NP's Gear Up for New Battle

Just in texas.

If only I had gone to NP school instead of med school. I could already be an "attending" since NPs are so brilliant they don't even need a residency.


I've read editorials from their side of the fence. Their ultimate goal is to convince everyone that med-school education is overkill in the age of EBM and cookbook-- er I mean, protocol-based medicine, and that a much less expensive, more focused NP training without the broad, science-based foundation of the MD (and of course, without the high intellectual and work-ethic barriers to entry) is best for current patients' needs. Primary care NPs would have only the most basic understanding of health and exist mainly to know to which specialist NP they should refer patients; these specialists in turn are focused solely on their field without understanding of other fields or of basic science. Their education dispenses with basic science and instead adds a lot of MPH and MBA style classes.

Also essential to the NP model is the idea of "certifications." For just about any disease, issue or procedure you can think of, a practitioner must first be "certified" above and beyond their degree. The idea that, say, a surgeon can legally perform a broad array of procedures straight out of residency without additional certification is flat-out appalling to them. Or the idea that practitioners can be allowed to "break bad news" without gaining an external certification in that as well is also anathema to the NP model.

Personally, the idea of healthcare-worker-as-assembly-line-worker did not appeal to me when I considered all my healthcare education options, but that's just me.

Well, given our ligitious society, if NPs are truly as bad as some say, the higher death and malpractice rates would check their progress into physician-dom.

drfunktacular said:

And this is from Texas Republicans. There aren't many more doctor-friendly constituencies...

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I've never understood why so many think republicans are a physician-friendly group. They voted against halting medicare-payment cuts last summer, and the whole malpractice "reform" is really aimed at benefiting the malpractice investment, ehh...excuse me "insurance", companies.

turkeyjerky said:

I've never understood why so many think republicans are a physician-friendly group. They voted against halting medicare-payment cuts last summer, and the whole malpractice "reform" is really aimed at benefiting the malpractice investment, ehh...excuse me "insurance", companies.

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I think the biggest part of this is because physicians salaries put us smack dab in the Republican's power base: We make more than 90, 95, 99% of the population and pay big taxes...but we're not in the super rich level which tend to lean Democratic.

Both sides treat us like crap, after all...they're mostly Lawyers after all

And to the NP's I say: "Doctors! Ready your breakfast and eat hearty... For tonight, we dine in hell!"

turkeyjerky said:

I've never understood why so many think republicans are a physician-friendly group. They voted against halting medicare-payment cuts last summer, and the whole malpractice "reform" is really aimed at benefiting the malpractice investment, ehh...excuse me "insurance", companies.

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A large amount of support for the Democratic party comes from trial lawyers. Nuff said....

Texas physicians need to respond by introducing legislation that would change the regulation of APN's like NP's and CRNA's to be under the boards of medicine. Until that happens, I will refuse to hire NP's. I will always hire a PA preferentially. I hope that other physicians and physicians-in-training voice their concern over these aggressive nurses and show their solidarity by taking similar actions. Let's see how the NP's like watching their salaries drop as the demand for their services dwindle and worse being on the unemployment lines.

NonTradMed said:

Well, given our ligitious society, if NPs are truly as bad as some say, the higher death and malpractice rates would check their progress into physician-dom.

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Fortunately, Texas was one of the first states to pass tort reform. In those states, it has been observed that NP's are more likely to be sued because of the liability cap on physicians. If lawmakers are bought out by the nurses, let's hope that the lawyers and insurance companies rein in the nurses. Just because you can legally do something doesn't mean it's wise to do so. I may be allowed to practice medicine and surgery with my medical license, but if I were an internist it would be foolish of me to perform surgery. The same principle should be applied here to NP's. Make it so expensive and risky in liability for NP's to function autonomously.

Malpractice suits against advanced practice nurses are rising in number and increasing in severity

Malpractice insurers’ profitability in covering APNs has dropped, perhaps because more nurses are being sued these days.​

Woah. Did you read the end of that article?

Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting. APNs who’ve had a lot of claims against them and have settled out of court can often work in different states without fear of retribution because of confidentiality agreements.

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Talk about burying the lede!

I knew there was a relative lack of accountability for NPs, but still...

ZincFingers said:

I knew there was a relative lack of accountability for NPs, but still...

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Yeah, I really like that article. It contains so much useful information. Ironically, it was written by nurses for nurses. If you liked that, here's another one for ya.

regulators [California Board of Nursing] acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.​

Do people understand now why the NP's want to be regulated by their boards of nursing? Because they're a joke when it comes to regulating.

NP = propaganda and lies, lies, lies

I fear for public safety. We all need to get involved politically. We need to educate the lawyers and insurance companies.

I cannot believe this is even a consideration. It's laughable. And WHY should I go to medical school again?

This is just disheartening.

If they wanted such freedom, why not just apply to medical school?

Instead they use money and push for reform that shouldn't even be in question.

Where will this end? Family Practice? I think not. Give an inch take mile.....

I know. If I had gone to NP school instead of med school I could already be practicing right now. With a small fraction of my debt. And without having to worry about any of those pesky MCATs or USMLEs. And none of those science courses either. Instead I could sit around in seminars and discuss my feelings about social change and being a nurse leader. And no residency either! And being completely independent -- unless the malpractice suit hits, of course, in which case I'll conveniently have an MD legally responsible.

Not sure what kind of wacky **** is going on in Texas or if it's just bad journalism but how can a board of nursing be empowered to give licenses to practice medicine?

meister said:

Not sure what kind of wacky **** is going on in Texas or if it's just bad journalism but how can a board of nursing be empowered to give licenses to practice medicine?

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Because theyre more politically active

Taurus said:

Do people understand now why the NP's want to be regulated by their boards of nursing? Because they're a joke when it comes to regulating.

NP = propaganda and lies, lies, lies

I fear for public safety. We all need to get involved politically. We need to educate the lawyers and insurance companies.

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BS, you know physicians have traditionally received a slap on the wrist while nurses are being beaten about the head and shoulders. Go look at a monthly report from the board of nursing vs the medical board.

zenman said:

BS, you know physicians have traditionally received a slap on the wrist while nurses are being beaten about the head and shoulders. Go look at a monthly report from the board of nursing vs the medical board.

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Dude... What are you even talking about? Go check the "general residency" board. It is chock full of stories of docs being driven out of medicine for what a nurse would consider insignificant infractions.

Meanwhile, boards of nursing seem incapable of stripping NPs of their ability to see pts no matter how incompetent. Check my quote above... And remember it comes from a *nursing* publication.

zenman said:

BS, you know physicians have traditionally received a slap on the wrist while nurses are being beaten about the head and shoulders. Go look at a monthly report from the board of nursing vs the medical board.

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No. Physicians may very well recieve the metaphorical slap on the wrist. But if we are playing metaphors, then the nurses would recieve a stern talking-to...

Physicians not infrequently (and sometimes justifiably) get forced out of medicine. How many mistakes do you see RNs make on a daily basis, with NO critique at all? All we are suggesting here is that if they want to practice medicine on their own, they should be allowed to. Right after they take and pass Step 1,2, and 3, and complete their residency in the respective field. Then, they should have the same oversight committees that we have.

If they can not pass the exams, then they DO NOT have the ability to practice alone. It is as simple as that. They may be EXCELLENT nurses. In fact, the doctorate of nurse practioner is a great way to put out educated NPs... but let's be honest. They are not medical doctors, and should not be granted priveledge as such. They have every right to practice as a NP, just not as an MD.

zenman said:

BS, you know physicians have traditionally received a slap on the wrist while nurses are being beaten about the head and shoulders. Go look at a monthly report from the board of nursing vs the medical board.

