Interesting Nurse Practitioner Document

[RNMedic911]

What part of that shows evidence that Nurse Practitioners refer patients more frequently than PA's or other Family Practice Docs?

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[APRV]

What part of that shows evidence that Nurse Practitioners refer patients more frequently than PA's or other Family Practice Docs?

Once more, how about answering my questions:

Not that many years ago, many physicians graduated from medical school, did a one year rotating internship, and then went out and did general practice. When it became obvious that with increasing complexity of dealing with patients of all ages in a primary care setting more training was necessary, the specialty of family practice was developed, and physicians began doing THREE YEARS of residency training to meet this need.

Maybe someone can explain to me logically, how a "practicioner" can independently practice primary care without going to medical school (which involves two academic years of clinical training), and then doing a three year residency??????

Is medicine becoming less complex?

 

[cpants]

What part of that shows evidence that Nurse Practitioners refer patients more frequently than PA's or other Family Practice Docs?

See my last post. You will have less knowledge than a family practice MD. Therefore, you will see more patients with problems of which you have no working knowledge and are unable to treat. One of two things will happen: you will not recognize these problems and release the patient or you will recognize them and refer the patient to more knowledgeable people (real doctors). Giving NP's the benefit of the doubt by assuming that you will actually be able to recognize when you are in over your head, you will generate more referrals than an FP. If you aren't generating more referrals, then you are missing stuff, which wouldn't surprise me.

 

[RNMedic911]

See my last post. You will have less knowledge than a family practice MD. Therefore, you will see more patients with problems of which you have no working knowledge and are unable to treat. One of two things will happen: you will not recognize these problems and release the patient or you will recognize them and refer the patient to more knowledgeable people (real doctors). Giving NP's the benefit of the doubt by assuming that you will actually be able to recognize when you are in over your head, you will generate more referrals than an FP. If you aren't generating more referrals, then you are missing stuff, which wouldn't surprise me.

Again, just conjecture, how about some facts to support this claim.

 

[psychbender]

Again, just conjecture, how about some facts to support this claim.

If you are looking for any kind of controlled study showing this, then it has already been addressed that you will not find anything. So you can go ahead and look away and stick your nose up in the air, saying that there is no proof that NPs/DNPs are any worse than Family Medicine Physicians in diagnosing and treating their patients. However, absence of evidence is not evidence of absence. I, and many others here, can give you anecdotal stories about midlevels referring everything more complicated than a med refill or flu to a specialist. However, the plural of anecdote is not fact. If the only thing you will accept as fact is a published study with proper statistical power, then you are correct in stating that there are no facts to support the claim that midlevels practicing independently will increase healthcare costs (either by late diagnosis, or over-referring). I would hope, however, that you would not blind yourself thusly, and would be open to logical reasoning showing how a minimalist education in medicine can lead to decreased medical knowledge, which can, in turn, lead to either missed/delayed diagnosis or an increase in specialist referral frequency.

 

[cpants]

Again, just conjecture, how about some facts to support this claim.

The fact is you will be less knowledgeable than a family practice MD. You don't need a study to show that.

 

[RNMedic911]

The fact is you will be less knowledgeable than a family practice MD. You don't need a study to show that.

While it is a fact that I don't have the same training as a FP Doc, I have never seen the need to refer a patient to another FP provider. Not that I haven't made a call to a physician a time or two and run a treatment plan past them but I have never sent a patient for a second visit unless they needed a specialist.

I was only asking for something more that "cuz I said so" to show that NPs / PAs generate more "unnecessary" referrals than doctors.

 

[RNMedic911]

I actually envy the position you are in...being one of the trailblazers into a new field that was born out of a small kabal of nurses who wanted more respect, status and power than they currently feel they receive who generated an entirely new field with a "doctorate" without much of a curriculum, research, publication, time investment or an idea about. But they were smart, I'll give them that. They made sure that they were not under state medical boards, even though it is obvious that they are practicing medicine, because they knew that their idea is a joke.

No, there is no data or evidence to prove anything about DNPs, good or bad. None. Because every study done was no good. Pure, unadulterated, biased crap. Sure, that Mundingle study in 2000 made it to JAMA, where it was dissected and seen for what it was by numerous people, and then the subsequent paper based on the same experiences a few years later was published in a no name journal that no one reads.

So, no, there is no evidence to refute your position. Yet. We can only hope that someday there will be. So, go forth and "practice". Hopefully you aren't too beaten down by what I'm sure you think was very difficult training. QAnd if anyone gives you flak, you just pull out the, "Show me the evidence" nonsense and then smile because there is none. That must be a very satisfying feeling.

I would hardly call myself a trail blazer for joining a profession that has been around for longer than I've been alive.

 

[Taurus]

While it is a fact that I don't have the same training as a FP Doc, I have never seen the need to refer a patient to another FP provider. Not that I haven't made a call to a physician a time or two and run a treatment plan past them but I have never sent a patient for a second visit unless they needed a specialist.

