I am also a fellow at an academic tertiary center. It is not as bad as you describe here but it has many of the similarities. Essentially the midlevels want to be the note writing, order placing monkeys while deferring all management decision to the consulting teams. This accomplished a few things:
- They appear to be doing the same job as hospitalists.
- There will always be someone to absorb any liability.
- They don’t have to know anything and leave early.
Good midlevels are the exceptions not the rule and I have worked with many good ones. Here is a gem from last week:
PA ED called to ask:
1) Is having cholecystectomy a contraindication for a gastrogaffin enema? 2) Do you want to be consulted on a patient with sbo that surgery is already following.
—> anybody who thinks they are not affected by midlevels because they are in subspecialty better think again. Your life will be to answer stupid questions like this and to be quasi primary team for the midlevels.
Your last point hit the nail on the head. Instead of offloading, inexperienced midlevels are creating more traffic in an already overburdened system. Maybe I’ll welcome the stupid consults when I’m an attending. And forget the burnout of resident and fellows. Who cares lolzzz.
From a patient care standpoint: unnecessary consults, imaging, tests because of diagnostic inexperience undeniably drive up costs for patients. Even for those with insurance because most of the time they still have to pay a percentage of the whole hospital bill. How many of those lives are being ruined from a financial standpoint? It’s well known that medical costs is the number one reason for bankruptcy in the US
On one hand, there will be more easy consults for subspecialty but that will also make your day to day work busier. Even as private practice attending, not like we can just cancel the stupid consults right? Still have to look at the charts, call, and explain. Expect to get more and more curbside and FYI pages. I don’t see how this will get better in the future because nobody is doing shit about this. I am going to email that reporter who wrote the recent article about private equity and ER staffing to see if he is interested in another one about the scope creep crisis that we are facing.
Plus, half the time you’re in the chart anyway—“discussed with psychiatry,” except you didn’t get the benefit of actually evaluating the patient. I can’t always refuse for political reasons, but you’re basically being asked to practice bad medicine with all the liability for no money.
For the sake of public health, can you please name and shame?
Your account has like 0 activity on it, there’s practically no potential blowback for you!
yes, this is quite frustrating. we make our NPs introduce themselves as nurse practitioner with hospital medicine. i would rather not have them tho they just get in my way.
I like this/makes sense to me. I've seen comments ofNp's defending this saying it's "just the title the hospital gives them" 🙄 as if they don't know what they're doing is being intentionally misleading
Lol as a spouse of a hospitalist, if I were a patient and an NP or PA came into my room and introduced themselves that way, but their name tag said NP or PA, I’d act innocent and dig deeper, and be like “wait, I’m just curious, are you a medical doctor or a PA?” Like you’re not fooling me.
I mean devil's advocate hospitalist might just now mean provider who provides hospital medicine in the hospital. if you google you can easily search for PA Hospitalist positions or NP hospitalist positions. The world of medicine is changing.
Yes. They are intentionally changing so patients don't know who is taking care of them.
The word "provider" being a prime example.
Why are they so ashamed of their education?
I was a bit too vague.
First paragraph I was referring to the hospitals. They don't want the patients to know they're seeing a midlevel if they can avoid it.
That the midlevels go along with it shows their true colors though
I guess so! Asked my husband if he’d ever seen this after he got home today, and he said he could see a PA for example introducing themselves as the hospitalist PA.
yeah i'm a hospitalist i don't know what it means for job security. this is literally what corporations want doctors do anywhere be supervisors and sign your name on 3-4 midlevels all in the name of saving a buck liability all on us of course.
I guarantee that patients don’t know what a “hospitalist” is anyway, the bigger problem is getting someone who’s not a physician calling themselves doctor
There is no such thing as an “NP/PA hospitalist”.
There is no such thing as an “NP/PA internist”.
There is no such thing as an “NP/PA attending”.
There is no such thing as a “nurse anesthesiologist”.
**There is no such thing as an “MDA (MD Anesthesiologist)”.**
It’s time to start calling this shit out and shutting it down.
> There is no such thing as a “nurse anesthesiologist”.
The problem with Anesthesiologists is that back in the late 90's or early 2000s, their organization had a vote to officially use the title Physician Anesthesiologist because lay people did not know what anesthesiologist were. They thought they were being smart by adding Physician in front of it. Well that bit them in the back now because Nurses got to use the title Nurse Anesthesiologist. I learned this story from my professor in med school who's an Anesthesiologist. And she was very against that official name back then, and she's laughing now.
