Should the VA should use Nurse Practitioners to help ease long waiting times?

Lt Col John (Jack) Christensen — Tue, 31 May 2016 09:50:21 -0400

I ask this because I don't understand all the controversy over the issue. Anyone who has used the military health system has received care from Nurse Practitioners. The concept isn't new, I can recall my dependents being treated by NPs back in the 70s. There were never any issues with quality of care and if something came up that a NP couldn't handle a doctor was called in. Seems like a smart move

Response by PO2 Mike Vignapiano made May 31 at 2016 9:55 AM

PO2 Mike Vignapiano — Tue, 31 May 2016 09:55:01 -0400

I think this is a great idea. Personally, I prefer NPs over General Practioners anyway. Nurses have a better knowledge of patient care and meds, and an NP is just like a Dr, except for some bs protocols & licensing.

Response by SFC Private RallyPoint Member made May 31 at 2016 9:56 AM

SFC Private RallyPoint Member — Tue, 31 May 2016 09:56:41 -0400

My wife deals with a NP or PA in Leavenworh and the service is less than desirable. The lady refuses to give any type of consult for anything speciality related. My wife had cancer and the radiation destroyed her thyroid and she's never been able to see a endocrinologist. The lady sucks at refilling medication or dealing with the long term effect of keeping my wife on narco drugs for upwards of five years. I would say keep and promote quality, but can the government employee union in the va system. It allows too many substandard individuals a paycheck at the expense of our veterans' health.

Response by SSgt Trevor Smith made May 31 at 2016 9:59 AM

SSgt Trevor Smith — Tue, 31 May 2016 09:59:03 -0400

I don't think it's a big deal at all. Some of the best medical practitioners I know and have worked with back in my medic days, are Nurse Practitioners. When I went for my C&P at the VA I saw a Nurse Practitioner and she was excellent, very thorough and right on with my conditions. Aside from that, as was stated, there are always doctors that can be referenced or brought in on a case if need be. I think it's fine, and would not hesitate to see one at all.

Response by Capt Private RallyPoint Member made May 31 at 2016 10:03 AM

Capt Private RallyPoint Member — Tue, 31 May 2016 10:03:23 -0400

I have had nothing but great care from PAs and Nurse Practitioners. both with on base and civilian side. In fact, ofter better than from a Dr.

Response by CPO Joseph Grant made May 31 at 2016 10:35 AM

CPO Joseph Grant — Tue, 31 May 2016 10:35:17 -0400

At least the NP seem to care more than the docs

Response by LTC Kevin B. made May 31 at 2016 11:18 AM

LTC Kevin B. — Tue, 31 May 2016 11:18:19 -0400

I'm not sure we have enough information to tell if this will help. Most of my experience with PAs and NPs involve primary care, not specialty care. Most of the waiting time issues that I've read about regarding the VA involve specialty care, not primary care.

Response by SFC Douglas Davis made May 31 at 2016 11:45 AM

SFC Douglas Davis — Tue, 31 May 2016 11:45:18 -0400

I used a NP in Colorado Springs for the last ten years. As I discovered last September the VA is like the Yugo of healthcare and my NP will not use his VA benefits he calls Tricare the Camaro of Healthcare. Great bang for the buck. He also explained why two of the Meds that were working on me were suddenly gone. You can get them through Tricare, Medicare ect but the government will not let VA use them. So the problems at VA are caused by a government that does not care about us.

Response by CAPT Kevin B. made May 31 at 2016 11:47 AM

CAPT Kevin B. — Tue, 31 May 2016 11:47:22 -0400

VA needs to look at it like the rural world. We have a clinic. It has a doctor (GP type), PAs, NPs, and a couple RNs. You see whatever level you need to depending on what the issue is. I look at it like I hope I don't need to see the doctor. For around 90% of what's going on, the PA/NP many times have a better handle on it because they see a lot of it. Also the PAs and NPs are more in tune with dealing with patients who are in the medical field too. Doctors like to pronounce. My wife is a respiratory therapist who has ongoing respiratory issues. She just needs to tell the PA/NP what she needs that works and they are more likely to understand sooner than the Doctor. Usually along the line she'll pass on a tidbit of pulmonary information that helps the PA/NP out. They're typically more receptive to it.

