New idea for NP/PA to MD

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FNPinKS

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I have recently been presented with a series of events that got me thinking about an evolutionary educational process that I believe will help this country tremendously.

I have emailed the Dean of the University of Kansas School of Medicine; a place where I believe will be a perfect launch pad for such a program.
I am a practicing NP in rural Kansas, where I do clinic, hospitalist function, ED, long term care, and just about anything that comes through the door. The hospital I work at is very rural, and the two docs are nearing the end of their career. Needless to say, there aren’t a lot of physicians beating down the door, which threatens the very existence of the whole institution. We all are aware of the ever-worsening shortage of primary care docs, especially since many of us PA/NPs are filling that role. In comes my idea…

We all have been reading about and some of us participating in doctorate programs, which I believe is an effort, at least in part, to become completely autonomous providers. However, I don’t think we’ll ever be on a level playing field with physicians, whether we think we should or not (I personally don’t think our education is anywhere near where it needs to be if we were to even consider competing with allopathic or osteopathic physicians).

So, instead of fighting all the time, I propose a solution: a new educational pathway for NPs and PAs can become physicians using the most advanced telecommunications and internet technology available so we can continue to provide care but we can earn a MD or DO. Now I’ve heard the cynics who will say “no shortcuts to medicine, blah blah blah” but I urge you to find anyone that has been through the minimal 6-7 years of education, and then the probable 3-4 years of additional training it would take to complete a new program such as this, to consider this a “shortcut”.

At this point in time, there is only one program I am aware of that one can do something like this. It is in American Samoa, and although I’m certain there are students and graduates doing just fine, I know several states will not license graduates of this program. The only other way to earn a MD or DO is to start as if you are a 22 year old college graduate - something that is just not practicle or feasible in the vast majority of our situations.
When I enrolled in a DNP program at Saint Louis University, I was encouraged to finally hear about these new “clinical-based doctorate programs” for nurse practitioners. However, after sitting through the first two days on the campus and hearing what it was really all about (really no different than a PhD in my opinion), I was very disappointed but not terribly surprised and dropped out immediately.

I did hear a common statement from many NPs in the program - the hunger for more education and the desire to earn a MD/DO. Several of us spoke about the reason why none of us are able to do it (families, income, etc etc).
So, the people and their desire is there (probably on a much larger scale than I can imagine). The need for primary care doctors is there. Now we need to find some open-minded schools to create a program to make it happen.
The program would have to allow for a great deal of self study. It would have to have practicing physicians who could mentor NP/PA students in the program, which wouldn’t be a stretch in many cases as many of us are already working side-by-side. It should fill the gaps in our education which needs to be determined by a team of both NP/PAs and MD/DOs. It should not include rotations in specialty fields; only primary care. And, we should only be able to practice primary care medicine so graduates don’t go into specialties thus defeating the purpose of the program. It should have an abbreviated residency training program since many of us have already been practicing every day for many years (ie every 3 years of practice equals 1 year of residency, etc). If graduates do poorly on the USMLE and board certification exams, it will be clear where the weaknesses are and adjustments could be made accordingly.

The institution providing such a program could charge just about anything they wanted, as there are many programs that will pay back student loans for practicing in rural areas. It would also command attention from federal funding, especially in light of all the Obamacare changes.

I believe there would be literally thousands of us jumping all over a program such as this. I certainly would be first in line....
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Why not just get a degree in chemistry and apply for medical school?
 
There's already a PA-DO bridge that recently started.
 
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Call me old school, but having gone through both on-line and traditional classes on my way to a masters and PA certification, I have serious reservations about pursuing any MD degree on line....
 
bradt9881 said:
Call me old school, but having gone through both on-line and traditional classes on my way to a masters and PA certification, I have serious reservations about pursuing any MD degree on line....
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I strongly agree with you. There's no shortcut to Medicine.

PA-C ->MD
 
Paseo Del Norte said:
Why not just get a degree in chemistry and apply for medical school?
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Did you even read the post? That is the traditional route and is not possible for the majority of us old practicing NPs/PAs with families. Change is difficult, I know. But open up your mind and admit there is more than one way to accomplish something for the greater good of the people.
 
PICUPNP said:
There's already a PA-DO bridge that recently started.
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PA to DO bridge is a start, and maybe this will start the ball rolling for other programs and schools to start opening their minds. It needs to be more marketable to practicing NPs and PAs.
 
bradt9881 said:
Call me old school, but having gone through both on-line and traditional classes on my way to a masters and PA certification, I have serious reservations about pursuing any MD degree on line....
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Okay, you are old school. But, so is everyone else. The point is trying to introduce a new concept and method to achieve something. Something has to change, or there aren't going to be enough doctors in primary care. I think we can all agree on that.

I've taken class courses and online courses too. The bottom line is you have to be able to learn enough in either program to pass the USMLE. If you can't online, then don't do it. What's really the difference between listening to someone talk about origins and insertions in person or online? You can still see, hear, and communicate with them, unless you just want to throw something at them.
 
princekc said:
I strongly agree with you. There's no shortcut to Medicine.

PA-C ->MD
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You clearly skipped paragraph 5. Let me simplify it:

Student: How can I be a doctor?
Faculty: You have one of two choices: You can get a Bachelors, then go through four years of medical school, then two or three years of residency for primary care.

Or, you can get a bachelors, then be a NP in an additional 3 years, then work for several years doing basically the same thing but for 1/2 the salary, then go through 3-4 years of telecom and onsite rural clinical rotations while still working.

Which one sounds good to you?

Student: Uhhh... I'm going to law school. :oops:)

You get the point...
 
FNPinKS said:
Did you even read the post? That is the traditional route and is not possible for the majority of us old practicing NPs/PAs with families. Change is difficult, I know. But open up your mind and admit there is more than one way to accomplish something for the greater good of the people.
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I know, I know... it's rather inconvenient doing all that school. I understand your concern because I've found doing six extra semesters of full time school quite inconvenient and often wonder why having a degree in nursing does not entitle me to "fast track" my way to a degree in respiratory therapy.

The problem I have with this theoretical programme is that nurses on the average do not have near the scientific nor the clinical preparation to think about some online quickie course. In my humble non-physician opinion of course. In fact, the respiratory folks laughed at the amount of chemistry I took as a student nurse. This would be the amount of chemistry required for many of the NP programmes I've seen.