I was only asking for something more that "cuz I said so" to show that NPs / PAs generate more "unnecessary" referrals than doctors.

The eye cannot see what the mind does not know.


I'm not surprised that you haven't. If you don't know what to look for, how do you know when you should seek someone with more training?

 

[core0]

Again, just conjecture, how about some facts to support this claim.

There are a number of studies for the UK that show that NPs there use more resources and preform more tests. However, as usual the problem is with the definition of the NP in the UK which is substantially different than it is here.

There is a study here that shows in comparison to residents and attendings NPs have a much higher consult rate and resource utilization. The major drawback is again the sample size:
http://www.acponline.org/clinical_information/journals_publications/ecp/novdec99/hemani.htm

There is also a nice study that shows the addition of NPs to a cardiology service has a fairly dramatic affect hospital costs, but this is done in the context of a collaborative work.

What little data there is suggests that yes NPs do generate more referrals and order more tests. Of course part of the point brought up in the renal study is that NPs may be better at following guidelines than physicians (although in the case of ophthalmology screening in diabetics all did a pretty poor job).

David Carpenter, PA-C

 

[ForbiddenComma]

So, in your opinion, what would be the equivalent degree to a doctorate in nursing practice ?

This is an older post but I'll reply to it anyway....

There is already a doctorate in nursing. It is called the PhD.

There is also already a doctorate in nursing clinical practice. It is called the MD.

Many nurses enter med school every year. They are often better equipped for the rigors of medical education, especially in third year. They fight their way to an MD degree even though MD schools, unlike DO schools, still favor the traditional biology major over nurses (which is a big mistake, in my opinion).

What I don't understand is why some people think it's okay to piss all over the achievements of their nursing colleagues while seeking a shortcut.

A sensible option that most people here would get behind is some sort of midlevel-to-MD bridge program, or even making DNP programs follow a similar curriculum as MD schools, just like the DO programs before them.

Instead, many people wish there to be an "easy mode" path to independent medical practice. No yucky MCATs, no tough nights away from home on call, no icky USMLEs/COMLEXs, and watered-down hard science classes since hard science makes their heads hurt.

This obviously makes real doctors and real med students such as yours truly a little pissy. But hey, maybe we're all just being territorial and elitist, trying to reserve the cool independent medical jobs to people with unfair advantages such as "good work ethic" or "high IQ."

But never mind all that. What is probably more important is trying to explain to your patients why you chose to take the easy route to independent practice. Why you felt that you did not need to spend all those tough years learning real medicine, and instead spent time on such demanding courses as "Nursing Leadership in Medicine" and "Theory and Practice of Nursing." Why you did not feel any particular need to learn all you could learn before putting yourself in charge of the health of your patients.

The patients. Remember them?

 

[APRV]

This is an older post but I'll reply to it anyway....

There is already a doctorate in nursing. It is called the PhD.

There is also already a doctorate in nursing clinical practice. It is called the MD.

Many nurses enter med school every year. They are often better equipped for the rigors of medical education, especially in third year. They fight their way to an MD degree even though MD schools, unlike DO schools, still favor the traditional biology major over nurses (which is a big mistake, in my opinion).

What I don't understand is why some people think it's okay to piss all over the achievements of their nursing colleagues while seeking a shortcut.

A sensible option that most people here would get behind is some sort of midlevel-to-MD bridge program, or even making DNP programs follow a similar curriculum as MD schools, just like the DO programs before them.

Instead, many people wish there to be an "easy mode" path to independent medical practice. No yucky MCATs, no tough nights away from home on call, no icky USMLEs/COMLEXs, and watered-down hard science classes since hard science makes their heads hurt.

This obviously makes real doctors and real med students such as yours truly a little pissy. But hey, maybe we're all just being territorial and elitist, trying to reserve the cool independent medical jobs to people with unfair advantages such as "good work ethic" or "high IQ."

But never mind all that. What is probably more important is trying to explain to your patients why you chose to take the easy route to independent practice. Why you felt that you did not need to spend all those tough years learning real medicine, and instead spent time on such demanding courses as "Nursing Leadership in Medicine" and "Theory and Practice of Nursing." Why you did not feel any particular need to learn all you could learn before putting yourself in charge of the health of your patients.

The patients. Remember them?

Excellent post. Several times on this and another similar thread, I asked the following questions:

"Not that many years ago, many physicians graduated from medical school, did a one year rotating internship, and then went out and did general practice. When it became obvious that with increasing complexity of dealing with patients of all ages in a primary care setting more training was necessary, the specialty of family practice was developed, and physicians began doing THREE YEARS of residency training to meet this need.

Maybe someone can explain to me logically, how a "practicioner" can independently practice primary care without going to medical school (which involves two academic years of clinical training), and then doing a three year residency??????

Is medicine becoming less complex?"


