DNP (doctor of nursing practice) vs. DO/MD

[sheva1968]

No it has long been upheld, by the nursing associations, that wh, not at nurses do is nursing and is different. Now however, nurses are claiming they want equal pay for doing the same thing. If thats the case they should be regulated by the same board who are regulating everyone else doing the same thing.

No the courts have decided it. Not the bon.

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[Charles_Carmichael]

You so miss the point, it is a simple concept but the execution is so difficult that it will not happen. Your insistence on the impractical/impossible merely highlights your lack of experience.

So many things we do in health care every day do not meet this criteria of yours, but if you actually practiced you would know that.

They must not teach YOU about ASSUME the ass part, I am not an NP.
Now go back to the books the big people need to talk now.

I assumed you were either an NP or an NP student based on experience on these forums over the past two years. Generally, when someone just joins a site and their first posts are in a nursing midlevel thread supporting the midlevels, they've turned out to be some of the nurses from allnurses coming over to troll. I apologize if you're none of the above.

I don't think I'm (or any other med students and physicians who are arguing against nursing midlevel independence) are asking for much. We're asking for evidence that supports this as a good idea. As of right now, there isn't any. If nursing midlevels think that the "studies" they have so far are so good as to prove that they're equal/superior to physicians, it should be easy to convince an IRB to conduct a prospective RCT.

So, where is this data? Why would we want to give full scope of practice to practitioners who barely have 10% of the training that physicians get without any convincing data?

Let me ask you a question: do you think that 3rd year medical students (by the end of 3rd year) are equal to attending physicians and deserve an equivalent scope of practice? I'm curious because, by the end of 3rd year, med students not only have far better basic science training that NPs/DNPs, but they also have significantly more clinical hours of training (compared to the 500-1000 hrs of training that the average NP/DNP gets). So, by logical extension, if you think someone with less training than what 3rd year med students get is competent enough to be given full scope of practice, it only makes sense that you would also support independence for 3rd year med students (and above) as well.

OK, I retract my previous statement.

NPs have nothing more to prove to you when they are out there, like it or not, successfully practicing "advanced practice nursing".

Are you happy now?

I'm not sure if you're saying that you're retracting that bolded statement or that you retract your previous post. There isn't any convincing evidence suggesting that NP/DNPs = physicians. Even naturopaths, homeopaths, chiropractors, etc, are "successfully practicing." Doesn't mean that they have "nothing more to prove" to the medical community.

No the courts have decided it. Not the bon.

You're right about this part. The nursing lobby is incredibly powerful! Let's be honest here. The only reason that NPs/DNPs have greater scope of practice in some states than PAs (who easily have far superior training) is because of how powerful the nursing lobby is. Not only that, the ANA, AANA, etc, are very good at manipulating public opinion via the use of the media. I mean, practically every article you read regarding nursing midlevels has someone being quoted saying that they're better than physicians. The nursing leadership/lobby is definitely better than what physicians have.

 

[PSYCHNP]

I assumed you were either an NP or an NP student based on experience on these forums over the past two years. Generally, when someone just joins a site and their first posts are in a nursing midlevel thread supporting the midlevels, they've turned out to be some of the nurses from allnurses coming over to troll. I apologize if you're none of the above.

I don't think I'm (or any other med students and physicians who are arguing against nursing midlevel independence) are asking for much. We're asking for evidence that supports this as a good idea. As of right now, there isn't any. If nursing midlevels think that the "studies" they have so far are so good as to prove that they're equal/superior to physicians, it should be easy to convince an IRB to conduct a prospective RCT.

So, where is this data? Why would we want to give full scope of practice to practitioners who barely have 10% of the training that physicians get without any convincing data?

Let me ask you a question: do you think that 3rd year medical students (by the end of 3rd year) are equal to attending physicians and deserve an equivalent scope of practice? I'm curious because, by the end of 3rd year, med students not only have far better basic science training that NPs/DNPs, but they also have significantly more clinical hours of training (compared to the 500-1000 hrs of training that the average NP/DNP gets). So, by logical extension, if you think someone with less training than what 3rd year med students get is competent enough to be given full scope of practice, it only makes sense that you would also support independence for 3rd year med students (and above) as well.



I'm not sure if you're saying that you're retracting that bolded statement or that you retract your previous post. There isn't any convincing evidence suggesting that NP/DNPs = physicians. Even naturopaths, homeopaths, chiropractors, etc, are "successfully practicing." Doesn't mean that they have "nothing more to prove" to the medical community.



You're right about this part. The nursing lobby is incredibly powerful! Let's be honest here. The only reason that NPs/DNPs have greater scope of practice in some states than PAs (who easily have far superior training) is because of how powerful the nursing lobby is. Not only that, the ANA, AANA, etc, are very good at manipulating public opinion via the use of the media. I mean, practically every article you read regarding nursing midlevels has someone being quoted saying that they're better than physicians. The nursing leadership/lobby is definitely better than what physicians have.

Never mind.

 

[sheva1968]

I think we should address this issues one at a time.
1. There will never be a multi centered blind randomized study on outcomes. Ever. There are too many variables and no one will volunteer for it. Insisting on this is a nonstarter, as I pointed out there are huge parts of clinical practice that have been established and are used every day that have not had this level of research, do we throw them away? No we use them watch them and see if we are right, remember Beta blockers, HRT, Vit D supplements just point out a few.

2. Education, you are right about the amount of education that a resident receives relative to a NP, but you have failed to take into account the type and end goals, the first 2 years of medical school have limited if any clinical value in themselves, genetics is nifty and so is embryology, but they have no clinical utility. Medical school prepares one to know a little about a lot. When I say a little it is only small relative to an area of specialization, I mean c'mon do you think a med school grad is really an expert in neurology or cardiology or any other ology?

3. After medical school starts residency in which huge amounts of med school are forgotten and a doctor starts learning to be a real clinician in his or her area of specialization. After residency they may or may not then pursue a fellowship.