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I've only seen nurses get in trouble for three things:

1) Falsifying records: This will get you sacked (and rightfully so) regardless of nurse or doctor.
2) HIPAA Violations: Often for stupid, but undefendable stuff, likely looking up their neighbors test records.
3) Narcs/Benzos: Often after repeated attempts at rehab.

However, many nurses love to trot out "I can't do that, I'll lose my license!" for any number of situations where they won't.

Ok, I stand corrected.

Well this is a much larger problem than I had originally expected. Check out this report guys:

http://www.webnp.net/downloads/pearson_report09/ajnp_pearson09.pdf

This year, I performed a deeper analysis of information compiled in the forementioned NPDB and HIPDB in terms of the safety of the care that NPs provided relative to that provided by other healthcare professionals. These two data banks compile the number of accumulated malpractice and adverse actions, licensure actions (and any other negative actions, findings, and/or adjudicated actions), civil judgments, and criminal conviction reports submitted against NPs, DOs, and MDs. In years past, I have reported
on the absolute number of actions reported against each of these groups and let it go at that. But these numbers need to be placed in a context. So, for this year’s report, I determined the absolute numbers of accumulated reported occurrences against NPs, DOs, and MDs over the past 18 years as well as the absolute numbers of NPs, DOs, and MDs in practice, and then computed the ratios (Table 3).

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This might be the dumbest "deep analysis" I have ever seen, and all the state and national NP organizations are pushing this to make the final plunge to get absolute full autonomy. The entire conclusion rests on the wholly faulty logic that since physicians have a 1 in 4 incidence of malpractice litigation and NPs have a 1 in 170 figure that means NPs provide better care. I hope I don't have to detail to anyone here why this is utter lunacy. It is just such a dumb "report" that I'm at a loss for words.

This is very scary, because if we think "what's the end game?" then you realize that if they achieve what they're after we go from 150 medical schools in this country to 250+ turning out autonomous providers. Massive dilution of the labor pool, excess supply and depressed salaries. And they get to do this in under 3 years, with no residency, and with online fluff classes. Unbelievable.

God that report is so ****ing stupid I can't believe it. I mean I voted for Obama but to quote "Yes, we can!" in a supposedly professional report?! How junior high school is that?!

This is a GOOD thing. Think about it. Say they gain their precious autonomy. 5 years down the road can you imagine the legal suites, death rates, and overall damage to the system. The entirety of the degree will be trashed and the world of medicine will have regained its natural balance. It won't take long. Just make sure YOU don't get sick in the next few years!!!!!!!

Do you all think primary care doctors are overskilled, as one of those articles said? I talked to an older FP/MPH whom I respect, and she suggested that NPs may be the primary care of the future and FP doctors might become obselete. Maybe 4 years of med school and 3 years of residency are too much for a more basic form of primary care, particularly one that focuses on wellness education, managing controlled chronic illnesses, and prevention as many healthcare reform ideas are calling for?

Maybe doctors should come out with their own fast-track to primary care medicine, involving just 1-2 years of an outpatient-only residency. If NPs can do it, why not MDs? Why should we do so much training to do what others do with much less?

meister said:

Well this is a much larger problem than I had originally expected. Check out this report guys:

http://www.webnp.net/downloads/pearson_report09/ajnp_pearson09.pdf



This might be the dumbest "deep analysis" I have ever seen, and all the state and national NP organizations are pushing this to make the final plunge to get absolute full autonomy. The entire conclusion rests on the wholly faulty logic that since physicians have a 1 in 4 incidence of malpractice litigation and NPs have a 1 in 170 figure that means NPs provide better care. I hope I don't have to detail to anyone here why this is utter lunacy. It is just such a dumb "report" that I'm at a loss for words.

This is very scary, because if we think "what's the end game?" then you realize that if they achieve what they're after we go from 150 medical schools in this country to 250+ turning out autonomous providers. Massive dilution of the labor pool, excess supply and depressed salaries. And they get to do this in under 3 years, with no residency, and with online fluff classes. Unbelievable.