That I didn't get a reply from the nurses on here who wish to play doctor is not surprising to me at all. There is no logical repsonse, unless you believe that less training makes you a better practicioner.

What this all boils down to is two things. Greed and ego.

 

[Tired]

Is medicine becoming less complex?"

Your question is appropriate if you believe that residencies were extended because medicine has become more complex. Personally, I don't, and I have heard excellent lectures from Medical Historians that cite the GI Bill and hospitals' desire for cheap labor as the primary reason residencies became (and continue to become) longer.

 

[Josh L.Ac.]

People were being swayed by the inherent logic of APRV's [repeated] Q&A, but then it happens...

Once again, Tired has to be a buzzkill.

 

[APRV]

Your question is appropriate if you believe that residencies were extended because medicine has become more complex. Personally, I don't, and I have heard excellent lectures from Medical Historians that cite the GI Bill and hospitals' desire for cheap labor as the primary reason residencies became (and continue to become) longer.

As for FP, not according to this:
http://www.aafpfoundation.org/PreBuilt/foundation_dennisresearch.pdf

By the way, I'm not a primary care physician.

 

[Richard Head]

If dealing with nurses can be a pain now because they think that they know medicine when they don't, can people imagine what it will be like when these nurses start to proclaim, "Well, I'm a doctor too and I'll do as I please". There will be constant bickering from these DNP's because they no doubt want to run the show too. This is a very good reason why more states need to restrict the use of the title "doctor" in a clinical setting. There should be no confusion as to who is in charge of patient care.

You are truly an enlightened individual. Nurses have no business practicing medicine. That's why Medical Doctors practice Medicine and Doctors of Nursing Practice exclusively practice Nursing.

 

[Josh L.Ac.]

Gosh, now this thread is getting good.


So APNs are exclusively practicing nursing because their scope of practice and BON says they are?



Quick question. When an APN assesses a patient, do they give them a NANDA diagnosis and then order specific interventions based off of this nursing diagnosis?


Josh BSN RN

 

[Tired]

As for FP, not according to this:
http://www.aafpfoundation.org/PreBuilt/foundation_dennisresearch.pdf

By the way, I'm not a primary care physician.

Not sure I see the relevance. Looks like the FP residency started in 1969-70 and was originally designed to be 3y. Nothing in there about extending the length of residency training based on an increasing complexity of medicine.

I was specifically referring to the post-WWII era, when residencies really got swinging. I have been told (sorry, no citation) this was a result of the VA choosing to designate post-graduate medical/surgical residencies as "educational" and therefore eligible for reimbursement from the government.

 

[APRV]

Not sure I see the relevance. Looks like the FP residency started in 1969-70 and was originally designed to be 3y. Nothing in there about extending the length of residency training based on an increasing complexity of medicine.

I was specifically referring to the post-WWII era, when residencies really got swinging. I have been told (sorry, no citation) this was a result of the VA choosing to designate post-graduate medical/surgical residencies as "educational" and therefore eligible for reimbursement from the government.

Committee on Preparation for General Practice
�� 1959 – released the “Report of the Committee on
Preparation for General Practice.”
�� Recommended several 2 year graduate pilot
programs to teach General Practice.
�� This eventually grew to 165 programs offering 783
positions, however within 10 years most of the
general practice programs closed.
�� The 2 year pilot programs had focused mainly on
Internal Medicine and Pediatrics, however several
GPs were also practicing minor surgical procedures.
This led to 8 resolutions at the 1960 AMA meeting
which led to including Surgery and Obstetrics in the
programs.

July 1963 – World Health Organization
(WHO) Expert Committee on General
Practice released report:
– Training of Physicians for Family Practice
• Recommended a postgraduate study program
specifically designed to meet the needs of the General
Practitioner.
• Postgraduate study program should include:
mechanisms for continuing medical education, research
in Family Medicine, and teaching of medical students.

Not to dwell on this anymore, but this shows that the push to create the FP residency started well after you stated.

Don't think it's because medicine became more and more complex? Go open some medical texts from the 50's when they were treating HTN with phenobarbital.

 

[TRR in ATL]

Now a little subset of med school rejects comes along and gets everyone riled up by saying that they should be making the decisions. The sad thing is that now we have all these excellent nurses starting to believe that if you're not the one making the decisions, you're not important.

