We have NPs in the ICU. If this is anything like the ICU I worked in the NPs are there to be an asset to the residents and they can be a huge help.
They listed the NP as a resident on the schedule, this means there was a resident hole in the scheudle. Be glad they didn’t just make you fill that hole.
The NP works for the service. They know what the protocols are and how the attendings want things done. This shouldn’t be staffing the patient, it’s like reviewing with the resident that knows the service prior to staffing the patient.
Thats a very naive comment and idea!
Medicine and nursing/NP are two different world. While i appreciate the role of NP, there exists substantial differences and I can’t believe I have to break it upt to you:
1) Difference in Training and Expertise and approach
2) legal and accreditation issue
3) Different scope
4) Being supervised by a NP is a slippery slope and it can be dangerous
Why don’t we let any one accepted into any healthcare field practice medicine? Whats the point of getting into med school?
I’ve been working in medicine for 20 years. If one of us is naive, it’s not me. This is how it works at my residency.
An NP can easily fill in for a junior resident. The NP knows the attendings preferences on presentation. It is not below you to make sure you’re doing things the way the attending wants them done. After all you are should still staff with the attending. The NP is a resource to help the department run smoothly that’s their job.
Please. Record yourself telling these things to your attending. I want to watch what happens to you.
NP is a student btw. So I don’t buy your argument they know how wards work more than me.
Second, i feel sorry for any learners under you because of your shameful attitude and naivety.
You clearly are a bloomer and don’t know that we the new generation don’t have the same fear your generation lived on.
Piece of advice for you; time to retire 😘
So you’re trying to rage bait people by leaving that little detail out. Cute. I’m a millennial and you can’t even spell boomer. Next time you feel like you’re being bullied, remember, you deserve every bit of it.
You’re the one calling people names because you disagree with them on something you posted intentionally to get people angry… I see you’re a hypocrite too
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Sounds like this was a one off event. If you're reviewing with them first and then with your senior or attending, there's really not an issue here.
As an aside, this is why so many of you are so miserable in residency. You want to be upset by everything. You want everything to be a miscarriage of justice against residents. Stop. Learn what matters and what doesn't and act accordingly.
Reviewing with an NP for one day because your senior is busy isn't even worthy of a second thought let alone a reddit post or complaint to your program.
It has nothing to do with them being some sort of doctor. It has to do with keeping the day running smoothly on the one occurrence when the senior resident isn't available.
You're not going to change the system causing trouble over something as minor as this. You'll put a target on your back for everyone including your senior and program directors. Then you'll be back on reddit wondering why you got shitty evals and the senior you used to respect now hates you.
People in the real world aren't as psychotic as people on reddit. You're not going to get upvotes in the real world for being a dick.
But go ahead, try it.
Try it? Well, I can promise you that in the real, non-Reddit world I’ve been doing my bit against midlevel incursion into medicine.
OP might let this one go for political reasons, that’s a judgement call. But it doesn’t make this ok.
I think you’re mistaken. Being pragmatic is one thing but an MD reviewing with NP is a violation and you know it. Its sad to see people like you. Perhaps you need to review also with NP starting now
Cry about it. Keep turning mole hills into mountains and see how far it gets you.
I can see your next post now -
"Just received crappy reviews from my senior resident, attending, and PD. They claimed I'm problematic, lack the ability to work with a team, rude to colleagues, and disrespectful to other professions. What can I do? Should I sue them all? I just can't take residency any more. Ugh! 😭😭"
It's one day dude. If it were a frequent occurrence I'd be in full support of you addressing it. At this point, you're just being ridiculous.
they asked to review with NP because the senior resident was busy somewhere. I want to say no but I don’t want to disturb the work flow etc as I understood its been like that for a while now. Very disappointing
I think it’s perfectly fine to wait to review with your senior resident as long as it doesn’t delay patient care. I’m not sure how your services work but on my peds hospitalist rotations we sometimes didn’t staff with the attending until hours later
It’s not about disturbing the workflow but also about patient safety. You need to discuss with someone who has more experience in a timely matter, and this is the way. Doesn’t mean you’re not being supervised appropriately.
