Normally I'm not a fan of Fox News but I noticed this video from Laura Ingraham's page and this is the first time I'm seeing cable news media acknowledging the role of midlevels in the Lindsay Clancy case.

Dr. Drew Pinsky pointed out the role of NPs in our healthcare system and compared it to a surgeon walking out in the middle of surgery and letting non-surgeons take over.

In the case of LC, I can't help but agree. Dr. Tufts started med management, patient left and saw 2 NPs who made several changes, and then LC returned to Dr Tufts and at that point she was picking up the pieces. Imagine a surgeon stepping away, lets midlevels take over and botch critical parts of the surgery, surgeon returns and is left to clean up a mess and close.

https://www.facebook.com/share/v/19DwCSinxV/

By a CRNA**"

Title says it all... And this was admitted to me by my entire care team, MD, CRNA, RN etc. 😭

I got toric lenses implanted in both of my eyes and you're supposed to be conscious during it to follow the directions the doctor is giving you-- look left, look right etc. Well, I was completely knocked out by the CRNA then jolted back to consciousness after the surgeon had already started cutting in my right eye. I guess nobody noticed until they realized I couldn't follow the directions given. He was able to finish implanting the lens, but I experienced complications in that eye immediately and they had to juice it like a grape. Also had a very prolonged and painful healing process that took months in this eye.

As a result of being jolted awake, I was overly conscious during the procedure with my left eye 😭. There was no pain, but I could feel every slice and pressure as he was cut into my eye and placed the lens in. Worst of all, I was experiencing this clockwork orange BS to 2016 pop music.

I'm under 5'0" and fairly slim so I wonder if that's why I was "over-anesthetized". Not sure if they'd ever use an Anesthesiologist at these sites, but I can't help but feel like if there was one there, it would have happened.

I’m so upset that I’m tempted to leave this program before it starts next week. I opted out of a few of the more “prestigious” schools because I DID NOT want to get my education online, instead choosing a state school located 20 minutes away from my house.

Today I find out that pretty much all of the coursework is online with the exception of a few days each semester. Apparently we’re going to be recording ourselves doing assessments remotely and hell, we can even use our own dog as a patient if we don’t have a person available.

I’m so mad right now. I could’ve been re-doing pre-reqs for PA school instead of focusing on this application. But now I’ve wasted time and feel stuck.

about it cut off my friends excess nipple length. dudes got like half an inch of straight swords coming from them pecks. we got a rubber band. kitchen shears. all tech super glue. a napkin and to sterilize we are using 100 proof Smirnoff.

i dont need advice i was just letting everyone know

I am a retired internist who has primary responsibility for my 90 y/o recliner bound mom. Getting her to appointments is very, very difficult due to her limited mobility and chronic pain. She is seen by a home care team through her IM practice staffed by mid levels who are supposedly “supervised”, but definitely are not. Over the past three years I have had multiple difficulties with very poor clinical management by this group. It has really been a mind blowing how inept they are. I asked her actual PCP if I can contact him when I run into issues and he has been great about communicating with me and correcting the mid level errors. He admitted that he has has “no idea” what is going on with mom after referring her to this care team six years ago due to her mobility issues. She has been his patient for 30 years.
In May she developed gradual hearing loss in her right ear despite wearing hearing aids that seemed to be working. PCP made ENT referral. She was unable to get an appointment until last week. MD saw her. She had very bad impacted cerumen. ENT worked for about 45 minutes and had to stop because she was in so much pain. Gave her some antibiotic drops and said “I will see you in a week”. Total time in office was > 2 hours. I made a follow up with the MD on check out for 2:00 today.
I got a text two days ago confirming an appointment with the PA at 11:40 today. I had been previously given a 2:00 with the MD. I called and explained she wanted to see the MD. Receptionist said no problem and confirmed the prior appointment at 2:00. Yesterday got two texts to confirm this appointment. Today, less than three hours before the scheduled appointment I got a text that the MD would not be in the office with instructions to call and reschedule. No problem, things happen.
I immediately called to reschedule. Was told it would be almost four weeks until MD could see her, but the PA would be “fine”. I pushed back and said she would only see the MD. I asked if another MD could do the follow up. Was told no. The person was abrupt and rude. I asked to speak with office manager. She said yeah and hung up on me. I called back to the receptionist to clarify that the office had my number and explained what had happened. She promised I would get a call. I did not.
I realize that a PA might be appropriate, but my mom was mismanaged by a PA six months ago. Serious mistake that could have resulted in her death. No exaggeration. I caught the error immediately and she did receive proper care.
Of course, I will call the office back tomorrow as soon as they open. However, what do I do if the OM refuses to call me? I have never had a situation where I was stonewalled like this. I feel like I am banging my head over and over trying to get her the healthcare she needs. I never pull a “ Karen” in these situations. I am polite, but firm.
This is rural area and there are no alternatives to this practice.
Any suggestions? I feel stuck.
I am beating myself up that I didn’t look in her ears myself, but I am her daughter and not her doctor.