For someone that started out with a great post, you completely discredited yourself with the above statement. Just to clear things up, I"m an RN with 20 years of experience. I WAS accepted to medical school, because my family gave me a hard time about going to nursing school and said I did it due to the fact that I couldn't get accepted into med school. So, I got accepted and STILL DIDN'T GO, because it's not what I want to do.
I am now in an Adult health NP program, MAINLY because it was a program at the local Unversity, where I could attend for "instate" tuition rates and finish my MSN part time so that I could teach nursing school. As I realize now, going the NP route was a great choice because I really feel that I am learning about pathology, pathophysiology and medical treatments to care for patients. I really don't care if I ever have Rx rights and can dispense scripts for ABX or write an order for a CXR. What I DO care about is being able to better care for patients and teach other nurses to do the same.
As a college professor, I would be "encouraged" to obtain my terminal degree. My options would be a PhD in Nursing (which usually is either administrative or management related and not my idea of interesting) an Education Doctorate (which is probably what I'll do as I think they make better nursing professors) or a DNP (which makes sense as I would be teaching nursing students to perform clinical skills.) I really don't give a crap about ordering labs, xrays or rx's, but IMHO, having a nurse that has a CLUE about the pathophysiology of a disease process and understanding the normal and abnormal signs and symptoms related to that prosess would be a HUGE help for an MD.
A prime example would be caring for a cardiac patient in the ICU. If a 85 year old presents with A fib and is on a heparin gtt, I'm a happy camper and it's gonna be an easy night. The pt is probably going to be a "flip and feed" and make sure her PTT's are okay on her heparin. But what if she develops tachycardia or a 1st degree heart block. Should I be worried, should I call the cardiologist at 3am to tell him she's now in a 1st degree, should I stop her Digoxin? Or what if she develops a junctional rhythm and has a stable blood pressure? But the zinger is, what if she starts having bradycardia, has difficulty breathing, complains of chest pain and possibly complains of a headache?!? Will I be smart enough to know that she may have thrown a clot either to her brain or to her lungs? So, having some advanced knowledge is not a bad thing, it's in how you use that knowledge.
For WAY too long, I was scared to learn to read EKGs and 12 leads, like it was some kind of sacred ground that only cardiologist were allowed to walk. Then one day, the most intelligent nurse I've ever met sat down with me and showed me basic EKG and 12 lead interp. For the most part, I learned to recognize what would kill patients, and that's all I needed to know at the time. How do I know if a patient is having an MI. It was so simple. No great revelations and no great epiphonies. So now, I can look at a 12 lead and know when I need to call the MD immidately, or when I can finish doing patient care to call him.
I agree, patient care is a TEAM approach, Every team wins with power and strategy. Knowledge is power, communication is strategy. So why are we all arguing over knowledge that will provide our patients with better care AND outcomes.

PS, I've had dyslexia LONG before it was diagnosed in the school system, so my spelling SUCKS and I know it, no need to beat a dead horse in further posts.

 

[TRR in ATL]

Now a little subset of med school rejects comes along and gets everyone riled up by saying that they should be making the decisions. The sad thing is that now we have all these excellent nurses starting to believe that if you're not the one making the decisions, you're not important.

For someone that started out with a great post, you completely discredited yourself with the above statement. Just to clear things up, I"m an RN with 20 years of experience. I WAS accepted to medical school, because my family gave me a hard time about going to nursing school and said I did it due to the fact that I couldn't get accepted into med school. So, I got accepted and STILL DIDN'T GO, because it's not what I want to do.
I am now in an Adult health NP program, MAINLY because it was a program at the local Unversity, where I could attend for "instate" tuition rates and finish my MSN part time so that I could teach nursing school. As I realize now, going the NP route was a great choice because I really feel that I am learning about pathology, pathophysiology and medical treatments to care for patients. I really don't care if I ever have Rx rights and can dispense scripts for ABX or write an order for a CXR. What I DO care about is being able to better care for patients and teach other nurses to do the same.
As a college professor, I would be "encouraged" to obtain my terminal degree. My options would be a PhD in Nursing (which usually is either administrative or management related and not my idea of interesting) an Education Doctorate (which is probably what I'll do as I think they make better nursing professors) or a DNP (which makes sense as I would be teaching nursing students to perform clinical skills.) I really don't give a crap about ordering labs, xrays or rx's, but IMHO, having a nurse that has a CLUE about the pathophysiology of a disease process and understanding the normal and abnormal signs and symptoms related to that prosess would be a HUGE help for an MD.
A prime example would be caring for a cardiac patient in the ICU. If a 85 year old presents with A fib and is on a heparin gtt, I'm a happy camper and it's gonna be an easy night. The pt is probably going to be a "flip and feed" and make sure her PTT's are okay on her heparin. But what if she develops tachycardia or a 1st degree heart block. Should I be worried, should I call the cardiologist at 3am to tell him she's now in a 1st degree, should I stop her Digoxin? Or what if she develops a junctional rhythm and has a stable blood pressure? But the zinger is, what if she starts having bradycardia, has difficulty breathing, complains of chest pain and possibly complains of a headache?!? Will I be smart enough to know that she may have thrown a clot either to her brain or to her lungs? So, having some advanced knowledge is not a bad thing, it's in how you use that knowledge.
For WAY too long, I was scared to learn to read EKGs and 12 leads, like it was some kind of sacred ground that only cardiologist were allowed to walk. Then one day, the most intelligent nurse I've ever met sat down with me and showed me basic EKG and 12 lead interp. For the most part, I learned to recognize what would kill patients, and that's all I needed to know at the time. How do I know if a patient is having an MI. It was so simple. No great revelations and no great epiphonies. So now, I can look at a 12 lead and know when I need to call the MD immidately, or when I can finish doing patient care to call him.
I agree, patient care is a TEAM approach, Every team wins with power and strategy. Knowledge is power, communication is strategy. So why are we all arguing over knowledge that will provide our patients with better care AND outcomes.

