r/healthcare

I’m a neurosurgeon at a large hospital and something happened recently that turned into a complete mess politically.

We have an NP who works with the hospitalist service. Honestly, clinically she was fine, no big red flags. Nurses liked her, patients liked her, never really had major complaints. Very confident personality.

A few months ago I started noticing patients referring to her as “the doctor” during consults. At first I assumed they were just confused because that happens constantly in hospitals. But then one patient specifically told me:

“Your hospitalist doctor already explained all this to me.”

I mentioned the NP by name and the patient goes, “Yeah, her.” Then I corrected them, it was actually an NP and he didn’t seem to care much.

Still didn’t think much of it.

Then one of the ICU nurses mentioned that the NP almost never corrected patients when they called her doctor. Apparently she’d say things like “I’m with the hospital medicine team taking care of you today” and just let patients assume whatever.

Things escalated when a family member filed a complaint because they later found out she wasn’t a physician after believing she was “one of the doctors managing the case.”

Administration reviewed it and apparently there were multiple witness statements from staff saying they’d heard her introduce herself vaguely before. One MA even claimed the NP once said, “It’s easier if you don’t overexplain titles to patients.”

What completely buried her was social media.

Someone found her LinkedIn where she listed herself as “Doctor of Hospital Medicine” because she had a DNP. Legally maybe defensible academically, but optics-wise it looked horrible once compliance got involved.

The medical staff office and legal department apparently lost their minds over it because neurosurgery, trauma, ICU, etc. all involve high-risk consent discussions and patients need to know exactly who is and isn’t a physician.

She was terminated last Friday.

Now the hospital suddenly has mandatory scripting for introductions.

“I’m Jane Smith, nurse practitioner with the hospitalist team.”

No deviations.

Personally, I’m happy to see hospital admin doing something about this shit. It’s getting out of hand…

Edit: I fucking used chat gpt to help me make it grammatically sound and so I could drive the point home without making it sound discombobulated, it’s AI written but it’s a true story.

Hello,

I am enrolling at a new employer and it is the first time im considering a high deductible plan + HSA.

I typically select a PPO plan in the 2k-3k range.

My wife and I are in our 30s with a 5 year old and a 1 year old. No outstanding health complications, but we have had to visit urgent care before for the kids.

Would anyone be able to tell me if the hdp us hsa is a no brainer? I am concerned I will switch and regret my choice later.

Here are the stats for a family plan for either plan.l:

YOUR COST

You + Family

PPO$48.49 | HSA $0.02

HSA CONTRIBUTION

Employer HSA Contribution if on HDP

$150 (Monthly). No minimum employee funding required.

DEDUCTIBLE & OUT OF POCKET

Yearly Deductible

PPO $2000/person or $6000 family for in network $6000 individual/ $18,000 family for out of network.

HDP $2500/person or $5000 family for in network $4000 individual/ $8000 family for out of network.

Out‐of‐Pocket Maximum

PPO $6000 person or $12000 for family in network. $12,000 individual or $24,000 for out of metwork

HSA $3425 person or $6850 for family in network. $10,000 individual or $20,000 for out of metwork

DOCTOR VISITS

Preventive Care

$0 copay per visit either plan

Primary Care

PPO $45 copay per visit | HSA $0 +0% after deductible

Specialist Care

PPO $75 copay per visit | HSA $0 +0% after deductible

PHARMACY (per 30-day supply)

Generic (Tier1)

PPO $20 copay | HSA $20 copay (after deductible)

Preferred Brand (Tier2)

PPO $55 copay (after prescription deductible) | HSA $50 copay (after deductible)

Non-Preferred (Tier3)

30%* Either Plan

URGENT CARE AND EMERGENCY ROOM

Urgent Care Visit

PPO $75 copay per visit | HSA 0% (after deductible)

ER Visit

PPO $600 copay per visit (waived if admitted) | HSA 0% (after deductible)

Thank you!

Edit: updated deductible and out of pocket max to reflect both individual as well as family as i think that is where I caused confusion!