To add insult to my injured pride, I spent the first part of my respiratory student experience learning about better living through Schrodinger.
 
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I don't ever see an NP -> MD/DO bridge program. Can't even imagine it.

With PAs, their training is much more similar to that of physicians, both in rigor and content. With NPs, on the other hand, there is very little similarity to that of physician training. Instead of basic science courses, there are courses in nursing theory and health policy in NP programs. Instead of tens of thousands of hours of clinical training, there are a few hundred hours in NP/DNP programs. So, how can you reasonably suggest a shortcut bridge program between NP and MD/DO?

You also do realize that passing the USMLE Steps isn't enough to be a physician right? Anyone can pass a test given enough time to study. Any physician can feel free to correct me if I'm wrong, but I get the sense that passing the Steps is necessary to become a physician, but not sufficient.

It's unfortunate that you are unable to apply to medical school due to other obligations, but that doesn't mean you can place a shortcut between two programs that are so drastically different like the NP and MD/DO. If I remember correctly, even the PA -> DO program doesn't really shorten the length of medical training much (I think it cuts it down by a year? Feel free to correct me if I'm wrong). As an NP then, you might as well go through med school and residency like 99.999% of physicians do.
 
Paseo Del Norte said:
I know, I know... it's rather inconvenient doing all that school. I understand your concern because I've found doing six extra semesters of full time school quite inconvenient and often wonder why having a degree in nursing does not entitle me to "fast track" my way to a degree in respiratory therapy.

The problem I have with this theoretical programme is that nurses on the average do not have near the scientific nor the clinical preparation to think about some online quickie course. In my humble non-physician opinion of course. In fact, the respiratory folks laughed at the amount of chemistry I took as a student nurse. This would be the amount of chemistry required for many of the NP programmes I've seen.

To add insult to my injured pride, I spent the first part of my respiratory student experience learning about better living through Schrodinger.
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Inconvenient? Fast track? You are taking a new concept and twisting it into negativity without even thinking. If I told you I'd rather do 15 years of part time school than 3 years of full time, you'd say "you lazy short cut taking loser" without any more thought.

I agree, nursing education isn't there. That's why I want there to be some more. And I personally have taken all your pre-med sciences, and got the best grade in the course, so don't patronize me.

The fact of the matter is this country needs primary care doctors, period. I'm simply offering a solution to the problem. What's yours?
 
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Kaushik said:
I don't ever see an NP -> MD/DO bridge program. Can't even imagine it.

With PAs, their training is much more similar to that of physicians, both in rigor and content. With NPs, on the other hand, there is very little similarity to that of physician training. Instead of basic science courses, there are courses in nursing theory and health policy in NP programs. Instead of tens of thousands of hours of clinical training, there are a few hundred hours in NP/DNP programs. So, how can you reasonably suggest a shortcut bridge program between NP and MD/DO?

You also do realize that passing the USMLE Steps isn't enough to be a physician right? Anyone can pass a test given enough time to study. Any physician can feel free to correct me if I'm wrong, but I get the sense that passing the Steps is necessary to become a physician, but not sufficient.

It's unfortunate that you are unable to apply to medical school due to other obligations, but that doesn't mean you can place a shortcut between two programs that are so drastically different like the NP and MD/DO. If I remember correctly, even the PA -> DO program doesn't really shorten the length of medical training much (I think it cuts it down by a year? Feel free to correct me if I'm wrong). As an NP then, you might as well go through med school and residency like 99.999% of physicians do.
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Most of practicing professionals in any field will agree that training is great, and necessary, and whatever, but real learning and becoming competent comes from experience. I knew all you SDN people would give the most BS about all this, which is good for me, because when I reach the federal level, I'll have already heard all the BS and will be ready to handle it.

You all are so stuck on "short cut". I knew you would be, as I mentioned in the original message. You are so stuck on traditional methods that you won't open up to new possibilities and avenues to accomplish something. Are you afraid I won't have to work as hard? Fine, make it twice as hard. I don't care. The issue isn't pissing a bunch of kids off, it's who's going to keep these rural hospitals open and take care of all the good people who actually work for a living in rural America? If you aren't willing to going the traditional route (and believe me, I wouldn't either, having the option to specialize), then let those of us that already are there. Would you rather NPs and PAs take over all primary care and leave physicians to specialties only? That's where all this is headed, whether you take your premed sciences or not.

The fact that you can't fathom a bridge to something means you aren't really thinking about it at all. If you truly think there is absolutely no medical training or experience in being a NP, then fine, make it a "bridge" that has no boards hammered at all. Make it the whole damn program. Just make it available outside of the 19th century walls of traditional medical school. There are plenty of qualified people that would step up and take care of all the people who need it.
 
FNPinKS said:
Inconvenient? Fast track? You are taking a new concept and twisting it into negativity without even thinking. If I told you I'd rather do 15 years of part time school than 3 years of full time, you'd say "you lazy short cut taking loser" without any more thought.
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But that's not what you're suggesting. You're not saying let's cut down on 7+ years of part-time education into a few years. What you're saying is that you want to cut down on 7 years of rigorous, full-time education into a few years. That's completely different from what you are saying in the above quote. No one will call you a loser if you cut down 15 years of part-time schooling into 3 years. Most people would likely be impressed. However, when you want to cut down 7 years of what is widely considered to be one of the toughest training paths to go through, then I start to question your motivation.

FNPinKS said:
I agree, nursing education isn't there. That's why I want there to be some more. And I personally have taken all your pre-med sciences, and got the best grade in the course, so don't patronize me.
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PS. "Pre-med sciences" involve more than one course. Either way, that's neither here nor there.

FNPinKS said:
The fact of the matter is this country needs primary care doctors, period. I'm simply offering a solution to the problem. What's yours?
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The solution isn't to allow NPs to shortcut their way into primary care medicine. That's not going to entice medical students to pursue that field if they perceive others with lesser/less rigorous training can get into it just the same. Isn't that one of the problems right now? That medical students think primary care physicians don't get much respect (part of which has to do with midlevels with a fraction of the training physicians get being allowed equivalent scope of practice in several states)?

