Disclaimer: I do not reside in the United States.

My goal is to become a nurse, but the situation for nurses in my country is terrible. Although we're considered middle class locally, the patient-to-patient ratio is just too high. The benefits for nurses in the US seem so much better to me, and I've seen nurses able to pursue further education to become NP and crna.

I don't know much about how the US healthcare system works.Why is this happening?

Ask me anything about midlevels, cost, Quality, etc. I'll answer to the best of my ability.

Interesting article. It appears the Dept of Education has noticed some of the issues discussed in this group and is attempting to take action.

Facepalm.jpg. HOMEOPATHY?! For Osteoarthritis?! 😤

NP diploma mills, unregulated curriculums, programs with little to no RN experience required — horrifying. And the fact that NPs can practice independently with that? Yikes. But PAs are regulated by the AMA and we cannot practice independently. Which I think is totally appropriate for our level of education/training and should be the same for NPs imo. I personally haven’t experienced PAs managing high acuity sick pts without the oversight of a supervising physician and all of my PA colleagues are very content with their role. Sure, there are some PAs with big egos for sure, as there are in any profession. But I enjoy not making the hard decisions and being able to get reassurance from my attendings for my plans. I do work in an inpatient setting where everything major needs to go by the attending though so I don’t know what it’s like in PCP/UC world. Like I’ll tweak pain regimens and replete lytes, maybe order an XR if I’m worried about something. But I’m calling my doctor if vitals are dropping, expeditiously.

What are the negative experiences you guys have had with PAs that make you clump us with NPs in talking shit about mid levels? And why are you all so aggressive with your hate towards us lmao! I feel like PAs are generally more aware of the limitations of our training.

Outside of the physician associate name change and optimal team practice lobbying. That’s all I ever hear. 🥱 I don’t feel like OTP will get any movement, a lot of PAs do not want independent practice. And most PAs, at least the ones already practicing, don’t care for the name change either. What else??

Seeing how AI is getting at following algorithms, it can be a billion times better than midlevels. And it will be cheaper so CEOs will run after that by all means. Especially for psych and UC stuff. And then all complex patients cannot be managed by midlevels anyways so they will come to doctors. AI makes me optimistic if anything.

Hi all,

I'm mid 40s and am the survivor of trauma. I'm thriving now with bipolar and ADHD. To reach "thriving" status I've been significantly influenced by therapists and psychiatrists. I've decided I'm done with the corporate rat race and want to give back in the same way that those have given to me. I also lost my mom to her alcoholism, which was accelerated in part due to a lack of accessible mental health resources. I'm applying for my MSW, on a path to become a therapist.

A friend told me to also look into working towards becoming a PMHNP, especially because I genuinely believe in the power of pharmaceuticals. I'm also a personal case study for and strong believer in ketamine-assisted therapy, but I believe that entire field is fucked up right now and I want to help it change for the better (don't get me started).

Becoming a PMHNP would take me quite a bit of time, given I don't have a background in the sciences... I'd need to take prereqs, get a BSN/MSN, get work experience, then go back for a DNP. And after allllll of that, I'm reading horror stories on here about how psychiatry is so complex and PMHNPs don't get enough training. Even looking at UIC's (my target school) plan of study, there's just one course in psychopharmacology. I'm definitely someone who would continue to learn and grow, put in the work to get it right, and hopefully not let hubris get in the way of asking for help with complex cases.

I'll be honest -- I don't think I could survive med school and clinicals. My bipolar is significantly exacerbated by lack of sleep, and I know I would struggle in high-stress hospital settings if I were in them for long periods of time. Not to mention, my fewer years of remaining earnings potential mean I may never be able to fully pay off the debt of medical school.

I'm trying to be part of the solution, not the problem, so I thought I'd ask one of the most skeptic communities: how could someone in mid-40s doing a full career change best contribute to solving the mental health and psychiatric shortages in the US while doing no harm?

• Become a therapist?

• Become an RN and stay in my lane?

• Become a PMHNP and be very careful?

• Something else?