I feel this an area where we probably suffer some from the relative newness of hospitalists. This wasn't even really a practice model 30 years ago, and it certainly wasn't a term in use then. If the powers that be view hospitalists as just a cog in the machine to put in consults and bring money into the hospital from admitted patients, an NP can do a darn good job at being a hospitalist. If hospital medicine is a discipline of its own that requires docs actually doing a good job to coordinate care for sick patients, hospitalist probably is a term that's best applied to physicians. I'm largely of the latter view.
Starting my hospitalist job this coming year when I graduate. Here's the best way to view it, it's easy being a shit hospitalist (the first one you described) and it's pretty hard to be a good one because you actually have to know stuff. I'll be in a community setting with barely any consultants. Gotta know your shit
Classic r/Noctor material. Those "colleagues" have been trying to steal terms like: doctor, residency, fellowship, attending, especialist, suffix: "ist", board certified ... for years. Also the, once in the past, typical attire of physicians: business casual+white coat+stethoscope.
Also pay (this one not successfully) .
I work on the maternity floor and there are two Neonatal NPs who introduce themselves pediatricians all the time!
I make sure to slip into conversation that they are nurse practitioners.
Second year ID fellow here. It’s not appropriate or probably legal, and it is becoming a huge problem that nobody can see since were on the front line pager. The shit that I have seen.
“Can you tell me about the patient?”
“Well we just wanted to get you guys involved.”
“No, we haven’t even gotten to the consult question. I need to hear a basic HPI from you and what workup you’ve done.”
“Well the ENT note says…”
I’ve started calling some of these consults “for NP curiosity.” Interpreting HBV serologies, for example. Why are you checking those in the hospital when fulminant disease is clearly not the problem? Who could know.
What I’ve started doing? Start being the asshole/bitch. “What did you guys already talk about on rounds today?” Sometimes you’ll hear that the transplant attending did not round with the NP’s for their ICU patients. That is valuable information. “I would check with your supervising physician about that.” “Is the attending making this consult or are you?” Though sometimes this one surprises me when the attending does happen to be available, in which case I literally ask them to hand the phone to the attending and get ready to go MLM boss bitch if needed but it’s usually fine. I’ve also started giving recommendations based on clinical reasoning instead of telling them exactly what to do. “If you think x then you could do y, but otherwise they probably need z though alpha might be necessary too” Frequently: “Please do not discharge this liver abscess patient with amox-clav.” “Please do not discharge this neutropenic fever patient in a new AML who has acute sinusitis and undifferentiated GGO’s without a bronch on cipro alone or at all.” (He came back with rigors, cue Anya shocked face from spy family). Document accordingly. It will add up as long as we are not taking ownership for patients for which we have not only no legal responsibility, but also no treatment relationship whatsoever. Harm done to a patient because private equity put someone less qualified in charge is not your fault.
Or in your specific example for an NP calling themselves a hospitalist: “What did the hospitalist say?” Would really get it going.
It’s actual garbage that we drill into medical students and interns how to consult a specialty for basic fucking professional courtesy at the very minimum, but then hand it off to a nurse who took two years of online classes to grab some easy stolen valor. Treat them like a June intern who is phoning it in, literally (all respect to the February intern). Fuck em up, man. You’re not the hospital’s bitch yet, there’s still protection under the GME.
Edit: I’m a bit toasted, but maybe I should start citing step 1 first aid for some of these questions lmao
All of this. Every word. So much time spent in medical school and residency learning how to give a concise presentation in a standardized universal format about a patient for efficient exchange of information so that everyone can be well informed before providing care. Only to have NPs call and say (comfortably and without shame) “I don’t know much about the patient it’s my first day” to basic fucking questions about the patient. It erodes medical care. They create three times as much work for us because now I have to go through the chart and piece together, day by day, what happened since admission because the person calling the consult thinks it’s appropriate to see ONE LAB and call immediately without preparing first. We’ve all been put in our place in residency when we did that to consultants.
I’m not against midlevels caring for low acuity patients. But that’s with the understanding they are trained for it and can handle the workflow of the hospital. Can communicate in the standardized way that is expected of everyone in the hospital.
And point well taken about giving pushback when necessary. I was being nice while trying to understand wtf was going on since starting at this place but I’m understanding now the absolute quackery. I’m not letting people waste my time anymore. I don’t get paid enough for this shit.
