NP preceptor

[Nasrudin]

OK -- opposite situation: I agreed to precept an NP student this summer. Slightly annoyed because she uses my first name in all her emails to me.

Tighten that *** up. Dress her down full metal jacket style.

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[DocVapor]

OK -- opposite situation: I agreed to precept an NP student this summer. Slightly annoyed because she uses my first name in all her emails to me.

on several accounts there.

 

[Psai]

OK -- opposite situation: I agreed to precept an NP student this summer. Slightly annoyed because she uses my first name in all her emails to me.

Slightly annoyed? At the beginning of the year I could barely call the peds residents by their first name even after they told me multiple times not to. I would never call an attending by their first name, can't even do last name only without the title like many of the residents do.

Thought nps were trying to do primary care in rural areas, what would they be doing with a breast surgeon in an urban area

 

[deleted480308]

OK -- opposite situation: I agreed to precept an NP student this summer. Slightly annoyed because she uses my first name in all her emails to me.

crush that, who the hell addresses a boss by their first name unless they are told to do so?

 

[Nasrudin]

Make sure she believes in the Virgin Mary. Have her dump out her lunch box and make sure she sure as **** doesn't have a jelly donut. And that above all else any peep out of that stupid mouth starts with Sir Doctor sir!




#stuffIWishWeCouldDoInPsych

 

[Winged Scapula]

Just tell her that's not appropriate. Otherwise she's going to show up and call you "Kim" in front of your patients.

EDIT - On a related note, why exactly does an NP need to be precepted by a subspecialty surgeon?

Tighten that *** up. Dress her down full metal jacket style.

on several accounts there.

Slightly annoyed? At the beginning of the year I could barely call the peds residents by their first name even after they told me multiple times not to. I would never call an attending by their first name, can't even do last name only without the title like many of the residents do.

Thought nps were trying to do primary care in rural areas, what would they be doing with a breast surgeon in an urban area

crush that, who the hell addresses a boss by their first name unless they are told to do so?

Slightly annoyed because:

1) I'm not really the easy to anger type
2) I tend to understate things

Ok, I'm pretty well annoyed. Is that better?

She's been with a local practice that refers heavily to me. While talking about a mutual patient one day, she asked if I took NP students. I didn't have a good reason (then) not to, so said I would consider it if she could provide all the things the medical students and residents do (malpractice, HBV status, HIPAA training etc). I then forgot all about it until her school contacted me.

As for what she's doing with me, I actually thought it would be beneficial to *me*. My partners and I get sent all sorts of non-surgical ****: breast pain, benign nipple discharge, genetic counseling patients (those I don't mind), benign skin lesions on the chest/breasts, bleeding with breast feeding and mastitis. So I was thinking if I could get the PCP community to stop sending me those by training them how to manage them on their own and to stop referring to us as "breast specialists" rather than as surgeons, it would make my life easier and I could focus on the malignancies. The former is a small part of the practice but its frustrating when I can't get a new cancer in because the "emergency" breast pain patient cursed at my staff and refused to be rescheduled.

I think when I send her the information about the rotation I'll put a little blurb in there about calling me "Dr" in front of patients. Since she's ballsy enough to call me by my first name already, I don't want to call her specifically out on it lest she take offense. If she was a stranger and her employer didn't refer to me, I wouldn't care, but I have to play it a little closer to the vest.

@Psai please tell me you're kidding when you said you thought NPs wanted to work in rural areas doing primary care. Nothing could be further from the truth.

 

[giantswing]

I think it's a nursing culture thing, to call everyone by their first name, despite the culture of abuse. Which is why heirarchies are so foreign and think they don't apply to them.

 

[Nasrudin]

I think it's a nursing culture thing, to call everyone by their first name, despite the culture of abuse. Which is why heirarchies are so foreign and think they don't apply to them.

I might agree yet they seem pretty keen on being called Dr in clinical settings whenever they get their doctor or nursing degree or whatever it is.

But it's unfortunate that WS is bridled by political concern here because if public humiliation has a place in this world, it's here. And also maybe that allo thread with the kid who can't stop crying in public.

There's just too much coddling going on the world these days.

 

[deleted480308]

WS, I absolutely agree with playing it a little more subtle if the nurse is an employee at an important business contact. Self-preservation>"right".

