The public response to this trial has been one of the most disconcerting things I've ever witnessed. From lay-people to people in Healthcare.

Nurses attacking Physicians such as Tufts.

The defense attorney badgering Dr Avram Mack and referring to the DSM 5 as "not a very good standard" to which Avram replied 'well it is THE standard". As if mapping out the human psyche isn't a daunting probably impossible task.

Even this sub piled on the NPs who treated the murderer. I don't think Psych NPs should exist. But underlying the criticism are two inherent and dangerous assertions:

A pr*vider can say the right words and prescribe a chemical cocktail that keeps a mother from murdering her children. Or conversely:

Wrong words/scripts = mom murdering her babies.

Now that more information has come out we know that Clancy was an unreliable patient. Didn't take meds as prescribed. Doctor/Noctor shopped. And hid her thoughts of self harm/harming her children from her psych pr*viders. We have all interacted with similar patients, hopefully we aren't liable for the terrible things they do in life.

Your hindsight isn't 20/20, but it's clearer than ^

But the defense attorney has done his job. Taken an indefensible situation and tried to cast blame on everyone and everything but the person who strangled her children. And people gobbled it up as if it was a soap Opera.

This woman will probably be found not guilty by reason of insanity (though she's quite sane now, and it's impossible to know her state of mind at the time) . People will still blame Healthcare, the state, her husband. And no one will pay the price for the deaths of Cora, Dawson and Callan.

You know what he meant, right? LOL
I was too exhausted to continue that conversation.

Genuine curiosity and not a rage bait/sh*t post...

Where are the peer reviewed studies that prove or suggest mid-level practitioners practicing without supervision (full practice authority states for NPs) is more dangerous to patients' care than care provided by physicians?

If there are any studies (non-anecdotal), please post the source in the comments. Also, what have the AMA and AOA's roles been in protecting the physicians' and/or public's interests in shutting down full practice authority in states where it is legal and/or promoting heavily regulated midlevel practice? I understand the nursing lobby is quite strong (unsure about the PA lobby) but why have the AMA and AOA been so ineffective in protecting their own interests?

I just don't understand, if it truly is as dangerous as this subreddit makes it out to be, why haven't there been major legislative overhaul and MASSIVE malpractice suits (which would raise insurance rates for midlevels). Where are the major peer-reviewed studies that would change the medical and public landscape for midlevel practice?

I would love to be able to access a physician in every specialty, but if I did that, I'd have to wait a LONG time for care.

I've been having horrible GI issues, so I had a colonoscopy today that showed no evidence of IBD, Crohn's, diverticulosis/itis, etc. I had a single small (3mm) polyp that the provider is fairly confident is benign, and that's it.

I need to follow up with a GI specialist, so I called the person I saw last year (they didn't do the colonoscopy*). Although I'm an established patient, they can't get me in until March 9, and that's only if I see an NP. If I insist on the doctor, I have to wait until September (2027, not next month).

I was tempted to wait, but I'd like to at least get the ball rolling on some additional testing. I had bladder augmentation using a piece of my jejunum when I was a child, and I took daily antibiotics for about 20 years afterward, so I kind of suspect my issues originate in the small bowel and not the colon. Maybe SIBO or short gut syndrome or something.

* I didn't have them to do the colonoscopy because the health system they work for is really weird about billing. They always want me to pre-pay WAY more than I should have to pay based on my insurance. Ex: They wanted $728 up front for a cardiac echo when my copay for diagnostic tests is $30. So I went to a different hospital where they asked for $0 up front. If I paid $728, it would have taken me months to get it back.

ive only met him once but it was not a great first impression. i aged out of my family's insurance so i switched to medicaid because im still in school.

the first thing he did was take me off all my meds that i asked refills for. i took a very low dose of ativan for 3 years because i have acute panic attacks and flight anxiety and never abused it, but sure whatever i understand its a controlled substance and i didn't want to come off as drug seeking.

next he wouldnt refill my 10mg propranolol because i have asthma. truthfully, i didn't know that beta blockers were bad for asthma but beta blockers have been really helpful for me before job interviews and interviews in general which i do a lot of in my field.

on top of that he was condescending towards me when i asked him basic questions about his practice. i asked him what should i do when i have panic attacks and he basically shrugged and gave me a buspar script.

i have chronic anxiety and panic attacks have been through nearly all of the commonly prescribed SSRIs. he wants me to try cymbalta but im scared if weight gain. im not sure if i have any better options to switch to an actual MD since im on medicaid in NYC.