God that report is so ****ing stupid I can't believe it. I mean I voted for Obama but to quote "Yes, we can!" in a supposedly professional report?! How junior high school is that?!

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By golly, I think somebody had an epiphany moment!

Now you begin to see how the nurses use propaganda and lies to advance their agenda. If the nurses want a war, let's give them one. I won't let my profession die without a fight.

Do you all think primary care doctors are overskilled, as one of those articles said? I talked to an older FP/MPH whom I respect, and she suggested that NPs may be the primary care of the future and FP doctors might become obselete. Maybe 4 years of med school and 3 years of residency are too much for a more basic form of primary care, particularly one that focuses on wellness education, managing controlled chronic illnesses, and prevention as many healthcare reform ideas are calling for?

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Indeed, you don't need much education or smarts to check glucose logs and interpret an A1c. Sure, NPs might not have much understanding of the biochemical pathways that lead to the glycolization of hemoglobin and its deletrious effects on oxygen transport, but so what? They have their flowcharts and their protocols to tell them which therapy to start next, and they'll get to lecture their patients on glucose control and feel superior, I won't have to deal with it myself, and everybody wins.

Of course, if the pt's glucose is out of control because an adrenal tumor is secreting cortisol and causing Cushing's, the NP won't catch it because they won't know the significance of the pt's abdominal striations and a buffalo hump. They'll just keep increasing the Lantus and keep lecturing the pt about his obvious lack of compliance, until the pt's untimely demise from an early MI.

The question is: should we even care? Things like Cushing's are incredibly rare. Maybe we should let such hard cases slip through the cracks because they are expensive to treat, expensive to even catch (in terms of the costs of med school education vs. NP education)... perhaps the public would be ok with occasional deaths like that if it means a lower insurance premium for everyone else. I mean, sure you might feel different if it's your spouse who has this happen but really, what are the odds, right? And besides, isn't it kind of patriarchal and mean how we reserve the ultimate patient care role for the best and brightest of college students, when even people of mediocre talents want to be doctor too?

Anyway, sarcasm aside, I do believe that primary care MDs will be out of a job soon enough. I don't think docs have a prayer against the incredible might of the nursing and nursing-education lobbies...

One NP who worked for a doctor I shadowed would see the patient then come out and plug the symptoms into some program, which would show a list of diagnoses with corresponding treatments. Needless to say, that did not always come up with the right answer

I haven't heard any outcry about medical errors though. Maybe the supervising docs catch them in time, or maybe they really don't make as many errors as some of us are assuming. A seasoned NP should be able to treat basic illnesses well even without fully understanding what they are in the way a physician would. I just don't like it when people claim that the 4 years BSN plus 2-3 years NP = 4 years premed, 4 years med, and 3 years residency.

Do professions ever see a reduction in their licensing rights/scope of practice or do those only expand? I'm curious about this for any PCPs who are not MD/DOs...nurse practitioners, naturopaths, chiropracters who consider themselves holistic primary care docs, and any others if I missed any.

ZincFingers said:

Of course, if the pt's glucose is out of control because an adrenal tumor is secreting cortisol and causing Cushing's, the NP won't catch it because they won't know the significance of the pt's abdominal striations and a buffalo hump. They'll just keep increasing the Lantus and keep lecturing the pt about his obvious lack of compliance, until the pt's untimely demise from an early MI.

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Wrong! They might even be the first to know as they might be more likely to disrobe the patient to examine them.

zenman said:

Wrong! They might even be the first to know as they might be more likely to disrobe the patient to examine them.

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Hahaha! No, seriously...

And Mr. Patient, we have been over this before how important it is for you to keep your sugars under control. Perhaps I should get you another pamphlet?

Pt: "But NP Smith..."
That's DOCTOR Smith to you!