The solution is to provide more incentives for medical students to pursue primary care. Reimbursements for PCP services have to change. A way to reduce/eliminate the debt burden would help a lot. Reducing the number of paperwork and non-medicine related crap that PCPs have to put up with daily. Things like these will help increase the popularity of primary care specialties. Allowing lesser trained individuals to shortcut into the field will, on the other hand, be a pretty strong disincentive IMO.
 
The fact of the matter is this country needs primary care doctors, period. I'm simply offering a solution to the problem. What's yours?[/QUOTE]

Also don't forget about GME time! ACGME will not let you abbreviate your post graduate training timeline. (regardless of prior experience). I once met a British trained FRCS (fellow of the Royal College Surgeon) who came to the US and guess what..he still had to do 5 years of general surgical residency in the US.

And if "family" is an issue for the traditional medical education...then your life will suck when you work your so called 80hr work week as a resident.
 
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FNPinKS said:
Most of practicing professionals in any field will agree that training is great, and necessary, and whatever, but real learning and becoming competent comes from experience. I knew all you SDN people would give the most BS about all this, which is good for me, because when I reach the federal level, I'll have already heard all the BS and will be ready to handle it.
Click to expand...

Once again, I don't think you're getting it. Physicians do get a ridiculous amount of experience before being allowed to practice independently. It's called residency. Maybe you've heard of it? Through a 3-year primary care residency, the resident gets over ten thousand hours of clinical training and experience. More importantly, it's supervised experience where lots of learning occurs. That's in addition to the several thousands of hours they receive in the third and fourth years of medical school.

Even after all this, some are considering increasing the length of residency for family medicine. If physicians, who (whether you like it or not) have the highest level of training in terms of clinical practice, think that they need even more training, what makes you think that you can cut down on it?

FNPinKS said:
You all are so stuck on "short cut". I knew you would be, as I mentioned in the original message. You are so stuck on traditional methods that you won't open up to new possibilities and avenues to accomplish something. Are you afraid I won't have to work as hard? Fine, make it twice as hard. I don't care. The issue isn't pissing a bunch of kids off, it's who's going to keep these rural hospitals open and take care of all the good people who actually work for a living in rural America? If you aren't willing to going the traditional route (and believe me, I wouldn't either, having the option to specialize), then let those of us that already are there. Would you rather NPs and PAs take over all primary care and leave physicians to specialties only? That's where all this is headed, whether you take your premed sciences or not.
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We are all stuck on shortcut because that's exactly what this program you're proposing is. We're stuck on traditional methods because there is abundant evidence that the methods work. And that they work well. Frankly, online lectures, etc, are still somewhat in their infancy. I would rather wait for more evidence that they work than jump on the bandwagon because it's convenient.

FNPinKS said:
The fact that you can't fathom a bridge to something means you aren't really thinking about it at all. If you truly think there is absolutely no medical training or experience in being a NP, then fine, make it a "bridge" that has no boards hammered at all. Make it the whole damn program. Just make it available outside of the 19th century walls of traditional medical school.
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"Make it the whole damn program?" That program already exists. It's called medical school + residency.

FNPinKS said:
There are plenty of qualified people that would step up and take care of all the people who need it.
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Yes, and they would probably go through medical school and residency rather than try to shortcut through it.

I mean, I want to be an NBA player. But I'm short and not very skilled with a basketball. And I also do not want to spend the thousands of hours in training to improve. So, how can I play in the big league?
 
Kaushik said:
But that's not what you're suggesting. You're not saying let's cut down on 7+ years of part-time education into a few years. What you're saying is that you want to cut down on 7 years of rigorous, full-time education into a few years. That's completely different from what you are saying in the above quote. No one will call you a loser if you cut down 15 years of part-time schooling into 3 years. Most people would likely be impressed. However, when you want to cut down 7 years of what is widely considered to be one of the toughest training paths to go through, then I start to question your motivation..
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Yes, I do think that a practicing, experienced NP or PA is leagues ahead of a medical layperson. That's part of the premise behind reducing a program that is intended to train a physician to go into any specialty so that it's intended on creating only primary care physicians. And you question my motivation? To make about the same money as I do now, but attempt to keep a rural hospital open that might not if I don't come do something about it? It's clear what your motivation is in responding to this thread in the first place.


Kaushik said:
PS. "Pre-med sciences" involve more than one course. Either way, that's neither here nor there.
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I know, I've taken all eight. Where did you pull that one out of?


Kaushik said:
The solution isn't to allow NPs to shortcut their way into primary care medicine. That's not going to entice medical students to pursue that field if they perceive others with lesser/less rigorous training can get into it just the same. Isn't that one of the problems right now? That medical students think primary care physicians don't get much respect (part of which has to do with midlevels with a fraction of the training physicians get being allowed equivalent scope of practice in several states)?

The solution is to provide more incentives for medical students to pursue primary care. Reimbursements for PCP services have to change. A way to reduce/eliminate the debt burden would help a lot. Reducing the number of paperwork and non-medicine related crap that PCPs have to put up with daily. Things like these will help increase the popularity of primary care specialties. Allowing lesser trained individuals to shortcut into the field will, on the other hand, be a pretty strong disincentive IMO.
Click to expand...

You are so stuck on worrying that someone is going to get somewhere with lessor training has clouded your entire judgement. For some reason, you are equating less redundant training with less training in general. If you can't see past this, then no change at all will ever be acceptable to you. The solutions you mention are clearly solutions that would succeed, but they are so far out there with our system that we have to start fresh and come up with something new. The bottom line is you have people who are ready and willing to take on anything you throw at them as long as they can get to it. So, it's really not something I have to sell to you, but something you have to create to make me interested enough to buy it. I am certain you would have most physicians on your side. But, the other 299 million Americans would likely think otherwise.
 
SPQR said:
The fact of the matter is this country needs primary care doctors, period. I'm simply offering a solution to the problem. What's yours?
Click to expand...

Also don't forget about GME time! ACGME will not let you abbreviate your post graduate training timeline. (regardless of prior experience). I once met a British trained FRCS (fellow of the Royal College Surgeon) who came to the US and guess what..he still had to do 5 years of general surgical residency in the US.