You are a business, not a justice warrior

 

[Winged Scapula]

I think it's a nursing culture thing, to call everyone by their first name, despite the culture of abuse. Which is why heirarchies are so foreign and think they don't apply to them.

But isn't it your job as a traveler in a foreign land to learn the culture?

That being said, I'll bet she calls her physician employer by his first name.

 

[giantswing]

But isn't it your job as a traveler in a foreign land to learn the culture?

That being said, I'll bet she calls her physician employer by his first name.

Yes, but that doesn't mean people do. It's my patients job to quit smoking and...

Whelp. I tremble in fear at the thought of ehat would happen if i addressed my superiors: "oh hey bob".

 

[deleted480308]

I do think that the level of deference to title is taken more seriously in the medical universe than in other fields...it might be a function of the fact that doctors (that's who I mean when I say medicinie) are the top of the knowledge food chain and therfore have a vested interest in everyone respecting experience/title. The nursing community does not stand to benefit from true recognition of training level and I think it contributes to their pushing the "everyone is on the team" mentality

 

[jl lin]

I refer to those who are not my peers as Dr Whatever, until they tell me otherwise, which most of the time, they end up doing over time.


On the point of the thread: Learning has a strong element of humility in it. I feel like I can learn from the tiniest insect or microbe, and if I can't, in my mind at least, I am not a true learner and I don't have a truly teachable spirit, so to speak.
Regardless of education, healthcare is an area where if you can't embrace humility, IMHO, you need to go elsewhere. It's always about the patients, and if that means I can learn from a CNA or tech or whomever in order to help perfect a particular skill or consider something that may be important for the patient/s, that's what I will do. Feelings of superiority go out the window when you are talking about addressing the health and psychological or social needs of patients and communities.

 

[chipwhitley]

Apparently so did your MD preceptor. If he wasn't there, why did he put you with the NP, especially knowing that she wasn't up to even NP standard? Why weren't you just given those days off? If there hadn't been an NP, would they have put you with the CNA and had then teach you pathophysiology?

The problem here is not the NP. It is the MD.

Yes, it is very much so the MD's fault. The NP should have never been hired in the first place or should have been fired for being so incompetent. It is also the NP school's fault for graduating someone with such a poor understanding of important concepts and the NP licensing board's fault for licensing her in the first place. She can actually practice independently in my state, which is horrifying.

 

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[chipwhitley]

In my mind, whether or not the NP is employed there is immaterial. That's a business decision, and there are a lot of factors that affect it. Even a "not very good" employee can fill a need.

But placing a student under the care of said NP is entirely inappropriate.

I don't think it's a business decision when this person is treating patients on her own while the physician is away without consultation, especially while the physician knows how incompetent she is. That's an issue of public safety, isn't it?

 

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[chipwhitley]

But it's not your business right? We have no idea whether this NP is good or bad at their job. We have no idea if they are capable of practicing safely. Any comments on that are simply supposition. But the poor teaching and poor understanding of basic science are very well described, and the MD was wrong for leaving this person to teach for them.

I mean, if you don't need to have a decent understanding of basic science to practice safely, why do we spend so much time learning it and getting tested on it? She didn't understand very fundamental things - I'd say that was a red flag and I wouldn't be too confident in her ability to properly diagnose and treat people.

 

[pulmoblast]

You can learn a lot from the CT tech or the EKG tech or the dialysis nurse or the dietician. That doesn't mean they should be your supervisors in medical school.

Any medical school which makes you shadow NPs is doing you a disservice.

This how we blur the lines between nurses and doctors (by calling them providers)

Funnily, these lines are very real in court and malpractice litigation...where the MD has vicarious liability

 

[chipwhitley]

You can learn a lot from the CT tech or the EKG tech or the dialysis nurse or the dietician. That doesn't mean they should be your supervisors in medical school.

Any medical school which makes you shadow NPs is doing you a disservice.

This how we blur the lines between nurses and doctors (by calling them providers)

Funnily, these lines are very real in court and malpractice litigation...where the MD has vicarious liability

I agree. If the school can't find enough MDs to teach students, they shouldn't be taking on that many students. It doesn't matter how much you can learn from everyone else.