Valley Health has decided to replace the physicians of Emergency Medicine of Blue Ridge with a private equity company currently based in Atlanta GA called SCP. The American Academy of Emergency Medicine (AAEM) is a national professional association representing over 8,000 specialists in emergency medicine (EM). We are concerned that the physicians of Emergency Medicine of Blue Ridge have been informed that, as of October 1, they will need to be employed by SCP Health in order to continue to care for patients in the emergency departments of Valley Health system. The AAEM endorses the notion that local physician ownership of their practice is the best arrangement for physicians, the medical staff, the hospital, and, most importantly, for the patients. SCP Health is owned by the private equity firm Onex. (1)

No offense to nurses at all, because nurses are absolutely essential and deserve respect. But I genuinely think Nurse Practitioners should require at least 10+ years of real bedside experience in the SAME field before being allowed to practice independently.

A lot of people are literally finishing nursing school and immediately planning to go become an NP. Some are even doing major parts of their education online. Meanwhile hospitals are giving these people insane levels of freedom to diagnose, prescribe medication, and give medical advice with little to no supervision depending on the state.

And yes, nursing IS medical, but nursing has traditionally been centered more around patient care, monitoring, support, and bedside treatment. Doctors go through years and years of clinical-focused training specifically centered around diagnosing, pathology, treatment plans, and complex medical decision-making. Those are two different things.

So why should someone with 3–5 years of nursing experience suddenly be allowed to operate almost independently giving patients medical advice? Especially when physicians go through residency, fellowships, brutal clinical hours, and constant supervision before they’re trusted alone?

If you want that level of responsibility, either:

Go become a doctor

or

Require a MINIMUM of 10+ years experience before independent NP practice.

And before people get mad….yes, there are AMAZING NPs. Some of the best providers I’ve met were NPs. But almost every great NP I’ve encountered had 10–20 years of experience first. You can feel the difference immediately. They’re knowledgeable because they’ve actually seen things. They’ve worked the floor. They’ve dealt with patients for years.

But hearing brand new nurses say:

“Yeah I’m going to nursing school and then immediately becoming an NP. I can do the work online but my clinical are in person. It’s not bad. ”

is honestly terrifying.

I’ve worked as an RN in BC and Alberta for 8 years across multiple hospitals, and the situation inside many Canadian hospitals feels completely detached from what the public thinks healthcare currently is.

We are told there are “bed shortages,” “hallway medicine,” and dangerous ER wait times because of staffing and funding pressures — which is true — but a major part of the conversation that nobody wants to openly discuss is how many acute care beds are being indefinitely occupied by patients who no longer require acute hospital-level care.

A growing number of admissions are tied into homelessness, addiction, behavioural concerns, inability to discharge safely, or lack of supportive housing placements. Once admitted, some patients remain in hospital for months or even years because there is nowhere else for the system to place them. If they came from the street, they can’t go back to the street

Meanwhile the burden falls directly onto bedside nurses, care aides, security, and other patients.

And yes, after years of this, resentment starts building among staff. I think many healthcare workers are afraid to admit that publicly because they’ll immediately be accused of lacking compassion.

But compassion fatigue is real.

Last week we responded to a code situation involving a patient smoking meth/crack inside a hospital room. Nearby patients had to be relocated, staff had exposure concerns, security became involved, and the patient ultimately required a blocked room and additional monitoring resources. And a blocked room in Canada is basically a private room- what people pay large money for.

Staff also deal with constant theft issues that never get talked about publicly. Supplies disappear, food gets taken, belongings get stolen from unsecured areas, and even staff lockers are targeted in some hospitals. Nurses are expected to tolerate increasingly unsafe and chaotic environments while still providing compassionate care under constant pressure.

Situations involving intoxication, aggression, threats, verbal abuse, disappearing from the unit for hours, returning impaired, demanding narcotics, refusing care, or creating unsafe environments are no longer rare events in some hospitals. They are part of normal workflow now.

One patient on our unit has occupied a bed for over a year while openly discussing how much money they’ve saved on disability because they effectively have free housing, meals, medications, nursing care, and security inside the hospital system. Meanwhile admitted patients wait in emergency departments for beds and elderly patients are placed in hallways.

