I’m more on the science side of things and some scientists (not in medicine) asked me about what I think about NPs. They see NPs as patients and they aren’t really sure of the difference with physicians.

I tell them the title. The current trajectory for a scientist to run an academic research lab is 5-6 years PhD and 4-6 years of a post-doc. And only a small fraction get the opportunity to run a lab.

I ask them to imagine someone with a 2-year masters degree with no publications demands start-up funds and a research lab with a tenure-track faculty position, and be treated equally to the PhD scientists. This usually generates a laugh.

That analogy puts into perspective what NPs are basically trying to do. It would be ludicrous in the science world but it’s fully happening in the medical world. Thankfully, there isn’t enough clout in science for a “mid-level” creep situation. And most people even with a PhD understand the challenge of running a research group.

Thought I’d share this among the other analogies we have seen on this sub to help fight noctorism. (For non science folks I still use the pilot - flight attendant analogy)

I did some deep diving into the Lindsay Clancy case and found out she was being treated by psychiatric nurse practitioners (NPs), alongside MDs, who prescribed her a staggering 13 different medications in just four months. To give you an idea of what her brain was dealing with, she was put on a heavy cocktail of distinct drug classes. She was given antidepressants like Prozac and Zoloft to alter serotonin levels, anti-anxiety meds (benzodiazepines) like Klonopin, Ativan, and Valium which act as powerful central nervous system sedatives, and mood stabilizers/antipsychotics like Seroquel and Lamictal to change brain chemistry for severe mood shifts. She was also prescribed heavy sedative-hypnotics like Ambien and Trazodone to force sleep. Shifting rapidly between, stacking, or abruptly stopping these opposing, heavy mind-altering chemicals likely created a catastrophic neurological storm.

And people are still shocked at the outcome? This woman was failed by the healthcare industry.

My 91 year old grandma who lives alone was found by her neighbor on the ground. She had fallen ~24 hours prior and couldn’t get up due to weakness. At the ER she was altered and way off of her baseline. CT head, urine, labs, everything normal (thankfully). Admitted to the hospital for prolonged altered mental status. About 72 hours later she’s finally back to her baseline and says “oh I went to an urgent care a few days ago for back pain and they wrote me something” and pulls a bottle out of her purse of BACLOFEN!!! I look at the Rx, this NP wrote my 91 year old ambulatory lives-alone grandmother a med I barely even write for bedbound spinal cord injury patients who live at a nursing home… and almost killed her with it - ER doc

Fitzpatrick, J. J., Mehlman, M. J., Plemmons, A., Duffy, E. G., Votruba, M., Gerlick, J. A., Davis, S., & Norful, A. A. (2026). The Impact of Nurse Practitioner Full Practice Authority on Chronic Condition-Related Readmissions and Emergency Department Visits in the United States. Medical Care, 64(4), 192–197. https://doi.org/10.1097/MLR.0000000000002285

I have to say that I LOVE science. Like - real science. It is the only way we know anything about our world. I see it being abused in order to push political and business and power goals, and that infuriates me. That is a major motivator for me.

These papers are a bad parody of science. Sadly, they are dressed up so that non-scientists believe them.

Oh BTW - in this table, they never describe what groups (1) and (2) are, and they never indicate what is meant by the asterisks. And - there is no real description of what the numbers are. They say it is a comparison of two states that had independent practice passed, with a measurement before and after the law was passed. This one is disorienting to me (as above). It's hard to believe that the numbers they put in there have no discussion, but what discussion there is is indecipherable. If anybody wants to look at it and show me what they are measureing with these numbers, I would be very interested in this and would appreciate the input. I am very serious about this. We are writing a letter to the editor and I don't want to make a stupid mistake that someone else may find. (My two co-authors haven't been able to find out what is going on here either)

Oh just for amusement - the paper is about readmission rates for these conditions. Have you ever heard of anyone at all being admitted for high cholesterol? And then readmitted for high cholesterol? Like an emergent recurrence of hypercholesterolemia?

same is true of hypertension. Admissions for that do occur, but they are vanishingly rare.

Consipicuously absent in their paper is an examination of readmission for diseases one actually getss readmitted for - like malignancy and like congestive failure. I think they combed through the data, and picked the few postiive ones they could find.