And if "family" is an issue for the traditional medical education...then your life will suck when you work your so called 80hr work week as a resident.[/QUOTE]

I realize that there are many barriers to something like this. But change is inevitable, and necessary to fix the problem. The work week isn't the issue; residency, as I have been told by multiple physicians who have been through it, is supervised practice and reporting to attendings. What do you think we do every day? If it's not enough, then what is? Make a program that is enough! Yes, I know. Back to the default, "Go to medical school and residency like all of us have done."

Thanks for helping me prepare for answering the questions when they really matter. I appreciate it.
 
Kaushik said:
Once again, I don't think you're getting it. Physicians do get a ridiculous amount of experience before being allowed to practice independently. It's called residency. Maybe you've heard of it? Through a 3-year primary care residency, the resident gets over ten thousand hours of clinical training and experience. More importantly, it's supervised experience where lots of learning occurs. That's in addition to the several thousands of hours they receive in the third and fourth years of medical school.
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The resident gets over 10,000 hours... hmmm. I've had over 12,000 hours of supervised experience in the last 5 years of practice. Soooo...

Kaushik said:
Even after all this, some are considering increasing the length of residency for family medicine. If physicians, who (whether you like it or not) have the highest level of training in terms of clinical practice, think that they need even more training, what makes you think that you can cut down on it?.
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I can cut it down because I don't need to learn how to listen to a heart and lungs. I don't need to know what an H&P is. If you don't think so, then test me. If I fail, I'll be happy to take whatever course you think is necessary. If I pass, then maybe we aren't just a bunch of brainless bodies filling spots because they're there.


Kaushik said:
We are all stuck on shortcut because that's exactly what this program you're proposing is. We're stuck on traditional methods because there is abundant evidence that the methods work. And that they work well. Frankly, online lectures, etc, are still somewhat in their infancy. I would rather wait for more evidence that they work than jump on the bandwagon because it's convenient.?.
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Again, shortcut means a shorter route to the same place. I'm proposing taking several additional years onto the 8 I have completed along with the many years of experience. 18 years is longer than 11.

Kaushik said:
"Make it the whole damn program?" That program already exists. It's called medical school + residency.
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Yes it does. So make it available to more than a few who aren't really willing to do primary care in the first place.


Kaushik said:
I mean, I want to be an NBA player. But I'm short and not very skilled with a basketball. And I also do not want to spend the thousands of hours in training to improve. So, how can I play in the big league?
Click to expand...

Kaushik: "The only way to get to the NBA is to practice on the court on University campuses."

Me: "But I have a regulation court that is exactly the same in my rural town that I've been playing on for ten years, I just need someone to come here and help me learn."

Kaushik: "Sorry, that doesn't count. We've been doing it this way for over 100 years."

Me: "Why can't we come up with new ways to accomplish the same thing?"

Kaushik: "Just because"


Thank you for helping me prepare for answering these questions when they come to me from people who care about the healthcare of this country. I appreciate it.
 
FNPinKS:

I am a FNPstudent in NC and I'm curious, why do you want to be a physician? Sounds like you have a pretty good gig. If it is just about your rural hospital, surely you can find a physician to supervise/collaborate (choose your preferred nomenclature) from a distance?

I just don't see that much of a cross over between the two. Should a physician want to be a NP, :cool: s/he'd have to go to nursing school after all. I don't think a medical degree should qualify one to sit for NCLEX anymore than it would a CPA exam. Logic dictates the reverse be respected. Each profession is distinct and I think it is proper to require individals to pursue the appropriate education and credentials specific to the goal.

I'm not savvy enough to argue the merits/pitfalls of the current state of medical education. Whatever it's flaws, it is the best way to prepare to be a physician. I don't see the wisdom of your proposal.
 
Lemme guess, 12,000 hours as a nurse is ~ physician like practice.

Your argument is absurd, you are not even a physician yet you seem to think you are entitled to some fast track course because of your nursing experience.
 
Paseo Del Norte said:
Lemme guess, 12,000 hours as a nurse is ~ physician like practice.

Your argument is absurd, you are not even a physician yet you seem to think you are entitled to some fast track course because of your nursing experience.
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Not as a nurse, but a NP. There's a huge difference, but you know that. I'm satisfied at this point in the fact that you aren't making any sense. You may go now.
 
ChillyRN said:
FNPinKS:

I am a FNPstudent in NC and I'm curious, why do you want to be a physician? Sounds like you have a pretty good gig. If it is just about your rural hospital, surely you can find a physician to supervise/collaborate (choose your preferred nomenclature) from a distance?

I just don't see that much of a cross over between the two. Should a physician want to be a NP, :cool: s/he'd have to go to nursing school after all. I don't think a medical degree should qualify one to sit for NCLEX anymore than it would a CPA exam. Logic dictates the reverse be respected. Each profession is distinct and I think it is proper to require individals to pursue the appropriate education and credentials specific to the goal.

I'm not savvy enough to argue the merits/pitfalls of the current state of medical education. Whatever it's flaws, it is the best way to prepare to be a physician. I don't see the wisdom of your proposal.
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I don't expect you to understand this yet. You will in a few years. I'm not saying the way it's done now is not acceptable. I'm just saying there could be new ways to help fill gaps that the current system is leaving.

Or, we can all just leave everything alone and let the primary care world be completely handed over to us lowly midlevels.
 
I want to thank all of you regulars for chiming in. I am aware that there are many obstacles in a new idea of changed.

Luckily, I am aware of the fact that people who frequent forums like this are completely removed from the real world, as no one ever talks to anyone face to face like you people do in here.

I once discussed a study of physician behavior with an old healthcare exec who has been around for 40 years. He told me it was found that many physicians who throw fits, act like children, and basically socially resemble teenagers couldn't cope with the tremendous stress of medical training and never matured. You all demonstrate that to a T.

Go ahead and get it out of your system, because if you don't, you'll likely lose sleep over it. But, rest assured I will not be back here or read any more posts. I got what I came to get. Thanks again. ;o)
 
FNPinKS said:
I want to thank all of you regulars for chiming in. I am aware that there are many obstacles in a new idea of changed.

Luckily, I am aware of the fact that people who frequent forums like this are completely removed from the real world, as no one ever talks to anyone face to face like you people do in here.

I once discussed a study of physician behavior with an old healthcare exec who has been around for 40 years. He told me it was found that many physicians who throw fits, act like children, and basically socially resemble teenagers couldn't cope with the tremendous stress of medical training and never matured. You all demonstrate that to a T.