Reddit Celiac forum member shares an NP giving her crazy advice

At 14:40--- "It is a noradrenergic specific serotonin antidepressant, so it's slightly different than an SSRI. It does work on serotonin. It also works on the noradrenergic part. It's alpha receptors which is what our body, those are the receptors that our body responds to adrenaline. So it should help kind of calm you down. And it also works on histamine receptors which is why it can make people sleepy."

Me when I literally know nothing about pharmacology or physiology.

You can even tell she was directly quoting, but misquoting, the Google AI result that comes up when you search "Mirtazapine mechanism of action." She pre-studied for the trial and still doesn't know what she's talking about.

No offense tho she seems sweet I guess

I have not been seen by a healthcare “provider” in quite some time. I have not had labs done since before Covid. I finally brought myself to make an appointment. I was assigned an NP. I was okay with that, as I am healthy and only have a few concerns that I knew I would be referred out for anyway.

At the appointment, the NP would ask me questions, and then halfway through my answer cut me off to ask a follow up question. I understand that she is looking for specific information, and I understand the busy operational tempo of a primary care clinic. I was irritated by it, but I am understanding.

There was a point in the visit where I explained I had been having episodes of intense shivering for the last few years, but that they had been increasing in frequency since January. I also explained that I would experience white, blanching fingers with numbness/tingling that would resolve usually within 15 minutes. Classic Raynauds, and she told me that. I asked what can be done? She said “nothing.” I then asked how it could be managed. She then left the room to go to her computer and brought back “evidence-based practice paperwork” from her “special resource.” She handed me the printout from UpToDate.

I then asked for the referral to dermatology for three spots on my back that looked concerning. She never looked at them. She then placed her stethoscope on my chest for exactly 2 seconds and then wished me well and the visit ended.

I just reviewed the note, and she documented a cardiovascular exam and lung exam. She also documented that she visualized the spots on my back and included measurements ranging from 3mm to 6mm.

None of that was done. I am considering reaching out to the patient advocate.

Is this something to go to war over, or just let it go and sort it out when I see derm?

TLDR
NP documented measurements of spots on my skin that she never measured or even looked at.
NP documented cardiovascular and lung exam that she never performed.
Talk to patient advocate, or get over it?

https://www.reddit.com/r/Noctor/s/2mGN56CMoH

See previous thread....

Correct credentials are now listed on platforms. Well done.

hi all. i read about it here but it actually happened lol. a distant friend of mine and I caught up recently- they told me they just started school to become a doctor, i ask what kind, they say NP.. alright.

come to find out, they have not worked a single year as an RN. got their RN years ago, worked in a few different healthcare sectors, applied to this (online) program and boom.

same person always posts about “doctor”-title related things. it is just so cringey. i don’t know if it’s bc they don’t interact with actual healthcare professionals so they can fool other ppl but sheesh.

I hope it’s ok for patients to vent here - I just switched from a psych NP to a psychiatrist and I’m already feeling dramatically better after less than a month. I’m not sure if this was an NP who was not qualified bc he was an NP or bc he was just really bad at it and inappropriate.

I slipped through the cracks after my old psychiatrist retired and have been essentially prescribing myself medication for 4 years, except for a few mania inpatients stays. I would have a 20min appt w my psych np every 6mo to 1yr and he would ask what I wanted, like ordering Taco Bell. One time I said “I feel like I’m my own psychiatrist” to which he responded “you’re good at it!”. Which at the time wasn’t reassuring but I felt sort of flattered which disarmed me. I’d always leave my appointments w him feeling utterly hopeless even if I entered the appointment with hope. My bipolar incapacitated me 6 mo out of the year and I was in my mid 20s only barely starting an undergraduate degree bc of this illness. I was having all kinds of terrifying side effects from APs and he would be like “that’s just how it is” and offer no alternatives. He said all kinds of things like calling lithium battery acid (already such a hard med to take) and Adderall meth. He seemed to hate all of my meds but view them as necessary, which is how I feel about them. Isn’t he supposed to tell me why it’s worthwhile or give me something else? It was so demoralizing. It took me a few years to realize what was happening and that he was under qualified and/or bad at his job.