 

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[chipwhitley]

Because NPs are not MDs, which was kind of my point in this thread from the outset.

But here in my state, they practice independently and see patients and diagnose/treat them. So how is that different from what an MD does? How is it that one needs to know basic science well and the other doesn't - to do essentially the same job safely? It sounds like that's what you're saying.

 

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[jl lin]

Apparently some never read about Blalock and Vivien Theodore Thomas, a black surgical research tech pioneer who basically showed Blalock and Taussig how to get it down.

Thomas was given the job of first creating a cyanotic condition in a dog, and then correcting the condition by means of the pulmonary-to-subclavian anastomosis. He did much work on perfecting this, and he even was needed to assist, b/c Blalock didn't have the same level of skill on this as what Thomas had developed over time. Soon the Blalock–Taussig shunt came to be, but of course Vivien Thomas received no real credit for it.
During an atrial septectomy, the procedure was said to have been executed so flawlessly by Thomas that Blalock, upon examining the nearly undetectable suture line, was prompted to remark, "Vivien, this looks like something the Lord made."

Point is, sure, the evals should come from the right people; but forget it if you can't learn from someone else b/c of station. That's way sad. Mimelim is right on point. Holy cow.

 

[Nasrudin]

Apparently some never read about Blalock and Vivien Theodore Thomas, a black surgical research tech pioneer who basically showed Blalock and Taussig how to get it down.

Thomas was given the job of first creating a cyanotic condition in a dog, and then correcting the condition by means of the pulmonary-to-subclavian anastomosis. He did much work on perfecting this, and he even was needed to assist, b/c Blalock didn't have the same level of skill on this as what Thomas had developed over time. Soon the Blalock–Taussig shunt came to be, but of course Vivien Thomas received no real credit for it.
During an atrial septectomy, the procedure was said to have been executed so flawlessly by Thomas that Blalock, upon examining the nearly undetectable suture line, was prompted to remark, "Vivien, this looks like something the Lord made."

Point is, sure, the evals should come from the right people; but forget it if you can't learn from someone else b/c of station. That's way sad. Mimelim is right on point. Holy cow.

Who said anything about not learning from other people. How about patients. Many of mine are homeless and smell funny. I still learn from them. So what. We're talking about training. These are different types of learning.

I know it rubs your Nightengale training the wrong way to not be thought of as playing a role in shaping the minds of the residents who rotate through but that's just what's up. You show them how to do aspects of the job but you don't refine their clinical skills in the way that an attending will model for them. Sorry. There is actually a chain of transmission.

As for your snarky example, that surgical tech should've and perhaps would've been a surgeon himself if Jim Crow wasn't as powerful as he was during that time. This does not mean we should be trained by nurses. After all, by their own confusing dogma, the don't practice medicine they practice advanced nursing, whatever that is.

 

[jl lin]

Who said anything about not learning from other people. How about patients. Many of mine are homeless and smell funny. I still learn from them. So what. We're talking about training. These are different types of learning.

I know it rubs your Nightengale training the wrong way to not be thought of as playing a role in shaping the minds of the residents who rotate through but that's just what's up. You show them how to do aspects of the job but you don't refine their clinical skills in the way that an attending will model for them. Sorry. There is actually a chain of transmission.

As for your snarky example, that surgical tech should've and perhaps would've been a surgeon himself if Jim Crow wasn't as powerful as he was during that time. This does not mean we should be trained by nurses. After all, by their own confusing dogma, the don't practice medicine they practice advanced nursing, whatever that is.

A. Snarky is your spin. Never had that in mind. Honestly I am totally beginning to think you project a lot when it comes to me and how YOU THINK I THINK.

B. Semantics: learning versus training.

C. I really don't care so much about such ego-based crap; b/c in truth and sincerity, I am there for the patients and families, first. I couldn't care less who choses to listen or learn from me one way or another, so long as the patient does well, and we get him, her, them what they need. The ego-crap is something with which your really young, NY, chippy RNs had an issue. Where I have worked, it's about the patient. So who cares whose idea you make it sound like or who gets the credit? Our satisfaction is in knowing the patient is stable and is getting what he or she needs and can move forward.