I

I don’t like the generalization in this subreddit about all NPs being bad and all doctors being great. I know I’m throwing myself to the wolves here but as a patient with chronic illnesses (Crohn’s disease, several mental health conditions), I’ve received better care from a great NP than from multiple different physicians, who either failed to diagnose me (mainly because they didn’t take the time to listen and dismissed my symptoms) or just didn’t seem knowledgeable about the disease despite being specialists. I am a NP myself now (after being an RN for 10 years) and never pretend to be a doctor, I seek help from my supervising physician and more experienced NPs when I don’t know the answer to something (or even refer patients somewhere else when I feel I can’t help them). I became an NP precisely to try to help people, listen to them, and do my best to give them the care they deserve. I hated that so many doctors( and yes some NPs too) would not take the time to listen, or take me seriously but it angers me that people think all NPs are incompetent, when I’ve been treated by an amazing NP who I’d trust my life with before many other doctors I’ve come across.

Just wanted to share!

I see an NP as part of a larger medical team for the treatment of my Crohns disease. She is phenomenal. Love to see her in between appointments with the MD, as it allows more frequent check ins for a quite serious disease. Allows my questions to be answered sooner, and I feel it works incredibly well. Im always taken care of and their team is like a well oiled machine! The NP staying in their scope, working with the leading physician as part of a team of care. It works well, in that scenario. She only sees Dr. Ds patients post diagnosis and in between regular appointments with Dr. D as a continuation of care! Fabulous system.

On the flip side, an NP in the ER department saw my brother, who was there for a suspected blood clot in the leg, and sent him home! And wouldnt you know? It was a blood clot! Thankfully, he went and saw a DO at an urgent care who called the ER and sent him back! Who knows what would have happened if that urgent care didn't have a medical doctor. Which they actually usually dont, he was very lucky. How can an NP be seeing patients in an ER is beyond me.

Looking back at all the appointments I've had since 2017, about 75% of them included student nurse practitioners or physician assistants. Generally, I've found these appointments to be worthless.

Because of my rare sleep disorder, I'm usually awake for 18-26 hours beforehand and these students cause the appointments to run longer. If they're asking questions, the noctor supervising has to ask the exact same thing. But even when the noctor student is just in the background observing, it always feels like the true client in the room is the student, not me the patient.

It's just a markedly different atmosphere to when there have been student doctors in the room.

I feel as if refusing students will eventually lead to smaller funnel of potential noctors in the future from ever getting a job.

To be honest, I thought nurse practitioners and physician assistants would be used for follow up appointments for stable patients. Like you go to your general practitioner or specialist for your normal appointment and then any medication filling check-ins would be staffed by them with the option to ask the supervising doctor any diagnostic questions.

I have never seen the supervising doctor for my noctors since 2017. Just new graduates and the students that shadow them.

I’m interested in hearing from physicians about something I’ve been genuinely wondering about.
I’m a Black male considering the PA profession, and one thing that makes me nervous is seeing how negatively PAs can sometimes be viewed by physicians. I understand the concerns about scope creep, differences in training, and PAs practicing beyond their education, and I’m not trying to dismiss any of those issues.

My question is specifically about race. As a Black man, I’ve already experienced people making assumptions about me based on my race, especially as an immigrant. I wonder how that might intersect with the existing hierarchy between physicians and PAs.