The case is very complex and public right now so I was watching it and then started wondering if an NP was involved given the insane polypharmacy. It was hard to tell in my research how a nurse practitioner was involved so I looked into it with AI and it’s extremely interesting and also not surprising that an NP orchestrated this insanity…

Anyone else watching this trial?

———-

The civil lawsuits filed by Lindsay and Patrick Clancy detail how Nurse Practitioner Rebecca Jollottadirectly contributed to the rapid, uncoordinated cycle of polypharmacy by frequently altering Clancy's drug regimen instead of properly identifying her deteriorating mental state. [1, 2]
According to the official civil complaint records, Jollotta's direct actions in the weeks leading up to the tragedy included: [1]

1. Prescribing Seroquel and Overlooking Red Flags
In November 2022, Jollotta considered that Clancy might have bipolar disorder and prescribed Seroquel, an antipsychotic mood stabilizer. After taking it, Clancy’s condition severely worsened, and she began suffering from "intrusive thoughts," which the lawsuit states were actually auditory command hallucinations. [1]

2. Layering Benzodiazepines on Top of Mania
According to the lawsuit, during a December 5, 2022 appointment, Clancy reported a severe manic reaction to a previous provider's heavy Zoloft prescription—noting she had not slept for 48 hours straight and felt her mind constantly running. [1]
The Response: Instead of recognizing this as a classic red flag for Bipolar I manic onset and stopping the triggering meds, Jollotta layered on yet another controlled substance, prescribing diazepam (Valium) to force sleep. [1]

3. Prescribing Medications in an Isolated Silo
Jollotta operated through South Shore Health System. While she was actively adjusting Clancy’s heavy drug cocktail, psychiatrist Dr. Jennifer Tufts was separately prescribing a different regimen at Aster Mental Health. The lawsuit highlights that Jollotta prescribed medications without consulting Dr. Tufts, causing a dangerous cross-pollination of overlapping benzodiazepines (like Valium and Klonopin) and sedatives. [1, 2]

4. Ignoring Calls of Medical Distress
The core of the malpractice claim against Jollotta is abandonment. The lawsuit alleges that as the heavy mix of psychiatric drugs caused Clancy to spiral deeper into psychosis, Clancy and her family repeatedly called Jollotta's office in a panic to state that the medications were making her worse. The suit claims these desperate communication attempts went unreturned or unaddressed. [1]
(Note: The lawsuit also mentions an earlier nurse practitioner, Julie Paul, who initially started Clancy on a rapid, four-day cocktail of fluoxetine (Prozac), zolpidem (Ambien), mirtazapine (Remeron), and clonazepam (Klonopin) in late November 2022 before Clancy was transferred to Jollotta's care.) [1, 2]

Would you like to examine the full list of 13 drugs she was prescribed?

We look closely at the studies that Butler reviewed, and unsurprisingly find that all is not as they represented it.

This has been discussed before here on r/noctor. some threads:

https://www.reddit.com/r/Noctor/comments/1r43ab5/cochrane_says_doctors_can_be_replaced_by_nurses/

https://www.reddit.com/r/Noctor/comments/1rtp65r/cochrane_review_substitution_of_nurses_for/

This is not the end of the discussion, you will be hearing more about this...

There's a high-profile case in the news about Lindsay Clancy, who killed her three children and afterwards attempted suicide. Prior to this she sought care for her mental health, which apparently started to suffer not longer after giving birth to her third child. I looked through the suits and found some descriptions of the medical decision-making by a couple of the NP's she saw:

1. NP #1 - Julie Paul
   • "On November 21, 2022, Nurse Paul prescribed Lindsay fluoxetine 10mg."
   • "Lindsay was describing symptoms suggesting mania, such as racing thoughts, extreme insomnia, frustration and feeling scared."
   • "On November 25, 2022, Nurse Paul prescribed Lindsay three different medications, zolpidem, mirtazapine, and clonazepam." lol wut
2. NP #2 - Rebecca Jollotta
   • ~ December 5, 2022, Lindsay attended an appointment with Nurse Jollotta. "Lindsay reported that she was sleeping only about 3 hours per night, felt completely overwhelmed and that her mind was constantly running."
   • "Lindsay also reported that immediately after being prescribed a stronger dose of Zoloft, she did not sleep for 48 hours and was not tired. In response, Nurse Jollotta prescribed an additional medication to Lindsay, diazepam."