PS, I've had dyslexia LONG before it was diagnosed in the school system, so my spelling SUCKS and I know it, no need to beat a dead horse in further posts.

 

[Tired]

A prime example would be caring for a cardiac patient in the ICU. If a 85 year old presents with A fib and is on a heparin gtt, I'm a happy camper and it's gonna be an easy night. The pt is probably going to be a "flip and feed" and make sure her PTT's are okay on her heparin. But what if she develops tachycardia or a 1st degree heart block. Should I be worried, should I call the cardiologist at 3am to tell him she's now in a 1st degree, should I stop her Digoxin? Or what if she develops a junctional rhythm and has a stable blood pressure? But the zinger is, what if she starts having bradycardia, has difficulty breathing, complains of chest pain and possibly complains of a headache?!? Will I be smart enough to know that she may have thrown a clot either to her brain or to her lungs? So, having some advanced knowledge is not a bad thing, it's in how you use that knowledge.

Who are kidding? You're going to become an NP so that you can be a better ICU nurse, or do more nursing education? Kudos for the complexity of the lie, but it is a lie nonetheless.

Let me help you out with your little hypothetical dilema: Call the doctor. Your job isn't to figure out what's going on, your job is recognize the change in clinical status and make the call. You don't need to figure out the med changes, nor do you need to determine if a Cardiology consult needs to be placed.

But suppose for a moment you really are interested in learning all these things. There are a host of continuing education courses for nurses, there are also tons of text books. You have all the opportunity in the world to learn these things, and hardly need an NP to do so. Given the emphasis of primary care in most NP programs, one would imagine you would be better served learning these things on your own anyway.

 

[RNMedic911]

The eye cannot see what the mind does not know.


I'm not surprised that you haven't. If you don't know what to look for, how do you know when you should seek someone with more training?

your job is recognize the change in clinical status and make the call.

You guys can't have it both ways.

Given the emphasis of primary care in most NP programs...

Their are many programs that aren't focused at primary care. Acute care NP, Emergency NP, Neonatal NP, Psych / Mental Health NP, Nurse Midwife.

 

[swimguy23]

You guys can't have it both ways.


Their are many programs that aren't focused at primary care. Acute care NP, Emergency NP, Neonatal NP, Psych / Mental Health NP, Nurse Midwife.

explain why the first two of your examples should not have a focus in primary care

 

[oldpro]

Nurses are doing research all the time ..and publishing it.

What does this really prove? Research? Politicians do research by phone polls, so they do research! You see this is the point you can say a simple statement like this to rebut but really it proves nothing. Scientific clinical trials, good research with focus on treatments for diseases and new diagnosis criteria for diseases and treatment.

Nursing research is concerned with Patient Care delivery issues and a lot of Psych social issues.

Big differences.

 

[oldpro]

You guys can't have it both ways.


Their are many programs that aren't focused at primary care. Acute care NP, Emergency NP, Neonatal NP, Psych / Mental Health NP, Nurse Midwife.

Explain how this can possibly replace a MD or DO ? ( I cannot see how)

Your focus as a NP is Psych so sorry you have no idea how to treat other medical or even Orthopedic problems? AN MD or DO does have an Idea of care since they had to learn it in Rotations and medical school (Even surgery like I just finished)

This is why these ideas to replace FP's are just ridiculous

 

[oldpro]

. Just to clear things up, I"m an RN with 20 years of experience. I WAS accepted to medical school, because my family gave me a hard time about going to nursing school and said I did it due to the fact that I couldn't get accepted into med school. So, I got accepted and STILL DIDN'T GO, because it's not what I want to do.
I am now in an Adult health NP program, MAINLY because it was a program at the local Unversity, where I could attend for "instate" tuition rates and finish my MSN part time so that I could teach nursing school. As I realize now, going the NP route was a great choice because I really feel that I am learning about pathology, pathophysiology and medical treatments to care for patients. I really don't care if I ever have Rx rights and can dispense scripts for ABX or write an order for a CXR. What I DO care about is being able to better care for patients and teach other nurses to do the same.
DNP (which makes sense as I would be teaching nursing students to perform clinical skills.) I really don't give a crap about ordering labs, xrays or rx's, but IMHO, having a nurse that has a CLUE about the pathophysiology of a disease process and understanding the normal and abnormal signs and symptoms related to that prosess would be a HUGE help for an MD.

I agree, patient care is a TEAM approach, Every team wins with power and strategy. Knowledge is power, communication is strategy. So why are we all arguing over knowledge that will provide our patients with better care AND outcomes.