4. Practice huge amounts of residency are forgotten as the every day work and routine procedures are done, you have learned to do so much more but that is not what pays the bills and it is not what you see, GI guys spend hours dealing with constipation, the occasional Crohns and discovering colon cancer, anesthesiologists spend countless hours with ASA 1 Knee scopes or lap choles, not high level stuff. Are you getting the picture?

Now the NP is meant to operate in a very narrow scope, they are not going to inject joints like a lot of FP guys do they are going to for the most part mange chronic health conditions in which we have many protocols for that everyone, and I mean every man jack in medicine follows, period. That is EBM and we all are beneficiaries of all of the hard work and research performed by physicians for decades along with the nurses and the rest that gathered that information.

The ability to follow a protocol and to recognize when you are no longer on the path is much less then the ability to discover research and make said protocol. Md's are going to be doing all of that for the foreseeable future.

As for better politics I believe thattThe ASA has the largest medical PAC and the orthopods are not far behind. Md's control the political discourse related to medicine, control the majority of hospitals via committees and credentialing and determine who has what privileges. Better politics Puh-leeze. Poor doctors being picked on by nurses. Do. The. Math.

 

[Pleepl3us]

I think we should address this issues one at a time.
1. There will never be a multi centered blind randomized study on outcomes. Ever. There are too many variables and no one will volunteer for it. Insisting on this is a nonstarter, as I pointed out there are huge parts of clinical practice that have been established and are used every day that have not had this level of research, do we throw them away? No we use them watch them and see if we are right, remember Beta blockers, HRT, Vit D supplements just point out a few.

2. Education, you are right about the amount of education that a resident receives relative to a NP, but you have failed to take into account the type and end goals, the first 2 years of medical school have limited if any clinical value in themselves, genetics is nifty and so is embryology, but they have no clinical utility. Medical school prepares one to know a little about a lot. When I say a little it is only small relative to an area of specialization, I mean c'mon do you think a med school grad is really an expert in neurology or cardiology or any other ology?

3. After medical school starts residency in which huge amounts of med school are forgotten and a doctor starts learning to be a real clinician in his or her area of specialization. After residency they may or may not then pursue a fellowship.

4. Practice huge amounts of residency are forgotten as the every day work and routine procedures are done, you have learned to do so much more but that is not what pays the bills and it is not what you see, GI guys spend hours dealing with constipation, the occasional Crohns and discovering colon cancer, anesthesiologists spend countless hours with ASA 1 Knee scopes or lap choles, not high level stuff. Are you getting the picture?

Now the NP is meant to operate in a very narrow scope, they are not going to inject joints like a lot of FP guys do they are going to for the most part mange chronic health conditions in which we have many protocols for that everyone, and I mean every man jack in medicine follows, period. That is EBM and we all are beneficiaries of all of the hard work and research performed by physicians for decades along with the nurses and the rest that gathered that information.

The ability to follow a protocol and to recognize when you are no longer on the path is much less then the ability to discover research and make said protocol. Md's are going to be doing all of that for the foreseeable future.

As for better politics I believe thattThe ASA has the largest medical PAC and the orthopods are not far behind. Md's control the political discourse related to medicine, control the majority of hospitals via committees and credentialing and determine who has what privileges. Better politics Puh-leeze. Poor doctors being picked on by nurses. Do. The. Math.

I'm curious as to why you think the bolded statement is correct. Thinking back I remember learning a lot about a lot. Embryo not having any clinical utility? Talk to any pediatric doctor (specialty or not) and see how much embryo they use and you better believe they didn't learn it all straight from residency. Understanding genetics and the biochemical pathways of diseases allows the physician to understand the pathology and clinical symptoms much better and more importantly helps with better treatment.

Of course you are going to forget many of the nuances of the basic sciences of first year, but the knowledge is absolutely necessary to build off of when you deal with clinical systems. Anyone who has gone through/going through medical school quickly understands this.

 

[Dr Oops]

I think we should address this issues one at a time.
1. There will never be a multi centered blind randomized study on outcomes. Ever. There are too many variables and no one will volunteer for it. Insisting on this is a nonstarter, as I pointed out there are huge parts of clinical practice that have been established and are used every day that have not had this level of research, do we throw them away? No we use them watch them and see if we are right, remember Beta blockers, HRT, Vit D supplements just point out a few.

2. Education, you are right about the amount of education that a resident receives relative to a NP, but you have failed to take into account the type and end goals, the first 2 years of medical school have limited if any clinical value in themselves, genetics is nifty and so is embryology, but they have no clinical utility. Medical school prepares one to know a little about a lot. When I say a little it is only small relative to an area of specialization, I mean c'mon do you think a med school grad is really an expert in neurology or cardiology or any other ology?

3. After medical school starts residency in which huge amounts of med school are forgotten and a doctor starts learning to be a real clinician in his or her area of specialization. After residency they may or may not then pursue a fellowship.

4. Practice huge amounts of residency are forgotten as the every day work and routine procedures are done, you have learned to do so much more but that is not what pays the bills and it is not what you see, GI guys spend hours dealing with constipation, the occasional Crohns and discovering colon cancer, anesthesiologists spend countless hours with ASA 1 Knee scopes or lap choles, not high level stuff. Are you getting the picture?

Now the NP is meant to operate in a very narrow scope, they are not going to inject joints like a lot of FP guys do they are going to for the most part mange chronic health conditions in which we have many protocols for that everyone, and I mean every man jack in medicine follows, period. That is EBM and we all are beneficiaries of all of the hard work and research performed by physicians for decades along with the nurses and the rest that gathered that information.

The ability to follow a protocol and to recognize when you are no longer on the path is much less then the ability to discover research and make said protocol. Md's are going to be doing all of that for the foreseeable future.

As for better politics I believe thattThe ASA has the largest medical PAC and the orthopods are not far behind. Md's control the political discourse related to medicine, control the majority of hospitals via committees and credentialing and determine who has what privileges. Better politics Puh-leeze. Poor doctors being picked on by nurses. Do. The. Math.