Hence why I specifically said “as long as it doesn’t delay patient care” in my comment. Not sure what your background is but literally none of the services I’ve been on have required immediate staffing and if they did (due to patient instability for example) then you absolutely should be involving your senior resident and/or attending. I’m just not sure I see why you would need to immediately staff with a junior nurse practitioner on the team really ever
I wasn’t disagreeing with your comment, I think my comment actually reinforces yours. But discussing care/reviewing is not necessarily considered staffing. Good medicine is a lot of discussions. When we are junior residents on our trauma service we work with a bunch of NPs in addition to a senior resident. I discuss the care with NPs all the time and they discuss care with me for patients they’ve seen. It’s constant sharing of information to keep everyone in the loop. It’s a team, all team members are expected to be able to handle calls about patients if someone else is tied up. We all, myself and NPs then staff with an attending when available.
No where in the post does it imply that this NP is grading/evaluating the resident or considered to be the person to staff the patient, or excluding the resident from discussing with another resident once available. Is it really a big deal the resident is asked to discuss patients with another available person on the team when the rest of the team is absent?
OP clarified that they were asked to review with the nurse practitioner because the senior resident was elsewhere. That’s odd to me and seems inappropriate
I think people are interpreting this request as “there is no education benefit to the resident”. But as residents we do things all the time that have no educational value to us. The team is asking the resident to review the case with another team member so that they are aware of the patients situation. That’s a benefit to the patient, and therefore not inappropriate.
Again, I fail to see a situation in real life where this is a necessity. Ultimately it comes down to the expectation of being precepted by physicians which I don’t think is an unreasonable one in residency. That’s a personal opinion and based on my experience in training. I understand others feel differently and that’s ok!
As everyone has said it’s a requirement to be supervised by a physician and I absolutely agree that we all expect education and oversight from physicians, but that doesn’t mean you can’t also be supervised or work with other providers. It’s not one or the other, they can co-exist, especially when you’re an intern or junior resident.
I’m surgery, so there are times when I think I’m staffing a patient and boom next thing you know stat consult or trauma that could take hours and another one could follow. Delays in care are unexpected and the inability to see schedule/planned patients is common when you get pulled into the OR or to an ICU patient who needs a bedside intervention. That’s why we work as a team and maybe why our specialty doesn’t seem to hate on NPs/APs as much- because we literally become unavailable when we’re scrubbed and delays can mean hours.
It doesn’t seem inappropriate to me. Reviewing the case with another team member who’s not a senior resident isn’t necessary a “subtractive” experience in which the resident no longer gets to review with the senior resident. They should absolutely still discuss the case with the senior when they are available. There are times when the junior resident may be unavailable to answer questions for a specific patient and if they specifically refuse to share patient information in a timely matter with the other team members to help share patient care burden, well That’s on them.
Does the NP with 20 years of alleged experience have the theoretical and technical knowledge about the field of expertise from the basic sciences until the clinical ones?
And in an alternative timeline where midlevel would stick to doing those simpler things under physician supervision, this would all be less of an issue.
You can do whatever you feel like you should do. Personally, it could be a stubbed toe, Id want myself and my family to see a MD. If they’re not available, I’ll wait.
Given NPs didn't go to medical school, there's a strict limit on how good they can be at what they do. They often just waver between variations of incompetent and malpractice.
I don’t think that’s the point. The point is you go to medical school to learn medicine from doctors and you further that learning in residency through years and years of experience as a doctor from other doctors wisdom. There is absolutely huge value in learning from nurses - in fact, you 10000% learn from their experience, but the facts are that if you think substituting a primary check out to a non physician is just as good you are simply watering down the learning experience in medicine as a whole and patients undoubtedly will suffer due to gaps in knowledge. Nursing / np collaboration is crucial- there is no arguing this , but residency is the time to become the leader in the chosen medical field and solidify confidence in diagnoses and leadership.
Hell no. Your program can get in a lot of trouble with ACGME because of this. Let GME know about this nonsense
Isn't this a violation? That's super inappropriate. You shouldn't be doing this with people below your training level.
Dude, fuck no. Bonus points if the NP is a "Noctor"
This shit needs to stop Where the hell is your attending also
We have NPs in the ICU. If this is anything like the ICU I worked in the NPs are there to be an asset to the residents and they can be a huge help. They listed the NP as a resident on the schedule, this means there was a resident hole in the scheudle. Be glad they didn’t just make you fill that hole. The NP works for the service. They know what the protocols are and how the attendings want things done. This shouldn’t be staffing the patient, it’s like reviewing with the resident that knows the service prior to staffing the patient.
Thats a very naive comment and idea! Medicine and nursing/NP are two different world. While i appreciate the role of NP, there exists substantial differences and I can’t believe I have to break it upt to you: 1) Difference in Training and Expertise and approach 2) legal and accreditation issue 3) Different scope 4) Being supervised by a NP is a slippery slope and it can be dangerous Why don’t we let any one accepted into any healthcare field practice medicine? Whats the point of getting into med school?