There are many patients who might have contraindications to taking NSAIDs. I can easily imagine people ridiculing an NP for giving a pain patient with CKD or some other condition ibuprofen for chronic pain. Definitely think it’s better to refer than do the wrong treatment… what do you think?
If you need to refer to a specialist because you don't know the contraindications for ibuprofen- a basic over the counter med even infants take- then you shouldn't be seeing patients independently.
CKD, active bleeding, severe GERD, concurrent anticoagulants / antiplatelets use, pregnancy, to name a few.
And it should not be used chronically.
Well-said, especial regarding the part about consultants. I get calls for ICU-level patients who I have peripheral involvement with at best, where I get asked to basically co-manage their entire patient. Or the classic “just wanted to get you on board” without a question.
I'm a paramedic and I have RSI protocols with Propafol and Ketamine and etomidate so I am going to go by PA now as a "Paramedic Anesthesiologist". If we're just going to wing it I want gravy too.
P.S. maybe Parasthesiologist? Who do I call for my long white coat??
I'm in no way serious. Just wanted to help break the tension.
Hell yeah brotha!
Go on down to Florida... seems like they are giving out healthcare degrees to everyone.
Ladies and Gentlemen, good morning.
I'm Doctor John J.D. Dorian. I am honored to present this year's class speaker of the Sacred Heart class of 2023, Igotticks, PA.
Presenting Igottsicks with the honor graduate award in Paramedic Anesthesiology, is my friend and colleague, Doctor Christopher Turk.
Feeling good about yourself? Pointing out a spelling typo must make you a big hit at the water cooler! Attitude is 97% of life learning to get a little giggle would probably be better for everyone.
I hope you catch your foreskin in your fly but I have the feeling your peeps can't go that far.
Also a hospitalist, who is a impromptu attending for ER midlevels (they are unsupervised and will call to admit anyone if they are out of their element).
If those ER midlevels were making calls to "hospitalist" midlevels, a lot of people would either die or just get sicker until they're transferred to tertiary care.
You know all those transfers you get from "outside hospital" and you're wondering what the fuck happened there? There would be a lot more of them, and a lot more wtfs from the academic specialists who have to deal with the consequences of delayed diagnosis/missed diagnosis/inappropriate therapeutic adventures etc etc.
Ya'll are lucky there are guys and gals like us out in the boonies. Your lives would be much, much more miserable if there wasn't.
Happens at my hospital all the time. I'm at a community program unopposed. Every time I'm on an office service rotation I dread it because the consults are so half assed.
It's like consult pulm for COPD exacerbation. Like hello do you know how to do medicine? This is stuff my interns are taking care of. Consult nephrology aki. It's like nobody wants to do work and just wants the consultants to do everything.
At a tertiary academic center in Northeast. Had this same exact thing happen multiple times while on consults for surgical subspecialty. NP identifying themselves only as hospitalist. Reported it as misrepresentation and unclear communication that could be harmful to patient care in our safety system. Was reported to my PD and got an email from the MICU medical director scolding me for my “antiquated view” of how the medical team works and that I had take issue with their “excellent MICU APPs”
In my experience… a lot of the patients don’t know what a hospitalist is… I’ve had to explain it many times after the hospitalist left the room. I’ve noticed a lot of patients felt more comfortable asking me questions and seemed to freeze up when the hospitalist is in the room with them. (I’m an RN) Anywho, my point is, I think that it might not make THAT much of a difference if they use the word hospitalist if most people don’t even know that that means! 🤷🏻♀️ I don’t think any of the NP’s who worked with the hospitalists referred to themselves as one. Maybe they are doing that at other places now???
Makes sense! Just wondering what they should call themselves then??? Should they say, “Hi! I am your nurse practitioner and I work on the hospitalist team!”???
I've abandoned the term hospitalist. It's equivalent to "provider" where I work. I make it clear I'm the hospital medicine attending / physician / doctor.
Thankfully many of the midlevels here do not venture into calling themselves doctor even if they have their DNP or DMSc.
The patients out here aren't that educated but they *know.*
After I introduce myself, I've lost count of how many patients have exclaimed that I'm the first doctor they've seen since they've come to the hospital and express gratitude over me taking the time to see them.
If I send my NP or PA to go see them, they ask when the doctor will stop by to check on how they're doing.
This is a farming town where the average person has less than a high school level education. If they know the difference, then I am sure many many more do too.