Pt: "Uh, right, Dr. Smith... sorry, didn't realize you went to med school --"
Of course not! My education is far superior than those patriarchal "physicians," dispensing with all that useless and racist "pathology" and "anatomy" so that I could learn more about nursing theory. I treat the patient, not the disease! It's holistic too! HOLISTIC!

Pt: "Right... holistic... anywho, I've got this--"
And don't let those patriarchal old men at the AMA spread lies about how I couldn't get into med school because I got an MCAT of 16. That is just not the case! Besides the MCAT is an oppressive, racist exam!

Pt: "Racist? But uh, you're white."
But it's still racist! That's why at DNP school, we have freed ourselves from the tyranny of exams.

Pt: "Right, sounds great. So I've got this bump on my back that has me worried, should I show it to you?"
...

Pt: "Oh, sorry, should I should it to you, *Dr. Smith*?"
Much better. You see this long white coat? You see all these letters after my name? There are 18 letters after my name on my coat! Count em yourself!

Pt: "No, I'll take your word for it--"
And in my book, 18 letters beats the 2 letters "MD." Don't you think? That's why I freakin have them on my coat! Just look at all of them!

Pt: "Right... about my hump... I read on WebMD that it could mean I have something called Cush--"
Web*MD* huh? What more patriarchal racist crap. Like an MD would actually take time to care about your health like I would.

Pt: "You sure do say 'patriarchal' a lot."
And why is it House, *MD* anyway? How about House, DNP, MSN, BSN, ARNP, RN, AARN? I bet THAT provider would listen a lot more to the patient than that creepy old MD with his cane!

Pt: "If I could ask you about this hump, here let me show it to you real quick!"
Eww! I don't want to see it. You're just trying to change the topic from your obvious lack of diabetes compliance. Trust me, I'm the expert. They don't let just anyone work a cubicle at the Walgreens MinuteClinic! You don't see any 'physicians' around here do you???

Pt: "No, no, I guess I don't! So, maybe if we changed around my insulin--"
Hell-O! Do you see this? This is a flowchart! A FLOWCHART! With protocols! One just does NOT deviate from a flowchart! It is not called a suggestionchart now is it, dumbdumb? I've already ordered your next batch of insulin, it should be ready at the counter. And be sure and check out our great selection of 50% off Valentine's candy!

Pt: "Er, you do know I'm diabetic, right?"
NEXT!


Ahhh... now where was I before I got off on a tangent.. oh yes.. zen, you've already been schooled once in this thread, you better quit while you're behind!

ZincFingers said:

Ahhh... now where was I before I got off on a tangent.. oh yes.. zen, you've already been schooled once in this thread, you better quit while you're behind!

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Cute but seriously, I've gone over Cushings several times in different classes. How many times before you think I've got it?

Schooled? Prove it.

If you really want some schooling yourself, throw down your stethoscope and all diagnostic equipment, labs and lets go somewhere where there is no electricity (so you can't cheat) and check out a few patients.

Sounds like it would involve rectal exams.

ZincFingers said:

Sounds like it would involve rectal exams.

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Well, for a complete exam...

Or would you like to do it without touching or talking to the patient

Not surprisingly, the nurses are lying about the DNP exam in their propaganda and once again the ASA is taking the charge to respond:


You can sample some of the DNP exam questions here. I installed the software and did the questions. It's not even close in difficulty with the USMLE steps.

zenman said:

Well, for a complete exam...

Or would you like to do it without touching or talking to the patient

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See, I don't think you're talking about going somewhere alone to do rectals on patients

midwesterner,

I think the answer to your question above is "no". I honestly don't think primary care docs are overeducated for what they are doing. I think that is wrong wrong wrong. I did 3 years of IM residency so I do have some basis for what I'm talking about. It's easy to do mediocre primary care. It's hard to do great primary care.