D. I can only imagine what terrible situations and nurses with which you had to work in NY. I am very sorry it left such a negative taste in your mouth and some kind of long-lasting ecchymosis. But your mass hatred is based on a generalization.

Vivien didn't get ahead and get to go to medical school not just b/c of Jim Crow; but b/c of the push to keep him in the research, b/c Blalock KNEW he needed him. It was as much about self-interest as anything, and Vivien had already committed so much to the work.

Your sad interpretation of snarky example is quite unfortunate--but seriously, you injected that on to the example.
I call total projection on you, especially with the use of the word snarky. That is so completely your deal. And You really aren't all that old but you seem like a crotchety old man already. Wow and sad.

Learning and training--semantics. I already stated that formal evals should come from the most appropriate people. That has nothing to do with being open and able to learn from everyone--and yes--including your patients and families.

I wish you would stop this negative reading into stuff with me. It's starting to become a bit annoying, and in fact it has always been unnecessary. Get over it already. Your issue. Your problem.

 

[Nasrudin]

A. Snarky is your spin. Never had that in mind. Honestly I am totally beginning to think you project a lot when it comes to me and how YOU THINK I THINK.

B. Semantics: learning versus training.

C. I really don't care so much about such ego-based crap; b/c in truth and sincerity, I am there for the patients and families, first. I couldn't care less who choses to listen or learn from me one way or another, so long as the patient does well, and we get him, her, them what they need. The ego-crap is something with which your really young, NY, chippy RNs had an issue. Where I have worked, it's about the patient. So who cares whose idea you make it sound like or who gets the credit? Our satisfaction is in knowing the patient is stable and is getting what he or she needs and can move forward.

D. I can only imagine what terrible situations and nurses with which you had to work in NY. I am very sorry it left such a negative taste in your mouth and some kind of long-lasting ecchymosis. But your mass hatred is based on a generalization.

Vivien didn't get ahead and get to go to medical school not just b/c of Jim Crow; but b/c of the push to keep him in the research, b/c Blalock KNEW he needed him. It was as much about self-interest as anything, and Vivien had already committed so much to the work.

Your sad interpretation of snarky example is quite unfortunate--but seriously, you injected that on to the example.
I call total projection on you, especially with the use of the word snarky. That is so completely your deal. And You really aren't all that old but you seem like a crotchety old man already. Wow and sad.

Learning and training--semantics. I already stated that formal evals should come from the most appropriate people. That has nothing to do with being open and able to learn from everyone--and yes--including your patients and families.

I wish you would stop this negative reading into stuff with me. It's starting to become a bit annoying, and in fact it has always been unnecessary. Get over it already. Your issue. Your problem.

Well. I have no idea what you're talking about but I think it's pretty obvious that they're are different types of learning. I speak from experience that one on one with attendings has been the most enriching clinical experience I've had. It happens with more frequency now that I'm a resident and many of our teams are 1 attending 1 resident outfits but I still think it's important for medical students to have physician lead teams as the source of training.

I still learn when my attending isn't around. And the sources are as wide as the scope of my perception. But what makes up the attending/resident relationship is the real heart and blood of physician training. And that's anything but just semantic differences from picking up things from other sources.

I project my thoughts onto you. Hoping that you'll get it someday.

 

[jl lin]

Well. I have no idea what you're talking about but I think it's pretty obvious that they're are different types of learning. I speak from experience that one on one with attendings has been the most enriching clinical experience I've had. It happens with more frequency now that I'm a resident and many of our teams are 1 attending 1 resident outfits but I still think it's important for medical students to have physician lead teams as the source of training.

I still learn when my attending isn't around. And the sources are as wide as the scope of my perception. But what makes up the attending/resident relationship is the real heart and blood of physician training. And that's anything but just semantic differences from picking up things from other sources.

I project my thoughts onto you. Hoping that you'll get it someday.

"As you know, projection is a defense mechanism that involves taking our own unacceptable qualities or feelings and ascribing them to other people." (Snarky--You-->on to me) "For example, if you have a strong dislike for someone, you might instead believe that he or she does not like you. Projection works by allowing the expression of the desire or impulse, but in a way that the ego cannot recognize, therefore reducing anxiety."--Kendra Cherry

You label my comment snarky, and that is your very MO.