Go ahead and get it out of your system, because if you don't, you'll likely lose sleep over it. But, rest assured I will not be back here or read any more posts. I got what I came to get. Thanks again. ;o)
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I'll be making sure to send this on to the Dean of the University of Kansas School of Medicine, with a note stating that this was written by the NP who wrote to them about the idea of an NP-MD program. (As well as a link to this thread). I think the Dean ought to know the way you react when others don't agree with you, and it should be sufficient to show that you are just another NP with a chip on the shoulder, and not someone truly interested in fixing the system.

Rest assured that I will not be back to read your response, and rest assured that I truly will be sending this on to the Dean.
 
Good, now that she's gone, let's talk about how crazy she was...
 
FNPinKS said:
Not as a nurse, but a NP. There's a huge difference, but you know that. I'm satisfied at this point in the fact that you aren't making any sense. You may go now.
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Huge difference? A couple of years of online courses and less than 1,000 clinical hours in some cases.

S6MD said:
Good, now that she's gone, let's talk about how crazy she was...
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Why, other than a few cheap thrills, I see no point. I have no idea who the OP was; however, if I am to believe he/she was really a NP and really believed her story, then it all goes back to, "You don't know what you don't know."

At least more than a few of us can admit to appreciating the above fact. Unfortunately, when ignorance fuels arrogance, this concept is forgotten.
 
I think the point of this whole thread has sorely been missed. I'm a med student (albeit a lowly first year) and I actually think it is a good idea! Let's be honest - it takes a ton of work to be a doctor, nobody is arguing or trying to get around that. It is not the majority of nurses/NPs/PAs that have the drive (or the desire, or the ability) to try to get there. For those who do, why not give them the option of taking our tests? If NPs/PAs are able to pass steps I and II why not consider letting them into residency programs? I do believe there should be required courses - the material would obviously be covered on the exams. I think it is totally feasible to have a 1-2 year fast track (f pre-reqs are already done) + residency for mid level providers. I don't see the harm in it.Those tests are extremely challenging, it is not really possible to slip though the cracks. Many med students and docs can be very condescending... ( I would bet $ that the posters sounding off are male!) There are several people in my class that worked as CNAs or MAs before coming to med school - people in these positions are usually expected to be totally incapable and incompetent, obviously not the case with my classmates. As mush as doctors like to believe that they (we) are the smartest folks around, that is just a ridiculous assumption. People make career choices for a million reasons.

Is medical training much more difficult than NP/PA training? yes.
Do doctors know a crap load more than NPs/PAs? you bet.

Is this because every person who becomes a doctor is intrinsically brighter, smarter, more capable, special, beautiful than every person that becomes a nurse? No, sorry, it doesn't.

Please get off your high horses. I can admit that clinically any nurse that has been working for a while knows a hell of a lot more that I do right now. That, of course, will change in the not too distant future. The road to medicine is long and hard. If someone wants to put him or herself though that - and can pass the standardized measures of his or her ability and competency - why not let them?
 
holyhekshler said:
I think the point of this whole thread has sorely been missed. I'm a med student (albeit a lowly first year) and I actually think it is a good idea! Let's be honest - it takes a ton of work to be a doctor, nobody is arguing or trying to get around that. It is not the majority of nurses/NPs/PAs that have the drive (or the desire, or the ability) to try to get there. For those who do, why not give them the option of taking our tests? If NPs/PAs are able to pass steps I and II why not consider letting them into residency programs? I do believe there should be required courses - the material would obviously be covered on the exams. I think it is totally feasible to have a 1-2 year fast track (f pre-reqs are already done) + residency for mid level providers. I don't see the harm in it.Those tests are extremely challenging, it is not really possible to slip though the cracks. Many med students and docs can be very condescending... ( I would bet $ that the posters sounding off are male!) There are several people in my class that worked as CNAs or MAs before coming to med school - people in these positions are usually expected to be totally incapable and incompetent, obviously not the case with my classmates. As mush as doctors like to believe that they (we) are the smartest folks around, that is just a ridiculous assumption. People make career choices for a million reasons.

Is medical training much more difficult than NP/PA training? yes.
Do doctors know a crap load more than NPs/PAs? you bet.

Is this because every person who becomes a doctor is intrinsically brighter, smarter, more capable, special, beautiful than every person that becomes a nurse? No, sorry, it doesn't.

Please get off your high horses. I can admit that clinically any nurse that has been working for a while knows a hell of a lot more that I do right now. That, of course, will change in the not too distant future. The road to medicine is long and hard. If someone wants to put him or herself though that - and can pass the standardized measures of his or her ability and competency - why not let them?
Click to expand...

Not sure; however, I bet your opinion is subject to change being that you have little experience. I would agree that I would probably make many med students look quite inexperienced when it comes to placing IV's and so on. However, we are talking monkey skills versus putting the big picture together and making a command decision so to speak.

Clearly, I m not a physician but from what I gather that is the role of a physician in the clinical environment. My role is to make sure that decision is carried out. Of course, I have to have the knowledge to identify problems or situations that require the physician to make other decisions. The point being, clinically my role is profoundly different from that of a physician.
 
FNPinKS said:
Did you even read the post? That is the traditional route and is not possible for the majority of us old practicing NPs/PAs with families. Change is difficult, I know. But open up your mind and admit there is more than one way to accomplish something for the greater good of the people.
Click to expand...

Yes, I read the post. The traditional route isn't open to you. Poor you. So standards should change so you get what you want? Hell, I've been a nurse for 25 years. I think there should be a shortcut for me to become an NP. I shouldn't have to do all that darn coursework; I've worked in a bunch of specialties; I've been certified in 5 different specialties. By golly, I'm smart as a whip! It's about time someone noticed and rewarded me!
 
Last edited:
Paseo Del Norte said:
Huge difference? A couple of years of online courses and less than 1,000 clinical hours in some cases.



Why, other than a few cheap thrills, I see no point. I have no idea who the OP was; however, if I am to believe he/she was really a NP and really believed her story, then it all goes back to, "You don't know what you don't know."

At least more than a few of us can admit to appreciating the above fact. Unfortunately, when ignorance fuels arrogance, this concept is forgotten.
Click to expand...