I think NP/PA's are fine but I believe in the team model of health care. I don't think an NP/PA = a primary care physician. The training and requirements to get there are not the same. They really aren't equivalent. I think what residency teaches you is how to deal with the subtle things, that are hard to pick up, and also the really sick patients. Many of the really sick patients are in the hospital, not the outpatient clinic, but they do appear in both areas and that is why I think physicians are still necessary in primary care. I think we can definitely use more trained health care providers - I'd say that having NP or PA's as part of a surgical team to help with seeing patients, rounding, helping with discharge planning, checking chest tubes, and helping teach the students, etc. is a great idea. I think that having an NP in a diabetes clinic as a dedicated diabetes educator is a great idea. I think one of the most important things in primary care is being about to differentiate the truly bad stuff that doesn't LOOK bad from the benign stuff - I mean getting the diagnosis right. I think med school and residency better equips people to do that than NP school...particularly for those NP's who go straight through without any practice experience.

ZincFingers said:

Hahaha! No, seriously...

Pt: "Racist? But uh, you're white."
But it's still racist! That's why at DNP school, we have freed ourselves from the tyranny of exams.

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Hilarious. I literally laughed out loud, thanks.

ZincFingers said:

Pt: "Right, sounds great. So I've got this bump on my back that has me worried, should I show it to you?"
...

Pt: "Oh, sorry, should I show it to you, *Dr. Smith*?"
Much better. You see this long white coat? You see all these letters after my name? There are 18 letters after my name on my coat! Count em yourself!

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That made my day.

Can we start a thread on THIS!!!! Just theoretical stories of (sub)standard of care if the DNP nightmare comes true.

IMO, what NP's may lack in experience, they (usually) make up for with givingadamn-ness. Something which was distinctly lacking in the last distracted, drive-thru style physicians that I've seen personally. It's not a fair assessment of all physicians, but neither is most of what I read about NPs. It seems like most NPs go through a more compressed version of medical school and residency, where in the MSN they focus solely on what their specialty is (ie Peds don't have to do an OB/Surg/Onc/Adult rotation, their rotations are all Peds, all the time).

Why not just let NP's challenge the USMLE? That would seem to solve everyone's problems... maybe?

RN>BSN>MSN = ~7 years
MD>Residency = ~7 years

Grif said:

It seems like most NPs go through a more compressed version of medical school and residency, where in the MSN they focus solely on what their specialty is (ie Peds don't have to do an OB/Surg/Onc/Adult rotation, their rotations are all Peds, all the time).

Why not just let NP's challenge the USMLE? That would seem to solve everyone's problems... maybe?

RN>BSN>MSN = ~7 years
MD>Residency = ~7 years

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You're joking, right?

Grif said:

IMO, what NP's may lack in experience, they (usually) make up for with givingadamn-ness. Something which was distinctly lacking in the last distracted, drive-thru style physicians that I've seen personally. It's not a fair assessment of all physicians, but neither is most of what I read about NPs. It seems like most NPs go through a more compressed version of medical school and residency, where in the MSN they focus solely on what their specialty is (ie Peds don't have to do an OB/Surg/Onc/Adult rotation, their rotations are all Peds, all the time).

Why not just let NP's challenge the USMLE? That would seem to solve everyone's problems... maybe?

RN>BSN>MSN = ~7 years
MD>Residency = ~7 years

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While I agree that some NP's could have better bed-side manner, I disagree in the importance as bad as that sounds. If I'm the patient I'd rather deal with an a** thats educated to make important decisions pertaining to my health than a nurse who'll sit down and chat with me. I do get what you're saying though and its a valid point. I also agree with you that most of the NP's I've met clearly aren't out to compare themselves with physicians. It's the small percentage lobbying for crazy things like autonomy that give them a bad rep.

Additonally its a stretch to say that NP's have compressed medical school curriculum. They aren't trained with a focus of being a physician. The scope is limited and superficial. There isn't a problem with this as the aforementioned training is enough for a nurse to function adequetly in the healthcare system in the PRESENCE of a physician.