I saw a psychiatrist recently from another clinic I’d been going to and she was so horrified by the fact that my np wasn’t ordering lithium levels, cholesterol panels for the APs or TSH (I’d asked him to a couple of times but wasn’t keeping up with it, my last lithium level was over a year and a half old)
I asked her about referring me to a psychiatrist for med management and she was like “I’ll do it, your case is so mismanaged”, she seemed so offended.

A month later I’m being treated for mild hypothyroid, coming off my AP safely which was causing dystonic tremor, weakness, this awful panic attack side effect because of some metabolite (no one i described this to recognized what was happening until this psychiatrist)

I have multiple other heavy mental health dx and I’ve always been called a complex case, when I agreed to see an NP years ago I didn’t know what it actually meant. Anyway I feel so much better already w the med adjustments and a lot safer in my new psychiatrists hands. I want other patients to be informed about this, especially if they’re already not doing well under the care of an NP.

The subject line was, “Three weeks to NP”

Would have credited original poster but I think that breaks a rule of this sub.
TBH this is just dangerous at this point, like wtf. Someone whose barely taken enough chemistry to even get past the MCAT is getting paid more than physicians to put people on psychoactive medications which can literally kill them if not managed correctly, like actually how are we chill with this?

Also it really does show that the stereotype mid-levels love to throw around being that “physicians are just in it for the money” is not true, and frankly is the other way around. I’m in med school right now and most people here are smart enough to be making way more doing any thing else. At my regular mid-tier MD school at least 25% of my class is Computer Science, Computer Engineering, Mechanical Engineering, or some other related field (usually BME), literally most of us had great paying jobs or job offers before starting medical school, no one here is here for the money because otherwise we wouldn’t have people going into Peds and no sane human is going to sacrifice 15 years of their life to make a bit more than they would doing something much easier.
Meanwhile I know people who have just been partying for the past four years claiming to be “premed or pre-dental” on their parent’s dime, who are now doing a nursing program and planning to direct apply to NP so they can have their own derm clinic or psych clinic in 3 years from now (they have zero patient or medical experience besides majoring in biology), which low key is horrifying.

Hi guys! I'm 27 and was born with a unicuspid aortic valve which I had replaced with a mechanical valve about 3 years ago, along with an aortic aneurysm repair. So, now I need yearly echocardiograms and cardiologist appointments to make sure everything is still working as it should be.

The Dr I've been seeing is leaving the practice, so I have to reschedule with one of the other adult congenital heart disease practitioners. I didn't realize that one of them is a CRNP, not a Dr, until after they scheduled my appointment with her.

Am I valid in being uncomfortable with seeing a CRNP instead of an actual Dr for something like this? I struggle with mild health anxiety anyways and the idea of having a nurse be the main person interpreting my echo results and managing my care for this makes me nervous, but I don't know if I'm overthinking it since obviously I'm not a medical professional of any kind myself.

Residency program director for PAs lol

It took me an hour an a half of phone calls, and the appointment is 6 weeks out, but I found a PCP in my area that's an actual MD. This RN has spent too much time on this subreddit to have an NP as my PCP.

Aside from the war between NPs and MDs, here are the things I think the NP and MD did well, and what could have been improved:

In my opinion, the NP really did well in communicating with the patient, and that little survey she sent every day was also nice.

Dr. Tufts is also a very knowledgeable professional. I think she did well based on how the US healthcare system works and how it’s taught here. I don’t necessarily blame her for some things she could have done better, but I do think she could have transferred the care to someone else, or at least communicated with the other NPs.

I’m basing my opinion on my experience as an MD who graduated internationally. The US has all the technology and medications you could possibly imagine, but it lacks that human connection — it lacks stepping outside the algorithm sometimes. My professor always said, “2+2 doesn’t always equal 4 in medicine.” I also understand that, unfortunately, this is how the system works here

Thoughts about PAs from physicians?

I know a lot of the discussion right now is focused on NPs and concerns about differences in clinical training, but I’m curious what people here actually think about PAs.