My pre-clinical education has more than limited usefulness, as you say. You really think we sit here and learn useless molecules and chemical reactions the entire two years? Yes there is some of that, but we also learn physiology, pharmacology, pathology, pathophys. The more you can remember the better a doctor you will be. Period. Am I gonna forget some of this stuff? yea. But part of the utility of it is, that I may not remember every single detail but I will hold pieces which allow me to do the necessary refresher, whereas in nursing where you get none of these teachings you have no direction, no guidepost at all. Theres plenty of times when I cant remember something fully but I remember enough to get me on the right path to find the rest. If i didnt remember that little tid bit taught to me I wouldnt have even had a chance.

I dont really like genetics but it also has its utility, I can use that info to develop my DDX. With a good family history I can say well this disease is autosomal recessive, and it occured X number of times in this family, so it can go here in my differential.

Same with embryology.

Your also forgetting the 2 clinical years of med school. We have clinical lectures during the preclinical years, obviously they are not enough to practice on our own, but they arent just completely non clinical information. We are not learning how the chemical structure changes during metabolism, but we are learning how these drugs are metabolized and how pathophys affects such metabolism. Then we start applying this information during our clinical educations. We will have 1 or 2 patients we are responisble for developing treatment plans and then have those plans critiqued by clinicians.

By the time we graduate, from med school we already have more clinical hours and training than alot of nurses.

As for anesthisologist doing ASA1 alot, yea that maybe true, but that doesnt mean they can just forget how to manage ASA 3s or 4s. To suggest so is just asinine. The patient starts declining and they say they just forgot? they wouldnt have a job if that was the case.

There are far more guidelines than straight protocols. Guidelines are just that, they give you a rough plan. Its up to the clinician to vary those plans based on the individual needs of the patient. If everything were protocol driven, we would harldy need any clinical staff, We could just have techs follow the protocols and apply the treatments. Unfortunately patients dont always read the book and protocols only cover the most common scenerios. This is where the medical education comes to fruitition.

 

[sheva1968]

I'm curious as to why you think the bolded statement is correct. Thinking back I remember learning a lot about a lot. Embryo not having any clinical utility? Talk to any pediatric doctor (specialty or not) and see how much embryo they use and you better believe they didn't learn it all straight from residency. Understanding genetics and the biochemical pathways of diseases allows the physician to understand the pathology and clinical symptoms much better and more importantly helps with better treatment.

Of course you are going to forget many of the nuances of the basic sciences of first year, but the knowledge is absolutely necessary to build off of when you deal with clinical systems. Anyone who has gone through/going through medical school quickly understands this.

OK but what about the other numerous non-pediatric doctors? The idea that you really understand the biochemical pathways is ludicrous let alone are able to apply them. You must be awesome seeing as that there those who spend years doing nothing but that and they are the ones who can really understand and apply that knowledge not some one who took a quickie (comparatively) course.

You are at this moment using a vast intricate electronic system you may be able to use it well perhaps very well. You know how to access huge amounts of data, how to hide an IP, but you cannot explain the basic architecture of the system repair or replace it. You do not need to know biochemistry to administer or safely use medications, just as you do not need to be an electrical engineer to turn on a light.

This idea that you have a truly deep profound knowledge of intricate details of the human anatomy to the molecular level after 1-2 years is laughable in the extreme.

 

[sheva1968]

Dude you cannot use genetics to diagnose anything except in the most cut in paste fashion (hemophilia). I suppose all of those who actually research and study genetics for years are just wasting time cause clearly you behave a deep and total understanding. I repeat your knowledge on these subjects is clinically irrelevant, to make it truly relevant then you would be sending years on just one part not 2 years covering all of it.

As for the anesthesiologist I never stated they cannot do more I am pointing out a real world fact. A. REAL. WORLD. FACT. Most of the work is relatively simple and does not require this "deep understanding" that so many casually toss about.

 

[rmsgolfer]

OK but what about the other numerous non-pediatric doctors? The idea that you really understand the biochemical pathways is ludicrous let alone are able to apply them. You must be awesome seeing as that there those who spend years doing nothing but that and they are the ones who can really understand and apply that knowledge not some one who took a quickie (comparatively) course.

You are at this moment using a vast intricate electronic system you may be able to use it well perhaps very well. You know how to access huge amounts of data, how to hide an IP, but you cannot explain the basic architecture of the system repair or replace it. You do not need to know biochemistry to administer or safely use medications, just as you do not need to be an electrical engineer to turn on a light.

This idea that you have a truly deep profound knowledge of intricate details of the human anatomy to the molecular level after 1-2 years is laughable in the extreme.

How much biochem have you taken? Explain to me the courses that you have completed that you believe have prepared you to manage someones health. These analogies are laughable and are only used by people (usually NP's) to defend their extreme lack of knowledge. I assume you know how to drive a car, but I would not come to you to build me an engine.

And yes in medical school you go into such painful detail about human anatomy and the molecular complexities. Will you remember it all, no, but I would refrain from assuming what goes on in medical school as you obviously have no idea what it involves.

 

[sheva1968]

OK I guess that all those spending years on said subjects must be *****s seeing as you have mastered it all in 2 years.

I repeat your knowledge on these subjects is rudimentary at best relative to those who REALLY know and use this material, if you think differently you really do not know what you do not know.

 

[Dr Oops]

Dude you cannot use genetics to diagnose anything except in the most cut in paste fashion (hemophilia). I suppose all of those who actually research and study genetics for years are just wasting time cause clearly you behave a deep and total understanding. I repeat your knowledge on these subjects is clinically irrelevant, to make it truly relevant then you would be sending years on just one part not 2 years covering all of it.

As for the anesthesiologist I never stated they cannot do more I am pointing out a real world fact. A. REAL. WORLD. FACT. Most of the work is relatively simple and does not require this "deep understanding" that so many casually toss about.

Youre completely missed the point of the genetics example. I never said we were taught a "deep" understanding (but certainly more than nurses-which is completely ok because their education was designed for a different role).

First of all while the people who study these pathways usually do take years to understand them, they usually are not the ones who apply the information clinically.

