Sorry for another "FNP vs. MD GP" threads, but...

Josh L.Ac. · Mar 24, 2006

I'm in a bit of quandary about which path to take. Here's a little background: I was pre-med in my undergrad and I got the opportunity to go to Korea for a year to learn acupuncture and get independent study and honors undergraduate credit for it. It was going to be an interesting and unique experience that would also make getting into a good medical school that much easier. Well the plan fell through on the other end, things happened...and then I graduated. The original plan was to go to DO school, but I was still interested in acupuncture. So after much debate, I decided to go to acupuncture school first for several reasons - I figured I wouldn't have to fortitude or time to go to three years of acupuncture school after DO school, and I also knew myself and figured I would be unable to make a paradigm shift after seven more years of reductionistic medicine.

So I went to acupuncture school with the plan of going on to DO school afterwards. But then life happens...got married, got divorced, and then found the perfect girl. After I graduated with my master's in acupuncture, I started researching DO schools but I wasn't too engaged since I was heading to China for a five week acupuncture internship. I figured I would take a fresh look at the situation when I returned.

Two weeks after I got to China, my girlfriend told me that I was going to be a daddy.

After some serious thought (while drinking very cheap Chinese beer), I realized that another seven years might be too much. By chance, one of my fellow classmates was a FNP. We talked a bit and I realized that I could fullfil my dream of having a integrative family practice by going the NP route. The benefits (shorter duration of the program, less intense program, program is essentially paid for by the hospital, more time at home after the program, less overhead costs) far outweighted the negatives (not a doctor, no residency, less training, much fewer patient contacts). Well, at least it did initially. Most of the information I am hearing is from nurses and nurse practitioners, so I expect it to be a little biased towards that side. But true to my nature, I jumped on this site with the intention of getting a broader perspective. The few threads I've skimmed on the topic of FNPs have been somewhat negative.

I am hoping that somebody here might be able to give me some of their insight or possibly point out some variable(s) that I am missing. I know it would be rough on my family to go to medical school, but my fiance is on board with either choice.

Any input would be greatly appreciated.

[/rambling drivel]

megsMS · Mar 24, 2006

The education for nurse practitioners is inadequate. Would you really want to put your patients in danger? I think this is the attitude of most physicians. Nurses and N.P.s may tell you differently, but why would they think that their education is inadequate? Of course they think they learn what they need to know. However, M.D.s get tons of more time in the basic sciences AND in the clinic. Trust me, you need that time to be able to treat people well medically. The two are not even comparable. There are plenty of people in my medical school class who are older, married, and have children...I am married and am in the process of moving/house renovation right now during my third year, and everything is fine. It's very "doable".

Josh L.Ac. said:
I'm in a bit of quandary about which path to take. Here's a little background: I was pre-med in my undergrad and I got the opportunity to go to Korea for a year to learn acupuncture and get independent study and honors undergraduate credit for it. It was going to be an interesting and unique experience that would also make getting into a good medical school that much easier. Well the plan fell through on the other end, things happened...and then I graduated. The original plan was to go to DO school, but I was still interested in acupuncture. So after much debate, I decided to go to acupuncture school first for several reasons - I figured I wouldn't have to fortitude or time to go to three years of acupuncture school after DO school, and I also knew myself and figured I would be unable to make a paradigm shift after seven more years of reductionistic medicine.

So I went to acupuncture school with the plan of going on to DO school afterwards. But then life happens...got married, got divorced, and then found the perfect girl. After I graduated with my master's in acupuncture, I started researching DO schools but I wasn't too engaged since I was heading to China for a five week acupuncture internship. I figured I would take a fresh look at the situation when I returned.

Two weeks after I got to China, my girlfriend told me that I was going to be a daddy.

After some serious thought (while drinking very cheap Chinese beer), I realized that another seven years might be too much. By chance, one of my fellow classmates was a FNP. We talked a bit and I realized that I could fullfil my dream of having a integrative family practice by going the NP route. The benefits (shorter duration of the program, less intense program, program is essentially paid for by the hospital, more time at home after the program, less overhead costs) far outweighted the negatives (not a doctor, no residency, less training, much fewer patient contacts). Well, at least it did initially. Most of the information I am hearing is from nurses and nurse practitioners, so I expect it to be a little biased towards that side. But true to my nature, I jumped on this site with the intention of getting a broader perspective. The few threads I've skimmed on the topic of FNPs have been somewhat negative.

