[LvmyPug2]

PAs and Nurse Practitioners are fully licensed medical providers and using them is standard practice in most primary care settings. Given the shortage of family practice physicians, you will see more and more care delivered by these "mid level" medical providers. The good news is there have been many studies publish in medical journals including JAMA that have shown Nurse Practioners deliver equal and often superior quality of care when compared to physicians and their patients have better health outcomes than physicians, especially when it comes to treating chronic diseases like diabetes, heart disease and asthma.

While one can sue any provider, mid-level or physician for malpractice, I seriously doubt anyone would be successful in suing simply because a licensed mid-level provided care, unless of course the mid-level misrepresented themselves as a physician.

[graciegirl]

Originally Posted by LvmyPug2

PAs and Nurse Practitioners are fully licensed medical providers and using them is standard practice in most primary care settings. Given the shortage of family practice physicians, you will see more and more care delivered by these "mid level" medical providers. The good news is there have been many studies publish in medical journals including JAMA that have shown Nurse Practicioners deliver equal and often superior quality of care when compared to physicians and their patients have better health outcomes than physicians, especially when it comes to treating chronic diseases like diabetes, heart disease and asthma.

While one can sue any provider, mid-level or physician for malpractice, I seriously doubt anyone would be successful in suing simply because a licensed mid-level provided care, unless of course the mid-level misrepresented themselves as a physician.

I think some of the confusion may be that Physicians Assistants are not licensed or used or seen in all states. In Ohio we have a completely different category called Nurse Practitioners and they do NOT have the powers that PA's have. It is something like a doctor's degree in nursing..but not exactly..being a Nurse Practitioner , they cannot practice unless under the direction of an MD in Ohio.

I had not heard of PA's until I moved here and I still am not clear what they can or cannot do. Our dermatologist always looked us over himself in Ohio.

AND no reputable MD of any kind sold " product" in their office as many dermatologists do here. It really puts me off.

[Villages Kahuna]

Originally Posted by champion6

This is a false rumor. During his presentation Mark Morse said we will be able to choose by location or by doctor.

That's NOT what I was told when I visited the Colony Cottage office. The "greeter" asked what village I lived in and told me that when a VHC facility was built serving my village, I would get a letter inviting me to visit and become a patient.

[ilovetv]

I googled "Florida physician scope of practice", but most results were written/published by the P.A. lobbying groups that want state-by-state restrictions lifted on what they can and cannot do. Other results were the legalese of state laws regulating/licensing them.

This article helps a bit:

Battles Erupt Over Filling Doctors' Shoes - WSJ.com

[Mack184]

Originally Posted by LvmyPug2

PAs and Nurse Practitioners are fully licensed medical providers and using them is standard practice in most primary care settings. Given the shortage of family practice physicians, you will see more and more care delivered by these "mid level" medical providers. The good news is there have been many studies publish in medical journals including JAMA that have shown Nurse Practioners deliver equal and often superior quality of care when compared to physicians and their patients have better health outcomes than physicians, especially when it comes to treating chronic diseases like diabetes, heart disease and asthma.

While one can sue any provider, mid-level or physician for malpractice, I seriously doubt anyone would be successful in suing simply because a licensed mid-level provided care, unless of course the mid-level misrepresented themselves as a physician.

My wife is an NP and I will put her skills and talent up against many doctors.

[Mack184]

Originally Posted by graciegirl

I think some of the confusion may be that Physicians Assistants are not licensed or used or seen in all states. In Ohio we have a completely different category called Nurse Practitioners and they do NOT have the powers that PA's have. It is something like a doctor's degree in nursing..but not exactly..being a Nurse Practitioner , they cannot practice unless under the direction of an MD in Ohio.

I had not heard of PA's until I moved here and I still am not clear what they can or cannot do. Our dermatologist always looked us over himself in Ohio.

AND no reputable MD of any kind sold " product" in their office as many dermatologists do here. It really puts me off.

G-Person...State rules vary all over the country about NPs & PAs. However they ALL are under the supervision of an MD and they have ALL had very comprehensive schooling. Most of them have Master's degrees plus. A lot of the difference between PAs & NPs is merely semantics. And.. most of these people are doing the vast majority of "hands-on" care in today's brave new world of health care. I'm lucky enough to have my very own personal one at home!!

[ilovetv]

Nurse practitioners and physician assistants have a definite place in clinical healthcare. But I think it goes out of bounds to say they are good to take the place of physicians. The education and training are not the same in each profession or para-profession.

It's like saying a paralegal is equal to a lawyer. Would you want a paralegal as your legal defense if prosecuted for a crime? I wouldn't. It would be fine if the paralegal researches and does filings and communicates with me for the lawyer, but not for making my case in trial. There's a reason why state bar exams are strident and difficult to pass.

It's also like saying a medical school graduate or first-year intern can take the place of the board-certified physician. After all, the medical school graduate with new diploma in hand has done 2 solid years of clinical experience in the hospital in addition to the classroom courses in the first couple of years. But there are state and national board exams for licensure, and there are strident board-certification exams for each specialty and subspecialty....for good reason.

I wouldn't want a med school graduate being in charge of my care.....unless an attending physician were right there observing and available for immediate, in-person consult. That is how P.A.'s are licensed and authorized to work, and I hope it stays that way....under the supervision and malpractice insurance of a physician.