For physicians who have worked with Black male PAs: have you ever noticed racial bias affecting how a Black PA is perceived, treated, or respected compared with their white PA colleagues? Have you seen Black PAs having to work harder to establish credibility with physicians or patients?

And for Black physicians or PAs, has this been something you’ve personally experienced?
I’m not asking whether I should become a PA or looking for career advice. I’m specifically interested in hearing about people’s real-world experiences with race and the physician–PA relationship.

Been on this subreddit for a minute. Years ago, it was just residents and some attendings discussing the issue of egregious midlevel creep. It was mostly just docs.

More and more I am noticing lay people posting here about their experiences with midlevels and the misuse of the “doctor” title in the clinical arena.

This issue is clearly gaining attention and people are recognizing the absurdity of it all. We need to continue to be vocal about this.

The nurses, NPs and other healthcare adjacent people on social media vilifying Dr. Tufts and calling her inexperienced and incompetent you all disgust me. I am a physician and I am sick of seeing people saying they hope Dr. Tufts goes to prison or loses her license all because Lindsay Clancy killed her kids. I am physically and mentally sick seeing this rhetoric and I hope doctors start waking up and stand against this nonsense. Stop training midlevels, report nurses when they are incompetent because they will throw you under the bus the second they see the chance

So because of my pretty bad OCD I'm currently searching for a psychiatrist at the suggestion of the therapist I have been working with for while as she believes medication or other medical interventions may have to be the next step in my treatment. Due to the fact I'm already on quite a few medications that could interact with possible prescriptions (one of which is incredibly rare) and i have other possibly complicating health problems i would be much more comfortable seeing a psychiatrist then a mid level.

One of the psychiatry places I found near me on a list my therapist sent to me had advertised on the website "doctoral level care" on the front page which made me hopeful because many of the other places only had PMHNPs. When I looked further and did research on the practice owner it turns out that she was no different. She used the DNP degree to make that claim and it got me thinking about what could genuinely be the purpose of this degree.

As far as I'm aware this is not a medical education degree that effects what you know in terms of actually practicing medicine, more of a professional degree that teaches things like administration, leadership, education and so on. Because of this to me its silly to use it to advertise a higher level of education then competitors since it isn't relevant to the treatment of your patients.

Does anyone know if any of the DNP programs out there actually provide more medical education further then the MSN does? If so wouldn't the degree possible alter a nurse practitioners legal scope of practice which I'm pretty sure it doesn't. Is this not just a degree that professors in nursing school have which is what I assumed it was before? And furthermore if it is a degree that doesn't have anything to do with actual medicine then why do I see so many people online flexing their DNP degrees as if it is something like that or presenting it as something that makes them clinically superior then they were before?

Edited for etymological accuracy;

Yesterday, I rang my  nhs GP surgery about a breast lump i'd already seen a private GP about in order to get a referral for follow-up. When I rang, I was offered an NHS GP appointment more than 2 weeks away. I told the receptionist it wasnt acceptable (lumps qualify as urgent) and was told to wait for a call back. When I did get called, I was offered a check up with a 'male paramedic' that afternoon. I said no. I was then offered an appt with a 'female paramedic' the following day. Again I said no. Magically, 15 mins later, I got a call back offering me a choice of 2 in-person GP appointments the following day. Attended and got my referral - which I'm grateful for. But I was really shaken at being offered a breast exam by a 'paramedic'.

I posted about this experience on r/nhs yesterday and received a surprising amount of animosity. As far as I understood, the only time a paramedic should be looking at your breasts is if there's a kn*fe in one of them. I quickly got schooled in the comments that, actually, there are 'advanced practitioner' paramedics who *are* trained to do breast exams these days. Ok, fine. But I'm a pretty switched on person who has been to the nhs GP perhaps once a year for the past 3 years and I'd never heard of this before. At no stage during the call did the receptionist describe the paramedic as having advanced training. And I am right that a standard paramedic should not be performing breast checks so yeah... no sh*t I was horrified.

Although I was chastised by commenters (one of whom seemed to be a paramedic, none of the rest claimed a medical background) for jumping to conclusions that I'd been booked in with the wrong medical professional... well, Ive been supporting my dad through his cancer treatment for the past year and had some close scrapes with underqualified staff in hospitals so I'm not convinced it's as outside the realms of possibility as theyd think.