Secondly yes, it took them years to do the research because they had to start from scratch, with unknowns. In our preclinical years we are not doing the research we are being taught already examined pathyways. No i will not know every little miRNA involved in the process, every single little snurp, that acts in that pathway, but we will learn a great deal of it, in the pathways that we do study. No we dont study every pathway, it would simply be impossible in 2 years. So we focus on the more clinically relevant ones.

As far as the anesthesiology thing, you havent pointed out anything. Relatively simple compared to what? Making a cake? Why not just have a 45 minutes seminar on it then? O were you saying the simple cases are easier than the complicated cases?- youre right that is certainly a real world fact. Most places use the ACT model, in which the anesthesiologist is there and supervising CRNAs.

So how much anesthesia have you practiced to know what is/isnt needed?

Relatively simple cases can easily turn into complicated ones. Like i said before you can have protocols to run everything, we wouldnt even need docs. But I would feel bad for those patients who forgot to read the book.

 

[rmsgolfer]

OK I guess that all those spending years on said subjects must be *****s seeing as you have mastered it all in 2 years.

I repeat your knowledge on these subjects is rudimentary at best relative to those who REALLY know and use this material, if you think differently you really do not know what you do not know.

Medical school is about layering, you have to start with the foundations if you are going to build up from there. In no way have I said I have more knowledge about the brain than a neurologist, or understand the heart as well as a cardiologist. There are thousands of people with vastly superior knowledge than me in a thousand different subjects all pertaining to medicine. But the people who have "mastered" these subjects all got their start at a common point and it is a place you know nothing about.

I am a second year medical student preparing for step one boards and am constantly reminded of things I need to re-learn. You still haven't answered my questions about the subjects that have prepared you for such endeavors. My sneaking suspicion is you are a np student/np (take your pick) who tries to hide their education (or lack thereof) for fear of transparency.

I am well aware of the knowledge I lack in many courses (cardio for example), but I am not trying to pass myself off as a cardiologist or tell one what they do or do not need to remember from residency.

 

[Nymphicus]

Sheva1968, your arguments are horrendous. They make me flinch they are so bad.

Why bother taking algebra when you're just going to forget how to manually solve for logs, factor quadratics and other techniques. It's not like anybody is going to come to you and say "PLEASE SOLVE THIS ALGEBRA PROBLEM FOR ME" when you are a "clinician". However, the applications of algebra and solving for unknowns are extremely useful. Just because you forgot how to factor, and because nobody at the hospital is going to make you "solve for y" does not make algebra useless.

Similarly, just because you took algebra does not make you an "expert" in algebra, but rather you are able to apply the basics to everyday problems. Nobody but you said anything about being an "expert". You don't need to be an expert in something to gain applicable knowledge.

As for the anesthesiologist I never stated they cannot do more I am pointing out a real world fact. A. REAL. WORLD. FACT. Most of the work is relatively simple and does not require this "deep understanding" that so many casually toss about.

A physician is trained to handle both cases that do not and do require this "deep understanding". That is why they are the gold standard in health care. This is why they do not need supervision.

 

[Charles_Carmichael]

OK I guess that all those spending years on said subjects must be *****s seeing as you have mastered it all in 2 years.

I repeat your knowledge on these subjects is rudimentary at best relative to those who REALLY know and use this material, if you think differently you really do not know what you do not know.

Please, just stop. With every new post, you're making yourself look worse and worse. Your arguments aren't even making any sense anymore.

No one has ever said that physicians know every little detail about the basic sciences. What people have said is that physicians receive significantly greater basic science training than nursing midlevels. And that's a fact.

Researchers know a LOT about a narrow topic. They're experts in whatever topic they've devoted their lives to studying. No arguments there. Physicians, however, do know quite a lot regarding the basic sciences. Will it be as in-depth as a PhD conducting research on that topic? No. But it will still be fairly in-depth and, more importantly to the physician, relevant to clinical practice. PhDs generally don't "apply" what they know in the real world. It's the clinicians that do.

 

[sheva1968]

stop please stop your knowledge of organic chemistry is just not enough to be used in any practical way, it is not that is a fact. not opinion fact.

As for your earlier point RCT I think finally we both know it is not going to happen so we can stop that nonsensical argument.

A third year medical student has NO practical clinical knowledge, as pointed out not how much you study but what you study, never seen any bio chem save a life.

And it is nice to see you have dropped this political argument, it must be embarrassing to be so what is the word hmmm.... delusional that is it! Poor persecuted doctors.

If you cannot recognize your lack of clinical knowledge all I can say is you got one steep learning curve.

It has been fun but now I journey once again to the real world where I take care of real patients and you know what they seem to do pretty well. ciao.

 

[zenman]

Exactly they don;t know what correct care is.

So, in the end, what patient satisfaction ends up being is a surrogate marker for amount of time spent with the patient.

I'll probably always have more of a focus on it since I listen to what they say about the care they receive behind your back. Looks like many of you have the mentality of, "the operation was a success but the patient died."

A Navy chaplain told me the bible had the answer to all of life's questions. I guess some of you guys who are heavy into science believe the same about the science "bible." However, they both are not totally non-fiction.

 

[Charles_Carmichael]

I'll probably always have more of a focus on it since I listen to what they say about the care they receive behind your back. Looks like many of you have the mentality of, "the operation was a success but the patient died."

A Navy chaplain told me the bible had the answer to all of life's questions. I guess some of you guys who are heavy into science believe the same about the science "bible." However, they both are not totally non-fiction.

Zenman, no one said that patient satisfaction is completely useless.

What myself and others have said is that patient satisfaction is a useless metric for quality of care. If I wasn't clear on this, I apologize. Just because a patient had a good experience with me doesn't mean I provided good medical care. And just because a patient had a bad experience with me doesn't mean that I committed malpractice.

The point is, the vast majority of patients don't have the knowledge base to truly assess the quality of care they're receiving. Most patients have probably taken maybe a biology course in college (if that) and might have looked something up on WebMD. You can't expect them to be able to distinguish between good and bad medical care. An average patient will be happy if you spend extra time with them and do everything they ask you to do. An easy example is regarding antibiotics for viral infections: many physicians have said that sometimes, it's less of a headache to just prescribe an antibiotic instead of trying to explain to the patient that they're useless against viral infections. All the patient is going to hear is that the doctor is not going to do what they want and they'll storm off to another practitioner until someone finally writes that prescription for them. Do you understand what I'm saying?

