Are nurse practitioners taking over for MDs?

[Rick Lee]

I'm not complaining (yet), but it seems to me NPs are seeing patients a lot more than MDs are. When I've called for script renewals, the NP handles it. Last time I had an appt., after waiting 40 min. past my appt. time I got up to cancel and leave. They had me see an NP immediately. Today I have an urgent care issue and they gave me an appt. with an NP. I know it takes a lot of school and training to become an NP. But when did they get the authority to write scripts? In my own life insurance sales job, I often have to notate an insured's doctor and scripts. Plenty of times they list no MD, but rather an NP. Just curious.

[flatbutt]

NPs are growing in numbers here too. I had squamous cells on my bald noggin removed by a NP.

[widebody911]

Anything to improve margins. In a few years they'll just have doctor kiosks where you type your symptoms into WebMD

[Rick Lee]

Last time I was there, I thought I was seeing a doctor, but everyone was calling her by her first name, and I couldn't make out her last name on her ID card, as it was in much smaller font than her first name. But I couldn't bring myself to call someone I thought was an MD by their first name. Today when I called, they said, "Terry can see you at 8:15." I know there are four MDs at this practice and none have a first name of Terry.

[VincentVega]

I see NPs now too, havent seen a dr in years. My experience has been positive, more time spent, they are knowledge and much more accessible.

[pavulon]

NPs are cheaper (by at least 50%) and often are willing to live in places some MDs won't (especially rural america). Also, unlike PAs, NP's may not have to practice under a physician. A DEA number is needed to write scripts. NPs can be issued DEA numbers.

[PorscheGAL]

As far as I know NP have been able to write scripts all along but they must have an MD supervising (but doesn't necessarily need to be in the same building). I think some of the growth in NP has to do with numbers. MDs must have residencies but there is a limited number of slots based on money. NP don't need residency. Most schools require they work as nurses for a certain number of years (usually between 2-5) before enrolling in their 24-28 month program to become a NP. There are new NP programs opening up all the time.

[GH85Carrera]

Right now it is a battle in the Oklahoma legislature to limit NP.

You need to find a different doctor. Mine is very punctual.

I don't mind a NP for things like flu shot, or even simple procedures, but I want a real MD to see me when I have a issue.

[Rick Lee]

I had a doctor in VA who would not renew a script without my making an appt. and coming in. Real pain in the ass and this was back before Claritin and Zyrtech were OTC, so I had to really suffer for a few days sometimes. I swear, this practice here in AZ would give me a script for anything over the phone, if I asked for it. I don't, but I do like to get renewals approved by phone instead of dealing with their horrible scheduling and coming in for an appt. and then $40 copay.

[Rick Lee]

Originally Posted by GH85Carrera

You need to find a different doctor. Mine is very punctual.

The office mgr. called me a few days later and suggested I switch doctors, since mine is always overbooked and never on time. She suggested another one in that practice who is 100% on time, so I agreed. But that one is unavailable today and I need to get something looked at now, not next week. I can't spend the day at urgent care either; need to get to work.

[Brando]

It "seems" that way to me as well. Last time I went into an Urgent Care office I was seen (quickly) by a NP. I think they had maybe one or two doctors on staff and the rest were Nurses or NPs.

[berettafan]

NPs and PAs do seem to be the front line of medical interaction. I would imagine it's an economics thing.

In our area there are a couple big urgent care places. one is built up pretty fancy and feels more like the clubhouse at a golf course than a docs office. they have a well earned reputation for being essentially a self medicating facility. that is to say you know what you're gonna get and they know how to get the most billing from every patient. not a positive thing IMO.

[Rick Lee]

Speaking of billing, is it legit to bill for an office visit and co-pay if you don't see a doctor? Again, not complaining, just curious. Seems to me, they shouldn't be able to charge the same amount for seeing an NP as an MD. Do NPs have to carry malpractice insurance or is there a blanket policy for the whole practice?

