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Would More Nurse Practitioners Reduce Health Care Costs?

9K views 220 replies 26 participants last post by  haley1 
#1 ·
The walk-in clinic I go to for minor health problems, like a bad cut or poison ivy, uses nurse practitioners. I believe the way this particular clinic works is it is in a group of 4 clinics and there is a supervising doctor.

Nurse practitioners are advanced registered nurses educated and trained to provide health promotion and maintenance through the diagnosis and treatment of acute illness and chronic condition. According to the International Council of Nurses, an advanced practice registered nurse (APRN) is "a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master's degree is recommended for entry level."[1] wikipedia
Nurse practitioners in these states have full practice authority. That means they can diagnose, prescribe, and treat patients without physician oversight. other states require some level of oversight.
Alaska, Arizona, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Washington, Wyoming.
There are currently about 200,000 NP in US. Let's say we increased the number to 300,000 in 5 years. Do you think it would lower the cost of healthcare?

Hint: There are slightly less than 5,000 Walmart stores in US.
 
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#125 · (Edited)
What is the problem with someone trying to treat their illness with diet? Yes, you can treat diabetes with drugs but it will never get better. The doctor will tell you it is a progressive disease. The more drugs you take the more you hurt your body and the more your disease progresses. It just gets worse. So instead you change your diet. You might just get better, you get off drugs. How is that a bad thing?
 
#128 ·
"The rate of people dying from Alzheimer's disease in the United States rose by 55% over a 15-year period, new data from the Centers for Disease Control and Prevention shows.
The number of those patients dying at home from the neurodegenerative condition also rose, from 14% to 25% over the same time period studied, 2009-2014." CNN

 
#133 ·
" That however is not topic we're discussing. We are discussing how diet can change what you're diagnosed with."

I'm fairly certain the topic of the thread was how to lower healthcare costs and if using RNPs would help with that, actually..... Maybe ya'll can make your own debate-about-diabetes thread?

Incidentally, my own regular care is provided by a RNP. I get all my prescriptions through her and the like. She does my annuals and puts my in touch with specialists at larger facilities if I need additional work. It's nice. She's nice. I like her.
 
#140 ·
That's still not a "cure".
That's your anecdote.
Simple logic:
If doctor's use lab test results to indicate disease, then the absence of these results has to mean no disease.

That's the internet hype.
It's not necessarily factual.
Humans everywhere tend to suffer from the "same diseases" since we are all the same species.
Then why do they not get diseases (in large numbers) like heart disease, type 2 diabetes, high blood pressure, etc until after they have adopted a western diet? Why is it that cultures that still eat a traditional diet don't have these diseases in large numbers?

Think about where we came from. Signaling within our biological systems are based on light, water, natural emf, temperature, and food. Mess with any one and you have modern disease. Mess with them all and you have the US.
 
#143 ·
Modern medicine can be a wonderful thing. Doctors are really good at some things, absolutely amazing at some things. Nutrition does not tend to be their strong point, though, as most get very little training in that area.

I don't say that to belittle doctors or NP's in any way. (Hey, I don't get upset that my dog's vet doesn't know how to fix my car. He's not studied and trained for that.) There are some amazing docs and NP's out there. But on the other hand, there is a lot of what makes people healthy that has much more to do with how a person lives on the days they don't go to the doctor than what the drug of the day happens to be. What's that saying, something about let your food be your medicine and your medicine be your food... Old wives' tale? I think there is something to it.

What you eat matters. What you don't eat matters. What you're brought up eating (culture) matters as it develops habits that people carry with them. There really are pockets of people who are healthier and have more longevity and studies, real studies, do bear out some differences in how people eat are significant factors. You can ignore that if you want to. I'd rather pay attention.
 
#146 ·
In recent years, it has become increasingly clear that diet plays a starring role in preventing and treating certain chronic diseases. And physicians are often on the frontlines of counseling patients about how their diets and other lifestyle habits can affect their health and weight – a reality that has gained added importance given the obesity epidemic. And yet, it turns out that only 29 percent of U.S. medical schools offer med students the recommended 25 hours of nutrition education, according to a 2015 report in the Journal of Biomedical Education.


http://health.usnews.com/wellness/food/articles/2016-12-07/how-much-do-doctors-learn-about-nutrition
 
#152 ·
I'm not disputing that diet is very important. My dispute is about whether or not diet provides a cure rather than a remission or reversal in diabetes. (And whether a lay person like me and presumably most people posting here have the educational background and framework to sort through google sites and proclaim themselves more educated than a board certified physician in their specialty).
Given that, I'd be curious to know how much nutrition education an endocrinologist receives and what the percentage is of endocrinologists referring diabetic patients to to dietitians is (since your article suggest this).
Admittedly, I know only about 5 people with type 2 diabetes but they all were referred to a dietician when diagnosed and fairly extensive diet counseling.

From what I can tell, people here are also quarreling with the advice given by dietitians too.
http://www.eatright.org/resource/he...rbohydrates-part-of-a-healthful-diabetes-diet
 
#149 ·
I am curious, is ANYONE reading or posting in this thread an actual physician or nurse practitioner?
I'm not a physician or a NP. I did (and still do PRN) clinical lab work for 36 years. I taught at the university level as an adjunct in an Allied Health department for 10 years.