Hmmm, how do you know that indeed you don't have a thing or two to "get?" As I am sure it is true for me, I think it also continues with you.

"...one on one with attendings has been the most enriching clinical experience I've had."

Well, provided the person is effective in this role, I have no doubt it is true. By all means; it should be the mainstay of a MS/resident's clinical education. Never said otherwise.

That's far different from getting a freaky attitude about learning from a PA, NP, Nurse, RRT, whomever. There is this sick kind of pride that wells up in some folks in healthcare. It's like this entitlement perk or something. In reality it has nothing to do with the job or learning or helping, period.

But, as you like it. I respect @mimelim's perspectives here. Every time I read his perspectives, I find they are quite logical and on target.

 

[Nasrudin]

"As you know, projection is a defense mechanism that involves taking our own unacceptable qualities or feelings and ascribing them to other people." (Snarky--You-->on to me) "For example, if you have a strong dislike for someone, you might instead believe that he or she does not like you. Projection works by allowing the expression of the desire or impulse, but in a way that the ego cannot recognize, therefore reducing anxiety."--Kendra Cherry

You label my comment snarky, and that is your very MO.

Hmmm, how do you know that indeed you don't have a thing or two to "get?" As I am sure it is true for me, I think it also continues with you.

"...one on one with attendings has been the most enriching clinical experience I've had."

Well, provided the person is effective in this role, I have no doubt it is true. By all means; it should be the mainstay of a MS/resident's clinical education. Never said otherwise.

That's far different from getting a freaky attitude how learning from a PA, NP, Nurse, RRT, whomever. There is this sick kind of pride that wells up in some folks in healthcare. It's like this entitlement perk or something. In reality it has nothing to do with the job or learning or helping, period.

But, as you like it. I respect @mimelim's perspectives here. Every time I read his perspectives, I find they are quite logical and on target.

I'm glad you have an sdn'er to love. Admit it though, this could be about the proper way to season mashed potatoes and you and I would be like Coyote and Roadrunner still.

Let's leave these people to their thread topic. I concede to an arrogant, self-involved, entitled, prideful, egomaniacal defeat.

 

[mimelim]

So can we just skip the extra school and do it their way? It would save us a lot of time and money.

I mean, if you don't need to have a decent understanding of basic science to practice safely, why do we spend so much time learning it and getting tested on it? She didn't understand very fundamental things - I'd say that was a red flag and I wouldn't be too confident in her ability to properly diagnose and treat people.

We get it, you don't know anything about NPs and hate them. You can learn a lot from people that have a tremendous amount of experience but lack 'basic science background' that the vast majority of practicing MDs have long forgotten. If you can't understand that concept, you are in for a rude awakening in the real world where experience counts for a lot at all levels. This seems to be your fundamental problem, other than the blind, "NPs are bad!" you don't understand that just because they aren't doing exactly what you will be doing in the future, doesn't mean that they don't have something to offer.

The only person making sweeping generalizations here is you. Nobody is arguing that NPs should be in full charge of a medical student's education. Nobody is arguing that NPs should step outside of the scope of their education or experience. Yes, any practitioner working outside of their area and hurting patients should be stopped. But, the number of MD violations of this is just as bad as any mid-level profession. It is a systemic problem.

 

[Psai]

Apparently some never read about Blalock and Vivien Theodore Thomas, a black surgical research tech pioneer who basically showed Blalock and Taussig how to get it down.

Thomas was given the job of first creating a cyanotic condition in a dog, and then correcting the condition by means of the pulmonary-to-subclavian anastomosis. He did much work on perfecting this, and he even was needed to assist, b/c Blalock didn't have the same level of skill on this as what Thomas had developed over time. Soon the Blalock–Taussig shunt came to be, but of course Vivien Thomas received no real credit for it.
During an atrial septectomy, the procedure was said to have been executed so flawlessly by Thomas that Blalock, upon examining the nearly undetectable suture line, was prompted to remark, "Vivien, this looks like something the Lord made."

Point is, sure, the evals should come from the right people; but forget it if you can't learn from someone else b/c of station. That's way sad. Mimelim is right on point. Holy cow.

I don't see how any of this has to do with np preceptors

 

[jl lin]

I'm glad you have an sdn'er to love. Admit it though, this could be about the proper way to season mashed potatoes and you and I would be like Coyote and Roadrunner still.

