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This tend is based SOLELY on cost savings, not better medicine. NP's are not qualified to fully take over for a physician.
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Lawyer here. When an expert witness testifies in a medical malpractice case, they are testifying about what the expected standard of care is in the local community. For example, a cardiologist is generally retained in medical malpractice cases against a cardiologist, and a general practitioner would be retained in a case against a general practitioner.
For this reason, an expert witness in a case against a nurse practitioner would be testifying about what the general expected standard of care is amongst nurses. What is broadly medically accurate isn't relevant. You have to show that this professional isn't providing care that meets the standard of their own profession. 
Let's say that a nurse practitioner misdiagnoses a rare disease. Certainly, a physician expert witness could testify as to what the correct diagnosis would have been. However, that physician can't testify as to whether or not your average nurse practitioner would have caught the misdiagnosis. The physician is not a nurse practitioner, has not been trained as a nurse practitioner, and does not interact with a nurse practitioner in the same way that they interact with other doctors. An expert in the field of nursing would know more about the relevant standard of care. >

Thank you for the guidance that makes since. But now in the cases of malpractice in independent practice states. A NP can bill for the same services as an MD can in some states. If they are being paid the same rate how can some NPs cannot be sued bc they dont practice medicine but nursing even though they are providing the same services as a MD? >

It's not the same services, it's just the same billing.  A nurse practitioner only has to do 500 clinical hours of learning; a physician will have done more like 10,000.  You can't really expect the nurse practitioner to know everything the physician knows, that's not a reasonable standard. >

So how can they bill the same if they are not as knowledgeable? So how is it fair to a patient to be billed the same amount if they are not seeing the most qualified individuals for their money? >

Well this is where choice comes in, clinicians have to clearly identify whether they are an MD, an NP, etc etc and patients can decide who they want to see.  If you want an MD ask for one.  It's not fair to choose to see an NP and then retroactively expect to hold the NP responsible for having learned way more than school teaches.
And it makes sense to bill the same so patients aren't put in the position of saying "I do want a doctor to see me but all I can afford is an NP".  This way they can more freely choose. >

Most ppl are not given a choice in rural practices. If an NP is practicing independently of a MD/DO they should be expected to practice at the same level of a physician. Im sure there are quality independent practice NPs but the overall data is shifted that NPs bill for more unneeded services than a physician to get a less accurate or inaccurate Dx. >

If there's not a choice and you have an NP, that means you probably would otherwise not have anyone.  Holding that NP to an MD standard would mean no care. >

so sorry that happened to you mate, hope she’s doing better now! Also did you sue the shit out of them like they deserved? >

Could you clarify what the current standard is for expert witnesses in independent practice cases?
The idea behind NPs being able to practice independently is not to compare them with doctors, but compare them the patient not receiving the care at all, given that in some places there aren't enough doctors and they may not be affordable. >

The solution is to have states incentives their rural medicine residency programs. Instead by expanding NPs there will be more medical errors due to a lack of medical education only increasing medical spending and a physician's workload somewhere else. >


Could you clarify what the current standard is for expert witnesses in independent practice cases?

or like medical malpractice cases in general? >

It was in regard to medical malpractice in general. Bc if you really think about if a nurse doesn't practice medicine they shouldnt be given a prescription pad or be able to diagnose. >

That’s the difference between a nurse and a nurse practitioner >

Nurse practitioner are still nurses. >

But they also have years of experience and training in medicine, even more than regular nurses. To include around a thousand hours of clinical as a nurses, thousands of hours of floor time as a nurse(usually NP schools want nurses to have 1-2 years of experience in their field) plus 3-5 years of nurse practitioner school, where they work full time unpaid under another clinician. It's at least 4000-5000 hours of direct patient care before they can even prescribe anything on their own, in states that do allow independent practice. >

I will say, as a side note, is we lack the manpower to have doctors like we want. It's not as sought after as a profession to keep up with demand. I don't like the idea either, but we don't have many alternatives. We already have increasing RN nursing shortages where LPNs are now taking up more roles and it still isn't enough. We are short on both the top and bottom end of the chain. 
Don't even get me started on how insurance guides care, and the focus Healthcare has on hiring business related jobs at a premium. All hospitals and insurances should be required to be non-profit. 
Healthcare as a whole is imploding. If we scrutinize too hard, we won't have anyone left to take care of the population. It's just a white elephant in the room. >