Weren't you dismissed? Why are you still talking? ;)
 
FNPinKS said:
I don't expect you to understand this yet. You will in a few years. I'm not saying the way it's done now is not acceptable. I'm just saying there could be new ways to help fill gaps that the current system is leaving.

Or, we can all just leave everything alone and let the primary care world be completely handed over to us lowly midlevels.
Click to expand...

I've been around message boards long enough to know this 'never coming back and reading' BS is...bull****.

So, since you are undoubtedly reading this, I have to reiterate my question, "Why do you want to be a physician?" What is the point? You stated you didn't want to make more money (odd, but some people are less materialistic than I am, so OK), and you are already providing the primary care in your rural area. What would change exactly?

It seems to me the difference is that a physician that has actually been to medical school and completed a residency would in fact have more to offer by virtue of same, yada yada yada. What would your short-cut to MD do for your patient population since you would be obtaining that degree, hypothetically, without the advantage of aforementioned education and experience? Med school and residency IS the advantage, it is what makes the difference. How is skipping that going to help your community? Don't pat me on the head and tell me I'll understand later. I want to understand now. If it isn't open for objective criticism and discussion, why did you bring it up in the first place?
 
Curious

THe basic objectives of medical school

1. Pre-requisites course work in physics, chem, org, bio (coursework for science majors only....not survey courses); must take MCAT's
2. Broad based generalist education in medical sciences (2 years of sciences/clinical sciences followed by 2 years of very specific clinical training + electives.
3. An approved residency (which has to meet very specific supervised objectives to specialize in family jmedicine) This is what makes the physician.

***Medical school is competency based education - not degree based.

4. the medical model requires the student pass a series of exams. Remember that part of what makes an exam valid is the coursework and clinical training that was completed to qualify to sit for it. Can people challange the exam and pass without....probably, But passing the exam would have far less meaning or validity. You can challenge the bar exam (and many people do and pass), but these people are in no way prepared to go into the courtroom or prepared to practice law.

What percentive of nurse practitioners have the pre-requisites coursework for medical school?

What portion of medical school does a nurse practitioner believe they should get credit for? I don't see much in their coursework that could crossover.

Can you do some of the medical school coursework online...(maybe some)?

Do you think you will have the support of either organization....nursing or medical? I dought it.

But at some point you have to understand that we do have training physicians down to a science. Is some tradition....sure. But it's still damn good training that is expensive, comprehensive, objectiv based....ect.

The fact is that the nursing model of education isn't at all similar. How do you "bridge" that.

You can make the case for PA's because they already have a masters degree in medicine. Their pre-requisites are similar, their didactic training is similar, their clinical training is similar, and you could theoretically bridge their didactic and clinical training. Their training is based on the system used to train physicians during the WWII era.

You're proposing that because a nurse practitioner might have aptitude, their should be a "bridge"
program. My thought is that aptitude (sp?) might help you in medical school, but it doesn't abreviate the program.

unedited
 
I think its absolutely offensive when an NP believes they can master the material that took me 8 hours of classroom time and 4 hours of home study time EVERY DAY for 2 years (with at least 8-9 more hours over the weekends) by logging onto the internet every evening after work.

This is NOT NURSING. Its not subjective, nebulous and touchy-feely. Anatomy and Physiology alone at the medical school level is not something you can spend a few hours on after a long day at work and making your family dinner.

Its just amazing to me. The work required for medical school is a challenge for those of us dedicating our every waking moment to it for 4 years after proving our worth in a 4-years undergrad science degree and fighting through the admissions process.

But you nurses are gonna handle it on evenings and weekends in pajamas via the internet.
 
JLM said:
I think its absolutely offensive when an NP believes they can master the material that took me 8 hours of classroom time and 4 hours of home study time EVERY DAY for 2 years (with at least 8-9 more hours over the weekends) by logging onto the internet every evening after work.

This is NOT NURSING. Its not subjective, nebulous and touchy-feely. Anatomy and Physiology alone at the medical school level is not something you can spend a few hours on after a long day at work and making your family dinner.

Its just amazing to me. The work required for medical school is a challenge for those of us dedicating our every waking moment to it for 4 years after proving our worth in a 4-years undergrad science degree and fighting through the admissions process.

But you nurses are gonna handle it on evenings and weekends in pajamas via the internet.
Click to expand...

Agreed - I say let them try....and then fail. They will fail, and they will then be thousands and thousands of dollars in debt. If they don't fail the curriculum, which would then have to be regulated by AOA or LCME - they would definitely fail the boards.

If they want this piece of pie so badly, let's see them eat it. And that is a challenge!
 
Full disclosure: I was a practicing RN before I became an NP, then I was a practicing NP when I started medical school.

This discussion reflects a common misunderstanding among people in nursing about how medical training works. Before I started med school, I also thought that medical school was simply additional training and that I could learn the same things through experience or self-study. This is not the case. Medical training is structured very differently, there is a different foundation (basic science versus clinical care experience), and the expectations of rapid progress are much more aggressive. And then residency is three to 5/6/7 years of intensive, exponential learning.

I am regularly asked whether I was able to test out of classes or whether I got credit for past experience. I did not and can say that I learned new information from every single class. I had a distinct advantage as an NP but what would I have tested out of? Learning a heart and lung exam takes about an hour. Understanding what an H&P is takes about 5 minutes and most people have a little card with all the sections on it. Was I going to get a pass on the lecture on hypertension since I had treated many people with hypertension? Not on your life. The depth that medical school is taught at is so much greater than my NP education that I can say there is really no comparison.

My bias is that I went to medical school, so take this with a grain of salt if you want.
 
JLM said:
I think its absolutely offensive when an NP believes they can master the material that took me 8 hours of classroom time and 4 hours of home study time EVERY DAY for 2 years (with at least 8-9 more hours over the weekends) by logging onto the internet every evening after work.

This is NOT NURSING. Its not subjective, nebulous and touchy-feely. Anatomy and Physiology alone at the medical school level is not something you can spend a few hours on after a long day at work and making your family dinner.

Its just amazing to me. The work required for medical school is a challenge for those of us dedicating our every waking moment to it for 4 years after proving our worth in a 4-years undergrad science degree and fighting through the admissions process.

