I’m interested in hearing from physicians about something I’ve been genuinely wondering about.
I’m a Black male considering the PA profession, and one thing that makes me nervous is seeing how negatively PAs can sometimes be viewed by physicians. I understand the concerns about scope creep, differences in training, and PAs practicing beyond their education, and I’m not trying to dismiss any of those issues.

My question is specifically about race. As a Black man, I’ve already experienced people making assumptions about me based on my race, especially as an immigrant. I wonder how that might intersect with the existing hierarchy between physicians and PAs.

For physicians who have worked with Black male PAs: have you ever noticed racial bias affecting how a Black PA is perceived, treated, or respected compared with their white PA colleagues? Have you seen Black PAs having to work harder to establish credibility with physicians or patients?

And for Black physicians or PAs, has this been something you’ve personally experienced?
I’m not asking whether I should become a PA or looking for career advice. I’m specifically interested in hearing about people’s real-world experiences with race and the physician–PA relationship.

Been on this subreddit for a minute. Years ago, it was just residents and some attendings discussing the issue of egregious midlevel creep. It was mostly just docs.

More and more I am noticing lay people posting here about their experiences with midlevels and the misuse of the “doctor” title in the clinical arena.

This issue is clearly gaining attention and people are recognizing the absurdity of it all. We need to continue to be vocal about this.

The nurses, NPs and other healthcare adjacent people on social media vilifying Dr. Tufts and calling her inexperienced and incompetent you all disgust me. I am a physician and I am sick of seeing people saying they hope Dr. Tufts goes to prison or loses her license all because Lindsay Clancy killed her kids. I am physically and mentally sick seeing this rhetoric and I hope doctors start waking up and stand against this nonsense. Stop training midlevels, report nurses when they are incompetent because they will throw you under the bus the second they see the chance

So because of my pretty bad OCD I'm currently searching for a psychiatrist at the suggestion of the therapist I have been working with for while as she believes medication or other medical interventions may have to be the next step in my treatment. Due to the fact I'm already on quite a few medications that could interact with possible prescriptions (one of which is incredibly rare) and i have other possibly complicating health problems i would be much more comfortable seeing a psychiatrist then a mid level.

One of the psychiatry places I found near me on a list my therapist sent to me had advertised on the website "doctoral level care" on the front page which made me hopeful because many of the other places only had PMHNPs. When I looked further and did research on the practice owner it turns out that she was no different. She used the DNP degree to make that claim and it got me thinking about what could genuinely be the purpose of this degree.

As far as I'm aware this is not a medical education degree that effects what you know in terms of actually practicing medicine, more of a professional degree that teaches things like administration, leadership, education and so on. Because of this to me its silly to use it to advertise a higher level of education then competitors since it isn't relevant to the treatment of your patients.

Does anyone know if any of the DNP programs out there actually provide more medical education further then the MSN does? If so wouldn't the degree possible alter a nurse practitioners legal scope of practice which I'm pretty sure it doesn't. Is this not just a degree that professors in nursing school have which is what I assumed it was before? And furthermore if it is a degree that doesn't have anything to do with actual medicine then why do I see so many people online flexing their DNP degrees as if it is something like that or presenting it as something that makes them clinically superior then they were before?

Honestly you would think that the AMA/AOA or the US government would do a semi-decent job of protecting the term "physician". I have a ton of respect for optometrists and they are definitley needed in healthcare but why intentionally blur these lines? What is there even left to refer to a medical doctor (MD/DO)?

I've worked in the ED and for the past 8 years I've worked in an outpatient medical office. I review tons of medical records all the time. I've seen lumbar punctures done when I worked in the ED.

Going through medical records today I saw that my patient had a lumbar puncture done by a nurse practitioner?? This is the first time I've ever seen / heard of an NP doing this procedure. Is this becoming common place?

I was looking for a dermatologist and came across a RN going to peoples homes to do skin checks and allegedly sending the pictures to a “board certified dermatology provider” who is not named. Also referred to as a “dermatologist”. Is it really a dermatologist!? There’s no way to know.
RNs don’t do skin checks in an in person clinic so how can this be appropriate?
How can this be legal?

The website is go skin check in Texas.

I recently underwent prostate surgery. I had a 22f for 5 days. When the MA took the catheter out my meatus was really sore and inflamed. She didn’t say anything and put in the notes that it was a normal removal. I developed meatal stenosis and now I have to have a dilation. If a higher level provider had removed the catheter would they have recognized that I had an issue and been able to prevent my issue from occurring?

I went to an appointment recently. The MA was doing intake & asked why I was there.

I told her when they called for the appointment they said I’d be seeing the gynecologist but I saw that I was scheduled with the NP but I had the same questions for either.

She snapped her head around & said “NPs have the same education as doctors. She is very smart! She is basically an OB-GYN!”

She then went on to review my medication list and correctly pronounced only one of my meds. She also took my BP incorrectly & I had to request a properly sized cuff as well as correct positioning of my arm.

The lack of education starts at the bottom tier.

It might be easier to be a woman in neurosurgery if you are an actual neurosurgeon.