Let's leave these people to their thread topic. I concede to an arrogant, self-involved, entitled, prideful, egomaniacal defeat.

Just in case you invite me over for dinner, well, I like my potatoes well-seasoned with freshly ground black pepper.

 

[chipwhitley]

We get it, you don't know anything about NPs and hate them. You can learn a lot from people that have a tremendous amount of experience but lack 'basic science background' that the vast majority of practicing MDs have long forgotten. If you can't understand that concept, you are in for a rude awakening in the real world where experience counts for a lot at all levels. This seems to be your fundamental problem, other than the blind, "NPs are bad!" you don't understand that just because they aren't doing exactly what you will be doing in the future, doesn't mean that they don't have something to offer.

The only person making sweeping generalizations here is you. Nobody is arguing that NPs should be in full charge of a medical student's education. Nobody is arguing that NPs should step outside of the scope of their education or experience. Yes, any practitioner working outside of their area and hurting patients should be stopped. But, the number of MD violations of this is just as bad as any mid-level profession. It is a systemic problem.

If experience is all it takes and practicing MDs forget their basic science knowledge anyway, I would really love to skip med school (at least the first two years) and just get to work. I feel robbed.

 

[chipwhitley]

If we let NPs teach us and supervise our education all that leads to is more evidence for the NPs to prove to the public and the lawmakers that they are equivalent to MDs. This is something we should not be in favor of.

 

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[chipwhitley]

Then go do that. But for the love of God, stop posting the same thing over and over again.

I was responding to someone else, not you.

Also, I would love to do that but the laws don't allow it. Hopefully they'll change because our licensing laws are kind of a joke right now. They're going in the direction of letting just about anyone practice medicine, but still maintaining a high standard for MDs, which makes no sense.

 

[Nasrudin]

I think a good way to look at it would to ask yourself as an attending or as a resident what you would think of NP supervision. And then depending on the answer work backwards to why we should delegate the responsibility of training medical students.

 

[chipwhitley]

This is about the 87 millionth time you've gotten stuck on this comparison between MD and NP education.

We have a different training pathway.

Whether or not state laws allow NPs to practice independently says nothing about the capacity of an MD graduate to do the same.

I don't want to get into this argument with you again, but I think you're dead wrong. It doesn't matter what your training pathway is, you need to have a certain amount of knowledge/experience to safely practice medicine independently, and you can't discriminate between training pathways. Doesn't make sense to have two different standards of safety. That's like saying one group of pilots who trained in System A only require 1000 hours of flight experience to safely fly on their own, whereas another group of pilots who trained in system B can't fly until they have 10000, although they're flying the same exact plane. Doesn't make a lot of sense, does it?

Anyway that's all I have to say on that. It's been beaten to death.

 

[chipwhitley]

We know. I'm not even really sure why someone who has said they hate every step along the path and wishes they'd quit, and didn't even apply for residency (or was that just false bluster?), feels so strongly on this issue.

I feel strongly because I don't like the path we have now, I think it needs to change, and I'm not the only one who feels this way. You just need to read the news to see how many practicing physicians feel as strongly as I do. Even if I quit and never looked back, unlike any other industry, I can't get away from it because everyone has to deal with the healthcare system at one point or another. I'd rather be part of the change than just walk away all together because I'm unhappy about it.

 

[W19]

I was responding to someone else, not you.

Also, I would love to do that but the laws don't allow it. Hopefully they'll change because our licensing laws are kind of a joke right now. They're going in the direction of letting just about anyone practice medicine, but still maintaining a high standard for MDs, which makes no sense.

I agree with you. People were up in arms in SDN when Missouri passed the law that will give MD graduates a license to become PCP with the title "assistant physician' after 1-year of 'clinical preceptorship' . They said that will 'degrade' the MD title. Guess what! This title is just a title now. People with a lot less education are practicing medicine...

 

[wxman393]

I don't want to get into this argument with you again, but I think you're dead wrong. It doesn't matter what your training pathway is, you need to have a certain amount of knowledge/experience to safely practice medicine independently, and you can't discriminate between training pathways. Doesn't make sense to have two different standards of safety. That's like saying one group of pilots who trained in System A only require 1000 hours of flight experience to safely fly on their own, whereas another group of pilots who trained in system B can't fly until they have 10000, although they're flying the same exact plane. Doesn't make a lot of sense, does it?