Response by PO3 Sandra Gomke made May 31 at 2016 12:53 PM

PO3 Sandra Gomke — Tue, 31 May 2016 12:53:37 -0400

I think NPs would greatly improve the wait times. I've had doctors that had great NPs who always cared about me. And that is in the civilian world. I believe they would be wonderful in the VA!!

Response by SFC Mike Edwards made May 31 at 2016 2:24 PM

SFC Mike Edwards — Tue, 31 May 2016 14:24:27 -0400

That's just another line of BSing is veterans. Just by saying this would make up feel good for short time.

Response by PFC Claude Cooper made May 31 at 2016 2:31 PM

PFC Claude Cooper — Tue, 31 May 2016 14:31:58 -0400

Nurse practitioners are not doctors by definition, but are advanced nurses, I would think it depends on individual cases and severity or advance an individual medical condition is, I have to seen by a doctor who specializes and familiar with my medical condition, where a Nurse practitioner is more for general check ups, but that my opinion.

Response by LTC David Brown made May 31 at 2016 5:04 PM

LTC David Brown — Tue, 31 May 2016 17:04:21 -0400

I think it is a great plan. When I was active duty Nurse Practioners did great jobs.

Response by SFC Private RallyPoint Member made May 31 at 2016 5:04 PM

SFC Private RallyPoint Member — Tue, 31 May 2016 17:04:45 -0400

I would give a thumbs up for that. My mother saw a NP for years, she took care of her well. As you say they need to have a Dr for backup. I'm sure this would eliminate a portion of the backlog at VA.

Response by LTC Paul Labrador made May 31 at 2016 5:35 PM

LTC Paul Labrador — Tue, 31 May 2016 17:35:09 -0400

For Primary Care needs, NPs and PAs do a wonderful job at a "cheaper" rate than physicians. The issue is that when you start encroaching on physician turf (even if it's a job most don't want to do, because let's face it, primary care is not what makes you money) you start getting pushback from the AMA. They see it as money being taken out of physician wallets.......and thus the AMA's. They will give you the excuse of "scope of practice" and "level of competency"....and that would be true if an NP were to try to do brain surgery. As you said, if the case goes beyond what an NP can handle, a consultation to a physician is in order.

Response by SPC George Rudenko made May 31 at 2016 5:59 PM

SPC George Rudenko — Tue, 31 May 2016 17:59:18 -0400

I like it. I have a NP, and she is AWESOME. Many issues can be handled by NP or PA's

Response by MSgt James Mullis made May 31 at 2016 6:03 PM

MSgt James Mullis — Tue, 31 May 2016 18:03:04 -0400

I think it "could" be a great idea, as long as they do not try to "speed up the hiring process" by waiving the requirements for the nurse practitioner to complete an internship/residency program in their chosen field. I mention this because years ago, the DoD waived the residency attendance and completion requirements for Doctors and PA's. They tried to claim that increased supervision by the "team doctor" could replace three years of practice in a teaching hospital.

While on active duty, I was the beneficiary of several months of poor medical care, provided by a young PA just out of medical school who had not completed a residency program. Once I was finally seen by a Medical Doctor, he was fuming at the incompetence of the PA and told me outright that the PA did not have the experience to handle my care or the apparent sense to bring in a Doctor when he was in over his head.

Response by LCDR Jim Bowman made May 31 at 2016 6:45 PM

LCDR Jim Bowman — Tue, 31 May 2016 18:45:33 -0400

I'm not a fan of them being in urgent care, I do think they are very useful for the routine medical care that tends to bog down every day operations at the VA!

Response by SGM Erik Marquez made May 31 at 2016 6:46 PM

SGM Erik Marquez — Tue, 31 May 2016 18:46:35 -0400

I have not seen an actual doc in about 20 years now.. My PCM has been an Army PA, or now, though Tricare a NP. Im not dead yet, generally get what I consider ok help with the issues I bring about. The issues I have come up against is, I have had to be VERY proactive and involved in my care. Insisting on specialty care when needed...vice it being suggested.. follow up post labs to go over results,, a few times when follow up actions or treatment were needed.