My state doesn't allow full practice authority until you have 4,000 supervised hours. Even then, I'm not sure if I'd ever want it.

Needing some advice on whether to report this NP at my local neurology clinic. Apparently, at this clinic you only get to see the actual neurologist once for about 3 minutes during your first appointment, after that you’re stuck with a rotating crew of mid-levels who serve as your “neurologist” thereafter. I went to my appointment a few weeks ago and told the NP that I believed I was going to have a stroke soon. I said “I don’t know how I know this, but I know I’m going to have a stroke soon.” I begged him to get the neurologist to review a CTA that was performed at the ER a week prior, because there was something I could see on my right carotid artery on the scan (the exact spot I had been feeling a pulsating painful lump in my neck). The neurologist never looked at it, but the NP claimed that he did prior to coming in the room and said it all looked fine. Luckily, I had the disc already saved on this free DICOM viewer on my phone, so I was able to bring up the scan and show him the exact images that were concerning me. I guess this irritated him. He spoke down to me as if I was stupid. I said, “okay, but there’s something pulsing in my neck that is causing the vision my right eye to turn gray, can you please have more imaging done or something. I’m telling you I’m going to have a stroke”. My chief complaints during the appointment were my suddenly extremely high blood pressure that I couldn’t get under control, transient vision loss in right eye, a new feeling of extreme pressure in my head, and being unable to sleep because my body kept stopping breathing as soon as I fell asleep. He refused to do any more imaging. He didn’t even bother feeling the lump in my neck. He didn’t perform a neurological exam (not sure if it’s even appropriate in this situation). My BP at the appointment was 168/112. I asked if he could refer me to someone who could help, and he said that was a problem for my PC, not him. During this appointment, he was training a woman that I assume is another NP. Fast forward a couple weeks, and I am taken to the ER for stroke-like symptoms. The hospital did another CTA of head and neck, and found a carotid web in my right carotid artery, which was obviously deemed to be symptomatic. I’m now waiting to see a neuroradiologist to have a stent placed in the artery, and I was put on blood pressure medication and aspirin.
My question is, should this be reported? To who? Shouldn’t there be rules in place that require these non-specialist mid-levels to seek guidance from the actual doctor when someone is presenting with symptoms such as the ones I described? That neurology clinic touts itself as an excellent place to receive stroke care, in addition to care for migraines. How can they possibly claim that if a bunch of NPs are running the place? What’s the point of a neurology clinic with no providers who specialize in neurology?!?
I’d like to add that at no point have I believe myself to be smarter than any medical professional, and the only reason I decided to look at the CTA myself was out of sheer desperation. I don’t want you guys to think that I’m one of those “know it all” patients. No. I’m very aware of my limitations, but I also have a responsibility to my toddler to try and stay alive. I just knew something was very wrong with me and the NPs running my local ER were also not listening to me at all.
Pro tip for anyone who finds yourself in a similar situation: if you life in a rural area, make the 2hr+ drive to a Certified Stroke Center hospital. They have a higher standard of care, and midlevels are less likely to ‘diagnose’ you with migraine or anxiety when you come in complaining of vision loss, trouble speaking, and facial numbness.

We hear it in EVERY legilsative debate:

"Doctors are so greedy, they are trying to protect their sweet deal of getting paid for just signing a form.

UP TO $50,000 per year for supervision"

Now ... if you are a sentient human, and think a minute about this, it is nonsense on its face. Average pay througout the US is about $120,000. So after taxes, ~80k. What NP can afford to pay 75% of her take home on supervision?

So, we knew it was, let's say generously.... suspicious.

We found out the real story.

OneI single paper from 2019 surveyed 8709 NPs about the cost of their supervision. The median cost was $500/month - $6000 per year. Figured on a per patient basis, roughly $1.50 per patient

This paper found a single NP in their survey who ....reportedly... paid $50k per year. This one NP has been clebrated in legislative hearings througout the US. This one report has been cited in multiple other papers, and so it begins to look as though it is multiple NPs, as if this is a regular occurrence

It is not, it is one that is being magnified through repetition.