Hi, I'm also a Nurse for 20 years, RN, Trauma, ICU and Hospice.

I went to medical school to be the "Team Captain"
where patient care needs a leader and a "Captain of the ship" If NP's want to be called Doctor ( In the ER here there is a PA who tells others he's a "Doctor" and just bought a new 60k sports car he parks in the Doctors Lot) then they are blurring the lines of who is the Captain of the ship or Team, MD and DO's are the team Captains and this is by Law, they are the only ones to be called Doctor (Captain) not any other part of the Team.

MD's and DO's should be the ones to make the decisions on Care and Treatment, of course with input from the whole team, but they make the final decision, like the captain of a ship, they do not steer but order direction, they do not scrub the decks but may order when they are scrubbed, they may not directly supervise all jobs on the ship but all answer to the Captain, so the Doctor does the same thing.

As far as NP giving you the ability to be a better Nurse, I beg to differ, I'm a great nurse before medical school and that was because I studied and read and studied more. Study and learning has more to do with being a better RN then what degree you have.

 

[Dr.Millisevert]

I"m an RN with 20 years of experience. I WAS accepted to medical school, because my family gave me a hard time about going to nursing school and said I did it due to the fact that I couldn't get accepted into med school. So, I got accepted and STILL DIDN'T GO, because it's not what I want to do.

Then why did you apply to med school if you knew you didnt want to go?

Sounds pretty sus to me.

 

[swimguy23]

Then why did you apply to med school if you knew you didnt want to go?

Sounds pretty sus to me.

it's kind of funny how many people "apply and get in to med school but chose not to go"

I usually ask what schools they applied to and keep the conversation going. You can usually catch them in the lie

not saying everyone wants to go to med school but it's funny how many people use that line solely for an ego boost

 

[oldpro]

it's kind of funny how many people "apply and get in to med school but chose not to go"

I usually ask what schools they applied to and keep the conversation going. You can usually catch them in the lie

not saying everyone wants to go to med school but it's funny how many people use that line solely for an ego boost

I do not think its an ego boost as much of a way to VALIDATE what they say as true.

Really there are many holes in this argument.

For Some reason that I cannot understand many people in America want a Shortcut into practicing medicine.

 

[cpants]

I do not think its an ego boost as much of a way to VALIDATE what they say as true.

Really there are many holes in this argument.

For Some reason that I cannot understand many people in America want a Shortcut into practicing medicine.

I understand why people want the shortcut. It's a great career. Good job security and compensation. I don't understand why we as physicians or the American people as patients would ever allow it.

 

[oldpro]

I understand why people want the shortcut. It's a great career. Good job security and compensation. I don't understand why we as physicians or the American people as patients would ever allow it.

They are fine as secondary care givers, as what they are intended to be, under a MD or DO, that is fine and they are greatly needed, just not as independent Primary caregivers, I cannot understand why they want the burden of missed diagnosis and potential harm to patients by this, a team of a MD/DO and a PA or NP is a great thing, two are better then one. Just as a in general rule MD and DO's are more experienced and better trained to be the Primary care leader.

 

[swimguy23]

and then you have threads like this where nurses are absolutely convinced the training is equivalenthttp://allnurses.com/forums/f34/do-you-think-np-s-midlevels-314439-3.html
remember "a doctoral degree is a doctoral degree is a doctoral degree"......riiiiiiiight

I also wonder what would happen if a CNA had a PhD in underwater basketweaving oir whatever and referred to their themselves as "Dr so and so and I basically do all the stuff nurses do anyways".....the nurses would probably go ape-crap over that

 

[oldpro]

and then you have threads like this where nurses are absolutely convinced the training is equivalenthttp://allnurses.com/forums/f34/do-you-think-np-s-midlevels-314439-3.html
remember "a doctoral degree is a doctoral degree is a doctoral degree"......riiiiiiiight

I also wonder what would happen if a CNA had a PhD in underwater basketweaving oir whatever and referred to their themselves as "Dr so and so and I basically do all the stuff nurses do anyways".....the nurses would probably go ape-crap over that

Yep this crap:

We are not physicians, we do not have the same scope of practice. I like the idea of being the best of both worlds, since we can consult someone if need be. What irks me is the idea that "only" an MD can provide full-spectrum care... if so, why do they refer to specialists?

For my own care I don't have a preference. I love NPs but that isn't an option here--if I ever get certified and licensed I will be the only one in the area providing primary care. There are some MDs that I would flat-out refuse to be seen by. Choice is a good thing. NPs will be their own best advertisements.

And this is wrong:

As for the time it takes to do the programs... a DNP and MD *ARE* the same amount of time (a doctoral degree is a doctoral degree is a doctoral degree), without residency factored in which can account for 1-4 additional years. My stating this is ABSOLUTELY NOT opening the door to arguing for or against the DNP degree. I am not discussing the DNP here... I just wanted to comment on the length of time it does take and clarify that the timeframe for most doctoral degrees, regardless of DNP vs MD vs PhD vs PharmD, is all the same.