But you nurses are gonna handle it on evenings and weekends in pajamas via the internet.
Click to expand...

The NP bridge is a ridiculous concept as is the PA bridge. But don't expect to feel sorry for you because of all the time you've invested in school! I think its offensive that physicians think that they're god's gift to the world and everyone should put them on a throne and worship them.:cool:
 
aftdesk said:
Full disclosure: I was a practicing RN before I became an NP, then I was a practicing NP when I started medical school.

This discussion reflects a common misunderstanding among people in nursing about how medical training works. Before I started med school, I also thought that medical school was simply additional training and that I could learn the same things through experience or self-study. This is not the case. Medical training is structured very differently, there is a different foundation (basic science versus clinical care experience), and the expectations of rapid progress are much more aggressive. And then residency is three to 5/6/7 years of intensive, exponential learning.

I am regularly asked whether I was able to test out of classes or whether I got credit for past experience. I did not and can say that I learned new information from every single class. I had a distinct advantage as an NP but what would I have tested out of? Learning a heart and lung exam takes about an hour. Understanding what an H&P is takes about 5 minutes and most people have a little card with all the sections on it. Was I going to get a pass on the lecture on hypertension since I had treated many people with hypertension? Not on your life. The depth that medical school is taught at is so much greater than my NP education that I can say there is really no comparison.

My bias is that I went to medical school, so take this with a grain of salt if you want.
Click to expand...

I understand it and I feel your pain. I'm taking the liberty to post some comments here from a PA who became an MD.

Re the USMLE step 1 “This is a useless standardized exam, that tests your ability to “recognize” in a multiple choice setting small and obscure non-important basic science facts.”

“Tradition is hurting the medical profession and our patients are
suffering also.”

“ Only the clinical training years are most beneficial in medical school. I ran circles around the DO’s and MD’s during clinics for two main reasons. In P.A school I learned from an organs systems approach where we for example started with eczema, studied the layers of skin as it related to eczema and the cellular proliferation of the stratnum germativium all the way up to the epidermis,then pharmacology explained why the medications worked for eczema based upon the histology and the inflammatory response involving arachadonic acid etc....Our hematology professor would teach us that anemia was too many cells, too few cells or no cells at all. Every lecture was integrated and focused on understanding real world medicine. This was in P.A school. In Medical school however it was confusion during the basic science years and the focus was on competition, passing the boards and stressing you out. We learned a lot of detail about academic diseases. No integration of clinical sciences to basic sciences. In P.A school however we were taught to be clinic ready.”

“When I took my MD licensing exams, I recognized many questions from my MD licensing exams that were on the P.A standardized exams.”

My concern, and point, is that nursing education, as well as medical education needs to be bought into the current century. I certainly wouldn't be arguing who's best, especially with our track record compared to other countries. I'm having flashbacks to my military days when buddies would argue, and almost get into fist fights, over who was the best because they survived the toughest training! :laugh:
 
zenman said:
I understand it and I feel your pain. I'm taking the liberty to post some comments here from a PA who became an MD.

Re the USMLE step 1 "This is a useless standardized exam, that tests your ability to "recognize" in a multiple choice setting small and obscure non-important basic science facts."

"Tradition is hurting the medical profession and our patients are
suffering also."

" Only the clinical training years are most beneficial in medical school. I ran circles around the DO's and MD's during clinics for two main reasons. In P.A school I learned from an organs systems approach where we for example started with eczema, studied the layers of skin as it related to eczema and the cellular proliferation of the stratnum germativium all the way up to the epidermis,then pharmacology explained why the medications worked for eczema based upon the histology and the inflammatory response involving arachadonic acid etc....Our hematology professor would teach us that anemia was too many cells, too few cells or no cells at all. Every lecture was integrated and focused on understanding real world medicine. This was in P.A school. In Medical school however it was confusion during the basic science years and the focus was on competition, passing the boards and stressing you out. We learned a lot of detail about academic diseases. No integration of clinical sciences to basic sciences. In P.A school however we were taught to be clinic ready."

"When I took my MD licensing exams, I recognized many questions from my MD licensing exams that were on the P.A standardized exams."

My concern, and point, is that nursing education, as well as medical education needs to be bought into the current century. I certainly wouldn't be arguing who's best, especially with our track record compared to other countries. I'm having flashbacks to my military days when buddies would argue, and almost get into fist fights, over who was the best because they survived the toughest training! :laugh:
Click to expand...


Not sure how old this blog is or when they took the exam. But, in very little way is this applicable to the exam in its current format.

I would say of each block of 44 questions--8-12 were straight recall.... the rest was application of the basic sciences.

The boards would not ask question in a straight forward matter, they would make you use what you know and reason through it.

I will go with a psych example cuz i know zenman is interested in psych

Instead of asking:
You have a 28 y/o diabetic Schizo patient what is the treatment of choice?
1) olanzapine
2) aripiprazole
3) haloperidol
4) hydrochrlorothiazide

It would ask:

You have a 28 y/o diabetic Schizo patient that began treatment for Schizophrenia two weeks ago. Recent blood work shows agranulocytosis. What drug did the patient most likely start?

1) acamproate
2) clozapine
3) aripiprazole
4) hydrochlorothiazide

Notice how question one just asks you to know the treatment of Schizophrenia. Question two asks you to make two steps: 1) whats the treatment for schizophrenia 2) out of the listed treatments a specific side effect of that treatment

This is a VERY simple example. Most board questions make you make 3 steps. The harder ones will make you make 4-5 steps.
 
FutureDoc4 said:
I will go with a psych example cuz i know zenman is interested in psych

Instead of asking:
You have a 28 y/o diabetic Schizo patient what is the treatment of choice?
1) olanzapine
2) aripiprazole
3) haloperidol
4) hydrochrlorothiazide

It would ask:

You have a 28 y/o diabetic Schizo patient that began treatment for Schizophrenia two weeks ago. Recent blood work shows agranulocytosis. What drug did the patient most likely start?

1) acamproate
2) clozapine
3) aripiprazole
4) hydrochlorothiazide

Notice how question one just asks you to know the treatment of Schizophrenia. Question two asks you to make two steps: 1) whats the treatment for schizophrenia 2) out of the listed treatments a specific side effect of that treatment

This is a VERY simple example. Most board questions make you make 3 steps. The harder ones will make you make 4-5 steps.
Click to expand...