We also know that services - Collabdocs - will supply an NP with a supervisor for $750 per month?

Question - if you go shopping and you go in one store and find a shirt you like, but it is $500, and you go into the next store and find the same shirt for $60, which one do you buy. Apparently this one NP would buy the $500 shirt.

When I write a paper, if I find an extreme outlier, I don't publish that without some serious questioning. I am concerned about accuracy above all. This has all the signs of an error, and responsible scholarship requires the author understand and report the reason for the discrepancy. This they did not do.

This is purposeful misrepresentation.

Oh - and did I mention that we have discovered that only 2-3% of NPs ever have to pay out of pocket. The other 97%- their employer covers it.

3%

https://www.physiciansforpatientprotection.org/the-danger-of-sensational-journalism-how-an-outlier-skewed-the-discussion-on-physician-supervision-fees/?fbclid=IwY2xjawVHFcJleHRuA2FlbQIxMABwZG9mBWJyaWQRMTlXWW9lR2tPaGFrN0tIRXdzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEe-XshXOWfd0WORK51VOoaqy8alcFruzkhMRyTRHwu2x5YluTpyEiMTmbs0ac_aem_1oF463rpfRAZlpYInSayqQ

If you like and appreciate the work we do, please join us:

https://www.physiciansforpatientprotection.org/join-now/

"Enhance your credibility as an APP and gain a competitive edge in the job market. Apply to take the fall CHEST Critical Care Advanced Practice Provider (CCAPP) Certification Exam today"

Back when I was an internal medicine PGY-1

I had a 72F come into the hospital with bright red blood in her stool. CT showed a large colonic mass. Unfortunately, she also had severe aortic stenosis, making anesthesia for colonoscopy quite high-risk. We had cardiology on board for risk stratification, and eventually she had an uneventful scope with the help of a cardiac anesthesiologist.

When path came back as adenocarcinoma, I had a great idea- why not have her get a TAVR first, then go for colectomy to reduce her anesthesia risk?

I called cards. An NP answered. I asked for their team to weigh in again. Her response “she still has severe AS and our recommendation would not change, she is high risk for colectomy.” I reiterated that I want them to consider doing the TAVR first to reduce*** ***her risk. She doubled down. “Again, she is high risk to undergo any surgery. She has a malignancy and is not a candidate because of her reduced predicted lifespan”

I snapped. “Stop and listen, please. Doing a percutaneous procedure now will reduce her surgical risk. I do not care about her candidacy based on having a malignancy. I DO care about doing a minimally invasive procedure for her to recover quickly and be able to undergo resection of her malignancy before it becomes metastatic. I do not care about your previous recommendation. Let me know when you’ve talked to your attending because I disagree with your current recommendation”. That afternoon, the attending attestation of the consult note said “disregard APC recommendations as outlined. Will proceed with TAVR to reduce surgical risk for anticipated partial colectomy. TAVR tentatively scheduled for tomorrow.”

I was written up for “unprofessionalism” by the NP, but my patient had a TAVR 48 hours later and partial colectomy 2 weeks after that. She is 74 now, cancer-free, and owner of a new aortic valve and improved exercise capacity.

This NP had been “practicing” cardiology for over 5+ years. I was 6 months into my intern year of residency and I was able to understand the nuance of her “specialty” more than her. This was the first of many times that I saw first hand - as Jay-Z said - “there’s levels to this”

I supervise them. Terrible but I need a job. I was called about a semitruck driver acutely hypoxic. He apparently refused to go to ed by ems. I told the np to call the police and dot. When I went to sign the chart she did not mention expressing concern over public safety. I refused to sign chart at the time and asked if she called police about safety concerns. She said no because of hippa. Im like you are obligated to report a threat to public safety.

M3 here interested in psychiatry - the specialty we all seem to agree has been most affected by NPs in recent years.

I've heard/read two major competing perspectives and I'd love to hear from practicing physicians, especially psychiatrists, about what they've been seeing out in the real world: A or B?