 

[oldpro]

Oh, and as far as residencies-First not required for the MD degree-its actually for board certification after licensing, so you are comparing one thing against something totally different,

Beautiful (100% wrong of course Nurses!)

I'm so disgusted I joined the site and rebutted the posts, they are so mislead!

 

[Dr.Millisevert]

and then you have threads like this where nurses are absolutely convinced the training is equivalenthttp://allnurses.com/forums/f34/do-you-think-np-s-midlevels-314439-3.html
remember "a doctoral degree is a doctoral degree is a doctoral degree"......riiiiiiiight

I find it hilarious.. I've even seen a nursing union (Pro DNP) document that was stating how they believe that the DNP is much better than some overseas doctors degrees because they only held a "bachelor of medicine degree".. and obviously the DNP was a higher degree because it was a "doctorate".



Cambridge University Medical school (Bachelor of Medicine: MB = US MD): http://www.medschl.cam.ac.uk/courses/cgc/index.html


UMass DNP: http://www.umassonline.net/degrees/NewDNP.html

 

[oldpro]

As for FP, not according to this:
http://www.aafpfoundation.org/PreBuilt/foundation_dennisresearch.pdf

By the way, I'm not a primary care physician.

What how do you get that from this?

1959 – released the “Report of the Committee on
Preparation for General Practice.”
􀂄 Recommended several 2 year graduate pilot
programs to teach General Practice.
􀂄 This eventually grew to 165 programs offering 783
positions, however within 10 years most of the
general practice programs closed.
􀂄 The 2 year pilot programs had focused mainly on
Internal Medicine and Pediatrics, however several
GPs were also practicing minor surgical procedures.
This led to 8 resolutions at the 1960 AMA meeting
which led to including Surgery and Obstetrics

then it says this:

1969 – 15 pilot programs in Family Practice were
approved and the AMA approved Family Practice as
the “newest” medical specialty.
􀂄 Spring 1970 – 1st administration of the certification
exam: 6 hour written exam, exams on charts,
diagnostic data, and patient management.
􀂄 In order to qualify to take the exam, the ABFP
required 3 years of residency with re-certification
every 6 years.
􀂄 American Board of Family Practice was the first
specialty to require periodic re-certification.
􀂄 Re-certification process made up of: mandatory
cognitive written exam, office record review,
mandatory CME of 300 hrs. per 6 year cycle, and a
valid and unrestricted license to practice

Family Practice went from 2 years to 3 years, my math says 3 years is longer, there are now programs that are 4 years in Family medicine.

What am I missing?

 

[oldpro]

Funny but I have been reading the thread at ALLNURSES and they believe that after 1 year of residency most states will License all Doctors to practice, I told them FMG's need at least 3 and FP does this, and that there are now 4 year IM programs, I was told I was wrong and that most only need a 1 yr residency again, I posted one of the states Law, where the 3 yr residency rule is clear, I bet I get insulted and told I'm a liar as well as I was already told I was not a Medical Student since IM residencies, ALL of them are only 3 years................................Yea Nurses we want them to Be physicians yea....LOL

 

[ForbiddenComma]

I also wonder what would happen if a CNA had a PhD in underwater basketweaving oir whatever and referred to their themselves as "Dr so and so and I basically do all the stuff nurses do anyways".....the nurses would probably go ape-crap over that

RNs hate it when LPNs get too big for their britches and invade their turf

Never, ever call an NP a "nurse"

There was a poster here who caused the allnurses.com community to go bats**t crazy by suggesting EMT's could become equivalent to nurses

But that's different, though.


We have an NP on my new rotation... when I was shaking hands with everyone, with everyone introducing themselves by their first names (including the attending), she made sure to introduce herself as "Jane Doe, ARNP." Yes, she actually said the letters out loud.

 

[oldpro]

This is what happens when you say PA-NP-DNP are not equals to MD/DO

To practice medicine in most states also requires an intern year which in our institution is 70.4 hours x 48 weeks or another 3379 hours. What most people miss is there is an average of 12.7 hours of formal didactic instruction per week in internship. So this adds up to another 597 didactic hours and 2800 hours of clinical work. Total minimum to practice medicine in most states (for a US grad) 2412 didactic hours and 6815 clinical hours.

To say that both the DNP and the MD are four year degrees after undergraduate school is technically true. To imply that the DNP and the MD are equivalent in either didactic or clinical training is simply false.

I don't really have a hard time supporting physicians in this, I do have a hard time supporting you. Nursing will now have to make up a new term when horizontal violence is practiced by a former nurse now practicing medicine. I precept medical students, PA students and NPs. I understand the difference in educational models and how to respect people.

This was directed towards me by a PA-C

WOW I have no response to this, they also kept saying that MD's can be licensed in one year post grad, I kept saying not all Like FMG's MD it is 3 years the PA-C kept telling me I'm wrong.