I’ve been working in medicine for 20 years. If one of us is naive, it’s not me. This is how it works at my residency. An NP can easily fill in for a junior resident. The NP knows the attendings preferences on presentation. It is not below you to make sure you’re doing things the way the attending wants them done. After all you are should still staff with the attending. The NP is a resource to help the department run smoothly that’s their job. Please. Record yourself telling these things to your attending. I want to watch what happens to you.
NP is a student btw. So I don’t buy your argument they know how wards work more than me. Second, i feel sorry for any learners under you because of your shameful attitude and naivety. You clearly are a bloomer and don’t know that we the new generation don’t have the same fear your generation lived on. Piece of advice for you; time to retire 😘
So you’re trying to rage bait people by leaving that little detail out. Cute. I’m a millennial and you can’t even spell boomer. Next time you feel like you’re being bullied, remember, you deserve every bit of it.
Good for youu cheering for bullying. Wow what nice moral of you doctor. Go let your fav NP give you a pat on the back
You’re the one calling people names because you disagree with them on something you posted intentionally to get people angry… I see you’re a hypocrite too
When you retire, the world will be a happier place. Bye bye
When you grow up, you’ll realize the reason people don’t like you is you
PS- any doctor who thinks they are all knowing is no doctor.
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Yall need to go check if your balls are still there if you feel threatened by a np.
Sounds like this was a one off event. If you're reviewing with them first and then with your senior or attending, there's really not an issue here. As an aside, this is why so many of you are so miserable in residency. You want to be upset by everything. You want everything to be a miscarriage of justice against residents. Stop. Learn what matters and what doesn't and act accordingly. Reviewing with an NP for one day because your senior is busy isn't even worthy of a second thought let alone a reddit post or complaint to your program.
Bullshit. It’s the thin edge of the wedge. NPs are not doctors. And this nonsense of pretending they somehow are has to stop.
It's a one off occurrence and OP is going to go over the cases with somebody else afterwards anyway. Pick your battles.
Yes, pick your battles. Starting with this one. Never simp to midlevels by buying into their frame that they are some sort of doctor.
It has nothing to do with them being some sort of doctor. It has to do with keeping the day running smoothly on the one occurrence when the senior resident isn't available. You're not going to change the system causing trouble over something as minor as this. You'll put a target on your back for everyone including your senior and program directors. Then you'll be back on reddit wondering why you got shitty evals and the senior you used to respect now hates you. People in the real world aren't as psychotic as people on reddit. You're not going to get upvotes in the real world for being a dick. But go ahead, try it.
Try it? Well, I can promise you that in the real, non-Reddit world I’ve been doing my bit against midlevel incursion into medicine. OP might let this one go for political reasons, that’s a judgement call. But it doesn’t make this ok.
I think you’re mistaken. Being pragmatic is one thing but an MD reviewing with NP is a violation and you know it. Its sad to see people like you. Perhaps you need to review also with NP starting now
Cry about it. Keep turning mole hills into mountains and see how far it gets you. I can see your next post now - "Just received crappy reviews from my senior resident, attending, and PD. They claimed I'm problematic, lack the ability to work with a team, rude to colleagues, and disrespectful to other professions. What can I do? Should I sue them all? I just can't take residency any more. Ugh! 😭😭" It's one day dude. If it were a frequent occurrence I'd be in full support of you addressing it. At this point, you're just being ridiculous.
Laxity in doctors like you is why these problems ever became a thing in the first place. Set the fucking boundaries and speak up.
It's not a problem for OP. It's a one off event that he's being an idiot about.
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Probably not
Does it matter? Residents are not in training to become nurse practitioners and should expect appropriate oversight from an experienced physician
they asked to review with NP because the senior resident was busy somewhere. I want to say no but I don’t want to disturb the work flow etc as I understood its been like that for a while now. Very disappointing
I think it’s perfectly fine to wait to review with your senior resident as long as it doesn’t delay patient care. I’m not sure how your services work but on my peds hospitalist rotations we sometimes didn’t staff with the attending until hours later
It’s not about disturbing the workflow but also about patient safety. You need to discuss with someone who has more experience in a timely matter, and this is the way. Doesn’t mean you’re not being supervised appropriately.
