldn’t be that expensive, compared to other things which are being done.In short – stop playing defense, start playing offense.
and of course, this takes people to do, and money to do.
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Great ideas about making them practice rural or paying primary care rural docs more. CA does have a state loan forgiveness for rural primary care docs already.
Dictated fracture of radial head on forearm X-ray. An NP splinted the wrist and got follow up wrist X-ray. Guess I should have dictated fractured elbow bone!
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I literally laughed out loud! Thank you for making my afternoon.
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Looks like it passed the california senate and the california assembly
[link=https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB890]https://leginfo.legislatu…bill_id=201920200AB890[/link]
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True in the main, radgrinder, but sometimes that backfires. Those making the decisions about these things may not have the same IQ, or may have even [i]higher[/i] IQ’s and have figured out a way to bypass our, um, supposed brilliance to make a tidy profit. Who’s smarter?
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Sure DD. Higher intelligence is only a small part of overall success. I was specifically referring to medicines requirement for a practitioner to continuously understand and synthesize a large amount of advanced material on a daily basis.
Paradoxically, the worst poker players I know are invariably doctors.
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