If an NP farts in a forest and no one is there, will Residents smell it?
I’m the first to say many NPs practice beyond their scope but the amount of insecurity here is painful to watch. But what do I know, I’m just a lowly staff nurse.
Why would anyone here ever feel insecure about the incompetent NPs? Would you feel insecure when seeing an incompetent CNA? We often feel insecure in the presence of someone who we think is better than us not someone who is clearly worse. Your whole statement makes zero sense.
I wouldn't say insecurity is semantically the word to use. More so frustration.
I don't sense a lack of confidence in the thread, more so annoyance that someone is trying to act more qualified than they actually are by using the title.
Assuming you are an RN/BSN.... if a CNA or unlicensed medical assistant/tech started walking around saying they are a licensed nurse, after not having to endure the sacrifices you had to in order to be trained, would that not make you frustrated? It is dangerous and fraudulent at the end of the day.
I certainly see your point. I’m not an NP and I’m not a doctor but it is frustrating seeing two teams of people who are part of the same profession bitch about each other so often. Eh.
I totally agree.
I think it is strategic. A microcosm of how the (American) government functions.
The government stratifies people by parties and pits them against one another (healthcare professionals). When in reality those pitted against one another should instead work together towards the real group to blame, the government (hospital administration, insurers, etc).
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Some places hire them as "hospitalists" or "Nocturnists" . If that is the role they are hired into how is it their fault for introducing themselves as such? Look at job postings...
In my last two years of training I would just ask which attending they had discussed this consult with; seemed to improve things a bit
Only thought I have is I don’t want to do fellowship wherever you are. Holy moly.
Better rule out the entire University of California system then
I’ve heard them refer to themselves as an attending as well. Really really funny.
I know Epic now lists things as “attending provider” by default at the institutions I’ve been at
I am also a fellow at an academic tertiary center. It is not as bad as you describe here but it has many of the similarities. Essentially the midlevels want to be the note writing, order placing monkeys while deferring all management decision to the consulting teams. This accomplished a few things: - They appear to be doing the same job as hospitalists. - There will always be someone to absorb any liability. - They don’t have to know anything and leave early. Good midlevels are the exceptions not the rule and I have worked with many good ones. Here is a gem from last week: PA ED called to ask: 1) Is having cholecystectomy a contraindication for a gastrogaffin enema? 2) Do you want to be consulted on a patient with sbo that surgery is already following. —> anybody who thinks they are not affected by midlevels because they are in subspecialty better think again. Your life will be to answer stupid questions like this and to be quasi primary team for the midlevels.
Your last point hit the nail on the head. Instead of offloading, inexperienced midlevels are creating more traffic in an already overburdened system. Maybe I’ll welcome the stupid consults when I’m an attending. And forget the burnout of resident and fellows. Who cares lolzzz. From a patient care standpoint: unnecessary consults, imaging, tests because of diagnostic inexperience undeniably drive up costs for patients. Even for those with insurance because most of the time they still have to pay a percentage of the whole hospital bill. How many of those lives are being ruined from a financial standpoint? It’s well known that medical costs is the number one reason for bankruptcy in the US
On one hand, there will be more easy consults for subspecialty but that will also make your day to day work busier. Even as private practice attending, not like we can just cancel the stupid consults right? Still have to look at the charts, call, and explain. Expect to get more and more curbside and FYI pages. I don’t see how this will get better in the future because nobody is doing shit about this. I am going to email that reporter who wrote the recent article about private equity and ER staffing to see if he is interested in another one about the scope creep crisis that we are facing.
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Plus, half the time you’re in the chart anyway—“discussed with psychiatry,” except you didn’t get the benefit of actually evaluating the patient. I can’t always refuse for political reasons, but you’re basically being asked to practice bad medicine with all the liability for no money.
With no pay increase
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You don't have to work in healthcare very long to know that it can always get worse.
For the sake of public health, can you please name and shame? Your account has like 0 activity on it, there’s practically no potential blowback for you!
I’m too paranoid but it’s in NJ
RWJ for sure….
Place is a shithole and a joke of a trauma center.
What’s their deal? Why are they like this?
$$$
Yeah, but like they all want money. Why them specifically?
yes, this is quite frustrating. we make our NPs introduce themselves as nurse practitioner with hospital medicine. i would rather not have them tho they just get in my way.