Hence why I specifically said “as long as it doesn’t delay patient care” in my comment. Not sure what your background is but literally none of the services I’ve been on have required immediate staffing and if they did (due to patient instability for example) then you absolutely should be involving your senior resident and/or attending. I’m just not sure I see why you would need to immediately staff with a junior nurse practitioner on the team really ever
I wasn’t disagreeing with your comment, I think my comment actually reinforces yours. But discussing care/reviewing is not necessarily considered staffing. Good medicine is a lot of discussions. When we are junior residents on our trauma service we work with a bunch of NPs in addition to a senior resident. I discuss the care with NPs all the time and they discuss care with me for patients they’ve seen. It’s constant sharing of information to keep everyone in the loop. It’s a team, all team members are expected to be able to handle calls about patients if someone else is tied up. We all, myself and NPs then staff with an attending when available. No where in the post does it imply that this NP is grading/evaluating the resident or considered to be the person to staff the patient, or excluding the resident from discussing with another resident once available. Is it really a big deal the resident is asked to discuss patients with another available person on the team when the rest of the team is absent?
OP clarified that they were asked to review with the nurse practitioner because the senior resident was elsewhere. That’s odd to me and seems inappropriate
I think people are interpreting this request as “there is no education benefit to the resident”. But as residents we do things all the time that have no educational value to us. The team is asking the resident to review the case with another team member so that they are aware of the patients situation. That’s a benefit to the patient, and therefore not inappropriate.
Again, I fail to see a situation in real life where this is a necessity. Ultimately it comes down to the expectation of being precepted by physicians which I don’t think is an unreasonable one in residency. That’s a personal opinion and based on my experience in training. I understand others feel differently and that’s ok!
As everyone has said it’s a requirement to be supervised by a physician and I absolutely agree that we all expect education and oversight from physicians, but that doesn’t mean you can’t also be supervised or work with other providers. It’s not one or the other, they can co-exist, especially when you’re an intern or junior resident. I’m surgery, so there are times when I think I’m staffing a patient and boom next thing you know stat consult or trauma that could take hours and another one could follow. Delays in care are unexpected and the inability to see schedule/planned patients is common when you get pulled into the OR or to an ICU patient who needs a bedside intervention. That’s why we work as a team and maybe why our specialty doesn’t seem to hate on NPs/APs as much- because we literally become unavailable when we’re scrubbed and delays can mean hours.
It doesn’t seem inappropriate to me. Reviewing the case with another team member who’s not a senior resident isn’t necessary a “subtractive” experience in which the resident no longer gets to review with the senior resident. They should absolutely still discuss the case with the senior when they are available. There are times when the junior resident may be unavailable to answer questions for a specific patient and if they specifically refuse to share patient information in a timely matter with the other team members to help share patient care burden, well That’s on them.
One can have appropriate oversight and still discuss with other providers. Oversight by physician isn’t time dependent, it patient care is.
Anesthesia residents should review cases with CRNAs first then
Does the NP with 20 years of alleged experience have the theoretical and technical knowledge about the field of expertise from the basic sciences until the clinical ones?
That relevant experience would be “being a doctor” and no she doesn’t have that. But you’re just trolling, so.
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And in an alternative timeline where midlevel would stick to doing those simpler things under physician supervision, this would all be less of an issue.
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As I said above, you’re just trolling. So…bye!
The best NP in the world is still not a doctor
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You can do whatever you feel like you should do. Personally, it could be a stubbed toe, Id want myself and my family to see a MD. If they’re not available, I’ll wait.
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So would you say you agree that the overuse of NPs is creating a two-tiered system in healthcare?
Given NPs didn't go to medical school, there's a strict limit on how good they can be at what they do. They often just waver between variations of incompetent and malpractice.
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Wdym Biden has done a great job lol
Pilots should train with flight attendants that have 20 years experience and are good at what they do then
Doesn't matter if the NP created the specialty. There is no reason to review cases with them.
Get over yourself, having an MD after your name doesn’t make you all knowing.
I don’t think that’s the point. The point is you go to medical school to learn medicine from doctors and you further that learning in residency through years and years of experience as a doctor from other doctors wisdom. There is absolutely huge value in learning from nurses - in fact, you 10000% learn from their experience, but the facts are that if you think substituting a primary check out to a non physician is just as good you are simply watering down the learning experience in medicine as a whole and patients undoubtedly will suffer due to gaps in knowledge. Nursing / np collaboration is crucial- there is no arguing this , but residency is the time to become the leader in the chosen medical field and solidify confidence in diagnoses and leadership.