I think there's so much wishful thinking about lowering costs of healthcare (and I wish that too), that people are giving in and concluding, "Let's save all that money and get rid of medical school and residency requirements." But I think, as always: You get what you pay for.

[looneycat]

Originally Posted by Russ_Boston

As I said and I'll say it again. Why sue the practice for using PA's? Why not sue the lab for saying it was negative? All PA's pass all their cases and care onto the doctor for approval and treatment options. If your mole was positive for cancer then sue the lab and doctor - PA had nothing to do with it IMHO.

And of course I wish you well but lawsuits are not the way to better health.

I see at least 20% of my patients who 'chase' cures when there is none to be had. They spend their last years on earth going from doc to doc since they didn't like the most recent prognosis. "There's always a better doctor" is what I hear. But sometimes even that 'better' doc has the same opinion.

the clinical evidence was obvious and contrary and over a period of 10 months showing continued growth....sorry, he was incompetent and the 'overseeing physician' was irresponsible. Doctors aren't special the are just people with specialized education, some are good, some are excellent and some are just plain terrible. I am an informed patient and don't chase cures, I have an incurable condition that has caused me more troubles than I would wish on any five people. One would have to be a moron to stick with a bad doctor, what happens when that 'better' doctor shows how your life was put at risk by the prior one? As for lawsuits, every professional is subject to suit when their service results in damage to their client or his business, over time it helps to weed out the incompetents!

[looneycat]

Originally Posted by Bonny

That's a shame, but what does that have to do with the PA ? I would think that's the lab's fault.

first off, was the sample supplied from the appropriate spot, next they are the clinicians, they kept falling back to the old sample rather than submitting a new one when their eyes and measurements showed it was expanding, and finally, as soon as the next dermatologist saw it...before I pointed it out..immediately said "that's a cancer, we need to remove it immediately". Biopsy was positive and the original report was obtained and it was noted that it had been a 'meager' sample. I would have expected more from such an 'advanced' practice.

[Russ_Boston]

Originally Posted by looneycat

first off, was the sample supplied from the appropriate spot, next they are the clinicians, they kept falling back to the old sample rather than submitting a new one

Wow, Having worked for a Derm for 2 years that is really hard to believe. But I will if you say it's true. Not sure what you mean by the appropriate spot. We used to take off the entire area all the way to clean margins (I think that is the standard of care even in areas that are not suspected cancer - just to be sure). Was it that large that they only took an area within?

[looneycat]

Originally Posted by Russ_Boston

Wow, Having worked for a Derm for 2 years that is really hard to believe. But I will if you say it's true. Not sure what you mean by the appropriate spot. We used to take off the entire area all the way to clean margins (I think that is the standard of care even in areas that are not suspected cancer - just to be sure). Was it that large that they only took an area within?

from what I saw along with the new Dr was an image of a small sliver of the raised rim of the circular edge. we both saw the 'meager sample' comment and he agreed as did the plastic surgeon who wound up removing it.

[Quixote]

Originally Posted by Russ_Boston

My guess is that the mole was pre-cancerous and thus negative from the lab. I have seen dermatologists (I worked for two of them up north) who take a 'cautious waiting' treatment option. In other words, keep and eye on it every few months and then treat if necessary. They certainly didn't remove every irregular mole they saw.

As a Clark's Level 3 melanoma survivor, I had been in the care of a dermatologist up north for forever. When I moved here, I began using a dermatologist whose practice structure is to allow the PA to determine what to biopsy, and when it comes back positive and not with clean margins, then the MD operates. I swear by the PA I use; half to three quarters of the questionable moles come back as what used to be termed as "early evolving melanoma." My body just seems to form these with gusto! IMHO, based on what I've learned from the both dermatologists and the PA, something that is "pre-cancerous" should not be described as "negative"....

I have records sent to the dermatologist up north, who during one of my rare visits there (I live in FL most of the year) he commented that some of what was biopsied may never actually become melanomas and that removing them that early was (pardon the expression) overkill, in his opinion. When I brought this up the PA, the response--which seemed pretty sensible to me--is that in FL we have to be that much more cautious than up north because of sun exposure so much more and so much stronger. And frankly, I'd rather err on the side of caution: "Take it off!"

[Russ_Boston]

Thanks for the info.

Now back to the topic

[twinklesweep]

Originally Posted by Russ_Boston

Wow, Having worked for a Derm for 2 years that is really hard to believe. But I will if you say it's true. Not sure what you mean by the appropriate spot. We used to take off the entire area all the way to clean margins (I think that is the standard of care even in areas that are not suspected cancer - just to be sure). Was it that large that they only took an area within?

Originally Posted by Russ_Boston

Thanks for the info.

Now back to the topic

Yes, good idea: Back to the topic!

[Advogado]

Originally Posted by ijusluvit

My most fervent hope is that people will suspend their skepticism and crushing disappointment that things are never perfect.

My suggestion is that the Developer's voluntary sponsorship of a primary health care system available to TV'rs only a "10 minute golf cart ride away", deserves a chance to succeed.

Let's give it a chance.

As I understand it, although the propaganda in the Daily Sun obfuscates about structure and ownership, the new health-care system is a for-profit operation of the Developer-- not a "voluntary sponsorship". This is not a criticism. If the Developer can run health-care delivery as well as he runs his other operations, this is a good thing, and he deserves to make a profit. However, to call it a "voluntary sponsorship" implies that the Developer's motives are altruistic.