Response by CW3 Jared Hickox made May 31 at 2016 9:59 PM

CW3 Jared Hickox — Tue, 31 May 2016 21:59:28 -0400

I've had both NP's and Dr's as primary care providers while on active duty over the past few years. I've had just as many positive and negative outcomes with each "classification." I would think, like most things, it's personality driven. As I get closer to retirement (less than 12 months) I've become more interested in the VA and it's comparisons to Tricare/Active Duty treatment. Since I will retire near a major military installation, I'll have the active duty hospital as well as the local VA hospital in very close proximity to me. I'm still very new to the retirement process, so I'm not sure which facilities I'll be able to use, but based on the number of retiree's I see at the on base hospital, I think that may be a better choice. Either way, if seeing a NP is an option to cut down extensive wait times, I see no drawbacks. As I stated, I've had both, and seen both go horribly wrong and exceedingly well. It's all about the person.

Response by SFC Matthew Mason made Jun 1 at 2016 9:50 AM

SFC Matthew Mason — Wed, 01 Jun 2016 09:50:50 -0400

I do see your point on the subject matter at hand. The biggest issue I can see happening is just that! Standard NPs not Licensed. After all, we are beating a dying horse that is losing funds just as fast as it is gaining SMs. $2.6 Billion alone last year! Our dependants are still seeing garbage local clinics. I certainly hope that something changes for the best, and soon.

Response by SGM Robert King made Jun 2 at 2016 12:47 PM

SGM Robert King — Thu, 02 Jun 2016 12:47:31 -0400

I don't see an issue either. The NP has to review most everything with a Doctor if they prescribe certain drugs or send you off to specialty care. This should speed up appointment wait times. A lot of NP are very experianced at at time know a lot more than some Doctors.

.

Response by CW2 Michael Mullikin made Jun 3 at 2016 12:27 AM

CW2 Michael Mullikin — Fri, 03 Jun 2016 00:27:00 -0400

NPs? why not corpsman, for the same reasons—and they're even cheaper.

Response by Maj Kim Patterson made Jun 3 at 2016 10:33 PM

Maj Kim Patterson — Fri, 03 Jun 2016 22:33:29 -0400

Lt Col John (Jack) Christensen I have worked professionally as a nurse alongside Nurse Practitioners(NPs), Physician Assistants (PAs) and physicians in many different specialty areas. I have also been cared for by professionals in each category. It has been my experience that NPs and PAs have a much better working knowledge of what's going around and what works. They also have superior critical thinking skills. As they worked with my patients, I felt confident that my patients were in excellent hands and at the moment, I can't even remember an exception. For my care, I have received professional compassionate care from NPs and PAs. They have taken the time to listen and respect my knowledge as a nurse. I have also worked with some great doctors and received excellent care. Unfortunately, I can name names of several incompetent doctors and I wonder how they are still in practice. While in the employ of the VA, one specialist supervised the overdose of a medication 10 times the amount that should have been given. Obviously I lived but that had been the second time he'd "cared" for me that nearly resulted in my death. The other instance occurred at a civilian hospital. I would happily have anyone care for me other than that highly paid specialist. And perhaps I am fortunate, having practiced in a couple of states to have worked with the good ones, but it would definitely be a thumbs up for me to use NPs.

Response by SGT Michael Kiumbe Reynolds made Jun 4 at 2016 5:46 PM

SGT Michael Kiumbe Reynolds — Sat, 04 Jun 2016 17:46:38 -0400

Warns for me!

Response by MGySgt Rick Tyrrell made Jun 6 at 2016 9:42 PM

MGySgt Rick Tyrrell — Mon, 06 Jun 2016 21:42:16 -0400

I agree why is this a big deal? It has happened before and worked fine. People have many other problems that can help instead of complaining.

Response by SFC Pete Kain made Jun 10 at 2016 12:11 PM

SFC Pete Kain — Fri, 10 Jun 2016 12:11:18 -0400

I actually prefer the P.A's, my last experience with one was OUTSTANDING.
Of course he was a S.F. medic (retired)
And yes they cut they wait times down.