Did I pass? :confused:
 
Pathway to MD:

Undergrad prereqs
MCAT
Med School
Internship
Residency

Good Luck.

P.S. I believe 3rd year med students, who have FAR superior scientific training and clinical judgement/hours than NPs, should be allowed to practice as NPs, competing with them for jobs, under the supervision of a physician. What do you think about that?

FNPinKS said:
I have recently been presented with a series of events that got me thinking about an evolutionary educational process that I believe will help this country tremendously.

I have emailed the Dean of the University of Kansas School of Medicine; a place where I believe will be a perfect launch pad for such a program.
I am a practicing NP in rural Kansas, where I do clinic, hospitalist function, ED, long term care, and just about anything that comes through the door. The hospital I work at is very rural, and the two docs are nearing the end of their career. Needless to say, there aren’t a lot of physicians beating down the door, which threatens the very existence of the whole institution. We all are aware of the ever-worsening shortage of primary care docs, especially since many of us PA/NPs are filling that role. In comes my idea…

We all have been reading about and some of us participating in doctorate programs, which I believe is an effort, at least in part, to become completely autonomous providers. However, I don’t think we’ll ever be on a level playing field with physicians, whether we think we should or not (I personally don’t think our education is anywhere near where it needs to be if we were to even consider competing with allopathic or osteopathic physicians).

So, instead of fighting all the time, I propose a solution: a new educational pathway for NPs and PAs can become physicians using the most advanced telecommunications and internet technology available so we can continue to provide care but we can earn a MD or DO. Now I’ve heard the cynics who will say “no shortcuts to medicine, blah blah blah” but I urge you to find anyone that has been through the minimal 6-7 years of education, and then the probable 3-4 years of additional training it would take to complete a new program such as this, to consider this a “shortcut”.

At this point in time, there is only one program I am aware of that one can do something like this. It is in American Samoa, and although I’m certain there are students and graduates doing just fine, I know several states will not license graduates of this program. The only other way to earn a MD or DO is to start as if you are a 22 year old college graduate - something that is just not practicle or feasible in the vast majority of our situations.
When I enrolled in a DNP program at Saint Louis University, I was encouraged to finally hear about these new “clinical-based doctorate programs” for nurse practitioners. However, after sitting through the first two days on the campus and hearing what it was really all about (really no different than a PhD in my opinion), I was very disappointed but not terribly surprised and dropped out immediately.

I did hear a common statement from many NPs in the program - the hunger for more education and the desire to earn a MD/DO. Several of us spoke about the reason why none of us are able to do it (families, income, etc etc).
So, the people and their desire is there (probably on a much larger scale than I can imagine). The need for primary care doctors is there. Now we need to find some open-minded schools to create a program to make it happen.
The program would have to allow for a great deal of self study. It would have to have practicing physicians who could mentor NP/PA students in the program, which wouldn’t be a stretch in many cases as many of us are already working side-by-side. It should fill the gaps in our education which needs to be determined by a team of both NP/PAs and MD/DOs. It should not include rotations in specialty fields; only primary care. And, we should only be able to practice primary care medicine so graduates don’t go into specialties thus defeating the purpose of the program. It should have an abbreviated residency training program since many of us have already been practicing every day for many years (ie every 3 years of practice equals 1 year of residency, etc). If graduates do poorly on the USMLE and board certification exams, it will be clear where the weaknesses are and adjustments could be made accordingly.

The institution providing such a program could charge just about anything they wanted, as there are many programs that will pay back student loans for practicing in rural areas. It would also command attention from federal funding, especially in light of all the Obamacare changes.

I believe there would be literally thousands of us jumping all over a program such as this. I certainly would be first in line....
Click to expand...
 
FNPinKS said:
Not as a nurse, but a NP. There's a huge difference, but you know that. I'm satisfied at this point in the fact that you aren't making any sense. You may go now.
Click to expand...

LOL, you are a nurse. What's wrong with that?

Nurse practitioner = nurse. Nurse practitioner = midlevel. Nurse practitioner does not = doctor/physician.

Remember, Pathway to MD:

Undergrad prereqs
MCAT
Med School
Internship
Residency

Good Luck.
 
Last edited:
Is this a joke? Med students like you become the doctors who have destroyed medicine.

holyhekshler said:
I think the point of this whole thread has sorely been missed. I'm a med student (albeit a lowly first year) and I actually think it is a good idea! Let's be honest - it takes a ton of work to be a doctor, nobody is arguing or trying to get around that. It is not the majority of nurses/NPs/PAs that have the drive (or the desire, or the ability) to try to get there. For those who do, why not give them the option of taking our tests? If NPs/PAs are able to pass steps I and II why not consider letting them into residency programs? I do believe there should be required courses - the material would obviously be covered on the exams. I think it is totally feasible to have a 1-2 year fast track (f pre-reqs are already done) + residency for mid level providers. I don't see the harm in it.Those tests are extremely challenging, it is not really possible to slip though the cracks. Many med students and docs can be very condescending... ( I would bet $ that the posters sounding off are male!) There are several people in my class that worked as CNAs or MAs before coming to med school - people in these positions are usually expected to be totally incapable and incompetent, obviously not the case with my classmates. As mush as doctors like to believe that they (we) are the smartest folks around, that is just a ridiculous assumption. People make career choices for a million reasons.

Is medical training much more difficult than NP/PA training? yes.
Do doctors know a crap load more than NPs/PAs? you bet.

Is this because every person who becomes a doctor is intrinsically brighter, smarter, more capable, special, beautiful than every person that becomes a nurse? No, sorry, it doesn't.

Please get off your high horses. I can admit that clinically any nurse that has been working for a while knows a hell of a lot more that I do right now. That, of course, will change in the not too distant future. The road to medicine is long and hard. If someone wants to put him or herself though that - and can pass the standardized measures of his or her ability and competency - why not let them?
Click to expand...
 
Coastie said:
P.S. I believe 3rd year med students, who have FAR superior scientific training and clinical judgement/hours than NPs, should be allowed to practice as NPs, competing with them for jobs, under the supervision of a physician. What do you think about that?
Click to expand...

I don't think M3's would be able to test out of classes or get credit for past experience. They would be learning new information from every single class.
 
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