 

[Nymphicus]

Most patients have probably taken maybe a biology course in college (if that)

You assume too much of them

 

[PSYCHNP]

stop please stop your knowledge of organic chemistry is just not enough to be used in any practical way, it is not that is a fact. not opinion fact.

As for your earlier point RCT I think finally we both know it is not going to happen so we can stop that nonsensical argument.

A third year medical student has NO practical clinical knowledge, as pointed out not how much you study but what you study, never seen any bio chem save a life.

And it is nice to see you have dropped this political argument, it must be embarrassing to be so what is the word hmmm.... delusional that is it! Poor persecuted doctors.

If you cannot recognize your lack of clinical knowledge all I can say is you got one steep learning curve.

It has been fun but now I journey once again to the real world where I take care of real patients and you know what they seem to do pretty well. ciao.

Good points.

What courses are med students required to take in their third year?

 

[karizma098]

Good points.

What courses are med students required to take in their third year?

3rd year medical students are on clinical rotations working resident hours learning more about their craft - of course they won't be as good clinically as a nurse or other mid level practitioner who has been trained in, and has been doing clinical work for a longer period of time . However, the shelf exams that medical students take in their 3rd year on surgery, internal medicine, OB/GYN, Peds, Psych, etc are very difficult. We are also studying for our Step 2 board exams. That, with the 50-70 hour work week doesn't leave time for much other classes.

The point here is , yes, some midlevels will be better than a med student, a 3rd year, and probably even many 4th years, and quite possibly a chunk of interns - on a strictly clinical leve.The difference is by the time a physician is done with residency, it is unlikely any midlevel in their field of practice has anywhere close to their level of knowledge. no matter what extreme examples get brought up. a CRNA will not know as much as an anesthesiologist, a PA won't know as much as a family prac doc, ER nurses won't know as much as an ER doc, etc - the difference is that many midlevels often pretend like they do..Doctors often don't give a crap, they don't have time to worry about stuff like that, and don't need to prove anything.

everyone has a role in healthcare , but when DNP's and other advanced midlevels start advocating for equivalency of knowledge and scope of practice, we have problems. If a DNP is anything even close to a MD/DO degree, it would take 4 years of medical school + residency to earn it. But it doesnt. And don't give me the numerical crap of how long nursing school takes, how long it takes to become an NP, etc - everyone knows the difference in difficulty between the two fields. Facts are facts, if nurses were better, equivalent, or even close to as proficient as physicians in their fields of practice, we wouldn't need doctors.

 

[karizma098]

stop please stop your knowledge of organic chemistry is just not enough to be used in any practical way, it is not that is a fact. not opinion fact.

As for your earlier point RCT I think finally we both know it is not going to happen so we can stop that nonsensical argument.

A third year medical student has NO practical clinical knowledge, as pointed out not how much you study but what you study, never seen any bio chem save a life.

And it is nice to see you have dropped this political argument, it must be embarrassing to be so what is the word hmmm.... delusional that is it! Poor persecuted doctors.

If you cannot recognize your lack of clinical knowledge all I can say is you got one steep learning curve.

It has been fun but now I journey once again to the real world where I take care of real patients and you know what they seem to do pretty well. ciao.

Well, see, this is the difference in training between a physician and a midlevel. Biochemistry saves lives every day - Blood gases, Cardiovascular complicatios, Arterio and Atherosclerosis, Diabetes, etc - everything down to the level of drug interactions is biochemistry. Sure, we're not talking about organic compounds and molecules every day, but MEDICAL biochemistry is a huge part of pathology and diagnosis.
3rd year medical students have a limited amount of clinical knowledge when they start, but within the year have amassed nearly 1800-2000 hours of clinical knowledge, MINIMUM. Again, as you said - steep learning curves are what defines medicine. A 3rd year medical student may be weak in the knees, ( as i was ), but by the time medical school comes to an end, and definitely by the end of an intern year, it's unlikely a midlevel in the respective residency program has much more clinical acumen. Just the facts.

 

[karizma098]

Dude you cannot use genetics to diagnose anything except in the most cut in paste fashion (hemophilia). I suppose all of those who actually research and study genetics for years are just wasting time cause clearly you behave a deep and total understanding. I repeat your knowledge on these subjects is clinically irrelevant, to make it truly relevant then you would be sending years on just one part not 2 years covering all of it.

As for the anesthesiologist I never stated they cannot do more I am pointing out a real world fact. A. REAL. WORLD. FACT. Most of the work is relatively simple and does not require this "deep understanding" that so many casually toss about.

LOL, except when there is a complication or a patient starts to crash - which happens a heck of a lot more often than you think..then what's the first thing the midlevel says: "Omg where's the doctor?!!"

Please don't preach to us. Less than 33% of your highest trained DNP's couldn't even pass a 'dumbed down' version of our easiest step 3 exam. There is no comparison between nurses and doctors. Patients can live without nurses - they can NOT live without doctors.

 

[sheva1968]

Well see here is the difference THE APPLICATION of bio chem saves lives and in a very narrow area ABG's are interpreted without knowing ohhh the structure fort amino acids cardiovascular complications (whatever those are? big area you know). This logic could be applied to say cooking, you really could not cook a steak until you understood how the protein denatures et al. ridiculous sounding no?

I am not denigrating the bio chem or saying that it is useless just pointing out that this "logic" that is used every day is nonsense. When I have things go wrong I do not say "ohh where is the doctor"

I assure a third year medical student would be completely unable to act as a clinician at that point the education is miles wide and an inch deep, with preparation to apply this knowledge in a clinical setting.

Should a DNP practice independently do not know as far as family practice, but the idea should be discussed free from the red herrings and distortions often spouted by med students who do not have a clue on what they are talking about.

 

[karizma098]

Well see here is the difference THE APPLICATION of bio chem saves lives and in a very narrow area ABG's are interpreted without knowing ohhh the structure fort amino acids cardiovascular complications (whatever those are? big area you know). This logic could be applied to say cooking, you really could not cook a steak until you understood how the protein denatures et al. ridiculous sounding no?