Response by CSM Thomas McGarry made Jun 10 at 2016 1:05 PM

CSM Thomas McGarry — Fri, 10 Jun 2016 13:05:39 -0400

Your spot on Sir-A nurse practitioner is licensed for their level of practice. To tell you the truth there are times it may be better to see a NP or a PA as they may not be as busy as a MD and can spend more time in diagnostics etc. In the interest of disclosure both my parents who are now deceased and a sister are or were MDs.

Response by Capt Seid Waddell made Jun 13 at 2016 1:27 AM

Capt Seid Waddell — Mon, 13 Jun 2016 01:27:22 -0400

Our local urgent care facility is run very efficiently, with minimal wait times.
One sees a candy striper first to log the information, then a nurse practitioner to determine the next step. If the NP can take care of the problem they will do so; if the problem requires further care an intern is called in. When required, the doctor is called in to treat the patient.

It is called triage.

Response by SPC Sheila Lewis made Jun 15 at 2016 1:01 PM

SPC Sheila Lewis — Wed, 15 Jun 2016 13:01:10 -0400

If I were a Nurse Practitioner I would be so happy for the work.

Response by TSgt Jay Nottingham made Jul 3 at 2016 11:25 AM

TSgt Jay Nottingham — Sun, 03 Jul 2016 11:25:08 -0400

From my experience here at our local VA clinic, the Nurse Practitioners are hands down the favorite. They take the time to listen, and respond, rather than listen to your heart, and jump up, calling that a physical.
Give me one of them over a regular MD any day of the week, and twice on Sundays.

Response by Maj Pamayla Darbyshire, MSN/CNS made Jul 29 at 2016 11:17 AM

Maj Pamayla Darbyshire, MSN/CNS — Fri, 29 Jul 2016 11:17:01 -0400

as an APRN (masters/clinical nurse specialist) and having worked with NPs and PAs in military health, i too see no big deal with having NPs give health care. i'd like to see them actually put us into the mix and ease some wait times in areas that are backlogged.

Response by MSgt Ken Flood made Oct 7 at 2016 2:03 PM

MSgt Ken Flood — Fri, 07 Oct 2016 14:03:09 -0400

I personally utilize the Nurse Practitioner at my civilian Doctor's office all the time. He takes his time with me and my wife and we don't feel rushed to get out of his office, unlike when we see the Doctor himself

Response by CMSgt Clark Mixon made Nov 22 at 2016 10:28 PM

CMSgt Clark Mixon — Tue, 22 Nov 2016 22:28:42 -0500

Not much. Most at VA need the attention and treatment by doctors, not nurses. Clinics are ideal places for nurse practitioners.

Response by TSgt Jay Nottingham made Dec 1 at 2016 4:50 PM

TSgt Jay Nottingham — Thu, 01 Dec 2016 16:50:09 -0500

My own experiences with the VA Nurse Practitioners is excellent. In my own opinion, they are more up to date on technology, than the older MD's who are not as proficient. Give me a nurse practitioner any day of the week, over an MD.

Response by MSgt Thelbert (Whitey) Roark made Dec 2 at 2016 12:03 AM

MSgt Thelbert (Whitey) Roark — Fri, 02 Dec 2016 00:03:35 -0500

My Primary Care Doc for the last five years has been a NP. No complaints from me. If I need/want to see a specialist she sends me to the VA in Durham.

Response by LCDR Private RallyPoint Member made Dec 6 at 2016 11:30 AM

LCDR Private RallyPoint Member — Tue, 06 Dec 2016 11:30:12 -0500

Nurse Practitioners are used in rural areas as well to extend many a physician's practice. Of course, the VA should use NP's. However, in most governmental organizations (including the VA), the wheels of progress grind terribly slowly. Bureaucracy is highly resistant to CHANGE.

Response by PO2 Mike Vignapiano made Dec 7 at 2016 11:49 AM

PO2 Mike Vignapiano — Wed, 07 Dec 2016 11:49:37 -0500

In my civilian & military experience, I prefer an NP over a doctor. They tend to give more time and listen more. They are not as stringent to the AMA and are willing to try other things besides the traditional ways . at least that has been my experience.