[MRM]

My clinic has about half physicians assistants/nurse practitioners and half MDs. If you set up and appointment they will first try to send you to a PA unless you specifically ask for an MD. I've seen PAs a couple of times when my regular MD wasn't available and I've had pretty bad results. The worst experience saw me with a PA at about 9 am one morning and back in the ER that night, resulting in an MRI, CT scan and more IV drugs than you can swing a dead cat at to resolve the issue she didn't address at the morning appointment which got worse as the day progressed. At the ER the docs chastised me for not getting treatment earlier. I told them I did. They asked me why the doctor didn't give me ___ when she saw me. Through gritted teeth I responded, "That's what I'd like to know."

Now I will see one if necessary for routine stuff but I'll drive longer to see a MD at a different clinic if my issue requires any thinking or analysis.

PAs charge like MDs with office visits and co-pays just like a regular doc. The charge will be less and your Explanation of Benefits will reflect the actual cost. The co-pay isn't affected since you pay dollar one of the charge as your co-pay regardless of whether the rest of the bill is discounted for being a PA rather than an MD. PAs work under the supervision of an MD and are covered by their malpractice insurance. The medical and insurance industries consider PAs to be equal to MDs. That's why it's important to ask if you think your visit requires an MD.

[Rick Lee]

Ok, might as well as the Pelican brain trust, though I have to leave in about 15 min. I have a rash on my ribs. I've had pain there for about two weeks, but the rash just appeared last weekend. It feels like a bad bruise when my shirt rubs against it, but isn't tender when pressing on the rash. WTF is this?

[Deschodt]

Nothing against NP. One at a dermatology practice did major skin surgery on me. Fantastic job too. Shoot I've thought of quitting IT and study for that actually, sounds fun...

On waiting - that's why I joined One Medical (kinda boutique doc group in major cities). My employer pays the yearly $190 fee so it's the same to me. I have a primary but there is always someone that can see me that day, either near work, on the way home, or near home. I can go wherever I want - they all have access to my records, great app for booking, telemedicine if you want, no need to fill anything out. They also have labs built in, one stop shop... They are always on time - longest I waited in the past 5 years was 5 minutes (primary doc was stuck in traffic, first appointment of the day, they apologized so much I practically felt bad). You get a survey everytime (try that with my old doctor, ha!!!) I highly recommend this kind of setup. Some things are worth a fee (even better when I don't pay it)

[pavulon]

Originally Posted by Rick Lee

Ok, might as well as the Pelican brain trust, though I have to leave in about 15 min. I have a rash on my ribs. I've had pain there for about two weeks, but the rash just appeared last weekend. It feels like a bad bruise when my shirt rubs against it, but isn't tender when pressing on the rash. WTF is this?

Herpes zoster (aka shingles)

[Evans, Marv]

I suppose I'm lucky. I've had Kaiser for decades and the same Kaiser primary care guy for almost 25 years. Now that I'm on Medicare, he sees me the obligatory one time a year unless I call in, in which case I get in that day or the next. In between if I have some minor issue or question, I message him on their site. He gets back to me the same day with a prescription or an appointment the next day. At appointments the wait time is usually 20 minutes at most. I've had NPs & PAs a few times & it's been OK with me. My main concern is to get in & out ASAP with a resolution to my problem no matter who solves it.

[pwd72s]

Originally Posted by pavulon

NPs are cheaper (by at least 50%) and often are willing to live in places some MDs won't (especially rural america). Also, unlike PAs, NP's may not have to practice under a physician. A DEA number is needed to write scripts. NPs can be issued DEA numbers.

I think our primary care is a PA (Physicians Assistant). Yes, she writes prescripts...
Yes, a small town clinic. Medicare under Obamacare...very much a bureaucracy and you're very much a number going through the approved protocols. If the left gets the all government care they want, it'll only get worse.

I'm NOT slamming the P.A. here...she's very good and works hard with a very busy schedule. It's the system of Govt. control and protocols that sucks.

[URY914]

I went to my Dr. today for a physical. He's the real deal. I've seen NP in the past. No big deal.