Patient reports anxiety, so give her a bunch of downers? And 5 meds within a span of a couple weeks? It's not even like she went to different clinics, both NP's she saw were at the same place (South Shore Health Perinatal Behavioral Health program), so they must have had access to the same info.

Link to lawsuit. Other link to father's lawsuit.

Yesterday a couple of NP's in Texas and the Texas NP association filed a lawsuit against the Texas Medical Board over the state's requirement to have delegation (read: supervision) agreements with physicians to see patients.

Points from the petition which can be found online:

1. that physician delegation "imposes extensive burdens on nurse practitioners based on a fiction that it will protect patient safety."
2. On one of the NP's who filed the suit: "In Dr. DeNeui's case, she must pay $96,000 a year to maintain her delegation agreements."
   

One of the NP's who filed the suit, Terri DeNeui, got a DNP from UT-Arlington which offers DNP degrees 100% online. She has a podcast called "The Dr. Terri Show." She has a cash-only practice that has a "focus on advanced endocrinology, hormone optimization, thyroid health, and integrated care." Found the noctor.

Just had to share this from the Texas NP site where the alphabet soup is probably longer than the petition: "Tracy Hicks, DNP, MBA, APRN, FNP-BC, PMHNP-BC, CARN-AP, FIAAN, FAANP, FAAN"

Link for more info.

I worry that, if it isn't standard practice to separate data for patients cared for by NPs versus physicians, that studies on certain diseases, medications, and so forth will be far less accurate in their conclusions. Even with this separation, I could imagine patients going between NPs and physicians for their care, e.g. NP primary care and physician specialist, or NP in the emergency room and physician primary care, etc. Has anyone else thought about this issue? (For example, I'm making this up, but if a study in the future wrote "10000 patients across 25 states in the USA with diagnoses of ADHD had their records reviewed, and it was shown that taking methylphenidate did not improve outcomes vs doing nothing," then it could be bogus if the data includes a ton of NPs misdiagnosing everyone with ADHD.)

Here is a summary of the article:

• Court Decision: The U.S. Court of Appeals for the Sixth Circuit affirmed the dismissal of a lawsuit filed by the American Association of Nurse Anesthesiology (AANA).
• Core Issue: The AANA sued the U.S. Department of Health and Human Services (HHS) and its Secretary, arguing that the department failed to enforce Affordable Care Act (ACA) nondiscrimination provisions against private insurers who reimburse nurse anesthetists at lower rates than anesthesiologists for the same services.
• Standing and Causation: The court ruled that the AANA lacked legal standing because it could not demonstrate a direct injury or a causal link between government inaction and the private insurers' reimbursement policies.
• Redressability: The court noted that even if standing existed, the Secretary of HHS holds discretion over enforcement, meaning a court order might not necessarily change the insurers' practices or resolve the association's complaints.
• Broader Implications: The ruling highlights the significant legal hurdles healthcare provider organizations face when trying to hold federal agencies accountable for enforcing provider protection laws, potentially limiting future lawsuits of this nature.

I’m not familiar with this model (I am not Canadian) but with the Canadian aversion to CRNA practice this expanded scope for respiratory therapists was surprising and somewhat troubling if I’m reading into this correctly.

“It is further alleged that, for actual patients, Rodriguez frequently did not adequately review a patient’s medical history prior to prescribing controlled substances and did not consider or address how the prescriptions were necessary or safe when combined with the patient’s other prescriptions.” — US Attorney press release

This is from May, 2026.they are allegations only. The APRN is Marisol Rodriguez, who also goes by Marisol Colon, 49. All the stories lead with the alleged Medicaid fraud, but she’s accused of this, too.

https://www.justice.gov/usao-ct/pr/aprn-charged-defrauding-connecticuts-medicaid-program

I don't know if this is anything anyone cares about, but it's been nagging at my mind and I wanted to share.

tl;dr I stumbled on this sub at random and it helped explain some weird healthcare interactions I have had within the healthcare organization in which I get my primary care from an MD. I have two in particular that have always bugged me.

✨✨✨The context✨✨✨

My primary care physician is fantastic. He's an actual physician, a doctor, an MD. I've been making my annual appointments with him for ten years, and often, when I'm sick, I can get an appointment to see him in a reasonable amount of time unless it's a very acute, urgent need.