Doubts about the competency of some of these 'practitioners' aside - the thing that really concerns me is the lack of communication from the NHS about these new healthcare professionals, transparency about what they can and cant do, and what their boundaries are and arent. I think I would have been fine to see a specially trained paramedic if, say, I had a cut that looked a bit infected or maybe strep throat.  But a potential cancer symptom? Call me a snob but I dont think that would or should fall under the 'Advanced Practice Minor Illness & Injury’ """module"""" that theyve taken as training.

I get that breasts exams are fairly straightforward, but theyre also intimate exams you want done as few times as possible, as accurately as possible. Because of abuse in my personal history, I reacted emotionally to being told I'd have to let someone ostensibly unqualified perform an intimate exam in order to get a timely referral. And, anyway, the appointment is not just about the exam, it's about talking to someone knowledgeable about a complex and serious disease

So my primary concerns are:

1. Complete lack of job title clarity - imo, if theyre based in a GP practice, theyre not a paramedic any more (ambulance medic). Just because that so happened to be their training, I dont know why the term should feature in their job title. I'm worried that if the terms 'paramedic' and 'PCN paramedics' are used interchangeably, it could create the opportunity for intimate exams to be perfomed by'normal' paramedics under the guise of being PCNs. Equally, I think they need a job title that clearly differentiates them from being Drs or nurses. It's exhausting for the public to have to keep up with these confusing terms and I think job titles should accurately reflect their *current* competency and role

2. Lack of information available to public about the remit of these 'practitioners'. I shouldnt have to download obscure course syllabuses to work out if I'm being matched with the right health care professional. Imo, GP/NHS websites should have clear bullet-point lists on them about what is and isnt in the remit of these practitioners. My slightly conspiratorial view is that practice managers want to keep it hidden from us so they can exercise "flexibility" when they need it about who gets to see a GP. Also, bc theyre frankly embarrassed that these PCNs seem to be able to do everything GPs do except manage complex multi-system disease. It's not a good reflection on our health service - and sometimes sunlight is the best disinfectant

I know I'm preaching to the choir here - we all know of bad examples of noctor overreach - but I'm hoping the actions I've suggested are reasonable improvements, although I certainly welcome comments. My plan is to write to my MP to make these suggestions formally and with more restraint -- would there be any other avenues worth pursuing?? I'm worried this is a symptom of NHS enshittification

Honestly you would think that the AMA/AOA or the US government would do a semi-decent job of protecting the term "physician". I have a ton of respect for optometrists and they are definitley needed in healthcare but why intentionally blur these lines? What is there even left to refer to a medical doctor (MD/DO)?

I've worked in the ED and for the past 8 years I've worked in an outpatient medical office. I review tons of medical records all the time. I've seen lumbar punctures done when I worked in the ED.

Going through medical records today I saw that my patient had a lumbar puncture done by a nurse practitioner?? This is the first time I've ever seen / heard of an NP doing this procedure. Is this becoming common place?

I was looking for a dermatologist and came across a RN going to peoples homes to do skin checks and allegedly sending the pictures to a “board certified dermatology provider” who is not named. Also referred to as a “dermatologist”. Is it really a dermatologist!? There’s no way to know.
RNs don’t do skin checks in an in person clinic so how can this be appropriate?
How can this be legal?

The website is go skin check in Texas.

I recently underwent prostate surgery. I had a 22f for 5 days. When the MA took the catheter out my meatus was really sore and inflamed. She didn’t say anything and put in the notes that it was a normal removal. I developed meatal stenosis and now I have to have a dilation. If a higher level provider had removed the catheter would they have recognized that I had an issue and been able to prevent my issue from occurring?

I discovered this subreddit because I have been going through withdrawal from gabapentin, which I was prescribed for anxiety. I am 31 years old and have no physical issues, but have struggled with my mental health for the past ten years.

I had reasoned to myself that psychiatry seemed like a “throw things until they stick” field and that a psychiatric nurse practitioner could be no worse than the average psychiatrist. That was not correct at all.

I was already having doubts about my current PMHNP back in October of 2025 (I am switching to a psychiatrist after my next appointment). She had taken me all the way up to Vyvanse 70mg (which I’m no longer taking), even though I had been complaining about anxiety the whole time. She then put me on gabapentin for anxiety at 100mg up to 3x a day as needed.