I am not denigrating the bio chem or saying that it is useless just pointing out that this "logic" that is used every day is nonsense. When I have things go wrong I do not say "ohh where is the doctor"

I assure a third year medical student would be completely unable to act as a clinician at that point the education is miles wide and an inch deep, with preparation to apply this knowledge in a clinical setting.

Should a DNP practice independently do not know as far as family practice, but the idea should be discussed free from the red herrings and distortions often spouted by med students who do not have a clue on what they are talking about.

Right, but he/she would still know miles beyond his midlevel counterpart ( 3rd year nursing student? idk )

Really? when a patient crashes at your hospital? you don't get the physician - you handle all this yourself? when an M.I occurs, a baby has RDS, there is postpartum hemorrhage, or a patient crashes during surg, your NP's, DNPs' and CRNA's handle this all themself? I should meet you and your crew of super nurses / PA's. Impressive.

 

[karizma098]

Well see here is the difference THE APPLICATION of bio chem saves lives and in a very narrow area ABG's are interpreted without knowing ohhh the structure fort amino acids cardiovascular complications (whatever those are? big area you know). This logic could be applied to say cooking, you really could not cook a steak until you understood how the protein denatures et al. ridiculous sounding no?

I am not denigrating the bio chem or saying that it is useless just pointing out that this "logic" that is used every day is nonsense. When I have things go wrong I do not say "ohh where is the doctor"

I assure a third year medical student would be completely unable to act as a clinician at that point the education is miles wide and an inch deep, with preparation to apply this knowledge in a clinical setting.

Should a DNP practice independently do not know as far as family practice, but the idea should be discussed free from the red herrings and distortions often spouted by med students who do not have a clue on what they are talking about.

Not ridiculous at all - biochemistry is a 1-2 semester course in 4 years of training. What about physiology? pathology? pharmacology? anatomy? Do you think those are unimportant clinically too? Clinical knowledge is useless without a strong basis of understanding as to what is happening on a pathological/basic science level. You don't have this knowledge or training so it's hard for you to grasp it's importance. Speak to a physician who used to be a midlevel ( there are tons ), they will often tell you how much they did *not* know or understand, even though they thought they had it down clinically.

 

[deleted87716]

When I have things go wrong I do not say "ohh where is the doctor"

And that is precisely the problem.

 

[sheva1968]

Now we are changing the subject, patho pharm, A&P have clear clinical utility and were not the point of the original conversation. The original point was about the bio chem embryology et al the basic sciences. The idea that these quick overviews have clinical utility is laughable and this is not the thing to hang your hat on.

 

[sheva1968]

No your belief that you (meaning your orginization) should control my practice is the problem.

 

[karizma098]

No your belief that you (meaning your orginization) should control my practice is the problem.

No your belief that you (meaning your orginization) should control my practice is the problem.

We should just let everyone practice independently. Why stop at CRNAs and DNPs? NPs , RNS, AA's...lets just train DNPs in the bread and butter cases of all specialties and fields, and leave the complicated and low-paying cases for the docs. In fact, since Docs take so long to get educated, and cost so much to educate, why not just only have NP's and midlevels? they are clinical masterminds from the get-go and should be able to practice without regulation from physicians - why would they? they are clinically equivalent so they should be regulated by other genius - nurses. No complications or patient harm here. Sounds like a great idea to me.

 

[karizma098]

Now we are changing the subject, patho pharm, A&P have clear clinical utility and were not the point of the original conversation. The original point was about the bio chem embryology et al the basic sciences. The idea that these quick overviews have clinical utility is laughable and this is not the thing to hang your hat on.

I'm not arguing the importance of basic sciences with you anymore. What's the point? you haven't been to medical school, you don't have that knowledge - you have no basis to argue it's importance.

 

[sheva1968]

OK, but if I have had these courses and I have clinical experience so I am in a far better position to judge the utility then you. Have a nice day!

 

[sheva1968]

The state regulates practice and can decide, all stakeholders get to air their concerns and we see where it shakes out, but medicine does NOT regulate nursing and vice versa. The inability of so many to understand your respective roles is the problem.

Nursing in no way is trying to dictate medical practice it is medicine trying to regulate nursing practice. And the STATE defines medical practice, not the AMA or any other PRIVATE organization.

 

[karizma098]

OK, but if I have had these courses and I have clinical experience so I am in a far better position to judge the utility then you. Have a nice day!

Really, you've gone to medical school? courses don't count as the same if you've taken them anywhere else, so thanks.

 

[altap]

The basic sciences are the foundation for the practice of medicine.

 

[Pleepl3us]

The state regulates practice and can decide, all stakeholders get to air their concerns and we see where it shakes out, but medicine does NOT regulate nursing and vice versa. The inability of so many to understand your respective roles is the problem.

Nursing in no way is trying to dictate medical practice it is medicine trying to regulate nursing practice. And the STATE defines medical practice, not the AMA or any other PRIVATE organization.

The last time I checked medicine is not trying to regulate nurses in the practice of nursing, but rather nurses masquerading as docs hiding their true position/education (hmmmm sounds firmiliar).

We are still waiting to hear what insight you have into med school or any education pertaining to healthcare.

I thought you were leaving?

 

[rmsgolfer]

Now we are changing the subject, patho pharm, A&P have clear clinical utility and were not the point of the original conversation. The original point was about the bio chem embryology et al the basic sciences. The idea that these quick overviews have clinical utility is laughable and this is not the thing to hang your hat on.

If a patient is having an I-131 uptake scan and a black spot is found near the base of the tongue, what do you think has caused this abnormal uptake.

Hint: It has a lot to do with biochem and embryo.