The ~7 year comparision is really tough point to make. Its incredibly relative. For example, in that period of time an NP will get around 2000 clinical hours and thats a generous estimate, in this same time period a physician will have nearly 20,000+ clinical hours (depending on specialty). Of course this is just one glaring variable but I could probably list 30 more to illustrate my point. Who do you want treating you?

I'm all for NPs or even the hardcore online-trained DNPs attempting to take the USMLE. Unfortunately we'd never see the results for obvious reasons......

Here's a great source that may shed more light, posted by schutzhund in the residents forum:

I have a unique perspective on this. I am a physician (i.e. I actually went to medical school). I was also a nurse and took NP classes.


There is absolutely NO comparison between the two. ZERO. Most NP programs contain less actual "medical" classes than you get in one semester of real medical school. Mine was 15 credit hours. The rest is nursing theory, research, nurse political activism and such. It is so unbelievably different, you can't compare the two. The truly scary thing is that they don't how much they don't know.

NPs, DNPs have absolutely NO right to independent practice. I think there is a role for them such as running coumadin clinics, helping with post-op evals, vaccinations and other such limited practice.

They simply do not have a fraction of the knowledge that the worst FM physician has. Not even close.

Imagine this. Would you let a fourth year medical student open up a clinic and do primary care? H@(( no! And the fourth year medical student already has VAST more medical education than an NP or DNP.

If this does not bother you, it should. I've seen the inside politics of this debate. These people want your job. They hate, resent and envy you. They are cunning and very political active. If we don't stop them, it will negatively affect us all. And their pathway to "independence" will be littered with the dead bodies from their blissful ignorance and pride.

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Cp22kjer said:

The ~7 year comparision is really tough point to make. Its incredibly relative. For example, in that period of time an NP will get around 2000 clinical hours and thats a generous estimate, in this same time period a physician will have nearly 20,000+ clinical hours (depending on specialty). Of course this is just one glaring variable but I could probably list 30 more to illustrate my point. Who do you want treating you?

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I do see your point, but I think that exceptional nurses should be allowed independent practice (having had X amount of experience). Midwives will always be around, whether they are legally licensed or not. I also think that it's not practical in states with large rural areas like Texas to disallow independent NP's because it means that many people would go without medical care.

I grew up in the south (Oklahoma) and in rural areas you either had no doctor or one doctor. And if that one doctor was racist, or didn't like you, or was just bad... you either had to go without or rustle up more money to travel to see someone else. If you have no money or car to see someone else (I'm thinking of a high school friend's experience, but I don't think it'll add anything to the discussion at this point). The big thing for me is options for the poor.

I once drove 100 miles to get an ultrasound and when I got there the machine was broken. I waited five hours, and the maint. tech. did not show up by the time their office hours closed. I sure didn't drive 100 miles back the next day.

I am right there with you on some specialties. I think it's better in general if Onc's work together as a group so they don't operate in a vacuum. So that means I also believe that NP-onc's should work with oncologists in a clinic setting. I'm not sure what to think about acute-care NP's working alone, but I do think you should have many, many, many years of experience as an acute-care nurse before you should be able to go for it as a specialty. I think midwives should work independently just like they always have.

I also think that psych/mh NP's should work independently if they are also PhD-level mental health workers. I'm thinking ahead to when I will be a PhD-level psychologist, and how silly it is to have to send someone out to another service provider to basically "ok" my assessment and write a script. IMO, it's also not fair to psychiatrists to treat them like a script dispenser in that situation. So lately I have been seriously weighing my options for becoming an NP as a part of graduate school. Of course, I probably wouldn't mind working with a nice doctor (especially as part of a volunteer situation), but by the nature of an independent psychology practice that may not be as feasible as it looks.

So I agree, but I also disagree and think that it's needed a lot of times.

Psychology is to medicine as Dentistry is to Medicine.

It is a separate area, requiring separate education and separate practice.