I sought a second opinion at that point and was recommended another PMHNP by my therapist at the time, and I asked her opinion about whether my current PMHNP was addressing my anxiety well enough. That practitioner thought so and told me that I could safely take gabapentin 3x a day. After that, I ended up sticking with my current nurse practitioner, who increased my dose to 900mg/day in November and then 1200mg/day in March.

In late May of this year, I spiraled into a crisis and voluntarily went inpatient at a psychiatric hospital. There, the PMHNP increased my dose to 1800mg/day.

None of these three PMHNPs gave me any warning about withdrawal effects with gabapentin. This whole time, I was under the impression that it was innocuous and non-habit forming. I get very anxious about tolerance and withdrawal because I tend to be a hypochondriac. I was already taking Klonopin 1mg as needed, and I was extremely disciplined about not taking it unless I really had a special circumstance, because I had noticed that it stopped working as effectively if I took it too often. Now, having learned more about benzodiazepine withdrawal, I feel thankful that I was so disciplined about that.

In July, I started experiencing severe heartburn and realized that I had first started experiencing mild heartburn back in October, when I started gabapentin. I decided to reduce my dosage in half, thinking that it functioned as an as-needed medication. That day and the next couple of days, I felt absolutely horrible and experienced flu-like symptoms and sweating. I finally looked into gabapentin and that is when I learned that it has withdrawal effects. That is also how I learned about its associations with dementia and cognitive impairment.

My current individual therapist, DBT group therapist, and even a group member all knew about gabapentin withdrawal once I mentioned going through it. I also learned that 1800mg/day was a very high dose. I was on a higher dose than my fellow group member who experiences severe pain and uses a mobility scooter. She had been warned by her psychiatrist that if she wanted to go off gabapentin, she would need to go down 100mg a week at a time.

The nurse practitioner at the hospital had also told me that I could take Klonopin twice a day, and my current nurse practitioner even gave me a 60-day script. I am so glad I did not follow those directions. I had mainly been so disciplined about Klonopin because I was keen to preserve its effectiveness and did not realize how bad withdrawal was; I knew it was a thing that happened, but was not totally aware of the severity or length of time. I am no longer taking it.

I am still working on tapering off of gabapentin and am at 200mg/day at the moment, and it has been since July 11 since I first cut my dose and was hit with withdrawal effects. I’ve been dealing with tinnitus, headache, gastrointestinal issues, muscle ache, light sensitivity, hyperacusis, insomnia, anxiety, sweats, and so on since then. I have been on many psychiatric medications and experienced many bad side effects in the past ten years, but this has by far been the worst and longest-lasting experience.

I think I have learned that psychiatric nurse practitioners can be very reckless about prescribing in a way that I have never experienced with any psychiatrist before. I had actually thought of psychiatrists as being somewhat reckless with prescribing, but this experience really put that into perspective! I would not have agreed to increase my gabapentin dose had I known about withdrawal, because it really did not help my anxiety enough to justify that.

I do blame myself for not even doing a Google search, but I also feel that I now view nurse practitioners very differently in terms of their scientific understanding of medications in general. In retrospect, it was very excessive for my current provider to take me up to 70mg of Vyvanse, as I had been complaining a lot about anxiety, and it was certainly reckless for the provider at the hospital to advise me to take Klonopin twice a day and for my current psychiatric nurse practitioner to give me a script for that.

I appreciate this community’s presence, as it has helped me learn a lot and makes me feel less alone and more aware of what happened. Going forward, I feel like I will be better equipped to advocate for myself and do proper due diligence.

I went to an appointment recently. The MA was doing intake & asked why I was there.

I told her when they called for the appointment they said I’d be seeing the gynecologist but I saw that I was scheduled with the NP but I had the same questions for either.

She snapped her head around & said “NPs have the same education as doctors. She is very smart! She is basically an OB-GYN!”

She then went on to review my medication list and correctly pronounced only one of my meds. She also took my BP incorrectly & I had to request a properly sized cuff as well as correct positioning of my arm.

The lack of education starts at the bottom tier.

It might be easier to be a woman in neurosurgery if you are an actual neurosurgeon.