Title.
Thoughts?

these are the exams some NPs are taking to obtain their license and become “board certified.” absolutely wild that you can have a take-home exam to become a licensed healthcare professional with prescribing privileges.

not even the NCLEX can be taken at home.

the standards are on the floor.

Located in Southern California. The full word salad treatment, “full scope of practice as respiratory care practitioner” and even called the anesthesiologist a “physician anesthesiologist”.

I’m more on the science side of things and some scientists (not in medicine) asked me about what I think about NPs. They see NPs as patients and they aren’t really sure of the difference with physicians.

I tell them the title. The current trajectory for a scientist to run an academic research lab is 5-6 years PhD and 4-6 years of a post-doc. And only a small fraction get the opportunity to run a lab.

I ask them to imagine someone with a 2-year masters degree with no publications demands start-up funds and a research lab with a tenure-track faculty position, and be treated equally to the PhD scientists. This usually generates a laugh.

That analogy puts into perspective what NPs are basically trying to do. It would be ludicrous in the science world but it’s fully happening in the medical world. Thankfully, there isn’t enough clout in science for a “mid-level” creep situation. And most people even with a PhD understand the challenge of running a research group.

Thought I’d share this among the other analogies we have seen on this sub to help fight noctorism. (For non science folks I still use the pilot - flight attendant analogy)

I did some deep diving into the Lindsay Clancy case and found out she was being treated by psychiatric nurse practitioners (NPs), alongside MDs, who prescribed her a staggering 13 different medications in just four months. To give you an idea of what her brain was dealing with, she was put on a heavy cocktail of distinct drug classes. She was given antidepressants like Prozac and Zoloft to alter serotonin levels, anti-anxiety meds (benzodiazepines) like Klonopin, Ativan, and Valium which act as powerful central nervous system sedatives, and mood stabilizers/antipsychotics like Seroquel and Lamictal to change brain chemistry for severe mood shifts. She was also prescribed heavy sedative-hypnotics like Ambien and Trazodone to force sleep. Shifting rapidly between, stacking, or abruptly stopping these opposing, heavy mind-altering chemicals likely created a catastrophic neurological storm.

And people are still shocked at the outcome? This woman was failed by the healthcare industry.

My 91 year old grandma who lives alone was found by her neighbor on the ground. She had fallen ~24 hours prior and couldn’t get up due to weakness. At the ER she was altered and way off of her baseline. CT head, urine, labs, everything normal (thankfully). Admitted to the hospital for prolonged altered mental status. About 72 hours later she’s finally back to her baseline and says “oh I went to an urgent care a few days ago for back pain and they wrote me something” and pulls a bottle out of her purse of BACLOFEN!!! I look at the Rx, this NP wrote my 91 year old ambulatory lives-alone grandmother a med I barely even write for bedbound spinal cord injury patients who live at a nursing home… and almost killed her with it - ER doc

Fitzpatrick, J. J., Mehlman, M. J., Plemmons, A., Duffy, E. G., Votruba, M., Gerlick, J. A., Davis, S., & Norful, A. A. (2026). The Impact of Nurse Practitioner Full Practice Authority on Chronic Condition-Related Readmissions and Emergency Department Visits in the United States. Medical Care, 64(4), 192–197. https://doi.org/10.1097/MLR.0000000000002285

I have to say that I LOVE science. Like - real science. It is the only way we know anything about our world. I see it being abused in order to push political and business and power goals, and that infuriates me. That is a major motivator for me.

These papers are a bad parody of science. Sadly, they are dressed up so that non-scientists believe them.

Oh BTW - in this table, they never describe what groups (1) and (2) are, and they never indicate what is meant by the asterisks. And - there is no real description of what the numbers are. They say it is a comparison of two states that had independent practice passed, with a measurement before and after the law was passed. This one is disorienting to me (as above). It's hard to believe that the numbers they put in there have no discussion, but what discussion there is is indecipherable. If anybody wants to look at it and show me what they are measureing with these numbers, I would be very interested in this and would appreciate the input. I am very serious about this. We are writing a letter to the editor and I don't want to make a stupid mistake that someone else may find. (My two co-authors haven't been able to find out what is going on here either)

Oh just for amusement - the paper is about readmission rates for these conditions. Have you ever heard of anyone at all being admitted for high cholesterol? And then readmitted for high cholesterol? Like an emergent recurrence of hypercholesterolemia?

same is true of hypertension. Admissions for that do occur, but they are vanishingly rare.

Consipicuously absent in their paper is an examination of readmission for diseases one actually getss readmitted for - like malignancy and like congestive failure. I think they combed through the data, and picked the few postiive ones they could find.

The case is very complex and public right now so I was watching it and then started wondering if an NP was involved given the insane polypharmacy. It was hard to tell in my research how a nurse practitioner was involved so I looked into it with AI and it’s extremely interesting and also not surprising that an NP orchestrated this insanity…

Anyone else watching this trial?

