<p>And trust me, most nephrologists don’t want to spend their time dealing with severe hypertensives.</p>
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<p>Not sure why you think that. I have known a lot of doctors and don’t know anyone who has a dislike for properly trained and placed midlevel provider. We employ one and we think she’s great but we have personally trained her and supervise closely.</p>
<p>The times you will see physicians groaning about midlevels is when the midlevels are placed in a position where they have to deal with situations that they are not adequately trained for nor adequately supervised. That’s not the fault of the midlevel, but some of them don’t speak out when they should. Don’t know if it’s a job security issue or not. As a specialist, I would personally rather that they called and asked me too many ‘stupid’ questions than not enough. That’s how one learns good part of the time.</p>
<p>Can you break this down for me? Fluoxetine is $4/month at the local Walmart pharmacy. As momlive says, Psychiatrists prescribe lots of psychotropics with little CBT. Certainly a counselor, which may be considered an “extender” of the Psychiatrist, would do a better job of bringing the number of psychotropics down.</p>
<p>“The times you will see physicians groaning about midlevels is when the midlevels are placed in a position where they have to deal with situations that they are not adequately trained for nor adequately supervised.”</p>
<p>You wouldn’t believe the number of times my wife (a two-year RN) groans about physicians who are not adequately trained to deal with situations she has to regularly deal with in her work. Luckily, because they are hospice patients, the docs never see them, and my wife (the two-year RN with superior training and experience) instructs the M.D.s (actually, usually the M.D.'s nurse) as to what needs to be done. And since the docs have virtually NO supervision, there is little chance that they will ever improve.</p>
<p>Ok, I am at an airport with free Internet. Yes, most psychotropics are prescribed by someone other than a psychiatrist. And yes, many psychiatrists have limited their practices to mess, but I think it’s largely driven by market forces. Psychiatry was probably the first branch of medicine to use “extenders”, and to “accept” that someone eles was going to provide the majority of care. So now, even though many will accept that mental health issues drive a lot of other medical costs, psychiatrist are carved out of the decision making, carved out of medical coverage, and carved out of decision making about when a patient should start with tertiary care, or with psychotropics. </p>
<p>“And yes, many psychiatrists have limited their practices to mess, but I think it’s largely driven by market forces.”</p>
<p>Whitaker’s point is that they (the psychiatrists) deliberately CREATED the market forces (beginning with the end of much of psychotherapy and the creation of the DSM). I take it you don’t agree (so I’d like to know more).</p>
<p>My son is in his 4th year of a 5 year P.A. program (combined BS/MA). I believe there around 45 students in his program, and when asked how many were planning on becoming primary care providers, only two students raised their hands. Like the MD’s, they also want to specialize. I’m sure it’s a combination of more money in a specialty and becoming really good in a specific area. He was considering med school, but even the physicians he shadowed advised him to go the P.A. route. The M.D. degree just requires too much time.</p>
<p>These sorts of things always amaze me. After my father’s first heart attack his health insurance paid for him to have some physical therapy classes to help him get back to better health. He’s been overweight, well, since I’ve known him, and after those classes that he really enjoyed, he had been down at his lowest weight ever. After a few months the classes ended. The hospital wouldn’t allow him to continue without the OK from his insurance. Fast forward a few months and he’s regained a lot of the weight and is back on a number of the meds (on the insurance company’s dime) he had been able to drop after losing the weight.</p>
<p>I see a NP for my GYN issues and I love her. Since I’m past having more kids, she perfect for my needs, plus she’s about 5 years older and shares her experiences of what females getting older go through. I have no doubt if any regular test came odd and it was beyond her scope, she would refer me to the appropriate physician.</p>
<p>They should hire more nurses for the prison system! Instead, employers would rather pile on the overtime on current workers. That way, you don’t have extra costs for health insurance and other benefits.</p>
<p>^^huh?^^^ try finding ones who can pass a drug test and background test? If you are talking about nurses that could be the most ridiculous statement you’ve made tonight, and you’ ve made several. ;)</p>
<p>Woody,^^^, the RNs I know who have worked in prisons claim those RNs need to pass a lie detector, fingerprint, extensive background check, in addition to the standard employment drug test.</p>
<p>The extensive background check eliminates most nursing applicants.</p>
<p>In addition, because of the safety issues in a prison, less nurses are interested in working in a prison, and few even apply.</p>
<p>Correctional nursing is a paradox. The nurses there make so much paradoxically because the pay is so low.</p>
<p>To explain, prison nurse hour rates are, generally speaking, the same or slightly less than those for nurses in hospitals. Benefits are usually pretty good, depending on the state. But the risks are so high, and the schedules generally so bad, that they can’t easily recruit nurses to work there (and keep them for a long time). So they end up having to pay huge overtime to those they have. So, paradoxically, they’d likely end up spending less if they doubled the salaries.</p>