But in a discussion with many of these folks, that does not matter. Everybody has their own opinion and pretty much nothing will change.

I've already stated that NP's are not physicians. They do not have the depth of knowledge that even a family practice guys has. They do have their place in healthcare, but do not expect them to be good diagnosticians. They are good at care plans and following up on patients.
 
#150 ·
I'm not a physician or a NP. I did (and still do PRN) clinical lab work for 36 years. I taught at the university level as an adjunct in an Allied Health department for 10 years.

But in a discussion with many of these folks, that does not matter. Everybody has their own opinion and pretty much nothing will change.

I've already stated that NP's are not physicians. They do not have the depth of knowledge that even a family practice guys has. They do have their place in healthcare, but do not expect them to be good diagnosticians. They are good at care plans and following up on patients.
I only know one NP personally. He works for a heart group, which is definitely a specialty area as opposed to just general practice. He's a very bright person and he takes his work very seriously. No, he's not a cardiologist, but I suspect he probably knows more about cardiology than most general practitioners. I've spent hours in his office (not because of my own heart, because of a family member) and I couldn't throw a question at him that he didn't have a reasoned answer for. On one occasion, he explained something that took probably 10 minutes to explain followed by, "that's a whole semester's worth of education right there." And we were getting pretty deep. He's the type that enjoys that kind of thing which shows a definite passion for what he does. I like him. And I have a lot of respect for what he has to say.

I would imagine that the world of NP's are a lot like the world of MD's. There are good ones, really good ones, mediocre ones, and ones there just for the paycheck. I think I've met just able all of those in person at one time or another. A few, like the guy I mention above are exceptional. A few, I wish they'd find another line of work before they kill someone. (One of them, an MD, I think I pretty much did watch kill someone, took a year to do it... I'll just say there is a lawsuit pending...)
 
#155 ·
https://www.sciencedaily.com/releases/2015/09/150921182105.htm

"In an innovative study in mice, Laura Alonso, MD, associate professor of medicine and the George F. and Sybil H. Fuller Foundation Term Chair in Diabetes, and Rohit Sharma, PhD, a postdoctoral associate, discovered how the pancreas knows that more insulin-producing beta cells are needed. When there's an increase in insulin demand, there's a corresponding increase in insulin production in the endoplasmic reticulum (ER) of the beta cell, which causes some stress to the ER system. "Although it was previously known that too much ER stress is bad for beta cells, causing them to die, our study found that a modest amount of stress is actually good for them, because it provides pressure to increase beta cell number to produce more insulin and keep blood sugar regulated," Alonso said."
 
#157 ·
https://www.ncbi.nlm.nih.gov/pubmed...diet-may-help-regenerate-a-diabetic-pancreas/

"
Fasting diet may help regenerate a diabetic pancreas
Fri, 24 Feb 2017 12:33:00 EST



"The pancreas can be triggered to regenerate itself through a type of fasting diet, say US researchers," BBC News reports.

Research in mice found a low-calorie diet may help in cases of type 1 and type 2 diabetes.

The pancreas is an organ that uses specialised cells known as beta cells to produce the hormone insulin, which the body uses to break down sugars in the blood (glucose)."
 
#169 ·
I've been watching this thread. I commented on it a long time ago. I did so because I was REALLY interested in the original topic not your debates about diabetes and off topic petty bickering! And then when I express disappointment in that it's; "Oooh! I know I have been arguing for like a WEEK on the internet throwing around petty insults and bickering about things mindlessly with people who won't listen to me, but YOU'RE the drama queen!"?

Please. You're doing nothing but petty childish bickering on the internet and wanna complain about ME being dramatic with even more petty insults? Great job. You sure showed me how to act with dignity and grace! Let's see, let's make sure I'm doing this right, OK?

The appropriate response to someone expressing indirect disappointment on the internet is to confront them directly by quoting them with insults, right? Because that's what you just did. So that's how I should be treating you, right? Golden rule and all that.

So the right response to being insulted directly in a petty way like this must be to FLIP THE HECK OUT!!!! THIS IS HOW I SHOULD ACT RIGHT!!?!?!?!? YOU SET SUCH A GREAT EXAMPLE!!!!!!11! SUCH GRACE, YOU DUMB SWANLING!!!! OMG! I CAN'T EVEN. WHAT IS WRONG WITH YOU, YOU AWFUL HUMAN BEING!?!?!?!? YOU CAN"T HANDLE CONSTRUCTIVE CRITISISM!?! OMgomgomg!

Grow up honey bun and get over yourself. I might not be be perfect, but at least I don't think I am. I know when I'm being petty. Apparently you just can't help yourself. :p
 
#170 · (Edited)
I've been watching this thread. I commented on it a long time ago. I did so because I was REALLY interested in the original topic not your debates about diabetes and off topic petty bickering! And then when I express disappointment in that it's; "Oooh! I know I have been arguing for like a WEEK on the internet throwing around petty insults and bickering about things mindlessly with people who won't listen to me, but YOU'RE the drama queen!"?