Response by LCDR Private RallyPoint Member made Dec 25 at 2016 9:28 PM

LCDR Private RallyPoint Member — Sun, 25 Dec 2016 21:28:36 -0500

I am a retired naval officer. My wife and I live considerable distance from any military or VA facilities because we chose country life. We live about seven miles from a small town where we receive most of our health care via a Nurse Practitioner, supplemented as need by a physician (Internal Medicine). We are very pleased with the Nurse Practitioner who spends more time with us as patients. She is very through, and not afraid to discuss items with the doctor if need be. I believe a well managed (key words) Nurse Practitioner program at the VA would improve the quality of services by that institution.

Response by SP6 Ron W. made Dec 28 at 2016 8:42 AM

SP6 Ron W. — Wed, 28 Dec 2016 08:42:34 -0500

Yes, they should. I have worked with & been treated by them with no problems.

Response by CW2 Jacob Bender made Jan 14 at 2017 5:38 PM

CW2 Jacob Bender — Sat, 14 Jan 2017 17:38:58 -0500

The VA should use televisions to ease long waiting times.

Seriously - you'd be surprised how much people don't mind waiting if they have something to hold their attention.

Response by CW4 Billy Dove made Jan 19 at 2017 1:04 AM

CW4 Billy Dove — Thu, 19 Jan 2017 01:04:50 -0500

The VA uses Physician Assistants.

Response by PO1 Leo Scott made Sep 22 at 2017 8:19 PM

PO1 Leo Scott — Fri, 22 Sep 2017 20:19:54 -0400

We have had them in the local VA clinic. I also have had them many times with my civilian doctors. Some of them have been far better than some with MD after their names

Response by LtCol Robert Quinter made Sep 22 at 2017 11:52 PM

LtCol Robert Quinter — Fri, 22 Sep 2017 23:52:02 -0400

I've been handled by a NP at the Lebanon Pa VA for about 15 years now. She saw me through heart surgery, kidney cancer and a bushel basket of other things that kill people. She pays attention to my conditions and know the VA system. As a retiree and an old guy, I've got Medicare and Tricare of life as a back-up, but don't feel comfortable with civilian physicians because so many are totally ignorant of service related problems. My NP has played it perfectly. She knows what the VA is capable of in our region, and when she feels my condition requires more immediate care than the VA can provide, she doesn't just send me out in town, she makes the arrangements, briefs the civilian physician or surgeon, then follows up. Who could ask for anything more?

Response by PO1 Tony Holland made Sep 23 at 2017 8:42 AM

PO1 Tony Holland — Sat, 23 Sep 2017 08:42:35 -0400

At the Dallas VA Hospital the hypertension clinic is run by a Nurse Practitioner with a Doctorate degree. After he modified the medications I was using my blood pressure finally stabilized for the first time in twelve years and at a much lower rate. Kudos to Harry Scher, DNP.

Response by SPC Joe Renforth made Dec 23 at 2017 6:47 AM

SPC Joe Renforth — Sat, 23 Dec 2017 06:47:57 -0500

My current private health care is a Nurse Practitioner.

Response by LTC James McElreath made Jun 11 at 2018 12:01 AM

LTC James McElreath — Mon, 11 Jun 2018 00:01:32 -0400

My present Doctor is a Nurse Practioner and much more professional than the doctor check replaced!!

Response by Capt George Kent Brashear made Jul 15 at 2018 5:42 PM

Capt George Kent Brashear — Sun, 15 Jul 2018 17:42:53 -0400

Colonel Christensen, I use the VA exclusively for all of my medical care at the Temple VA Medical Center in Temple, Texas. There in the specialty clinics nurse practitioners and physician assistants are used. It's my opinion that they give better care than the MDs.

Response by SSgt Patrick Driscoll made Nov 30 at 2018 12:35 PM

SSgt Patrick Driscoll — Fri, 30 Nov 2018 12:35:07 -0500

Have a NP for all my "Doctor" appointments. Trust her as much as any doctor on the staff.

Response by MSG James Cary made May 11 at 2019 10:56 AM

MSG James Cary — Sat, 11 May 2019 10:56:16 -0400

You got it Lt Col John, would be smart move so the VA will kick it down the street for a while. The VA will allow it's contractors they (the VA) use to evaluate us for disability to use NP's.

