Steve Carroll DO MEd

EM/EMS physician, EM at @christianaEMed, EMS w/ @GFACEMS, Creator EM Basic podcast-Airway Nerd, Olympic weightlifting, proud supporter of PPP @pppforpatients

[Steve Carroll DO MEd @embasic]

@ErickaAndersen You should read further down in the thread

Every state??? You sure about that??? You sure about that???

[Steve Carroll DO MEd @embasic]

@grok @TheBrancaShow @tqlemd Hahahahaha cooked by Grok.

How embarrassing

[Steve Carroll DO MEd @embasic]

@docskop Nonsense

It is so easy to say this when it’s not your license and your freedom on the line

[Steve Carroll DO MEd @embasic]

@paulswaney3 EoB is charges which is not what the surgeon receives

Charges are made up numbers so insurances can tell people that they got a good deal- no EoB actually shows what the doctor ultimately received

The best explanation in under 6 min

https://t.co/LCz9X6rrhJ

[Steve Carroll DO MEd @embasic]

@realdocspeaks @CE_HandSurg This guy is seriously unhinged

[Steve Carroll DO MEd @embasic]

@lecternleader Bro how damaging can this photo be if it’s your profile pic and your entire profile is that you’re The Lectern Guy

[Steve Carroll DO MEd @embasic]

@YannickBuccella @Advo_D As an EM doc (who takes the brunt of the blame for “docs order too many CT scan) this study’s methods were infuriating

I continue to remain skeptical that we will accurately predict the impact of medical imaging on cancer rates given our advancing technology

[Steve Carroll DO MEd @embasic]

@BryanHuntingto3 @mfcannon Go ahead and post what you have and I’ll tell you why it doesn’t answer this question

[Adam Bruggeman, MD @DrBruggeman]

600 Programs. 39,000 Graduates. 500 Unregulated Hours.

According to U.S. Department of Education data reviewed by Bloomberg Businessweek, more than 600 schools offered advanced nursing degrees in 2022. That is three times the number of medical schools in this country. In that same year, 39,000 nurse practitioners graduated from those programs, a 50 percent increase from 2017.

That explosion did not happen because we found a way to produce better-trained clinicians at scale. It happened because there is money in it. Bloomberg documented dozens of nursing students and professors saying programs are graduating thousands of students not properly prepared to care for patients. Institutions that offer primarily online training gave out the most degrees. The former director of the country's largest NP program acknowledged she could not recall ever denying a single applicant.

NPs are required to complete a minimum of 500 hours of supervised clinical training before licensure. According to Bloomberg's review, those hours are often unregulated. Many online programs do not even help students find clinical placements. John Canion, an emergency medicine NP and one of the loudest reform voices within the profession itself, testified at the AMA State Advocacy Summit that programs have no meaningful oversight of how those 500 hours are spent. He stated that programs cannot confirm whether a student was ever in a clinical setting, sat in a broom closet, or even showed up.

To put 500 hours in context: the Texas Department of Licensing and Regulation requires 1,000 hours of supervised instruction before it will license a cosmetology operator. Someone who will be diagnosing illness, ordering diagnostic studies, and prescribing controlled substances is held to half that standard.

The fastest initial NP licensure programs now run 12 months. Vanderbilt and others openly advertise one-year pathways for BSN-prepared nurses. A physician completing residency has between 12,000 and 16,000 hours of supervised clinical training, built through a nationally standardized accreditation system with no online pathway and no accelerated option. There are no online medical schools. The hours-in-training gap is at minimum 16 to 1.

Many programs now also offer direct-entry tracks for applicants with bachelor's degrees in unrelated fields and no clinical experience, preparing them for licensure in as little as three years. This is not the traditional pathway of an experienced bedside nurse earning an advanced practice credential. It is a production model built around enrollment revenue, not patient outcomes.

When Bloomberg published its investigation, the American Association of Nurse Practitioners responded by accusing the publication of cherry-picking negative information. Attacking the journalism instead of addressing the substance tells you everything you need to know about where the profession's leadership stands on the underlying problem.

[Steve Carroll DO MEd @embasic]

@mfcannon @LloydBraun9001 You have to acknowledge the problem we have created is that with the floor so low at 500 hours and advocacy groups claiming (and politically winning) the argument that this is sufficient that their training hours will never go up from there- so it’s a moot point

[Steve Carroll DO MEd @embasic]

@BryanHuntingto3 @mfcannon To date there has not been an RCT that has taken undifferentiated patients and randomized them to physician vs NP/PA care where the NP/PA was completely unsupervised

As far as patient satisfaction that’s a meh- you can treat someone with respect and still mismanage them

[Steve Carroll DO MEd @embasic]

@mfcannon @LloydBraun9001 Got it- overtrained doctors bad and we’re stifling innovation by advocating for reasonable training standards so don’t listen to us when we tell you that 500 hours won’t cut it

[Steve Carroll DO MEd @embasic]

@FiSurgi If you are saying that it is safe for patients for someone with less than 4% of physician training to practice at the same level as a physician and be completely unsupervised then it absolutely says that all your training isn’t needed

[Steve Carroll DO MEd @embasic]

@FiSurgi So equating that to discrimination that DOs face is a false equivalence

Really disheartening to hear a fellow doc think their long hours in training weren’t worth it and that you can be replaced with someone with a lot less training

[Steve Carroll DO MEd @embasic]

@FiSurgi But this isn’t about your wife

And it’s not discrimination to say “I don’t think people with less than 4% of physician training should practice independently”. It would be discrimination if NPs had the same amount of training yet couldn’t practice independently but they don’t

[Steve Carroll DO MEd @embasic]

@BryanHuntingto3 @mfcannon Not all states require post grad supervision before independent practice-there is a huge difference between a structured medical residency and logging hours after graduation without the quality control that proper supervision is done- something that is required for residencies

[Steve Carroll DO MEd @embasic]

@FiSurgi In all seriousness- you are telling me that about 8 weeks into your intern year (or roughly 500 clinical hours, ignoring the hours in med school) that you would have been competent to see patients by yourself without any supervision???

[Steve Carroll DO MEd @embasic]

@FiSurgi This is disappointing hearing from a fellow physician

No one is competent to practice independently with only 500 clinical hours- with or without AI

[Steve Carroll DO MEd @embasic]

@BryanHuntingto3 @mfcannon but it’s not the same skill set so counting previous nursing experience as a way of building up your clinical hours for NP school is disingenuous- in medical school everyone does the same training regardless of their prior experience in medicine (or none at all)

[Steve Carroll DO MEd @embasic]

@BryanHuntingto3 @mfcannon Additionally- nursing and medicine (which is what NPs practice despite them saying they don’t) are different fields with difference skill sets- does being a nurse help you learn medicine- absolutely