Anyway that's all I have to say on that. It's been beaten to death.

I completely get what you are trying to say. However, the pilot analogy might not be the best. I was a professional pilot prior to healthcare (and still am) and there are tracks for individuals to get their licenses at different hour requirements. A pilot that graduates from a Part 61 flight school traditionally has to obtain more hours than a pilot that graduates from a Part 141/142 flight school (e.g., Embry Riddle Aeronautical University). The FAA allows pilots that graduate from a 141/142 school to schedule their checkrides at "lower minimums" than those that graduate from 61 schools. We could argue competency all day long but there are pilots flying the same exact aircraft with varying amounts of hours. In some cases, there are aviation insurance providers that won't even cover you if you didn't graduate from a 141/142 flight school.

Obviously, I digress from the point of the OP. But perhaps there needs to be a minimum standard if schools are using NPs as preceptors. While I would have no problem learning from an experienced NP, I'd be hesitant to be evaluated by an NP that was fresh out of school. I value experience from any profession, whether it is an EMT-Basic or an attending physician. Obviously, the evaluations are mostly subjective and many schools use it as a "check the box". But specific, critical feedback would most likely be better "tolerated" from a physician rather than an NP.

 

[HooliganSnail]

Even an NP who is capable of teaching their limited area of expertise is not qualified to assess a student's professional growth and progression. I have learned much from mid-levels, but they should never serve as a primary preceptor judging your overall performance.

Using the excuse that "other options were poor" is unacceptable. If the options are that poor, the rotation should not exist.

Honestly, in my training I can not count how many times I was "taught" something by an NP/PA that was just flat out wrong.

In third year, you don't know better.

Heed this warning. If you are ever in a situation where you a pretty positive about something, and the PA is telling you that you are wrong, ignore the PA and go with what you think. I have looked stupid too many times in front of an attending because I did what the Mid level told me was correct.

Never again

 

[HooliganSnail]

NP might be right when they say physicians are overeducated.

Propaganda if there ever was.

How did we ever get to a place in this country when the discussion is about how "over educated" physicians are for "simple" things like primary care.

Primary care is so vast, so complicated, so layered, that the fact that a common rhetoric these days involves us having too much training is just plain ridiculous.

 

[W19]

Propaganda if there ever was.

How did we ever get to a place in this country when the discussion is about how "over educated" physicians are for "simple" things like primary care.

Primary care is so vast, so complicated, so layered, that the fact that a common rhetoric these days involves us having too much training is just plain ridiculous.

My cousin who is an internist told me he will never hire a midlevel even if mid levels would have increased his salary to at least 100k/year... He 'precepted' NPs when he was a hospitalist and he said it was scary.

I happen to think PA is legit and NP is a joke...

 

[Psai]

My cousin who is an internist told me he will never hire a midlevel even if mid levels would have increased his salary to at least 100k/year... He 'precepted' NPs when he was a hospitalist and he said it was scary.

I happen to think PA is legit and NP is a joke...

Nps are good for writing notes and following up on all the social stuff. They don't know enough to be competent by themselves and aren't even aware of how little they know

 

[jl lin]

My cousin who is an internist told me he will never hire a midlevel even if mid levels would have increased his salary to at least 100k/year... He 'precepted' NPs when he was a hospitalist and he said it was scary.

I happen to think PA is legit and NP is a joke...

I can definitely see that with NPs that have had very little clinical background and experience. And the schools don' t care if the RN-BSN has only been out of school a few years and hasn't had a lot of clinical hours practicing w/ medical and surgical patients. They see new grads as just more $$$$. These programs and licensing boards need to improve admission standards, clinical work hours--as well as type of clinical work for admission to advance practice programs. But when you work with good people enough, you know it. I would be remiss if I didn't share that I have seen and worked with some very stellar NPs, Clin Specs, and PAs w/ loads of knowledge and experience. But what your cousin has seen is very often the production line from undergrad to grad school programs with very minimal clinical practice and insight. This is where these programs and even nursing in general is cutting it's own throat.