I am hoping that somebody here might be able to give me some of their insight or possibly point out some variable(s) that I am missing. I know it would be rough on my family to go to medical school, but my fiance is on board with either choice.

Any input would be greatly appreciated.

[/rambling drivel]

8744 · Mar 24, 2006

Josh L.Ac. said:
I'm in a bit of quandary about which path to take. Here's a little background: I was pre-med in my undergrad and I got the opportunity to go to Korea for a year to learn acupuncture and get independent study and honors undergraduate credit for it. It was going to be an interesting and unique experience that would also make getting into a good medical school that much easier. Well the plan fell through on the other end, things happened...and then I graduated. The original plan was to go to DO school, but I was still interested in acupuncture. So after much debate, I decided to go to acupuncture school first for several reasons - I figured I wouldn't have to fortitude or time to go to three years of acupuncture school after DO school, and I also knew myself and figured I would be unable to make a paradigm shift after seven more years of reductionistic medicine.

So I went to acupuncture school with the plan of going on to DO school afterwards. But then life happens...got married, got divorced, and then found the perfect girl. After I graduated with my master's in acupuncture, I started researching DO schools but I wasn't too engaged since I was heading to China for a five week acupuncture internship. I figured I would take a fresh look at the situation when I returned.

Two weeks after I got to China, my girlfriend told me that I was going to be a daddy.

After some serious thought (while drinking very cheap Chinese beer), I realized that another seven years might be too much. By chance, one of my fellow classmates was a FNP. We talked a bit and I realized that I could fullfil my dream of having a integrative family practice by going the NP route. The benefits (shorter duration of the program, less intense program, program is essentially paid for by the hospital, more time at home after the program, less overhead costs) far outweighted the negatives (not a doctor, no residency, less training, much fewer patient contacts). Well, at least it did initially. Most of the information I am hearing is from nurses and nurse practitioners, so I expect it to be a little biased towards that side. But true to my nature, I jumped on this site with the intention of getting a broader perspective. The few threads I've skimmed on the topic of FNPs have been somewhat negative.

I am hoping that somebody here might be able to give me some of their insight or possibly point out some variable(s) that I am missing. I know it would be rough on my family to go to medical school, but my fiance is on board with either choice.

Any input would be greatly appreciated.

[/rambling drivel]

That reminds me of the joke which has the same kind of story, the punchline of which is, "So how do I tell my mother that I'm dating a disc jockey?"

Josh L.Ac. · Mar 24, 2006

Panda Bear said:
That reminds me of the joke which has the same kind of story, the punchline of which is, "So how do I tell my mother that I'm dating a disc jockey?"

Completely over my head. Please be gentle - this is my no coffee week and I'm feeling quite sensitive.

Okay, that's not true. I really don't get sensitive. I just couldn't think of a response.

Maybe I do need coffee.

McDoctor · Mar 24, 2006

Panda Bear said:
That reminds me of the joke which has the same kind of story, the punchline of which is, "So how do I tell my mother that I'm dating a disc jockey?"

I vaguely remember that joke, but the punchline I remember involves a lawyer instead of a disc jockey. Pretty funny though. I wish I remembered it well enough to tell it.

Josh L.Ac. · Mar 24, 2006

megsMS said:
The education for nurse practitioners is inadequate. Would you really want to put your patients in danger? I think this is the attitude of most physicians. Nurses and N.P.s may tell you differently, but why would they think that their education is inadequate? Of course they think they learn what they need to know. However, M.D.s get tons of more time in the basic sciences AND in the clinic. Trust me, you need that time to be able to treat people well medically. The two are not even comparable. There are plenty of people in my medical school class who are older, married, and have children...I am married and am in the process of moving/house renovation right now during my third year, and everything is fine. It's very "doable".

Thanks for the reply. I'm glad that those with families are able to deal with the workload without too much strain on the family.

Obviously the difference in training is huge. But the thing that keeps nagging me is that the few studies I've seen conclude that there isn't much difference between outcomes of patients seen by FNPs and those seen by GPs:

http://www.ncbi.nlm.nih.gov/entrez/..._uids=15358970&query_hl=8&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/..._uids=15846614&query_hl=8&itool=pubmed_DocSum

I wondering if these studies accurately reflect reality or if there is some flaw that I am missing in the design.

McDoctor · Mar 24, 2006

Josh L.Ac. said:
Thanks for the reply. I'm glad that those with families are able to deal with the workload without too much strain on the family.

