Nurse Practioner?

[pdpatty]

Our clinic now has a nurse practitioner  come instead of the doctor. WE see him or her about once a month. Some of the patients who have major health problems besides their kidney disease ,are livid having yo talk to her instead of the doctor.

Any other clinics doing this? How do you feel about this

[obsidianom]

That is horrible. Nurse practitioners are poorly trained for much other than simple primary care. I have seen so many negative outcomes with nurse practitioners. They are nurses who get basically a 2 year masters program and think they can practice medicine. Doctors go the same 4 years of college, then 4 years of medical school, then 3 years or more of residency , then for a nephrologist have to do a year or 2 at least of nephrology fellowship. So its 12 to 13 years for a doctor, while only 6 years for a nurse practitioner.  Basic nursing does not in any way prepare someone to practice any type of medicine. They are good at following orders and doing the technical aspects of patient care. Then a nurse practitioner goes just 2 more years and thinks they can practice medicine.  I WOULD NEVER LET A NURSE PRACTITIOER TOUCH ME OR MY WIFE>  This is not meant as an insult to nurses, as I think the world of good nurses. I just have a real problem with nurses playing doctor  with 2 years of training beyond nursing school.
As a renal patient you are far too complex for a nurse practitioer to toy with. SAY NO!!. They are just trying to save money at your expense(your life). Nephrology is far complex enough for well trained nephrologists. Poorly trained wannabe doctors have no place in dialysis or nephrology. This really gets my blood boiling.

[jeannea]

I don't want to paint all nurse practitioners with a broad brush. There are certain areas where they can be very helpful. Esp when they get specific training. However, I do not believe they are a sufficient substitute for a nephrologist. Does anyone know the Medicare rules better than me? Does it say you're supposed to see a doctor? Also, if they're charging for a doctor visit they could be in trouble. I would consider calling your local network. See the top of this page for a thread about report lack of care.

[obsidianom]

If they are working under a doctors supervision then Medicare can be billed for a nurse practitioner visit. That is allowed.
Nurse practitioners were originally supposed to work directly under a doctors supervision. The doctor had to be in the building and available. Over the years that has been relexed to the point of allowing them to function basically unsupervised. That is where the problems began. They are acting as doctors in diagnosing and treating with minimal oversight. Its a money making proposition for the group that hires them. Its bad medicine for patients.
I wouldnt even want an internist to be running my dialysis . i want a full nephrologist.  It is so complex an area. No way a nurse practitioner should be doing this. This is not to paint nurse practitioners as evil. Its just not in the best interest of patients.

[kporter85db]

A nurse practitioner almost killed me 3 1/2 years ago.

I had been prescribed a sulfa based antibiotic on Wednesday of that week by my primary care doctor. By Saturday morning I was feeling just horrible. The only one available to see me Saturday was a NP. After she did her assessment of me, she looked up something in a little book she was carrying then asked me what I thought the problem was. I told her the symptoms felt a lot like when I had congestive heart failure. Her diagnosis was that I had CHF. She prescribed some diuretics and sent me home.

By that evening I was in the emergency room with a gfr of 12.

Don't trust your complicated medical problems to a nurse.

[Bill Peckham]

Our clinic now has a nurse practitioner  come instead of the doctor. WE see him or her about once a month. Some of the patients who have major health problems besides their kidney disease ,are livid having yo talk to her instead of the doctor.

Any other clinics doing this? How do you feel about this

It's your nephrologist who sent the NP, not the clinic, unless you're at a clinic owned by the nephrologist the clinic does not deserve the blame. This situation was a predictable result of the rules that pay nephrologists a set rate based on how many times a month they see their patients. To Medicare your nephrologist is the Medicare Capitated Payment physician, the MCP physician. The MCP physician gets paid the most if they see the patient four or more times a month. This is a relatively new rule, it came about because there were patients who never saw their MCP physician.

The thinking was if physicians rounded in the unit they would have a better understanding about the treatment, their presence in the unit would have a positive effect on the operation of the unit and patients would be better managed by a nephrologist than the overworked unit staff. For instance better dry weight monitoring and adjustment with weekly physician visits. Unfortunately that isn't what happened for a lot of dialyzors. The system allows great care but it doesn't motivate it, and it allow terrible care without penalizing it.

The current system allows dialyzors to never see their MCP physician, a NP suffices. Rather than having your dry weight checked/confirmed every week by a nephrologist dialyzors are still being treated to a static, arbitrary number run after run. Dialysis has to be prescribed by a physician and Medicare should motivate nephrologists to engage and support patients to make dialysis go as well as possible but the current payment system is failing a lot of people.

[pdpatty]

The last time I saw the doctor ,he wanted to argue HE HAD been in sooner than the 21/2 months I said UNTIL he checked the sign sheet in the front of my records.  Haven't sen him since . Seen the other dr once,that was last week. Not seen him since before Thanksgiving.

By the way,the clinic is owned by American Renal. Are any of your clinics owned by them ?

[Cowdog]

My Neph also has a NP but I like how they work together. I see the NP weekly, he discusses lab results, coaches on better diet, discussess managing Hemoglobin (mine is high and managed through reduced washback) and writes prescriptions for routine meds (binders). Anything above the NPs paygrade is noted on the chart for the Dr or if an immediate answer is needed he calls the Dr for an answer.
I see the Neph or his partner monthly.
Seems to work for us!!

[Dman73]

Watered down socialized medicine.
Soon it will be LPN's performing that duty.
Then it will be ALB's (any live body).

[noahvale]

*

[kit78]

When I started at Fresenius in summer of 2012 we had a NP and doc only came in once a month.  I didn't mind as she does the same things he does.  He tells me I need to come to the office at least every 3 months but why waste my time?  He does the same thing at the center as he does in his office.  Why do I have to waste my precious money on gas and my time to sit in his office for an hr. or two just to do what he does in center?  BS I say, I'll go every 6 months just to keep him happy!  BTW, the NP's hubby got transferred in his job so Doc comes in every week now.