I agree with you x1000. The original patient protection and Affordable Care act limited over head costs to something like under <20% billed to the patient. Also many ppl dont know but even if an organization is a non profit they can still pay their executives what ever they want as long as those executives dont get bonuses or other incentives. Then you also have these mega non profit healthcare systems across the country the keep their non profit status by buying out under funded community hospitals that cared about patients instead of the bottom line. The right answer to this problem is to expand rural residency programs. >

You make very good points.  I agree you 100%. When I think of non-profit, I think of a true and idealized form, which rarely exists these days. We just need better protection to make sure the money goes to the right places. People are going to say that it is too much regulation, but it's needed more than ever. 
I can only imagine what society would be like in the U.S. if we had a focus on education. >

I worked in data collection for the department of anesthesiology of the University of Texas. 
​
We were a major teaching hospital with dozens of pain management clinics, a huge anesthesiology presence. We were on the forefront of nurse practitioners in anesthesiology when I was there.   
I have to say, flat out, that (1) anesthesiology is a unique area of practice that is absolutely isolated from pretty much every other medical arena out there. (2) Nurse practitioners must be, 100%, on the same level of skill as physicians in the field, and (3) with respect to malpractice, what matters are basically a few things: did the practitioner fall to prescribe based on known information; di the practitioner fail to adjust meds based on the known information; did the patient have a medical anomaly unknown to the practitioner; did something completely unpredictably happen.   
That's mostly it. Every malpractice case I was a part of (and there were many) rested on those criteria.   
Those criteria have nothing to do with if someone is a physician or a nurse.   
However, for juries, a physician seems to carry more weight than a nurse.   
Here's a bit of inside baseball -- of those people who  were tenured professors of medicine who worked in my department and who testified regularly in cases -- they pretty much split evenly between plaintiffs and defendants. Sometimes, oddly, in the same case depending on the level of appeal . . .  
Being a doctor or a nurse as an anesthesiologist doesn't matter. Being certified in anesthesiology is what matters. Since both MD's and the various nurse practitioners can practice anesthesiology, it is totally appropriate that either testify against the other in a particular case. >

Aren’t there supervision requirements for a CRNA that aren’t present for a MD anesthesiologist? >

I have stepped away from the field, and I was never a practitioner. I can say that when I was involved their were, but they were largely administrative bullshit.   
In the OR, there would be __A__ person. That person would be the one having to make the real-time decisions. Sometimes they'd be a Nurse anesthetist, sometimes they'd be an anesthesiologist.   
Take that for what you will. >

NPs are not independent anesthesia providers, CRNAs (much more rigorous than NP school) can be. - signed an MD anesthesiologist >

For clarity you agree with CRNA independent practice but not of NP independent practice? >

Reverse that. CRNAs are supervised during the care they provide by an anesthesiologist. Let’s say your case involves whether the CRNA should have told the MD something - that issue wouldn’t come up for an MD. So there’s a different SOC at issue. >

Nurses are putting on the biggest scam in the history of the U.S. at this point in medical history. Both Nurse Practitioners and Physician's Assistants can be very good at what they are trained to do. However, if you settle for a NP/PA instead of requesting a physician see you directly, you are not only literally accepting subpar medical care, but you are putting yourself at risk of being just another midlevel mistake swept under the rug to cover a medical practice's ass.
If you are an independently practicing NP or a PA, or if you advocate for midlevel independence, please don't bother responding to justify your Dunning-Kruger understanding of the comparison between a doctor and a midlevel. The only way this ever makes sense is in the most extreme remote rural conditions where a midlevel adhering to a clinical management algorithm is potentially life-saving versus the alternative (ie, driving 4 hours to an emergency room).
If you let a midlevel do an elective minimally invasive, image-guided intervention (eg, chemotherapy port) when a doctor is available on staff at your request, you are doing yourself a serious disservice. >

Nobody gives a shit about the scope creep really. Outside of physicians themselves and that’s pretty self-explanatory. Clients can choose not to see NPs. >

What about in rural communities where there are only independent practice NPs? >

If it was profitable for an MD physician to service rural communities, they would. So really the choice isn’t NP or MD, it’s NP or nothing. Or I guess spending a day driving there and back for non-emergency care. >

If it wasnt profitable why would doctors go into the many state run rural medicine residency programs such as FM and surgery? There was a recent survey done found rural general surgeons ob avg made more than urban general surgeons. NPs are not knowledgeable enough to independently care for a whole person. Even the slightest bit of supervision such as an email or phone call with a physician about a dx may be adequate for patient safety and quality of care. >


If it wasnt profitable why would doctors go into the many state run rural medicine residency programs such as FM and surgery? 