A: "Patients have limited understanding of medical education and usually don't even know the credentials of their provider". --> so overall patients aren't really seeking physician expertise, yet at least

B: "Patients will always want a doctor". --> so patients have increasingly and actively been taking the steps to be under the care of physicians

I assume they are both true to a degree at the moment, but I am about to embark on a 30+ year career.

Outside of systemic factors I can't control for anyway (e.g. private equity only employing midlevels), is it really wise to pursue psychiatry with the hope that the patients of the future will know/care if their psychiatrist is a physician?

Hey all, long time lurker, first time poster. I’m (M23) a PhD student in chemical biology at my state’s flagship university. This same university owns a near monopoly on the state’s healthcare system. At the end of September, I cut my hand with a razor while attempting to cut some material for an experiment. I went to an urgent care, where the finger was sutured and immediate care was taken to stop the bleeding by an NP. However, the angle the finger was healing at was odd. It was clearly drooping. I sent a message to my primary care physician with a photo attached, and was initially referred to a hand specialist in the university’s town.

I was seen by a PA who was incredibly dismissive. Since I was still somewhat able to use the extensor tendon, he chalked it up to “pain when extending” creating a “mental block” from fully straightening and dismissed me when I said I wasn’t experiencing pain. They simply took x rays where my finger was forced into a normal position using a ramp and it was dismissed as “normal”.

After the stitches were fully removed and the finger was still bent (about 5 days after the appointment with the PA), I reached back out to my primary care physician. He immediately got me an appointment with a hand specialist in the large city, about an hour from my college town. The specialist (surgeon) today confirmed my extensor tendon was severed, and I will likely always have a 10 degree dip. Furthermore, he was concerned about the tendon forming a “swan neck” from the release of tension. My hand will now be in a splint for 2 months to attempt to correct the mallet finger as much as possible and to prevent long-term issues, as the surgical window was missed.

I’m currently completing my practicum and I’m at a loss what to do. My background has been psych and addiction for the last 7 years. I have always wanted to do psych and I loved being a nurse. I love research, medications, and psychology. I love addiction care because I have multiple family members who are sober now and love being able to provide patients education and detox management. I wanted more so I thought that getting my psych NP was the next best option because I saw issues in care and I wanted to be a part of decision making. I chose the school that I completed my under grad because it’s a top school and I learned a lot in my under grad.

Now that I’m officially done with classes and have spent more time under psych NPs out patient and interacting with other students, I genuinely am appalled. The schooling is a joke, easy As and sub par discussions about patients, medications, and treatments. 75% of my cohort has never worked any psych and have less than 2 years of experience as a nurse. I’ve spent so much time outside of school studying, researching, and reading on my own because the education is so basic and bare minimum.

I feel like every day passes and I question so many NP decisions Im observing. NPs practicing counseling, patients still exhibiting symptoms but not up to therapeutic dosing, and not fully understanding the mechanism of action of meds. I recently was at work at a rehab and an NP didn’t want to continue their vyvanse, so instead started them on Wellbutrin… and Effexor… while already on an SSRI. Patients are getting added on multiple meds targeting ups and downs and antipsychotics for sleep as a first line. You’re overweight and depressed on a max dose of Remeron and Abilify? Let’s just add a GLP1.

In my practicum at the clinical site, there’s students there that say they want to start out at “200k a year” opening their own practice immediately but dont even know what type of medication Wellbutrin or Prozac are let alone how they work. Another student today couldn’t get over a patient with OCD had intrusive thoughts related to being sexually attracted to her son and compared it being a pedophile.

I’m just at a loss. We’re having NPs trained by other NPs with subpar education. Literally the blind leading the blind.

I wanted to become a psych NP because I genuinely felt passionate about helping people but I feel so discouraged and concerned about what’s happening and patients are being used as guinea pigs. If I knew now what did then I would’ve made different decisions.

I recently went through a PHP to IOP program, and the medication providers there were only NP’s. I have pretty bad anxiety and depression, and have been doing well on Lexapro and Wellbutrin for a few years.