Nursing is not. An upper level degree in nursing is still a degree in nursing. NOT in medicine. Really, it is scary that people think nursing is equivalent in ANY respect to medical school. One is a baccaleurette, the other is a doctorate. Not. Even. Close.

Grif said:

So I agree, but I also disagree and think that it's needed a lot of times.

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Haha fair enough! Given your background I can see where you are coming from. To me NP's are not the answer but again I can see why you might be for it.

Why not just let NP's challenge the USMLE? That would seem to solve everyone's problems... maybe?

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If you mean the real USMLEs, as opposed to the dumbed-down NP version, then yes, absolutely. I doubt you would find many MDs who would disagree with this approach.

Sadly, I doubt many NPs or DNP educators would go along with this, however. For some reason.

The Pearson report assumes accurate reporting and integrity of the National Practitioner Data Bank (NPDB) to make its claims

The problem is that NP's are underreporting their adverse events to the NPDB.

The Pearson report uses flawed data to make its case. Yet, that won't stop the nurses from pushing this analysis on lawmakers and the public to advance their agenda. Again, nursing uses propaganda and lies as its tools to get what it wants. When will somebody in medicine stand up to this crap and say enough is enough?!

Cp22kjer said:

While I agree that some NP's could have better bed-side manner, I disagree in the importance as bad as that sounds. If I'm the patient I'd rather deal with an a** thats educated to make important decisions pertaining to my health than a nurse who'll sit down and chat with me.

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You might but I once worked with a physician group that had an excellent but ego nut, piss poor personality of an ENT surgeon, that the other docs in the healthplan would try to refer outside the group on the sly rather than expose their patients to his bedside manner.

Grif said:

IMO, what NP's may lack in experience, they (usually) make up for with givingadamn-ness. Something which was distinctly lacking in the last distracted, drive-thru style physicians that I've seen personally. It's not a fair assessment of all physicians, but neither is most of what I read about NPs. It seems like most NPs go through a more compressed version of medical school and residency, where in the MSN they focus solely on what their specialty is (ie Peds don't have to do an OB/Surg/Onc/Adult rotation, their rotations are all Peds, all the time).

Why not just let NP's challenge the USMLE? That would seem to solve everyone's problems... maybe?

RN>BSN>MSN = ~7 years
MD>Residency = ~7 years

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Check your math. You are counting undergraduate training for nurses, but not for physicians. So, if you account for years of school properly, you have BS>MD>Residency = ~11 years.

Therefore, overall, I need to give your post a:

Taurus said:

The Pearson report assumes accurate reporting and integrity of the National Practitioner Data Bank (NPDB) to make its claims

total number of accumulated malpractice and adverse actions in the NPDB
against that group of providers, were 1 in 173 for NPs, 1 in 4 for DOs, and 1 in 4 for MDs​

The problem is that NP's are underreporting their adverse events to the NPDB.

Sadly, state boards of nursing may be underreporting unprofessional behavior and incompetence to the National Practitioner Data Bank, according to one government representative who spoke at the meeting.

many cases...in which [California Board of Nursing] regulators acted belatedly or not at all, even when explicitly told that nurses had committed serious crimes. Some were handed renewals after reporting their own felonies to the bureau.​

The Pearson report uses flawed data to make its case. Yet, that won't stop the nurses from pushing this analysis on lawmakers and the public to advance their agenda. Again, nursing uses propaganda and lies as its tools to get what it wants. When will somebody in medicine stand up to this crap and say enough is enough?!

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Not only that, but NPs are quite specifically not included in malpractice lawsuits because the MDs are almost uniformly the ones who own whatever practice made the mistake. It is all on their license.

Anyway the solution is, either make these DNP programs 4 years with a residency and require them to pass ALL of the USMLE exams in order to get full autonomy, or remain an NP who needs a supervising physician in order to practice. I'd prefer eliminating NPs entirely but the cat's already out of the bag. Want to practice but don't want to go to medical school?

Go to PA school! ****.