Obviously the difference in training is huge. But the thing that keeps nagging me is that the few studies I've seen conclude that there isn't much difference between outcomes of patients seen by FNPs and those seen by GPs:

http://www.ncbi.nlm.nih.gov/entrez/..._uids=15358970&query_hl=8&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/..._uids=15846614&query_hl=8&itool=pubmed_DocSum

I wondering if these studies accurately reflect reality or if there is some flaw that I am missing in the design.

I'm having a hard time locating the full articles. No mention is made of the general state of health of the individuals enrolled in the first study. Do they span all age and gender groups? Do exclusion criteria exist for individuals with chronic illnesses? I will be less impressed if the sample population specifies that individuals enrolled in the study had to be in a good state of general health to participate.
If this study compares outcomes of individuals with pre-existing multiple chronic diseases randomized to managed by MD's/DO's vs unsupervised management by NP's and demonstrates no measurable difference then I will be impressed.
In fairness, the study should be followed out at least 5 years. In the case of the second study cited, I don't think you can draw any meaningful inferences from comparisons made over less than a 1 year period. The authors of second study pretty much acknowledge as much in the conclusions.

To get to your original question, are these NP's you have been talking about in solo practice? This is a rarity. If you want to have your own practice and incorporate a multidisciplinary appraoch you should go the MD/DO route.

Josh L.Ac. · Mar 24, 2006

McDoctor said:
I'm having a hard time locating the full articles. No mention is made of the general state of health of the individuals enrolled in the first study. Do they span all age and gender groups? Do exclusion criteria exist for individuals with chronic illnesses? I will be less impressed if the sample population specifies that individuals enrolled in the study had to be in a good state of general health to participate.
If this study compares outcomes of individuals with pre-existing multiple chronic diseases randomized to managed by MD's/DO's vs unsupervised management by NP's and demonstrates no measurable difference then I will be impressed.
In fairness, the study should be followed out at least 5 years. In the case of the second study cited, I don't think you can draw any meaningful inferences from comparisons made over less than a 1 year period. The authors of second study pretty much acknowledge as much in the conclusions.

To get to your original question, are these NP's you have been talking about in solo practice? This is a rarity. If you want to have your own practice and incorporate a multidisciplinary appraoch you should go the MD/DO route.

I saw one of the full articles (the Cochrane Database System Review article) in passing a few months ago but I didn't get a chance to give it my full attention. I tried a finding the full articles through a few schools that I have access to but to no avail. Along the line of what you said, it would be difficult to honestly evaluate the articles without seeing them in their entirety.

Your comment that I need to go the MD (or DO) route if I want to have my own multidisciplinary / intergrative practice echoes the conclusion that I was slowly starting to acknowledge. My accelerated BSN program starts in a few months so I'll probably complete it. I haven't taken the MCAT or started the application process to medical school, so it would be another year before I could start anyway. Sitting on the sidelines doesn't appeal much to me. Plus the nursing school I am going to attend has a full-tuition reinbursement plan, so as long as I work at a HCA midwest hospital for two years, the program is paid for.

Any other comments?

sophiejane · Mar 24, 2006

I'm only a 3rd year medical student, but even in my limited experience, I've seen plenty of patients who have been screwed up by a well-meaning NP. End up with huge abcesses in the ER, or other problems that could have been easily averted by a more thorough exam, a better-developed differential. I've had a number of patients tell me they will never again trust an NP.

In the end, that's really the difference. Doctors know the full range of differentials and have the experience to spot and treat the zebras, not just the horses.

If it's not mild intermittent asthma, mild GERD, seasonal allergic rhinitis, gastroenteritis without complications, or bacterial vaginosis (I'm even not so sure about the last one)...I wouldn't trust it to an NP. There are just too many things that can and do go wrong with all of these common diagnoses.

Hypertension, diabetes, most infectious disease, heart failure, COPD...the thought of NPs treating this stuff regularly makes me shudder...I've seen NPs royally screw up kids, pregnant ladies, old people, you name it. If you are comfortable acting like a doc without a physician's license, I guess no one is stopping you, but you need to be up front with your patients about what you are and are not comfortable treating. The problem is that so many times, something walks in the door looking for all the world like a common problem, but it's cancer, or something equally life-threatening, and your limited experience and education will keep you from diagnosing it correctly, but your ego might not let you consult a doctor for clarification or second opinion, especially if you are in private "practice".