Please. You're doing nothing but petty childish bickering on the internet and wanna complain about ME being dramatic with even more petty insults? Great job. You sure showed me how to act with dignity and grace! Let's see, let's make sure I'm doing this right, OK?

The appropriate response to someone expressing indirect disappointment on the internet is to confront them directly by quoting them with insults, right? Because that's what you just did. So that's how I should be treating you, right? Golden rule and all that.

So the right response to being insulted directly in a petty way like this must be to FLIP THE HECK OUT!!!! THIS IS HOW I SHOULD ACT RIGHT!!?!?!?!? YOU SET SUCH A GREAT EXAMPLE!!!!!!11! SUCH GRACE, YOU DUMB SWANLING!!!! OMG! I CAN'T EVEN. WHAT IS WRONG WITH YOU, YOU AWFUL HUMAN BEING!?!?!?!? YOU CAN"T HANDLE CONSTRUCTIVE CRITISISM!?! OMgomgomg!

Grow up honey bun and get over yourself. I might not be be perfect, but at least I don't think I am. I know when I'm being petty. Apparently you just can't help yourself. :p

Good grief. All this screeching and on a holiday weekend.
I guess I was wrong about the swan song. But not the drama.

BTW: it's not my job to show you how to act with dignity and grace or when and where to do so. Make your own sammich.
 
#171 · (Edited)


AlL THiS sCREachINg On a HoliDaY WeekeNd! U shulD sEe a DoctOr!

Best part is, I'd love to see a doctor. But I'm probably not going to because rising healthcare costs, repealing Obamacrae, or the implementation of the new healthcare plan will take my coverage away.

Wouldn't it be nice to be able to talk about that instead of have trash fires of arguments on the internet?

TOO LATE! :D

Btw; It's not my job to respond with dignity to people who don't act with dignity. I love sandwiches so no idea what that means.
 
#173 · (Edited)
Actually, you were fine. It's not your fault it devolved and I didn't see you being aggressive or insulting people. I guess if the OP wants to get into a petty fight with other people they're welcome to. If you wanna participate you're welcome to.
But I'm also welcome to also say that it's dumb and not what I was hoping the topic would be about or was originally made to be. And I'm not the only one who thinks it's dumb and ya'll just being petty.
I'm also welcome to act with the same level of maturity as the posters. ;P Since they think it's acceptable to act that way, I should be fine.
Maybe it just didn't meet my criteria for dignity or grace. The posters should do better!

Cause, like, expecting other people to act better than you is OK right? ;)
 
#177 ·
You quoted me so I presume it's your desire. :) Like, wow! This is the third time I've unwatched this thread and people just keep deliberately calling me out and pulling me back! You are SO good at ending a discussion and letting things go! Very capable at it. Let's keep chatting about how bad this topic is instead! Maybe I was wrong about you not being aggressive or trying to instigate? Such fun! I've got all day btw. I work from home. :) :) :)
 
#182 ·
Endos are usually Internal Med docs (3 yr residency) that do a 2 year fellowship in endocrinology. Problem is, the money has been going down the last few years as reimbursements keep getting cut. It becomes financially advantageous to let your NP or your PA do the heavy lifting of diabetic education and nutrition counseling ( or refer the nutrition stuff), because you simply can't take the time to do it and keep the lights on.

More than of the endos that I know, will no longer take Medicare. You have to pay cash and file on your own.

As for PA's and NP's...Not a lot of difference. Both have Master's degrees. I think the NP's may be a bit more focused in one area, as that is how they train, whereas a PA receives a more general medical education. I think those differences iron out over the years. Personally, I'm not comfortable with either making an initial diagnosis. In medicine, when you hear hoof beats, think of horses, not zebras. That's fine and works well for these guys. But if you are a zebra...Not all docs are good diagnosticians. Some are heads and shoulders above the rest, so I think it's important to have a good doctor upon initial presentation of symptoms. For subsequent car, a lot of times you just don't have to have the M.D.

Obamacare recognizes three primary care givers - doctors, PA's and NP's.
 
#183 ·
The thing is I can usually see an NP the same day and if I want to see my regular doctor, it's more like 2 months. If I call with an urgent need they tell me to go to emergency room!

My point was that if we want to lower the cost of healthcare, one thing that could be done is to increase the number of NP's (at a lower reimbursement rate than doctors). There was talk several years ago of Walmart and some of the pharmacies opening clinics in their stores. If we have more options, the free market should drive down prices.
 
#184 ·
There's also plenty of times where a nurse practitioner can help you out when what's happening is really obvious. When I started getting severe cycles that left me incapacitated (probably from the same genetics that cause uterine fibroids in my family) it was a RN who helped find the right medication for me, not a doctor. And it was relatively painless. Since that's a pretty easy fix for most folks, she just grabbed a list of medications that normally work and started in the middle. If I had a problem with a medication she'd check a list and find me a similar one until we found one that controlled my symptoms without severe side effects.
 
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