That creates moral frustration for staff whether people want to acknowledge it or not.

This does not mean every homeless or addicted patient behaves this way. Many are respectful and genuinely sick. But there is also a subset of chronic high-utilizer patients who understand exactly how difficult discharge laws and policies have become, and staff are left managing the consequences indefinitely.

The public conversation around healthcare in Canada often focuses entirely on funding and staffing shortages while avoiding discussion about how hospitals have become catch-all institutions for addiction, untreated mental illness, homelessness, violence, and social system failures.

Acute care hospitals were never designed to function this way.

Nurses are burning out because they are expected to simultaneously provide high-level medical care while also acting as security, social workers, addiction support, behavioural management, and crisis response — often with little institutional support and increasing exposure to violence and abuse.

I’m curious how many other Canadian healthcare workers are seeing the same thing in their hospitals, because from the inside it feels like the system is reaching a breaking point.

I know I want to work in medicine. The only thing tearing me between nurse or physician is how much I value patient/family connection. I want to work in the ICU or ER.

What I love about being a doctor is the knowledge and extensive education that they have. I love to learn and especially about scientific processes and the human body.

Nursing? I like the hands on patient care. I know I personally remember my nurses more when I was in the hospital, and all the doctors I had I didn’t like (maybe I just had bad doctors).

I’d love to hear from any doctors, do you feel like you have an impact on patients lives emotionally? Or just medically? (and any nurses who have observed this!)

Thank you!!

I have Ankylosing Spondylitis which is a chronic illness that sometimes makes it hard for me to find jobs. I’m on an expensive biologic medication every other week. On Medicaid it’s $4 copay, but now that I got this job that pays $51,000 a year I will most likely lose my insurance correct?

The insurance my job offers would be $700 a month for my family plan, since they would lose Medicaid because of my new job as well. Then my medication should be a copay of $300 each month for specialty meds they say.. then doctor visits which I need to have regularly are $70 copay.

At this point is it even worth it should I actually not take the job and stick with my lower minimum wage job while looking for a job with better benefits or is this the norm?

I’m 26 so I’ve been on my parents insurance before this year so I have no experience with this stuff. Thanks!

The more I read about different healthcare setups, the more it feels like the average person is expected to make huge financial decisions without actually understanding how these systems are structured

people use the same words for completely different models:

insurance

networks

benefits

coverage

plans

but behind those labels, some setups are traditional policies, some are employer-style arrangements, some are tied to participation systems, and others are more membership-based

then people compare all of them using the exact same expectations and get frustrated when the experience doesn’t match what they assumed

honestly feels like healthcare has evolved faster than the language people use to describe it

curious if others think the real issue is less about “which option is best” and more about people not understanding what category they’re even dealing with anymore

There are special requirements for these careers. I am turning 38 this year and I've been doing a massive amount of research into many different fields that my community college offers. I want to get out of the warehouse type of work and atmosphere with all the slangs and profanity that's often used in that area of work.

I know that these three are very competitive and getting in usually means getting the highest grades possible in pre-res . Recently I completed CHM 114 - General Chemistry for Engineers at Arizona State University. Which is a 4-credit course and I finished with an A (93%).

Nursing -

1. Completion of Biology with B(83%) or higher
2. Completion of Chemistry with C(735) or higher
3. GPA of 2.7 or higher
4. Completion of TEAS with 60% in each section (Reading, Math, Science, and English)
5. One(1) recommendation form

RadioLogic Technology -

1. Completion of Anatomy & Physiology I and II with B(83%) or higher
2. GPA of 2.7 or higher
3. Three(3) recommendation form
4. Resume

Medical Laboratory Technology -

1. Completion of Biology with C(73%) or higher
2. Completion of Chemistry with C(73%) or higher
3. GPA of 2.5 or higher

What do you think will be the best path for me to go down? If any of these will matter about my age (turning 38 in a few months), working full-time (40 hours), Once I graduate which will help me get a job, Which will be most difficult to get into at community college, if it's hard to get into what would make things much easier, any anymore things that you would love to add that's great advice for me?

in conclusion, I am willing to go all in on this life changing decisions. I really want out of the warehouse atmosphere slang lingos. I don't want to start something then a year in think that I'm wasting my time. This is going to help me down the road for the rest of my life and I am ready to start this change now with all of your help.

