To MD or not to MD

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So…I was reading this article over at DisabledVeterans.org:

Clinical Pharmacists Now Handle Primary Care For Veterans Affairs

http://www.disabledveterans.org/2016/10/26/clinical-pharmacists-now-handle-primary-care-for-veterans-affairs/#comment-30040

I decided I would ask a Professional Nurse what they thought about it.

My niece is a Neonatal Nurse Practitioner at Princeton Baptist Medical Center and a Neonatal Nurse Practitioner at UAB Critical Care Transport.

Here’s  a transcript of my comment and our interaction:

My comment:

I’m all FOR increased access but NOT AT THE COST OF REDUCED QUALITY OF CARE…No Pharmacist has the training of an MD. That’s why they have a

No Pharmacist has the training of an MD. That’s why they have a PHD after their name instead of an MD…

I love nurses…

They’re great people and those that go into the field usually do so from the standpoint of caring for their patients.

My niece is a Neonatal Nurse Practitioner at Princeton Baptist Medical Center and Neonatal Nurse Practitioner at UAB Critical Care Transport.

She transports critical care infants (usually in a helicopter ) and is eminently qualified for her job (getting critical infants to a place where they can be better treated than where they are..)

As a matter of fact, I would bet that most of the MDs that she is transporting kids too would flounder in the high-pressure atmosphere she operates in…(no pun intended ) She’s GREAT at keeping kids alive till they get where they need to be…HOWEVER, She’s still not an MD…

When she gets the kids to UAB Hospital, their care is turned over to an MD who specializes in Pediatric care ( probably assisted by other Pediatric Nurses that specialize in in-house care…) I sent her a link to this discussion and here was our interaction…

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ME:

Hi Sweety…I need your perspective as a Nurse…Are you up for a discussion on whether or not NPs and Pharmacists  should be providing primary care at VA hospitals and clinics without an MD’s oversight??? Here’s the article I’m commenting on… I (and I’m sure other commenters ) would like to get your perspective as a respected practitioner of the art and science of Nursing…You can just reply here and I’ll forward your comments (unedited of course )

Here’s the article I’m commenting on… I (and I’m sure other commenters ) would like to get your perspective as a respected practitioner of the art and science of Nursing…You can just reply here and I’ll forward your comments (unedited of course )

You can just reply here and I’ll forward your comments (unedited of course )

http://www.disabledveterans.org/2016/10/26/clinical-pharmacists-now-handle-primary-care-for-veterans-affairs/#respond

Her:

Just read the article. My concern would be with a clinical pharmacist being the primary healthcare provider. After diagnosing the present issue they probably would be a great resource for managing medications and educating the patient and their families. NNP’s and pharmacists sometimes have more time to spend with our patients which would allow for proper education and answering questions regarding diagnoses, prognoses, care management, medications, and follow-up. NNP’s are highly regulated; we practice only under the supervision of a collaborating physician. I call them for questions, concerns, or advice on difficult cases. They are and must be available to us 24/7. There is also a strict standard of supervision after the fact in which our H&P’s, diagnosing, treatment plans, etc…are strictly reviewed and critiqued by our collaborating physicians. Our masters level training is specialized to a particular patient population (neonatal, pediatric, adult health, geriatrics) and we must pass boards in our specialty before applying for a license in our state. If the VA wants to use NP’s I feel it should be the patient’s choice, for more routine cases/follow up’s, and always under the supervision of a collaborating physician. I’m not familiar with the qualifications and educational background of a clinical pharmacist. Do they have training in Anatomy & Physiology, Pathophysiology, Cellular Biology, Genetics, Psychology, etc…? These are basic level nursing requirements. Are these clinical pharmacists practicing under the supervision of a collaborating physician? I would welcome their input in medication questions and management, but I would be asking about their qualifications and supervision. If they are to be used as providers it should be the choice of the patient.

After diagnosing the present issue they probably would be a great resource for managing medications and educating the patient and their families. NNP’s and pharmacists sometimes have more time to spend with our patients which would allow for proper education and answering questions regarding diagnoses, prognoses, care management, medications, and follow-up. NNP’s are highly regulated; we practice only under the supervision of a collaborating physician. I call them for questions, concerns, or advice on difficult cases. They are and must be available to us 24/7. There is also a strict standard of supervision after the fact in which our H&P’s, diagnosing, treatment plans, etc…are strictly reviewed and critiqued by our collaborating physicians. Our masters level training is specialized to a particular patient population (neonatal, pediatric, adult health, geriatrics) and we must pass boards in our specialty before applying for a license in our state. If the VA wants to use NP’s I feel it should be the patient’s choice, for more routine cases/follow up’s, and always under the supervision of a collaborating physician. I’m not familiar with the qualifications and educational background of a clinical pharmacist. Do they have training in Anatomy & Physiology, Pathophysiology, Cellular Biology, Genetics, Psychology, etc…? These are basic level nursing requirements. Are these clinical pharmacists practicing under the supervision of a collaborating physician? I would welcome their input in medication questions and management, but I would be asking about their qualifications and supervision. If they are to be used as providers it should be the choice of the patient.

NNP’s and pharmacists sometimes have more time to spend with our patients which would allow for proper education and answering questions regarding diagnoses, prognoses, care management, medications, and follow-up. NNP’s are highly regulated; we practice only under the supervision of a collaborating physician. I call them for questions, concerns, or advice on difficult cases. They are and must be available to us 24/7. There is also a strict standard of supervision after the fact in which our H&P’s, diagnosing, treatment plans, etc…are strictly reviewed and critiqued by our collaborating partners.

There is also a strict standard of supervision after the fact in which our H&P’s, diagnosing, treatment plans, etc…are strictly reviewed and critiqued by our collaborating physicians.

Our masters level training is specialized to a particular patient population (neonatal, pediatric, adult health, geriatrics) and we must pass boards in our specialty before applying for a license in our state.

If the VA wants to use NP’s I feel it should be the patient’s choice, for more routine cases/follow up’s, and always under the supervision of a collaborating physician.

I’m not familiar with the qualifications and educational background of a clinical pharmacist.

Do they have training in Anatomy & Physiology, Pathophysiology, Cellular Biology, Genetics, Psychology, etc…? These are basic level nursing requirements.

Are these clinical pharmacists practicing under the supervision of a collaborating physician? I would welcome their input in medication questions and management, but I would be asking about their qualifications and supervision.

If they are to be used as providers it should be the choice of the patient.
ME:

One of my chief concerns at the VA has always been that even the MDs they employ are often not held to the same standards as MDs outside the VA…

They are often from third world schools and the VA almost never requires them to be up to the standards of the state they are practicing in…
If they don’t hold the MDs up those standards how can we expect them to hold Pharmacists and NPs up to those standards…
Her:

Agree; if those administrators and congressmen wouldn’t send their own families to these providers then they shouldn’t be sending vets to them

Me:

You don’t know HOW MANY TIMES I’ve seen Vets express the same idea in this and other forums,

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So…So  you know what I think…What do you guys think?

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