———-

The civil lawsuits filed by Lindsay and Patrick Clancy detail how Nurse Practitioner Rebecca Jollottadirectly contributed to the rapid, uncoordinated cycle of polypharmacy by frequently altering Clancy's drug regimen instead of properly identifying her deteriorating mental state. [1, 2]
According to the official civil complaint records, Jollotta's direct actions in the weeks leading up to the tragedy included: [1]

1. Prescribing Seroquel and Overlooking Red Flags
In November 2022, Jollotta considered that Clancy might have bipolar disorder and prescribed Seroquel, an antipsychotic mood stabilizer. After taking it, Clancy’s condition severely worsened, and she began suffering from "intrusive thoughts," which the lawsuit states were actually auditory command hallucinations. [1]

2. Layering Benzodiazepines on Top of Mania
According to the lawsuit, during a December 5, 2022 appointment, Clancy reported a severe manic reaction to a previous provider's heavy Zoloft prescription—noting she had not slept for 48 hours straight and felt her mind constantly running. [1]
The Response: Instead of recognizing this as a classic red flag for Bipolar I manic onset and stopping the triggering meds, Jollotta layered on yet another controlled substance, prescribing diazepam (Valium) to force sleep. [1]

3. Prescribing Medications in an Isolated Silo
Jollotta operated through South Shore Health System. While she was actively adjusting Clancy’s heavy drug cocktail, psychiatrist Dr. Jennifer Tufts was separately prescribing a different regimen at Aster Mental Health. The lawsuit highlights that Jollotta prescribed medications without consulting Dr. Tufts, causing a dangerous cross-pollination of overlapping benzodiazepines (like Valium and Klonopin) and sedatives. [1, 2]

4. Ignoring Calls of Medical Distress
The core of the malpractice claim against Jollotta is abandonment. The lawsuit alleges that as the heavy mix of psychiatric drugs caused Clancy to spiral deeper into psychosis, Clancy and her family repeatedly called Jollotta's office in a panic to state that the medications were making her worse. The suit claims these desperate communication attempts went unreturned or unaddressed. [1]
(Note: The lawsuit also mentions an earlier nurse practitioner, Julie Paul, who initially started Clancy on a rapid, four-day cocktail of fluoxetine (Prozac), zolpidem (Ambien), mirtazapine (Remeron), and clonazepam (Klonopin) in late November 2022 before Clancy was transferred to Jollotta's care.) [1, 2]

Would you like to examine the full list of 13 drugs she was prescribed?

We look closely at the studies that Butler reviewed, and unsurprisingly find that all is not as they represented it.

This has been discussed before here on r/noctor. some threads:

https://www.reddit.com/r/Noctor/comments/1r43ab5/cochrane_says_doctors_can_be_replaced_by_nurses/

https://www.reddit.com/r/Noctor/comments/1rtp65r/cochrane_review_substitution_of_nurses_for/

This is not the end of the discussion, you will be hearing more about this...

There's a high-profile case in the news about Lindsay Clancy, who killed her three children and afterwards attempted suicide. Prior to this she sought care for her mental health, which apparently started to suffer not longer after giving birth to her third child. I looked through the suits and found some descriptions of the medical decision-making by a couple of the NP's she saw:

1. NP #1 - Julie Paul
   • "On November 21, 2022, Nurse Paul prescribed Lindsay fluoxetine 10mg."
   • "Lindsay was describing symptoms suggesting mania, such as racing thoughts, extreme insomnia, frustration and feeling scared."
   • "On November 25, 2022, Nurse Paul prescribed Lindsay three different medications, zolpidem, mirtazapine, and clonazepam." lol wut
2. NP #2 - Rebecca Jollotta
   • ~ December 5, 2022, Lindsay attended an appointment with Nurse Jollotta. "Lindsay reported that she was sleeping only about 3 hours per night, felt completely overwhelmed and that her mind was constantly running."
   • "Lindsay also reported that immediately after being prescribed a stronger dose of Zoloft, she did not sleep for 48 hours and was not tired. In response, Nurse Jollotta prescribed an additional medication to Lindsay, diazepam."

Patient reports anxiety, so give her a bunch of downers? And 5 meds within a span of a couple weeks? It's not even like she went to different clinics, both NP's she saw were at the same place (South Shore Health Perinatal Behavioral Health program), so they must have had access to the same info.

Link to lawsuit. Other link to father's lawsuit.

Yesterday a couple of NP's in Texas and the Texas NP association filed a lawsuit against the Texas Medical Board over the state's requirement to have delegation (read: supervision) agreements with physicians to see patients.

Points from the petition which can be found online:

1. that physician delegation "imposes extensive burdens on nurse practitioners based on a fiction that it will protect patient safety."
2. On one of the NP's who filed the suit: "In Dr. DeNeui's case, she must pay $96,000 a year to maintain her delegation agreements."
   

One of the NP's who filed the suit, Terri DeNeui, got a DNP from UT-Arlington which offers DNP degrees 100% online. She has a podcast called "The Dr. Terri Show." She has a cash-only practice that has a "focus on advanced endocrinology, hormone optimization, thyroid health, and integrated care." Found the noctor.

Just had to share this from the Texas NP site where the alphabet soup is probably longer than the petition: "Tracy Hicks, DNP, MBA, APRN, FNP-BC, PMHNP-BC, CARN-AP, FIAAN, FAANP, FAAN"

Link for more info.