 

[Makati2008]

I am pretty much done with Sheeva. Turning her into the mods. She is a dangerous NP which makes all MLP's look bad. BTW Sheeva-I am a PA in medical school so I think I have a heck of a lot more say than a "DNP"

 

[PSYCHNP]

3rd year medical students are on clinical rotations working resident hours learning more about their craft - of course they won't be as good clinically as a nurse or other mid level practitioner who has been trained in, and has been doing clinical work for a longer period of time . However, the shelf exams that medical students take in their 3rd year on surgery, internal medicine, OB/GYN, Peds, Psych, etc are very difficult. We are also studying for our Step 2 board exams. That, with the 50-70 hour work week doesn't leave time for much other classes.

The point here is , yes, some midlevels will be better than a med student, a 3rd year, and probably even many 4th years, and quite possibly a chunk of interns - on a strictly clinical leve.The difference is by the time a physician is done with residency, it is unlikely any midlevel in their field of practice has anywhere close to their level of knowledge. no matter what extreme examples get brought up. a CRNA will not know as much as an anesthesiologist, a PA won't know as much as a family prac doc, ER nurses won't know as much as an ER doc, etc - the difference is that many midlevels often pretend like they do..Doctors often don't give a crap, they don't have time to worry about stuff like that, and don't need to prove anything.

everyone has a role in healthcare , but when DNP's and other advanced midlevels start advocating for equivalency of knowledge and scope of practice, we have problems. If a DNP is anything even close to a MD/DO degree, it would take 4 years of medical school + residency to earn it. But it doesnt. And don't give me the numerical crap of how long nursing school takes, how long it takes to become an NP, etc - everyone knows the difference in difficulty between the two fields. Facts are facts, if nurses were better, equivalent, or even close to as proficient as physicians in their fields of practice, we wouldn't need doctors.

Not bad, impressive.

What are the names of actual courses taken in year 1 and year 2?

 

[PSYCHNP]

Well see here is the difference THE APPLICATION of bio chem saves lives and in a very narrow area ABG's are interpreted without knowing ohhh the structure fort amino acids cardiovascular complications (whatever those are? big area you know). This logic could be applied to say cooking, you really could not cook a steak until you understood how the protein denatures et al. ridiculous sounding no?

I am not denigrating the bio chem or saying that it is useless just pointing out that this "logic" that is used every day is nonsense. When I have things go wrong I do not say "ohh where is the doctor"

I assure a third year medical student would be completely unable to act as a clinician at that point the education is miles wide and an inch deep, with preparation to apply this knowledge in a clinical setting.

Should a DNP practice independently do not know as far as family practice, but the idea should be discussed free from the red herrings and distortions often spouted by med students who do not have a clue on what they are talking about.

Sheva is right in many regards.

For the years one and two of med school the, "basic sciences" portion, the MD in training would have little practical clinical knowledge.

It is not until their third year that they are actually getting "their feet wet".

As for a pre-med (just taking pre-reqs in a college/university), I am not even going to comment on them.

 

[PSYCHNP]

I am pretty much done with Sheeva. Turning her into the mods. She is a dangerous NP which makes all MLP's look bad. BTW Sheeva-I am a PA in medical school so I think I have a heck of a lot more say than a "DNP"

How about a lawyer who goes back to med school

or

an NP who goes to med school

or

an engineer who goes to med school

or

a pharmacist who goes to med school

Big deal, so you applied and got into "med school". So did half of the other folks who post on this thread.

 

[karizma098]

Not bad, impressive.

What are the names of actual courses taken in year 1 and year 2?

My schedule to date:

Year 1

Psychiatry 1
Psychiatry 2
Psychiatry 3
Biochemistry 1
Biochemistry 2
Biochemistry Lab 1 and 2
Patient/Physician Dialogue
Physiology 1
Physiology 2
Neuroscience 1
Neuroscience 2
Histology
Gross Anatomy 1 & 2
Gross Anatomy Lab 1 and 2
Embryology
History of Medicine
Health Care Issues

- in class roughly 8-4 monday through friday. study from 430 to 11ish every day.

Year 2

Clinical Topics in Medicine 1, 2, 3 - year long course
Practice of Clinical Medicine 1, 2, 3 - year long course
Immunology 1 and 2
Infectious Disease and Etiology
Pathology 1
Pathology 2
Pathology 3
Pharmacology 1
Pharmacology 2
Psychiatry 4
Psychiatry 5
Patients, Physicians, Society
Pathology 3
Integrated Physiology ( 3 )
Step 1 Board Review Course ( optional )

in class 9-4, study till 11 weekdays, study much more in spring for boards.
Year 3

Psychiatry - 1 month, ~ 40 hours a week
Surgery 1 and 2 , general surgery, colorectal surgery/ 2 months / 75 hrs/wk
Pediatrics 1 - 50 hours a week / 2 months
Family Medicine - 55 hours a week / 2 months
Ob/Gyn- 75 hours a week / 2 months
Internal Medicine 1 - 60-75 hours a week, 1 month
Gastroenterology - 1 month, 65 hours a week
Anesthesiology - 1 month, ~50 hours a week


4th year - pending.

 

[karizma098]

Sheva is right in many regards.

For the years one and two of med school the, "basic sciences" portion, the MD in training would have little practical clinical knowledge.

It is not until their third year that they are actually getting "their feet wet".

As for a pre-med (just taking pre-reqs in a college/university), I am not even going to comment on them.

That's not true. Med students won't be 'experts' clinically in their 3rd year, but we are taught everything from delivering a baby to taking a BP/ putting in a line / doing a vaginal/rectal/neuro/cardiovascular/pulm/ GI exam in our 2nd year of medical school. We have to rotate with doctors every month during 1st and 2nd year, and are tested on diagnosis and physical exams every quarter..it's not easy by any means.

 

[PSYCHNP]

That's not true. Med students won't be 'experts' clinically in their 3rd year, but we are taught everything from delivering a baby to taking a BP/ putting in a line / doing a vaginal/rectal/neuro/cardiovascular/pulm/ GI exam in our 2nd year of medical school. We have to rotate with doctors every month during 1st and 2nd year, and are tested on diagnosis and physical exams every quarter..it's not easy by any means.

I don't know much about the med school process.

I know that at the Carib Med schools like Ross and even in the U.S. schools they call a portion of the beginning of their program Basic Sciences.