If you can do that and still sleep at night, go for it. If I was in your shoes, I'd stick to accupuncture or go for an MD or DO.

Being able to write scripts does not a doctor make.

Flame away, nurses. I've earned it. But I stand behind what I say because patients have related these stories to me and I'm not making it up.

deleted87716 · Mar 24, 2006

Josh L.Ac. said:
I'm in a bit of quandary about which path to take.

It sounds like you want to be a doctor. You should go to medical school, not nursing school.

megsMS · Mar 24, 2006

Additionally, when I checked what other research several of the authors of that article had done, it was mostly nursing research, which leads me to believe that some if not all of the authors are nurses (one appeared to be a Ph.D.). Thus, yet again, it is another example of nurses believing that their education is equivalent to M.D.s without having anyone else there to tell them otherwise. I also agree with all the points made by McDoctor.

McDoctor said:
I'm having a hard time locating the full articles. No mention is made of the general state of health of the individuals enrolled in the first study. Do they span all age and gender groups? Do exclusion criteria exist for individuals with chronic illnesses? I will be less impressed if the sample population specifies that individuals enrolled in the study had to be in a good state of general health to participate.
If this study compares outcomes of individuals with pre-existing multiple chronic diseases randomized to managed by MD's/DO's vs unsupervised management by NP's and demonstrates no measurable difference then I will be impressed.
In fairness, the study should be followed out at least 5 years. In the case of the second study cited, I don't think you can draw any meaningful inferences from comparisons made over less than a 1 year period. The authors of second study pretty much acknowledge as much in the conclusions.

To get to your original question, are these NP's you have been talking about in solo practice? This is a rarity. If you want to have your own practice and incorporate a multidisciplinary appraoch you should go the MD/DO route.

ramonaquimby · Mar 25, 2006

considering your fiance is on board with either decision, i agree with the person that hinted that the decision is basically "do i want to go to nursing school or medical school?" it really is no contest, despite what the nurses may say - yes it's nice to be able to write a couple standard scripts and hang a shingle, but being a doctor is a whole different ball game. so much more analytical thinking involved, hence, so much more fulfilling!!! if the time/money is the real thing holding you back, i will throw out the option of PA school. at least their training is more in line with physicians than nurses. though again, i will state that they are not doctors either (though some seem to act like they are!). i'd much prefer seeing you go the PA route than the NP route...

but MD is best 😉

8744 · Mar 25, 2006

McDoctor said:
I vaguely remember that joke, but the punchline I remember involves a lawyer instead of a disc jockey. Pretty funny though. I wish I remembered it well enough to tell it.

The text of the joke isn't important. Basically you start the story saying, "Last week I met a disc jockey (sailor, Marine, Methodist, or whatever)" and then you spin a story about all kinds of trouble involving any combination of hookers, bar fights, drugs, bankruptcy, and other serious troubles.

The punch line is, "And now I have one problem....how do I tell my mother I'm dating a disc jockey?"

Other funny punch lines to which the joke is almost unnecessary:

"The last thing I remember is the look on the poor monkey's face while he tried to put the cork back in the elephant's ass."

"For fifteen bucks I want you naked, dammit, naked!"

etc.

Long jokes are such a bore. I have a theory that if the punchline isn't funny all by itself then you should skip telling the joke.

Sinnman · Mar 25, 2006

BTW, I think there's huge potential for someone with your training to do a lot of great things after you finish medical school.

I spent many years trying to convince myself that NP was the way to go. I was in a similar situation and didn't want to be "troubled" with all of those years of schooling. I decided that getting my NP would fulfill my goals and I really convinced myself that this was the best decision. I started taking some NP level classes.

Let me tell you, there's a darn good reason medical school and residency is so long. It has to be. Now that I'm seeing the light at the end of the tunnel of medical school I have learned some lessons. There are no shortcuts. It kills me when all the NPs think they know as much as someone has invested way more time in their training. The two are COMPLETELY different, not even on the same league. Sorry but it's the truth. The depth and breath of material in medical school and the amount of clinical training are not even comparable. Don't ever let anybody (or yourself) convince you otherwise. Been there, done that, TOTALLY different.

Having said all of that, I think you would be far better off going to medical school. Your understanding of things will be at a different level. If you want to truly practice integrative medicine, you need to truly understand the body and disease in detail. You simply will not get this, or anything even really close as an NP. For the record, I'm not trying to totally bash the NPs, but the level of understanding is just not comparable.