Response by SPC Kenneth Hales made May 13 at 2019 11:13 PM

SPC Kenneth Hales — Mon, 13 May 2019 23:13:18 -0400

No they should not,,, the VA is using them in giving evaluations that effect disabled veterans lives and they are not even doctors but are giving medical opinions about special injured areas of veterans and they have no clue what they are doing,,,, all of them here in Murfreesboro, TN does not even know basic laws of physics that impact Disabled Veterans Lives,,,, but the administration listen to them anyways,, and they constantly lie about the veterans to keep them from receiving benefits or increases.... The VA should only be using specialists in the particular field of what a veteran is being seen for.

Response by SFC David Reid, M.S, PHR, SHRM-CP, DTM made Aug 1 at 2019 10:05 AM

SFC David Reid, M.S, PHR, SHRM-CP, DTM — Thu, 01 Aug 2019 10:05:53 -0400

YES!

Response by SFC Terry Wilcox made Sep 17 at 2019 7:24 PM

SFC Terry Wilcox — Tue, 17 Sep 2019 19:24:55 -0400

I concur, there are instances where a Nurse Practitioner would be the better point of contact. An MD can be called in where necessary - so long as the facility doesn't rely on a simple MD to be on duty [other than light-duty periods]. NP's can improve the overall efficiency of a medical facility - again providing!

Response by LTC Charles T Dalbec made Nov 14 at 2019 2:24 PM

LTC Charles T Dalbec — Thu, 14 Nov 2019 14:24:15 -0500

The VA should bring on the ‘Assistants’
ASAP

Response by PO1 Doc Dennis made Nov 14 at 2019 4:26 PM

PO1 Doc Dennis — Thu, 14 Nov 2019 16:26:37 -0500

Hell yes they should. As a veteran corpsman with both combat and independent submarine duty I spent a great deal of my career with no close or immediate backup! First, the Nurse Practitioner and PA both have extensive training specifically for their responsibilities. Second, they usually have access to immediate support when needed. Third, I have been seen by both over the years and many times would rather have them than a physician. And finally, I hold my service responsibilities as an HM in reverence and they care for their patients just as much! In fact, they usually spend more time with their patients than the doctors! In fact, many are also prior service corpsman!

Response by MSgt James Littlejohn made Jan 2 at 2020 8:14 PM

MSgt James Littlejohn — Thu, 02 Jan 2020 20:14:28 -0500

NPs are extremely well educated and trained as first lined providers. They are well qualified to determine what patients need to see MD specialist; thus making the serious ill patient lines shorter so those patients can see specialists sooner. A NPs education and training is much greater than a typical PA. I’m not saying anything is wrong with PAs.

Response by PO1 Bob Richardson made Feb 10 at 2020 11:26 PM

PO1 Bob Richardson — Mon, 10 Feb 2020 23:26:35 -0500

A nurse practitioner saved me from migraine/ cluster headaches that I suffered from for 12 years! Something that Dr.s couldn't do ,or wouldn't do. She worked at Audie Murphy Hospital in San Antonio, Texas. Now lives in New Mexico. God Bless her.

Response by CWO5 Ray Lee made Mar 27 at 2020 6:36 PM

CWO5 Ray Lee — Fri, 27 Mar 2020 18:36:44 -0400

My VA health provider is a NP. Been seeing him for years. Good guy!

Response by SGT David A. 'Cowboy' Groth made Apr 6 at 2020 10:04 AM

SGT David A. 'Cowboy' Groth — Mon, 06 Apr 2020 10:04:23 -0400

I honestly don't see why they shouldn't.

Response by MSG Brenda Neal made Sep 12 at 2020 6:46 PM

MSG Brenda Neal — Sat, 12 Sep 2020 18:46:37 -0400

What I encountered was NPs making decisions without consulting a doctor. VA policy changes to suit their staff, not their patients. Physicians Assistants are far more qualified and who can get access to a doctor not seeing patients themselves is ideal. NPs do not refer to females only as has been traditional nor PAs being male. Their daily notes and prescribed drugs need double checked. I don't agree with NPs prescribing at all. Learned by experience.