Samantha

@trouble_man90 @WaterSmoothRock @Costello4Senate Nobody believes that Platner is a right-wing authoritarian. Centrism is no longer a viable political strategy in Maine hence why Costello has NO traction whatsoever among Maine democrats. Can't be business as usual when everyone is hurting in a democratic run state.

@WaterSmoothRock @Costello4Senate A centrist is better than a Nazi

I hope Graham Platner loses, and I hope Susan Collins loses. There’s a perfectly normal Democrat still in the race @Costello4Senate .

@plasticolicious @BrentAWilliams2 Australia has a publicly funded system and they pay their physicians quite well. In the US reimbursements are declining and will continue to decline in the coming decades.

@BrentAWilliams2 Also, eventually everyone in the HC system will earn much less.

This would require an insane amount of authoritarianism and health care rationing to achieve:

@BrentAWilliams2 The current system is already authoritarian. Pharmaceutical companies, private equity and insurance companies who bribe politicians create the rules. Healthcare rationing is not a bad thing. It encourages clinicians to be more thoughtful in their management of patients.

@markbgger @SCDC87 @jayfosterlaw That is not true specialization. You can't learn psychiatry or critical care medicine in a 2-year part-tine online degree without appropriate foundational knowledge.

@arghhhhhhhhh92 @SCDC87 @jayfosterlaw Many NP specialize while in school- psych, gerontology, acute care…

Anyone remotely interested in lower-cost or universal healthcare will need to get over unfounded biases against NPs/the belief that the current length and expense of medical education for doctors is necessary for quality in general practice.

@marcportermagee You'd command a similar salary if you went through 15-years of grueling training and sacrifice only to work 50-70 hour weeks with immense responsibility and liability.

So, healthcare

@SCDC87 @jayfosterlaw @markbgger The moment you are evaluating an undifferentiated patient with a neurological deficit as an NP/PA in a specialty clinic you are performing beyond your competency. That patient was referred to clinic for a specialist opinion (aka the highest level of expertise in that specialty).

@arghhhhhhhhh92 @jayfosterlaw @markbgger It does not, because I would not argue in favor of people performing beyond their competency. You’re making a fallacious slippery slope argument or simply deciding what you want me to be saying 🤷🏻‍♀️

@SCDC87 @jayfosterlaw @markbgger That is literally what makes physicians so special as a profession. They have immense depth and breath of knowledge. They have to not only be specialists, but also generalists. They have exposure to every area of medicine and an established competency in all domains.

@SCDC87 @jayfosterlaw @markbgger We do know that it increases fragmentation because NPs do not have to train in general medicine. A physician must first become a generalist (5 years) before they become a specialist. That foundational training is crucial to avoiding fragmentation and loss of general competence.

@SCDC87 @jayfosterlaw @markbgger Your entire argument leads to this conclusion. All non-physicians who are practicing in the role of a physician in specialties are practicing outside of their scope. That is the entire point here... Why spend 8 years training specialists when we can get them in 2-year part-time?

@arghhhhhhhhh92 @jayfosterlaw @markbgger I mean if this is your argument, I think you are making a completely different point than I am. I never said we should allow anyone to practice way outside their competency. This entire time I’ve been talking about the skill of NPs and PAs practicing within their scope.

@SCDC87 @markbgger @jayfosterlaw This is how medical science works. A company that produces drug A does not have to prove that the established drug A is better than the newly introduced drug B. Rather, its the company that produces drug B that has to prove that its clinically and statistically non-inferior.

@SCDC87 @markbgger @jayfosterlaw Physicians are considered the standard because medical education is evidenced-based, proven to produce results over a century, and have strict licensing and practice requirement. They don't have to prove superiority, other professions must prove non-inferiority.

@SCDC87 @jayfosterlaw @markbgger Nobody denies that there are aspects of medicine that can be performed by NP/PA (there are many such examples). The problem occurs when you deskill workforces without evidence for safety and efficacy, and allow people to practice way outside their competence level.

@SCDC87 @jayfosterlaw @markbgger An argument that should be rejected. We already know that fragmentation of care produce worse outcomes. The entire benefit of having physicians in these roles is because of their breath and depth of knowledge, which allows high level management across multiple domains.

@jayfosterlaw @markbgger @SCDC87 They don't practice what they preach.. If they have a progressive neurological disorder they would all demand to see the neurologist, rather than the NP with no formal neurology training.

@markbgger @arghhhhhhhhh92 @SCDC87 No, I posted a study for you but again, unless you have brain problems the amount of studying a MD does v. NP isn't close so the idea they can compete in any way with a MD is laughable.

@SCDC87 @markbgger @jayfosterlaw There are absolutely confounding factors that influence the perspective of physicians, hence why I brought it up. Its rather odd (and incorrect) to expect experts in a field to prove superiority, rather than expecting non-experts to prove non-inferiority.

@arghhhhhhhhh92 @markbgger @jayfosterlaw But there are no “confounding factors” in “just trust anecdotes from doctors who are totally not biased”…ok.

@SCDC87 @markbgger @jayfosterlaw You can complete direct entry MSN programs online that do not require a BSN. A BSN does not teach you much about the practice or nursing or medicine. The NCLEX and NP boards are quite straightforward and not remotely as rigorous as USMLE, specialty boards or PANCE (PA).

@arghhhhhhhhh92 @markbgger @jayfosterlaw ????

@markbgger @SCDC87 @jayfosterlaw Rather an expert account based on extensive anecdotal and circumstantial evidence. Idiotic to treat is as a mere laymen opinion when its clearly not the case. A single neurology group my cover an entire city, so their perspectives on neurology referrals and trends matter.

@arghhhhhhhhh92 @SCDC87 @jayfosterlaw So then at the end of the day it’s an OPINION- which is not based on any sort of science