Thank you in advance

After outpatient eye surgery a few weeks ago, MyChart pushed me the intraoperative note within hours. I've worked in healthcare my whole career and I still didn't fully understand what I was reading. So I dropped it into Claude. It explained the procedure and flagged that my surgeon had improvised mid-operation in a way I would have completely missed.

That moment did something the phrase "give me my damn data" never quite did for me. It made the knowledge-and-power thing concrete. Data you can't read is paperwork. Data plus expertise is standing.

So I built OwnChart. Open source, self-hosted, patient-owned. It pulls your record from most major EHR patient portals (Epic, athenahealth, Oracle Health, NextGen, ModMed and others), brings in HealthKit and wearables from the iOS app, lets you attach photos and life events, and lets you chat with all of it.

You pick the LLM vendor and model. Your data stays on infrastructure you control.

It's in alpha. It is not trivial to install. The README is honest about which EHR vendors are easiest to register with (Epic is essentially auto-approved; others take 1-2 days of review). I'm looking for the curious, the technical, and the brave.

• Code: github.com/nickpdawson/OwnChart
• Site + demo: OwnChart.me
• iOS preview on TestFlight: https://testflight.apple.com/join/z8QemcTe

Major inspiration and architectural credit: Hugo Campos's (huge tour de force in the ePatient movement) OpenKP and his Critical AI Health Literacy skill, which OwnChart uses as a foundational prompt layer so the LLM behaves like an empowering clinical expert.

Happy to answer questions, take bug reports, or debate about the design choices.

I'm new and the office portion of where I work has some very cheap pens that are crusty and need thrown away. Like they're wobbly you can't even write unless you hold it a certain way so it dosen't come apart.

I have decided to take it upon myself to get new pens.

What is the Cadillac of ink pens in healthcare? I prefer sharpie felt tip but they are manual caps (no clicking in and out) and I know that won't fly in this setting. What about sharpie s gel?

My practice has been evaluating new patient engagement platforms for about a month. Narrowed it to six vendors, sat through six demos, most of them 45-60 minutes with a follow-up technical call after.

The plan was always to build a comparison spreadsheet at the end. Pricing, integration list, support model, contract terms. Something the partner physicians could actually look at before our decision meeting next Thursday.

I sat down today to start filling it in. Two cells in I got stuck. Vendor C and Vendor E both had per-location pricing but one of them had a per-provider rider after the third provider per location, and I can't remember which. My notes say "PPL after 3" next to one and just "tiered" next to the other. Worthless.

This is a six-figure decision over the contract term and I'm doing comparison work from chicken scratch and memory. I sat there trying to mentally rewind the demos and they're already blending. The two younger reps with the same haircut do not help.

I can email both vendors and ask. I will. But what I actually want is to know in advance which of the other forty things I half-wrote down are going to bite me three months into implementation when somebody says wait, didn't they tell us X. By then the reps will all swear they said the right thing and I won't have a way to prove otherwise.

Still chewing on a better way to run the next round of this whenever it comes.

Family of 4, I pay $1400 a month for a united healthcare HDHP.
First scenario - 12 y/o daughter is struggling with some pre teen acne. 6 months to get into local dermatologist, so we call her pediatrician and the receptionist sets the appointment.
We show up, doc comes in and says “sorry, we don’t treat acne here, go see a derm”.
I get a bill in the mail for $94 a few weeks later. The whole ordeal took 30 seconds of her time. I called to dispute it and they told me to kick rocks.

Second scenario - oldest daughter forgot to tell us she ran out of her Vyvance (adhd meds), prescribed through her pediatrician.. on a Saturday.
We called and got the nurse on call who told us sorry about your luck.
I called the pharmacy, they recommended we go to urgent care.
Went to urgent care, they basically thought I was a tweaker trying to make meth, told me to pound sand. Whole ordeal at urgent care again took 2 minutes.
$195 bill just arrived in the mail.

How do you fix a system that is beyond broken? This is insane.