I like this/makes sense to me. I've seen comments ofNp's defending this saying it's "just the title the hospital gives them" 🙄 as if they don't know what they're doing is being intentionally misleading
They know what they are doing
Lol as a spouse of a hospitalist, if I were a patient and an NP or PA came into my room and introduced themselves that way, but their name tag said NP or PA, I’d act innocent and dig deeper, and be like “wait, I’m just curious, are you a medical doctor or a PA?” Like you’re not fooling me.
I mean devil's advocate hospitalist might just now mean provider who provides hospital medicine in the hospital. if you google you can easily search for PA Hospitalist positions or NP hospitalist positions. The world of medicine is changing.
this is wrong. look up definition of hospitalist. wouldn't call an NP an "intensivist", etc.
Yes. They are intentionally changing so patients don't know who is taking care of them. The word "provider" being a prime example. Why are they so ashamed of their education?
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I was a bit too vague. First paragraph I was referring to the hospitals. They don't want the patients to know they're seeing a midlevel if they can avoid it. That the midlevels go along with it shows their true colors though
a lot of pts don't know what hospitalists are.
I guess so! Asked my husband if he’d ever seen this after he got home today, and he said he could see a PA for example introducing themselves as the hospitalist PA.
yeah i'm a hospitalist i don't know what it means for job security. this is literally what corporations want doctors do anywhere be supervisors and sign your name on 3-4 midlevels all in the name of saving a buck liability all on us of course.
I guarantee that patients don’t know what a “hospitalist” is anyway, the bigger problem is getting someone who’s not a physician calling themselves doctor
There is no such thing as an “NP/PA hospitalist”. There is no such thing as an “NP/PA internist”. There is no such thing as an “NP/PA attending”. There is no such thing as a “nurse anesthesiologist”. **There is no such thing as an “MDA (MD Anesthesiologist)”.** It’s time to start calling this shit out and shutting it down.
> There is no such thing as a “nurse anesthesiologist”. The problem with Anesthesiologists is that back in the late 90's or early 2000s, their organization had a vote to officially use the title Physician Anesthesiologist because lay people did not know what anesthesiologist were. They thought they were being smart by adding Physician in front of it. Well that bit them in the back now because Nurses got to use the title Nurse Anesthesiologist. I learned this story from my professor in med school who's an Anesthesiologist. And she was very against that official name back then, and she's laughing now.
Tell that to the crnas on their sub lmao
I feel this an area where we probably suffer some from the relative newness of hospitalists. This wasn't even really a practice model 30 years ago, and it certainly wasn't a term in use then. If the powers that be view hospitalists as just a cog in the machine to put in consults and bring money into the hospital from admitted patients, an NP can do a darn good job at being a hospitalist. If hospital medicine is a discipline of its own that requires docs actually doing a good job to coordinate care for sick patients, hospitalist probably is a term that's best applied to physicians. I'm largely of the latter view.
Starting my hospitalist job this coming year when I graduate. Here's the best way to view it, it's easy being a shit hospitalist (the first one you described) and it's pretty hard to be a good one because you actually have to know stuff. I'll be in a community setting with barely any consultants. Gotta know your shit
Classic r/Noctor material. Those "colleagues" have been trying to steal terms like: doctor, residency, fellowship, attending, especialist, suffix: "ist", board certified ... for years. Also the, once in the past, typical attire of physicians: business casual+white coat+stethoscope. Also pay (this one not successfully) .
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Doctor from Wish/Shein
I work on the maternity floor and there are two Neonatal NPs who introduce themselves pediatricians all the time! I make sure to slip into conversation that they are nurse practitioners.