Oh and I hate PA's they said.


http://allnurses.com/forums/f34/do-you-think-np-s-midlevels-314439-5.html

 

[oldpro]

The Admin has told us to stop posting about education on the thread at allnurses

 

[psy]

I thought he said to post it on another thread to continue. Did you get a pm from the Admin?

BTW: I enjoyed reading this thread. I was told that DNPs had a similar education as a regular doc and can practice in private. However, I had always wondered how it is possible to have the same practice rights with less education and training. This thread certainly cleared up alot of the myth.
thanks!

 

[oldpro]

I thought he said to post it on another thread to continue. Did you get a pm from the Admin?

BTW: I enjoyed reading this thread. I was told that DNPs had a similar education as a regular doc and can practice in private. However, I had always wondered how it is possible to have the same practice rights with less education and training. This thread certainly cleared up alot of the myth.
thanks!

I did not think we could do clinicals under a PA?

Yes the Admin PM'd me and told me it was not SDN and I was close to being in trouble.

 

[Tired]

I did not think we could do clinicals under a PA?

The short answer is that of course they can't precept medical students.

The long answer is that you will occassionally run into attendings who, for whatever reason, wish to maintain their position as "Clinical Faculty" but have no desire to actually do teaching. In such instances, they may pawn off their students on to NPs and PAs. In such instances, I'm sure the NP/PA is under the impression that they are "precepting".

Of course, if the school actually knew what was going on, the situation likely wouldn't occur very long.

 

[ForbiddenComma]

The long answer is that you will occassionally run into attendings who, for whatever reason, wish to maintain their position as "Clinical Faculty" but have no desire to actually do teaching.

Hooray for attendings who fail to understand what the term "academic medicine" means. I am consistently amazed at attendings at my place who want nothing to do with students. Perhaps then, they should not be working at a hospital with the word "University" in its name?

For some reason, this seems related to the trend of staff anesthesiologists no longer working cases, and instead "supervising" a farm of CRNAs. (where "supervising" = signing on the form at the end of the case.) A large part of our current woes are self-inflicted.

 

[oldpro]

I proposed that if NP's and DNP's want autonomy then the programs should look more like PA programs, increased Medicine focus taught and less nursing.

I was asked to prove this will make it better.

I was told to prove that patients are at risk with autonomous NP's and DNP's

that at this moment 25% of the nation has Autonomous NP's that do not have to contact Physicians unless they "Want to".

I thought it was only 4 states

I'm not sure this is good for the patients? Looks like NP's are acting like "Cowboys" to me.

This is not about control but what is in the best interest of our patients right?

RURAL practice has been brought up, OK I'm doing clinicals in a rural area and its the 21st century out here too, its not so isolated anymore, we have all the "Toys" that the big cities have now.

 

[deleted6669]

The short answer is that of course they can't precept medical students.

The long answer is that you will occassionally run into attendings who, for whatever reason, wish to maintain their position as "Clinical Faculty" but have no desire to actually do teaching. In such instances, they may pawn off their students on to NPs and PAs. In such instances, I'm sure the NP/PA is under the impression that they are "precepting".

Of course, if the school actually knew what was going on, the situation likely wouldn't occur very long.

I have been clinical faculty at 2 fp residencies over the yrs. I was the preceptor of record. the residents see pts in the e.d., present pts to me, we formulate a plan, I see the pts and I sign their charts and write their evals. only my name and signature is on the eval. I also precept medstudents rotating through the dept.

 

[Tired]

I have been clinical faculty at 2 fp residencies over the yrs. I was the preceptor of record. the residents see pts in the e.d., present pts to me, we formulate a plan, I see the pts and I sign their charts and write their evals. only my name and signature is on the eval. I also precept medstudents rotating through the dept.

You have a supervising physician under whose license you practice.

 

[oldpro]

I have been clinical faculty at 2 fp residencies over the yrs. I was the preceptor of record. the residents see pts in the e.d., present pts to me, we formulate a plan, I see the pts and I sign their charts and write their evals. only my name and signature is on the eval. I also precept medstudents rotating through the dept.

Let me get this straight,

A PA is Co signing a CHart for a Doctor ( a resident) ? How is this legal?

 

[elr1983]

Let me get this straight,

A PA is Co signing a CHart for a Doctor ( a resident) ? How is this legal?

Yeah, I'm wondering this too!

PA's supervise med students in the ER at my school, which works out totally fine, but I am pretty sure the residents would be pissed if they had to answer to a PA. Generally the PA supervision of med students works out great. However, there's this one PA who just graduated from our school who takes every opportunity to remind the med students that she's in charge and she's making the decisions, blah, blah, blah. The ER doc watches her like a hawk because she's always messing stuff up and she definitely doesn't teach us anything. She's also the only one in the whole department who always wears her long white coat. I'd actually like to see someone try to make the residents answer to her.....they'd eat her alive.