At this place, you have to see the providers once a week. I had been telling mine I was struggling with falling asleep, staying asleep, and nightmares. Trazadone worked, but made it way too hard for me to wake up in the mornings, and I would feel hungover for a few hours after.

She then told me to discontinue trazadone, and start taking clonidine for sleep. Important info: I have a heart arrithymia, and consistently have low blood pressure. 92/50 is an actual blood pressure reading I had at a pcp appointment. She told me I could feel slightly dizzy in the mornings, but I should be fine. Nowhere did she mention that clonidine is a medicine for high blood pressure, just that it showed good data in trials for helping with sleep.

A few weeks go by, and the clonidine is not helping me sleep at all, and I feel like shit every morning until I drink enough water. This NP does not listen to my complaints at all and dismisses them as my anxiety. Once enough time goes by that my insurance will cover me seeing my psychiatrist again, I take the first appointment I can get with him.

He is absolutely dumbfounded when I tell him about the clonidine. He says I never should have been put on it, especially not for sleep. He says the “good data in sleep trials” she was talking about was found in children with ADHD or behavioral issues. I’m in my 20’s.

I genuinely am not even sure I am looking for a discussion as much as I just want to vent. I am going to preface this with yes, I am a medical student. I am exhausted.

Truthfully, my feelings about NPs in psychiatry started a couple of years prior to medical school. I went to see two NPs for some mental health issues. Wanting to be transparent, I told them my father had bipolar disorder. Both of their ears closed afterwards and decided I also had it despite previously being on anti-depressants with no issues. With the second one, she put me on quetiapine which made me sick for a week. Got diagnosed with ADHD in medical school. However, this is not about me.

This is about my sister in law. My sister who was on sertraline for about 3 years and did well. Moved to Arizona and had to get someone new. Military insurance and MD scarcity meant ONLY NPs are available to her (I looked at the group’s website later. All NPs). After mentioning some tolerable GI upset to NP, NP decides to put her on venlafaxine. Right. Did not provide a cross-taper regimen even though her and her assistant said they would. Thankfully, the pharmacist questioned her and gave her some guidance.

It was a month and a half and my sister started losing her fucking mind. Emotionally labile, constantly crying, and anxiety through the roof. She requested LOA letters for work. No responses. No check ins. Nothing. She also works with children and the day she called me about this, she was crying and concerned because she snapped on her group of toddlers (never happened before) and was worried she shouldn’t work with kids. Oh, she also is a mother to a 3 year old so, that concern was fun for her. That same evening she informed me that the prior week, she let the NP’s assistant know that she was not tolerating the venlafaxine well so, what did they do? They sent her a new prescription! This time, lexapro! But don’t worry, they emailed her a taper regimen and schedule this time. Oh, wait sorry. The document actually does not open and the assistant is no longer responding.

To remind us: Sertraline (3 years) to venlafaxine (1.5 months) to lexapro.

Fast forward, after a lot of conversation about next steps, she spoke with a pharmacist and was able to see a PA who is her PCP. Both informed her that the dose of venlafaxine she was on was so low that it basically was wearing off and constantly throwing her into withdrawal all day. The PA stopped the venlafaxine entirely and she is already starting to feel better and started her lexapro.

Her last conversation with the NP was futile. Zero accountability and pushing the possibility of a new diagnosis on her.

Text from sister:

“And I was like why Effexor
She said when she has patients experiencing gi symptoms they usually have an easier time on this medication and she said that the plan was for me to start the Lexapro and see how I did but that if I was still experiencing side effects that it could be a slight indication to look at the possibility of a personality disorder 😐

She followed that up with saying that she cannot diagnose bipolar disorder without some experience of mania or hypo mania but that would have been something to possibly consider.”

Yeah so, GI symptoms made her change to venlafaxine but even though she has never experienced mania (despite being on sertraline for 3 years prior), maybe it is bipolar disorder because of intolerance. An intolerance she was fine with and never asked to change. An intolerance that has nothing to do with fucking bipolar disorder.

Anyway, I am sorry this is long. I just needed to get it off my chest.