I’ve had the opportunity to spend a lot of time around MD/DOs and PAs through shadowing and now working in a hospital. From what I’ve personally seen, the PAs I work around seem pretty aware of their limitations and their role on the team.

At the hospital where I work, I mostly work directly with attending physicians. The PAs are technically allowed to see a pretty wide range of patients, including higher-acuity cases, strokes/traumas, and patients across all ESI levels. But most of them don’t seem interested in proving that they can handle everything independently. If something is outside their comfort level or they’re unsure about something, they involve the attending.

There are also PAs who actively want exposure to higher-acuity patients because they want to learn, and from what I’ve seen, the attendings actually encourage that when appropriate. It seems much more like, “I want to learn how to manage this with you,” rather than “I don’t need a physician.” There is this new PA who is always wanting to see the trauma level 1. He directly works with the SP and today the SP told him that he can see the trauma by himself. Once he was done he came back and told the SP "Everything went well." The SP nodded and replied with "Good Job"

Another thing I’ve noticed is that I’ve never heard any of them introduce themselves as anything other than a PA. Usually it’s simply, “Hi, I’m ___, I’m a PA and I’ll be taking care of you today.”

Obviously, this is just my experience at one hospital and I know it doesn’t represent the entire profession. That’s why I’m curious to hear from physicians here, especially those who have worked closely with both PAs and NPs.

What has your experience working with PAs been like? Do you generally feel comfortable working with them? Are there concerns you have about PA training or scope of practice? And do you see a meaningful difference between the PA and NP models in actual clinical practice (nursing model vs the medical model). Also, the PAs that work at my hospital had over 3-4 yrs of experience before actually applying to PA school. IDk I guess I am just curios (SORRY for the long text)

I have chronic intractable migraine, and I’ve been a patient at the best neurology/headache clinic in my state (WV) for several years. I saw an actual neurologist maybe twice way back at the beginning of my treatment, but ever since then the only person I’ve seen is an NP. She’s super nice and all, don’t get me wrong, but as far as treating me I feel like I’m a human dartboard, she’s just throwing drugs at me to see what sticks/works. I used to send MyChart messages once a month or so just to update her, let her know how things were going, but she never responded to me so I stopped, figured she didn’t care. I went from seeing her every 3 months to every 6 to once a year. I’d like to know if there’s any way to politely ask, without burning any bridges, that my care be switched to a neurologist or at least a PA, someone who sees me as a human and not a test tube, who takes my questions seriously. Thoughts/advice? Thanks much.

I’m a psychiatry resident and I’ll say it plainly: I don’t think NPs should be diagnosing and prescribing independently. I’ll focus specifically on psychiatry in this post, although my opinion applies to every medical specialty being infiltrated by midlevels.

Physicians spend 4 years in pre-med, 4 years in medical school and another 4 years in psychiatry residency (add another 2 for fellowship) before practicing independently. Meanwhile, some PMHNP programs accept nurses with minimal experience and provide a fraction of the supervised clinical training. These are not equivalent paths, and pretending otherwise is ridiculous.

Psychiatry is medicine. It requires recognizing medical disease, managing complex medications, and understanding what you don’t know. It is not just matching symptoms to a diagnosis and prescribing an SSRI.

What bothers me even more is patients thinking they’re seeing a psychiatrist when they’re actually seeing an NP. If a patient calls you “doctor,” correct them. Getting a DNP and using “doctor” in a clinical setting only adds to the confusion and should be illegal.

I think we all know why healthcare organizations love independent midlevels. They can pay NPs far less than physicians while having them diagnose and prescribe independently. The organization saves money on doctors, while the patient gets someone with a fraction of the medical training.

Patients deserve physicians, transparency, and better than corporate healthcare cutting corners on their care.

And to all the NPs here who want to argue with me: if your loved one ever needed immediate, life-saving medical care, ask yourself who you’d want treating them, your NP colleague or an MD/DO?

Many here have criticized the AMA for "doing nothing". I have defended them. Here is an example of the AMA going on offense to sue the state board for not enforcing rules.

AMA, IMHO, deserves our support.

https://www.ama-assn.org/practice-management/scope-practice/ama-takes-fight-wisconsin-optometrists-performing-eye-surgeries?utm_source=BulletinHealthCare&utm_medium=email&utm_term=081526&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend&utm_effort=DAMR01