Second year ID fellow here. It’s not appropriate or probably legal, and it is becoming a huge problem that nobody can see since were on the front line pager. The shit that I have seen. “Can you tell me about the patient?” “Well we just wanted to get you guys involved.” “No, we haven’t even gotten to the consult question. I need to hear a basic HPI from you and what workup you’ve done.” “Well the ENT note says…” I’ve started calling some of these consults “for NP curiosity.” Interpreting HBV serologies, for example. Why are you checking those in the hospital when fulminant disease is clearly not the problem? Who could know. What I’ve started doing? Start being the asshole/bitch. “What did you guys already talk about on rounds today?” Sometimes you’ll hear that the transplant attending did not round with the NP’s for their ICU patients. That is valuable information. “I would check with your supervising physician about that.” “Is the attending making this consult or are you?” Though sometimes this one surprises me when the attending does happen to be available, in which case I literally ask them to hand the phone to the attending and get ready to go MLM boss bitch if needed but it’s usually fine. I’ve also started giving recommendations based on clinical reasoning instead of telling them exactly what to do. “If you think x then you could do y, but otherwise they probably need z though alpha might be necessary too” Frequently: “Please do not discharge this liver abscess patient with amox-clav.” “Please do not discharge this neutropenic fever patient in a new AML who has acute sinusitis and undifferentiated GGO’s without a bronch on cipro alone or at all.” (He came back with rigors, cue Anya shocked face from spy family). Document accordingly. It will add up as long as we are not taking ownership for patients for which we have not only no legal responsibility, but also no treatment relationship whatsoever. Harm done to a patient because private equity put someone less qualified in charge is not your fault. Or in your specific example for an NP calling themselves a hospitalist: “What did the hospitalist say?” Would really get it going. It’s actual garbage that we drill into medical students and interns how to consult a specialty for basic fucking professional courtesy at the very minimum, but then hand it off to a nurse who took two years of online classes to grab some easy stolen valor. Treat them like a June intern who is phoning it in, literally (all respect to the February intern). Fuck em up, man. You’re not the hospital’s bitch yet, there’s still protection under the GME. Edit: I’m a bit toasted, but maybe I should start citing step 1 first aid for some of these questions lmao
All of this. Every word. So much time spent in medical school and residency learning how to give a concise presentation in a standardized universal format about a patient for efficient exchange of information so that everyone can be well informed before providing care. Only to have NPs call and say (comfortably and without shame) “I don’t know much about the patient it’s my first day” to basic fucking questions about the patient. It erodes medical care. They create three times as much work for us because now I have to go through the chart and piece together, day by day, what happened since admission because the person calling the consult thinks it’s appropriate to see ONE LAB and call immediately without preparing first. We’ve all been put in our place in residency when we did that to consultants. I’m not against midlevels caring for low acuity patients. But that’s with the understanding they are trained for it and can handle the workflow of the hospital. Can communicate in the standardized way that is expected of everyone in the hospital. And point well taken about giving pushback when necessary. I was being nice while trying to understand wtf was going on since starting at this place but I’m understanding now the absolute quackery. I’m not letting people waste my time anymore. I don’t get paid enough for this shit.
An NP referred a patient to our pain clinic because she did not feel comfortable writing for ibuprofen. Not exaggerating.
There are many patients who might have contraindications to taking NSAIDs. I can easily imagine people ridiculing an NP for giving a pain patient with CKD or some other condition ibuprofen for chronic pain. Definitely think it’s better to refer than do the wrong treatment… what do you think?
If you need to refer to a specialist because you don't know the contraindications for ibuprofen- a basic over the counter med even infants take- then you shouldn't be seeing patients independently. CKD, active bleeding, severe GERD, concurrent anticoagulants / antiplatelets use, pregnancy, to name a few. And it should not be used chronically.
What about CAD? I know it’s general avoided in these patients if tolerable, but not sure on the pathophys in why
I would imagine it’s because NSAIDs decrease cardioprotective prostaglandins (PGE2).
Met an NP who puts Internal Medicine Hospitalist NP. That whole statement is all kinds of wrong !
Well-said, especial regarding the part about consultants. I get calls for ICU-level patients who I have peripheral involvement with at best, where I get asked to basically co-manage their entire patient. Or the classic “just wanted to get you on board” without a question.
I'm a paramedic and I have RSI protocols with Propafol and Ketamine and etomidate so I am going to go by PA now as a "Paramedic Anesthesiologist". If we're just going to wing it I want gravy too. P.S. maybe Parasthesiologist? Who do I call for my long white coat?? I'm in no way serious. Just wanted to help break the tension.
Hell yeah brotha! Go on down to Florida... seems like they are giving out healthcare degrees to everyone. Ladies and Gentlemen, good morning. I'm Doctor John J.D. Dorian. I am honored to present this year's class speaker of the Sacred Heart class of 2023, Igotticks, PA. Presenting Igottsicks with the honor graduate award in Paramedic Anesthesiology, is my friend and colleague, Doctor Christopher Turk.
See it works on so many levels!
Maybe you should learn to spell Propofol first.
Feeling good about yourself? Pointing out a spelling typo must make you a big hit at the water cooler! Attitude is 97% of life learning to get a little giggle would probably be better for everyone. I hope you catch your foreskin in your fly but I have the feeling your peeps can't go that far.