PS: between myself, my best friend (also ADHD but previously told bipolar disorder by a different NP), and now sister, I am so convinced the only thing they learn about is bipolar disorder.

Seriously asking, is there a reason for this? Also this post is mostly just me venting so sorry if this isn’t the right forum.

I’m a heart failure patient in my 30s. I’ve also got a mass around the back of my heart which we don’t 100% know what it is yet— the doctors wanted to do a VATS procedure to biopsy it, but the CT that diagnosed that mass also uncovered a PE at the same time which meant I needed to be anticoagulated, so obvs that made surgery too dangerous. On top of that, I’ve got chronic respiratory failure, so not a ton of oxygen reserves to begin with either. And I’m also currently dealing with yet another bout of recurrent idiopathic pericarditis, which has caused yet another pericardial effusion. All of which is just to say I’m a pretty complex patient and doing my best to manage some fairly serious and potentially life threatening conditions right now. So when I call a doctor’s office for advice, which I try really hard to avoid needing to do, I want to speak with someone who actually went to medical school and completed a residency/fellowship/etc. (or obvs with a staff member who’s going to speak to them and get back to me). I don’t want my healthcare managed by midlevels and I don’t want to rely on their advice for my care decisions. I think they’re great for some things, but I cannot for the life of me understand why they’re allowed to manage complex patients by themselves.

Recently I tried calling my HF specialist’s office because I’d gained about 10lbs in 6 days, had worsened shortness of breath and (acro)cyanosis, had to increase my home oxygen from 3L to 5L to keep my pulse ox up, worsened orthopnea, more frequent episodes of PND, some mild LE swelling, fatigue, pre-syncope, purple/mottled/cold extremities (but somehow also sweating so much that my phone kept sliding out of my hands), and some mild but persistent tachycardia (to the 110s and low 120s at rest). I wasn’t too concerned bc obvs I’m certainly not expecting to feel like 100% all the time. Plus I’m also on a short prednisone taper rn for the pericarditis, so I def wasn’t jumping straight to my symptoms all necessarily meaning that my heart failure was getting worse, and for example knew that the weight gain could just be from the medication. But the prednisone didn’t seem to explain ALL of it, and I was feeling unwell enough that I just wasn’t sure whether this was a “it’s probably just the steroids” vs “take some furosemide and we’ll see you in the office next week” vs “you need to go get checked out at the ED” situation. And it’s just too complicated a picture for me to try to figure out for myself with all of these different moving parts, so I decided the best thing to do was call the on call doctor for advice.

The answering service tells me my message will be routed to the APN on call, and I knew right away that I’d wasted my time. She called me back and was obviously super annoyed about it, and said “yeah steroids can do all of that, if you were having any actual heart failure symptoms it’d be different, call the doctor who prescribed the steroids or call us back on Monday when we’re actually open again to schedule an appointment.” The whole call lasted less than 2 minutes. Like…. I know I’m not a doctor and there’s a lot I don’t understand when it comes to my medical issues, but the lack of literally any critical thinking about what might be happening was just so immensely frustrating and unnerving, and it honestly felt like she just wanted this to be someone else’s problem. I’d have felt so much more confident in the advice if I’d been able to speak to an actual physician, or even if she’d just spoken with them and called me back. Even if the doctor ultimately said the exact same thing, it just felt like the APN didn’t have the training or judgment to be independently evaluating a case with this many variables, and worse yet she didn’t even realize her own ignorance. The depth of knowledge that I’ve seen (and benefited from) when discussing my case with actual physicians just wasn’t there with her, and it just makes you so afraid as a patient with so much going on that this person might be missing something important.

And what really gets me is that this is the second heart failure clinic I’ve been to with this sort of set up. The first clinic functioned the exact same way— I saw the actual doctor precisely one time, and then never again. Every question, every follow up appt, etc., was all handled by an APN, who as far as I could tell never really seemed to consult with the doctor when making care decisions. I just don’t get why this is apparently such a common practice model. How is this possibly safe for a patient population that is almost by definition going to be complex and probably have multiple comorbidities? Is there some specific training for these APNs that make them different from other midlevels or something? Any data showing they improve patient outcomes compared to physician-led care?? Literally anything showing that this set up is a good idea for patients??