I know some of the foreign programs accept just about anyone wth a pulse who could foot the bill.

The curriculum is definitely challenging, but the third year seems like the time where clinical competency is gained.

Yet, as I look over the list of courses Karizma took I must admit that I am quite impressed.

 

[karizma098]

I don't know much about the med school process.

I know that at the Carib Med schools like Ross and even in the U.S. schools they call a portion of the beginning of their program Basic Sciences.

I know some of the foreign programs accept just about anyone wth a pulse who could foot the bill.

The curriculum is definitely challenging, but the third year seems like the time where clinical competency is gained.

Yet, as I look over the list of courses Karizma took I must admit that I am quite impressed.

Thanks for being honest, I'm all for a fair discourse between health professionals, I just get annoyed when people run around stating that we don't learn anything before residency, etc.

you are 100% correct. Many carribbean medical schools are a joke to get into - but getting into med school isn't really the problem, it's passing the boards. American medical schools, and the big name carrib schools with decent standards like SGU and Ross , have a very high board pass rate - the 'easy' carrib schools often have lower than a 40% board pass rate on first attempt. the Usmle steps 1, 2, and 3 are very very difficult and well written exams - they will easily weed out any 2nd year student who is not ready to move forward to rotations or onto residency. Regardless of where a doc went to med school, if they passed their boards, and matched a residency in the US, they know their stuff , trust me...Now, some carrib kids may take 1, 2, 3, or 4 attempts to pass these boards - and you probably will see them in less competitive specialties bc of that. If a med student can pass their boards and do decent on their 1st try, they are proficient, wether they are from Ross or Harvard.

 

[Makati2008]

How about a lawyer who goes back to med school

or

an NP who goes to med school

or

an engineer who goes to med school

or

a pharmacist who goes to med school

Big deal, so you applied and got into "med school". So did half of the other folks who post on this thread.

No offense smart ass I am just stating that due to her acting like DNP's are so superior to anyone else and people without healthcare experience have no say in this but people like myself who are in the trenches do have a say. I know several people in my class that fill the fields that you mentioned and I am amazed at how they can go back to medical school.

And no offense Psych NP, why don't you come to medical school and I am willing to bet you struggle. Its not like that part time NP school you go to and able to work 40hrs a week. We do get clinical experience in our first two years of medical school fyi.

 

[PSYCHNP]

No offense smart ass I am just stating that due to her acting like DNP's are so superior to anyone else and people without healthcare experience have no say in this but people like myself who are in the trenches do have a say. I know several people in my class that fill the fields that you mentioned and I am amazed at how they can go back to medical school.

And no offense Psych NP, why don't you come to medical school and I am willing to bet you struggle. Its not like that part time NP school you go to and able to work 40hrs a week. We do get clinical experience in our first two years of medical school fyi.

I'm not messing with that stuff.

I'm getting too old already.

I had my fill of bad professors; professors who tell you to read one textbook while they get the test questions from another; inconsistencies in grading and what is needed to pass; institutions that change their requirements every other week; schools that care more about their rating than the students who pay the tuition; schools that deflate grades, and student loans etc..

 

[zenman]

Zenman, no one said that patient satisfaction is completely useless.

What myself and others have said is that patient satisfaction is a useless metric for quality of care. If I wasn't clear on this, I apologize. Just because a patient had a good experience with me doesn't mean I provided good medical care. And just because a patient had a bad experience with me doesn't mean that I committed malpractice.

The point is, the vast majority of patients don't have the knowledge base to truly assess the quality of care they're receiving. Most patients have probably taken maybe a biology course in college (if that) and might have looked something up on WebMD. You can't expect them to be able to distinguish between good and bad medical care. An average patient will be happy if you spend extra time with them and do everything they ask you to do. An easy example is regarding antibiotics for viral infections: many physicians have said that sometimes, it's less of a headache to just prescribe an antibiotic instead of trying to explain to the patient that they're useless against viral infections. All the patient is going to hear is that the doctor is not going to do what they want and they'll storm off to another practitioner until someone finally writes that prescription for them. Do you understand what I'm saying?

Yes, I understand what you're saying. I know many can't distinguish between good care or not, but it's very important IMO to check in with them about how you're doing. Many therapists, for example will spend the last few minutes of a session just to check and see if the patient got anything out of the session. I find they really appreciate that.

 

[zenman]

You assume too much of them

Don't make that mistake. Many have liberal arts degrees so will be smarter than you.

You would be surprise how many people surf the web. In my area, psych, I regularly look at sites like:

http://www.psycheducation.org

http://www.crazymeds.us

http://www.dr-bob.org/babble

just to see what patients think, especially about their meds.

My wife had a cervical cervical discectomy last night at 7pm in a Bangkok hospital. I went into the RR after her surgery, had a chat with her surgeon and her anesthesiologist who then left, leaving the nurse anesthetist in charge. This morning I had my chef-prepared breakfast served on an insulated tray so it was still warm. Each plate was plastic wrapped and I enjoyed my copy of the Bangkok Post while I ate. I have yet to see a hospital in the states that could compare to the efficiency and patient satisfaction some of the hospitals here provide.

 

[zenman]

3rd year medical students are on clinical rotations working resident hours learning more about their craft - of course they won't be as good clinically as a nurse or other mid level practitioner who has been trained in, and has been doing clinical work for a longer period of time . However, the shelf exams that medical students take in their 3rd year on surgery, internal medicine, OB/GYN, Peds, Psych, etc are very difficult. We are also studying for our Step 2 board exams. That, with the 50-70 hour work week doesn't leave time for much other classes.

Maybe if you didn't have to study for exams all the time you could actually be taking those other classes and be learning something. You want to talk with my educator wife about how our educational system sucks because students are taught to pass tests instead of learning much of anything?

 

[zenman]

Patients can live without nurses - they can NOT live without doctors.

Really? Then explain why in 1976 when doctors went on strike in Los Angeles, the death rate actually went down?

Remember that doctors can do very little without nurses and other support staff. I've first hand experience of that during a nurse's strike which almost shut everything down. It's kinda like, "I have all this knowledge but can't do cr*p by myself!"