I agree that formal evaluation clinically should be by a physician. But please don't think that there aren't physicians out there that will make you scream for a stellar NP or PA. You find out in the clinical situations. You learn. But yea. Keep formal clinical evals to reputable, practicing physicians.

 

[giantswing]

I will never hire NPs once Im at that level. I will not work w crnas wo an anesthesiologist, if at all. You never know what you're going to get, competency wise, as all standardizations and safety precautions have been removed as they "streamline" their education.

 

[JustPlainBill]

Interesting thread -- I did my FM residency at a large university system for family reasons -- and our Ob/Gyn experience was with midwives, some of whom were RNs. The L&D deck the FM residents were on was the "non-complicated" deliveries and we had firefighters/paramedics and medical students on that wing also. Interestingly, all the other residencies at the institution who had to do deliveries were over on the other wing with the Ob/Gyn residents taking care of "complicated" deliveries -- which tells you how our residency was viewed by the institution in general.

Anyway, some of the midwives were studying for their FNP and at the time their organization was fighting for independent practice rights in Texas. For the entire 2 months on that rotation I heard over and over how an FNP == a BC FM attending.

It was interesting when they tried to pimp me about L&D stuff -- the entire thought process was completely different to the point of not resembling logical thought IMO.

I also saw a lot of dangerous things go on in terms of patient care and refusal to call in OB when needed as "women have been having babies for thousands of years and all doctors want to do is cut". This usually happened when the OB residents had booked off to go grab lunch and weren't watching the monitors.

The politics got so bad that as interns/residents we were put behind med students/paramedics/firefighters in terms of getting our required deliveries. When advised by one Ob/Gyn resident to take the freakin' deliveries from them by playing the doctor card, I had to explain that the midwives/NPs had input into our evals.

The final straw came one day when they noticed my cheat sheet notes from Doctors-In-Training for OB -- Dr. Jenkins does a complete job and it was well written. They asked if I had one for DM as that was the module they were going over and being tested on next.

I offered to help them study and began with basic questions -- it quickly became apparent that the NP students were lacking a basic "fund of knowledge" and could not even define DM much less had any knowledge of treatment considerations. I had had enough of their "holier than thou" BS over the 2 months -- smelling blood in the water, I proceeded to introduce them to a full blown pimp session a la pissed off ICU attending style (which I had seen while on that rotation as a student).

I paid for that one.

My point is, IMO -- at least in my experience -- NPs have no business teaching/precepting med students -- ever;

As far as an NP calling me by my first name -- I've had that happen and I just gently correct it as "It's Dr.JustPlainBill" while looking them straight in the eyes. Usually gets my message across and I've had no problems after that ---

 

[ortnakas]

But isn't it your job as a traveler in a foreign land to learn the culture?

That being said, I'll bet she calls her physician employer by his first name.

I was a clinical research coordinator before I became a medical student. I called the doctors I worked with by their first name in private or in internal meetings, because that was the culture of our office, but I never would have dreamed to call them anything other than Dr. X when talking to patients or any outside party.

And now as a student, I find this story shocking. If anyone at my school was heard calling a physician anything other than Dr., our faculty would be all over us.

Edit: came across post months later and typos bothered me

 

[Mass Effect]

Yup had an RN as a preceptor on surgery. Im sure the thread has gone down in SDN history. Ahh well, ended up fine.

There's a big difference in an RN serving as a preceptor and an NP serving as one. Neither is ideal, but the RN is just unacceptable.

Doctors should be trained by doctors. It's really that simple.

No one is saying that doctors shouldn't be trained by doctors. But NPs and PAs have something to offer. So someone met a bad NP who got the pathophysiology all wrong. Guess what? I've met more than one MD who got the pathophysiology wrong as well. There were many MDs preaching about the link between autism and vaccinations. There are still MDs out there who believe all medicine is toxic and people should be healed naturally. The point is, there are bad MDs, just as there are bad NPs and determining that no NP is qualified to teach based on that is short-sighted.

I would not use the word 'competent' for most NP. They probably learn to follow algorithm. PA is legit though!

That's just your bias talking. Become a physician, work alongside NPs, and then we'll talk. There are several NPs and PAs that I would trust over the MD they're working under.