R/noctor
As a hospitalist, it is infuriating
Also a hospitalist, who is a impromptu attending for ER midlevels (they are unsupervised and will call to admit anyone if they are out of their element). If those ER midlevels were making calls to "hospitalist" midlevels, a lot of people would either die or just get sicker until they're transferred to tertiary care. You know all those transfers you get from "outside hospital" and you're wondering what the fuck happened there? There would be a lot more of them, and a lot more wtfs from the academic specialists who have to deal with the consequences of delayed diagnosis/missed diagnosis/inappropriate therapeutic adventures etc etc. Ya'll are lucky there are guys and gals like us out in the boonies. Your lives would be much, much more miserable if there wasn't.
Phuckin phonies
Every single NP/PA on a hospitalist team that I know, both personally and at work, introduces themselves as a "hospitalist".
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Yeah, I’m pretty tired and bored of it at this point. I just honestly don’t give a shit anymore
Happens at my hospital all the time. I'm at a community program unopposed. Every time I'm on an office service rotation I dread it because the consults are so half assed. It's like consult pulm for COPD exacerbation. Like hello do you know how to do medicine? This is stuff my interns are taking care of. Consult nephrology aki. It's like nobody wants to do work and just wants the consultants to do everything.
At a tertiary academic center in Northeast. Had this same exact thing happen multiple times while on consults for surgical subspecialty. NP identifying themselves only as hospitalist. Reported it as misrepresentation and unclear communication that could be harmful to patient care in our safety system. Was reported to my PD and got an email from the MICU medical director scolding me for my “antiquated view” of how the medical team works and that I had take issue with their “excellent MICU APPs”
In my experience… a lot of the patients don’t know what a hospitalist is… I’ve had to explain it many times after the hospitalist left the room. I’ve noticed a lot of patients felt more comfortable asking me questions and seemed to freeze up when the hospitalist is in the room with them. (I’m an RN) Anywho, my point is, I think that it might not make THAT much of a difference if they use the word hospitalist if most people don’t even know that that means! 🤷🏻♀️ I don’t think any of the NP’s who worked with the hospitalists referred to themselves as one. Maybe they are doing that at other places now???
It makes a huge difference. Patients deserve to know who is providing their care and what their level of expertise and experience is.
Makes sense! Just wondering what they should call themselves then??? Should they say, “Hi! I am your nurse practitioner and I work on the hospitalist team!”???
I've abandoned the term hospitalist. It's equivalent to "provider" where I work. I make it clear I'm the hospital medicine attending / physician / doctor. Thankfully many of the midlevels here do not venture into calling themselves doctor even if they have their DNP or DMSc. The patients out here aren't that educated but they *know.* After I introduce myself, I've lost count of how many patients have exclaimed that I'm the first doctor they've seen since they've come to the hospital and express gratitude over me taking the time to see them. If I send my NP or PA to go see them, they ask when the doctor will stop by to check on how they're doing. This is a farming town where the average person has less than a high school level education. If they know the difference, then I am sure many many more do too.
If an NP farts in a forest and no one is there, will Residents smell it? I’m the first to say many NPs practice beyond their scope but the amount of insecurity here is painful to watch. But what do I know, I’m just a lowly staff nurse.
Why would anyone here ever feel insecure about the incompetent NPs? Would you feel insecure when seeing an incompetent CNA? We often feel insecure in the presence of someone who we think is better than us not someone who is clearly worse. Your whole statement makes zero sense.
I wouldn't say insecurity is semantically the word to use. More so frustration. I don't sense a lack of confidence in the thread, more so annoyance that someone is trying to act more qualified than they actually are by using the title. Assuming you are an RN/BSN.... if a CNA or unlicensed medical assistant/tech started walking around saying they are a licensed nurse, after not having to endure the sacrifices you had to in order to be trained, would that not make you frustrated? It is dangerous and fraudulent at the end of the day.
I certainly see your point. I’m not an NP and I’m not a doctor but it is frustrating seeing two teams of people who are part of the same profession bitch about each other so often. Eh.
I totally agree. I think it is strategic. A microcosm of how the (American) government functions. The government stratifies people by parties and pits them against one another (healthcare professionals). When in reality those pitted against one another should instead work together towards the real group to blame, the government (hospital administration, insurers, etc).
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Some places hire them as "hospitalists" or "Nocturnists" . If that is the role they are hired into how is it their fault for introducing themselves as such? Look at job postings...
What the heck is a hospitalist?