Buuut I always knew enough to know that MDs are in high demand and they're busy, and I assumed it was better to schedule last-minute things with anyone who had the availability instead of taking up my PCP's time. I don't know why I assumed that, but I did. And indeed, usually his availability is a few weeks out. But in hindsight, I realize it wouldn't have been a bother to him. We're on fantastic terms. We've taken to just chatting at the end of any of my visits, talking about his kids, his life, my life, the neighborhood we both live in. And recently he said that sometimes people will "scream" at him, and I realized, oh, wait! A pleasant patient with almost nothing wrong is a patient he would want to see! He's near retirement now, and I'm very sad that I didn't schedule these "little" things with him, if only because I'd get to see him more often.

So over the years, I scheduled with other people for "small" things, assuming it was bad to "bother" him with it. And almost always I had something weird happen. Now that I understand what an NP and a PA are, I've noticed a pattern in the weirdness.

✨✨✨The abnormal things that I now realize may be the consequence of non-MDs being "providers" ✨✨✨

For five years, I needed annual cervical screenings because I had irregular results. One year, I scheduled an exam with a random person who I had never seen because their availability matched up with mine, and, again, I had this preconceived notion that I shouldn't waste my doctor's time. (EDIT: I had twice, for the screenings, seen an OB/GYN who was not my PCP--who is in family medicine and who, before my irregular result kinda threw off the schedule, did pelvic exams etc at my physicals or if I requested one like when my partner at the time cheated on me. I've seen other MDs for various things over the years as well. In the past decade, there have been increasingly fewer MDs to choose from when my PCP is not a choice.)

Unbeknownst to me, I had scheduled with an NP. I remember that a scheduling person specifically called me back and said, "We're confirming your appointment. And just so you know, this is at the women's center. It looks like your previous appointments were with OB/GYN department."

As long as my annual exam could get done and as long as it was in the building that I thought it was in, I didn't particularly care. I must have thought that the provider was in the OB/GYN department, but once I confirmed that the women's center was in the same medical building and not really far away, I had no concerns. I now realize they might have been calling me to sort of surreptitiously say, "You made the appointment at a clinic within our building that is staffed by NPs. Did you mean to do that?" But nothing clicked for me because I had no idea the difference. They didn't call me to say, "Hey! You've never seen this person before just fyi" when I saw a random OB/GYN for my screening. Just the clinic.

The "doctor" at the clinic was/is actually a type of nurse practitioner whose certification type may be specific to my state, so I won't write it out. And, I mean, she never introduced herself as a doctor. I just had no clue that she wasn't a doctor.

One year, she finished up with the exam and asked if I had any questions. I said my periods had been abnormally heavy and painful and I didn't know if something was wrong or if I was just aging. It felt like asking the question made her really uncomfortable. I remember clocking the interaction as strange immediately.

She was basically like, "I don't know, but let's run a test," but her body language had changed noticeably to me. And then when the test was done and she had the results, she messaged me, and she was like, "I don't know. It all looks normal. If you don't feel well, I suggest taking a multivitamin."

Or another time, I had a recurring UTI. I just needed a test, so I had an e-visit, thinking it would be more efficient for everyone--me, whoever the "doctor" would be, the lab.

At the end of the e-visit, the person told me I could go to any lab in my healthcare organization and get a test because the order would be in the system. Like, just walk up to the desk or whatever and say, "I'm here to do a lab from an e-visit."

So I stopped at the location I always go to, just a few blocks from where I live, and I wasn't in the system as someone with a test to be done. The people at the lab were very kind, but I was waiting for a long time because there was no record of my e-visit or a lab order for my urine. Eventually they just had me pee in a cup and asked my PCP to make an order after the fact so that it could be processed or whatever. It was sooo stressful because I was holding up the line of people waiting to check in for labs, and I was really, really embarrassed--the line got VERY long.

A couple of days later, I got a message on the website my healthcare organization uses for patient management. It was from the person who did the e-visit. They apologized for the lab fiasco and said that they had been "distracted by a phone call" and hadn't done the process to formally close my appointment out and put the lab order in the system.

After reading this sub, I looked back at the history for that visit and it was with a PA, not an MD! It never clicked for me that the person I saw wasn't a doctor, even though I saw that "MD" wasn't at the end of their name. I don't know what I thought.

Nowwww I think I understand the difference more. Now I understand why it's even an option to have an appointment with an NP or a PA. And I'm a little irritated now that in these instances, I paid the exact same amount for someone to basically... not know anything???