They do that to get their loans paid for. They work their contracted length, then move to an urban area where they can make more money. I don't know the numbers off hand, but I imagine it's a staggeringly small percentage of people who actually stay rural after an agreement like that, unless they have family where they were working. Just like the military. It's a means to an end.

There was a recent survey done found rural general surgeons ob avg made more than urban general surgeons. 

I'd be interested to see this study. If it's true, which I kinda doubt, then that surgeon was probably on call 24/7, and they move to get in with a practice to have a life. For example, I heard about an orthopedic trauma surgeon who was offered $1M a year to provide every other day call in a relatively rural area. They didn't make it a year, because that's not a sustainable life, really for anyone, but especially if you have a family. 
By the way, you're acknowledging a lot of changes in your view in other threads while not awarding deltas. Feels like moving goalposts for your actual cmv. >

Tbh i dont know how to award delta's >

Type !delta under the comment of the user you want to give a delta to >

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interesting, i wonder how this is the case when they haven't received the same education. is the education not as important as it seems or is it perhaps just hands on experience giving you the knowledge to give the same level of care. >

definitely counter to what i would have thought, thanks for the links! >


How are nurses taking over primary care roles when they have never had true scientific based classes like physics chemistry biology that modern science is based upon? 

Excuse me? I have BNS (bachelor's in nursing science) and I can tell you I very much took biology and chemistry.  I also took pharmacology and pathophysiology. And if I went to get my NP then I would take advanced versions of all those classes. Yes, there is absolutely a different emphasis between nurses, even advanced practice nursing, and doctors. Doctors treat diseases, and nurses treat patients. I'm not saying that NPs should replace doctors or that even they should operate independently in all cases (I think there are some cases where NPs are as good or better than seeing a doctor) but to say NPs or nurses in general aren't scientifically trained is an outright lie. >

This is a naive and immature take. To imply that doctors don't treat patients is just typical nursing/midlevel propaganda. And to suggest that nurses, are more qualified than or better equipped to provide care in any capacity than physicians is so ridiculous and unfounded I can't even begin to explain how nonsensical it is.
I would wager that even given 12 full months of dedicated study time, no nurse on the planet would be able to pass USMLE Step 1, 2 CS, 2CK, 3, or any medical board examination. And no, arguing that "well, well, clinical training this, clinical practice that, exams don't always translate to practice", just no. Provide a better measure of medical acumen than test taking. And no, "rubbing a patient on the shoulder inappropriately and telling them everything will be okay" is not a judge of being able to actually manage their medical care.
Nurses use the NP route as a way to sidestep the hardships of traditional medical training and to milk all of the "glory" of being a doctor without any of the hard work. This is why so many are adamant about wearing a white coat and god forbid if the patient asks them what their role on the medical team is (as it would expose their true role).
As a patient myself, I've literally asked nurses, "Who are you, what's your role?" and only get their name in response until I have to pull their role out of them. They love when patients think they are the doctor. >

They really should be... Like... Docter?! >

It’s all cost. It’s all from capitalism >

In what state is it the case that they cannot? >

The lawyer comment really helped me understand but to my knowledge all states were as such bc explained even though MDs and NPs practice almost the same skill they were not trained or educated the same. Even though the MD knows more they are not experts due to a different education/ training path. >

I’ve seen many cases where MDs have testified as to the SOC for mid levels like PAs and NPs. It’s mostly in the context where their care overlaps - places like the ER or family practice. >

Because physicians aren’t taking new patients…, So, NP it is! >

MSN here - I had chemistry and biology among many other science based classes. Please stop spreading this nonsense. >

Like organic chemistry that covers reactive intermediates, epimers, Woodward hoffmann ruled or a bronson lowry theory? Biology that covers processes like  operons, developments processes such as mesenchymal differentiation? Its not non sense im demonstrating there is a clear curriculum/education  gap that can translates to a poorer understanding of our world. To more efficiently care for our patients we need to decrease these knowledge gaps if NP want some sort of independent practice.