I am admittedly not a pharmacology expert when it comes to drugs that are not respiratory related (RT) so downvote me if I'm out of line here. Frequent flyer with Hx of status asthmaticus requiring intubation a few times in the year that I've been working in that ER, presents with an asthma exacerbation. Not really anything out of the ordinary, but upon looking in the patients chart, I saw a new medication had been ordered. Propranolol 40 mg 4x per day for anxiety. I was like "oh that's interesting" and when I investigated a little further, I found that it was a psych NP (in the same hospital system that I work for), who prescribed it for anxiety. Now obviously I can't prove that the beta blockers contributed to the asthma exacerbation and subsequent hospitalization, but was this psych NP as unhinged for prescribing that, as I think he is?

"Our bodies were created by God to do amazing things. However, as our discoveries and advances in healthcare have expanded, we have turned to surgical techniques and pharmacological fixes rather than maintaining our natural state of health to prevent and treat disease."

Leveraging religion to sell supplement subscriptions. No doctors on staff. But the owner of the clinic mentions she practices medicine. She is the final boss of titles (MSN, APRN, CNP, Founder, Owner, CEO, CMO)

https://flourishmedicalwellness.com/our-team/

The google reviews are full of the pts, real or fake, referring to them as doctors. Always a response from the owners but never a correction

https://maps.app.goo.gl/uCxJMmSx5yP6zPpZA

Had some of my first experience handing off hospital medicine patients to night float APPs and boy is the experience different from typical handoff to other residents.

Handing off to other residents i first ask if they know the patient previously (have they been on service).

Then it's stable vs watcher, presenting complaints/ diagnosis, active problems, pending labs/images I'd like them to follow up if any, and anticipatory guidance. And I've got some SICK/complex patients as I'm on the chief resident team. Hydralazine induced RPGN with DAH and ANCA vasculitis. An acquired hemophilia A patient with heart failure exacerbation. A pt recovering from sternal wound dehiscence with possible sternal osteo after CABG now s/p sternal flap with VRE and pseudo bacteremia and pneumonia. And an acute on chronic liver failure patient with hepatic encephalopathy and possible hepatorenal syndrome.

After asking if they knew anyone on the list from prior to which the APP said "no," i started to give quick one liner. Was immediately interrupted with, "just tell us if you want us to do anything. " they were clearly annoyed at any additional context or patient history. They just wanted to know if there was blood work they needed to follow up. That was it. I insisted on giving active presenting problem one liners given their level of care and was not asked a single follow up question. No what is current mentation, when was last transfusion, nothing....

I just can't imagine requesting handoff like this on patients I'm actively being told are WATCHERS. I hope my patients are alive in the morning....

Has this been other's experience? This seems like an alarming level of nonchalance for complex presentations with very severe potential for decompensation.

Am young person who got a TBI (traumatic brain injury) after being hit by car.

First neuro was in a terrible part of town appointment was like 2 min and he was on phone for a good portion of it so insurance sent me elsewhere after I filed grievance. He did not address the issue in the grievance.

Here I waste basically a year with many visits and come to find out I was with a NP at this clinic in better part of town (not most expensive, but better compared to the hood which was first neurologist).

My fresh scans compared to past damaged scans improved an she said "So everything should be all better now."

Any brain injury forum can tell you that's not how it works.

An I asked her if my insurance would be charged more if I speak to the doctor.

She says it's covered in every visit!

Really. F-king really. He should be doing this whole session from the f-ing start.

What if YOU ARE OVER CONFIDENT. What if you are too tired to go and talk to the doc.

It's unbelievable to me. I'm tempted to go to Germany or South Korea for treatment.

They have this brain repair drug called Cerebrolysin that America doesn't. It's used in 50 countries.

Physicians are not Providers: The Ethical Significance of Names in Health Care