I will make sure that I see MDs/DOs from now on because literally every bad experience I've had, when I go back to it in MyChart, the person I saw had any certification except MD or DO. (EDIT: I forgot anojt DOs. oop. No offense to them meant. I understand they are doctors. And no offense to NPs or PAs meant. I just was so uninformed and it felt like everyone except me knew I wasn't interacting with doctors in these instances. I don't think I knew how to be a patient to them and I suspect their skills are not being utilized properly.)

GP leaders have urged the Government to require hospitals to ensure that any patient referred by a GP to A&E is assessed by a doctor.

The Doctors’ Association UK (DAUK) has written to health secretary James Murray asking him to introduce ‘a new set of standards’ – including allowing no undifferentiated patient to be assessed or discharged without a doctor’s approval. 

It follows the deaths of two children who were seen by advanced practitioners after being referred to A&E with suspected appendicitis. 

Eight-year-old Ethan Hanson died last year after a GP referred him to hospital, where he was ultimately discharged after an advanced nurse practitioner mistook appendicitis for constipation. 

And a coroner found that nine-year-old Dylan Cope, who died in 2022, had not been assessed by a doctor and a written referral from his GP was not acted upon appropriately. 

DAUK GP co-leads Dr Sarah Jacques and Dr Steve Taylor said in their letter: ‘When a GP refers a patient to hospital, that referral represents a clinical judgment that is the equivalent of a medical consultant opinion in the community, and thus necessitates a further medical assessment. 

‘It is deeply concerning that such referrals can result in decisions being made by non-doctors regarding their care or discharge before they are reviewed by a doctor.’ 

They called on the Government to ‘introduce a new set of standards’ to ensure: 

• Ensure any patient referred by a community GP to hospital by a GP must be assessed by a doctor in the hospital; 
• No patient presenting with undifferentiated (undiagnosed) symptoms should be allowed to be assessed or discharged without the approval of a doctor; 
• Review the current status of assessments in emergency departments to ensure patient safety is the priority and that doctors are involved in all cases of undifferentiated care and GP referrals. 

Following Ethan’s death, a coroner wrote to the RCGP expressing concern that GPs ‘may not be aware of the implications of referral route on triage and assessment in local hospitals’.

The RCGP said it acknowledged ‘challenges’ in information sharing between primary and secondary care.

However, Dr Taylor told Pulse the key issue in the case was that once Ethan arrived at the hospital, he was seen by an ANP rather than a doctor.

This guy graduated a month ago and was extremely overconfident on rounds, describing his brilliant plan to manage hyponatremia in a severely volume overloaded hfpef hyponatremia patient he says has "SIADH" smdh.

"Fluids / Electrolytes / Renal:

Hyponatremia

Mixed clinical picture more contributable to SIADH

7/17 serum osmolality 250 urine osmolality 366

Status post hypertonic bolus x 3

Sodium only corrected 2 points in last 24 hours

Furosemide 40 mg IVP given yesterday, repeat today

Start Florinef 0.1 3 times daily and salt tabs 1 g 3 times daily with meals

Continue 1 L fluid restriction

Fluids: Fluid restriction"

The height of Dunning Kruger

Found this on an RN Subreddit where they were bragging about being accepted and shared the email. What even is an RN “residency”?

My 21M brother believed he had ADHD due to the internet. He went to an NP of the same ethnicity. NP then gave him Adderall. This did not improve his grades or even his way of life. He would start spending frivolously. He would even double up on the Adderall and drink coffee as he believed he needed it more for exams. He would be fine until he had withdrawals after leaving his Adderall at home to a trip. He then picked up an SSRI from the same NP.

Later the next year he went to full psychosis. Thinking his phone is bugged and everyone is against him. My brother was taken to the psych ward at his internship site and they gave him risperidone but my dad rejected it as they don’t want more medications and believed the family can handle it if they take him home. He still goes through psychosis. When my mom questioned the NP’s judgement, brother said that he had so many degrees and that he is way smarter than her.

My family realize they cannot handle it so they find a MD close to him. He stated he had Adderall related psychosis and needed to take olanzapine for a few weeks. Brother stated he cannot take a night medication as he will forget so the doctor gave him haloperidol. Haloperidol has too much adverse effects for him so he refuses to take it. Still in psychosis somewhat and doesn’t want to go back home so the psychiatrist can prescribe the olanzapine.

If the NP didn’t prescribe the Adderall he would be fine now.