Here is his statement: “Here is a recent report of a 10-year experience of independent nurse practitioners in Mississippi. JMSMA January 2022 (msmaonline.com) The APP patients had higher total costs per person, worse when adjusted for the fact that their patients were not as sick as the physician patients. The increased utilization came from increased referrals, tests, and other similar measures. Their quality scores were not better either.
Tnanks Bekki: The pharmacists I worked with on a team had great knowledge of the medications and they were certified diabetic educators. We treated high risk patients in a systematic, coordinated and integrated way
Hi, Bill. I'm so very glad that you responded the way you did. I think that the special training is key for any clinician, whatever level of education or degrees.
Thanks David. I think the best analogy is special operation teams in the military. Everyone is trained as an infantryman. Teams of infantrymen with intense special training around a specific mission will out perform every time. That is the model. Focus on the mission. Provide the team with the equipment and support needed for success. Train for the mission. We have seen that model succeed and we have provided multiple example of how that model succeeds in chronic disease management.
Finals just began...but I wanted to make at least a brief reply to this statement especially.
"And the way NP/PA schools have exploded the last 10 years, the average quality of the grads has diminished. The clinical preparedness of many of these new grads is pretty pitiful."
As someone who has been in PA education in both a private university as well as a public academic medical institution, I would have to call that particular statement, at least with regards to PA education, wholly inaccurate and uninformed.
If anything, with the increase in PA programs, the standards have become higher and more rigorous just for that reason. The concern that too many schools too fast would decreased graduate quality. Our national educational org along with the certifying org have maintained an extremely close watch over the growth in PA education.
And it IS all about working as a team. There is far too much complexity to think an individual can single-handedly manage a panel of patients alone. Good grief!! Practice is stressful enough without that!
However, let me declare that I am not among those in my profession as a PA who is clamoring for independent practice. And that is a whole story in and of itself! But part of my reason is that I believe there is a safer middle ground to be had with a collaborative model that is more a blend of talents than a separation of them and us.
Any change in practice structure will require a change in the education model, IMHO. The cart went before the horse when our national PA org decided to launch with unbridled fervor into a loud call for independent practice for PAs. And there is a schism in the profession about independence as it is being pursued by some. Again, another topic for another day.
I fully agree with @David C. Kibbe's statement "I think that the special training is key for any clinician, whatever level of education or degrees." As you know Bill, you have many physician colleagues that are unfamiliar with OMT.
The discussion needs to go to the point where you are, Bill...let's focus on helping patients get better!! We need to leave everyone's egos on the sideline and get on with business!!!
More later after finals and the Bar Exam in late July! All prayers in that regard are welcome...no solicited!!!!! Great being in touch again! :)
I respect your wisdom and comment as a very seasoned veteran of healthcare delivery-and now you are about to get a law degree! I think there is a place on the team for the physician with 20 years of education and three years of primary care residency. That depth of training goes a long way when it is available to deal with exceptions to the protocol, complications, and other complexity. 80-90 percent of diabetes and hypertension can be managed by protocol and system. Patients are not getting optimal medical therapy because an 8 minute visit every three months just won't get it. As the team has more and more exposure to these high-risk patients, all members become much better at managing these patients. Physicians should be part of the team to manage exception and complexity-not to manage issues that lend themselves to a systematized approach. Great to hear from you.
There is a fundamental need for accurate objective functional early detection of cardiovascular diseases using Multifunction Cardiogram Technology to enable primary prevention via lifestyle optimization and best outcomes based secondary OMT assisted working with telemedicine help to allow the care team to succeed. It is the best and the ONLY way to save the system from collapsing!
Working as a healthcare team is vital. Everyone has their strengths and those should be utilized
Tnanks Bekki: The pharmacists I worked with on a team had great knowledge of the medications and they were certified diabetic educators. We treated high risk patients in a systematic, coordinated and integrated way
Hi, Bill. I'm so very glad that you responded the way you did. I think that the special training is key for any clinician, whatever level of education or degrees.
Thanks David. I think the best analogy is special operation teams in the military. Everyone is trained as an infantryman. Teams of infantrymen with intense special training around a specific mission will out perform every time. That is the model. Focus on the mission. Provide the team with the equipment and support needed for success. Train for the mission. We have seen that model succeed and we have provided multiple example of how that model succeeds in chronic disease management.
Finals just began...but I wanted to make at least a brief reply to this statement especially.
"And the way NP/PA schools have exploded the last 10 years, the average quality of the grads has diminished. The clinical preparedness of many of these new grads is pretty pitiful."
As someone who has been in PA education in both a private university as well as a public academic medical institution, I would have to call that particular statement, at least with regards to PA education, wholly inaccurate and uninformed.
If anything, with the increase in PA programs, the standards have become higher and more rigorous just for that reason. The concern that too many schools too fast would decreased graduate quality. Our national educational org along with the certifying org have maintained an extremely close watch over the growth in PA education.
And it IS all about working as a team. There is far too much complexity to think an individual can single-handedly manage a panel of patients alone. Good grief!! Practice is stressful enough without that!
However, let me declare that I am not among those in my profession as a PA who is clamoring for independent practice. And that is a whole story in and of itself! But part of my reason is that I believe there is a safer middle ground to be had with a collaborative model that is more a blend of talents than a separation of them and us.
Any change in practice structure will require a change in the education model, IMHO. The cart went before the horse when our national PA org decided to launch with unbridled fervor into a loud call for independent practice for PAs. And there is a schism in the profession about independence as it is being pursued by some. Again, another topic for another day.
I fully agree with @David C. Kibbe's statement "I think that the special training is key for any clinician, whatever level of education or degrees." As you know Bill, you have many physician colleagues that are unfamiliar with OMT.
The discussion needs to go to the point where you are, Bill...let's focus on helping patients get better!! We need to leave everyone's egos on the sideline and get on with business!!!
More later after finals and the Bar Exam in late July! All prayers in that regard are welcome...no solicited!!!!! Great being in touch again! :)
Thanks Theresa.
I respect your wisdom and comment as a very seasoned veteran of healthcare delivery-and now you are about to get a law degree! I think there is a place on the team for the physician with 20 years of education and three years of primary care residency. That depth of training goes a long way when it is available to deal with exceptions to the protocol, complications, and other complexity. 80-90 percent of diabetes and hypertension can be managed by protocol and system. Patients are not getting optimal medical therapy because an 8 minute visit every three months just won't get it. As the team has more and more exposure to these high-risk patients, all members become much better at managing these patients. Physicians should be part of the team to manage exception and complexity-not to manage issues that lend themselves to a systematized approach. Great to hear from you.
There is a fundamental need for accurate objective functional early detection of cardiovascular diseases using Multifunction Cardiogram Technology to enable primary prevention via lifestyle optimization and best outcomes based secondary OMT assisted working with telemedicine help to allow the care team to succeed. It is the best and the ONLY way to save the system from collapsing!