There are many people that go to med school later in life. There are people in their 40s and 50s and beyond. Lots have kids and other commitments. It's completely doable if you want to. Don't doubt yourself. Don't let the MCAT, admissions, the workload, the debt (although it is painful), or anything else dissuade you from your dream. I only wish I had not wasted a few years deliberating or not if I should do it.

Good luck. PM me if you want.

Echinoidea · Mar 25, 2006

The reason I would advise you to stay away from NP programs is this: From the NPs I have spoken to, they all seem to share a trait in common: They don't know how much stuff that they don't know. And that's scary. I'm only an MSII and I can't beleive how much crap I have learned in the past 2 years...yet it is dwarfed by the amount of material I have YET to learn. That is why my family will never see an NP as a PCP.

megsMS · Mar 26, 2006

That is my point exactly!! They think they know it all because who tells them that they do not? Their "professors" who are mainly N.P.s and R.N.s as well? I would never allow myself or anyone else in my family to be touched by a N.P...it is simply a crime to let them practice alone without the guidance of actual physicians.

Echinoidea said:
The reason I would advise you to stay away from NP programs is this: From the NPs I have spoken to, they all seem to share a trait in common: They don't know how much stuff that they don't know. And that's scary. I'm only an MSII and I can't beleive how much crap I have learned in the past 2 years...yet it is dwarfed by the amount of material I have YET to learn. That is why my family will never see an NP as a PCP.

Josh L.Ac. · Mar 26, 2006

Thanks for all of the input. Taken with the discussions I've had recently in the real world, it has helped to get a more accurate perspective.

It is too late to apply for medical school this year, so I am going to go ahead and complete the accelerated BSN program that I am signed up for in August. While in the program, I am going to take care of the logistics of applying to medical school for the following year.

The accelerated BSN program is paid for if I work for a HCA Midwest hospital for two years. My fiance graduates with her master's in acupuncture in June of this year, and if her practice is successful enough financially, then I will go to med school the next year and eat the cost of the nursing program. If not, then I will work for two years as a RN, pay off the cost of the program (and my other student loans), and then go to medical school.

But as much as I enjoy talking about myself, let's continue the topic of FNP vs. GP. So far I posted the abstracts to two studies that had the conclusion that the patient outcomes between those treated by NPs and GPs were statistically insignificant. But as McDoctor pointed out, with out seeing the full studies we can't critique the methodology. In addition, MegsMS pointed out that most of the authors are involved in nursing research. This doesn't invalidate the studies, but just makes finding the actually research much more important.

Here is an interesting study about neonatal NPs:

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16390522&query_hl=2&itool=pubmed_docsum

"RESULTS: The analysis of the patient outcome data and quality assessment of nursing and medical records revealed that there was no statistical difference in the standard and quality of care provided between nurse practitioners and medical staff in the vast majority of areas evaluated. However, trends in the data suggest that Advanced Neonatal Nurse Practitioners (ANNPs) did not perform as well as their medical counterparts in terms of the overall completeness or comprehensiveness of the standard care provided in a number of areas. "

I was unable to get the full article from EBSCOhost [again].

Obviously the study didn't focus on FNPs, but my guess is that many of you would see the the lack of "...overall completeness or comprehensiveness of the standard of care..." as a reoccuring theme that could be applied to most NPs.

Any thoughts or comments? Or are we beating a dead horse (whatever that means)?

sophiejane · Mar 26, 2006

While I think it's good to take the evidence-based approach, I think most of what you will get here is anecdotal. Stories from patients, experiences that medical students, residents, and physicians have had with NPs, which are going to be heavily biased against NPs, because we compare them to ourselves and our level of education.

I do think there is a need for NPs in areas where docs are not willing to practice. They are better than nothing, in other words. My hope is that as more medical schools (especially DO schools) are opening to meet the physician shortage, that will change.

Hopefully, the motivation to have a super easy lifestyle with super high pay will die out somewhat in medicine as well. Right now it seems to be peaking, Reagan-era style, with what appears to be the emergence of a new "Me" generation.

secretwave101 · Mar 26, 2006

This is one of those arguments that really has no conclusion. You'll get polarized opinions depending on whom you're asking. Objectively, it's very difficult for me to accept that someone who's put SO much less on the line than I have all these years, is equivalent to me in their ability to care for patients. Either I got seriously ripped off, or they're FOS. Naturally, I'm inclined to argue for the latter just for my own sanity.

But, in trying to remove my own emotions about this issue, I believe there's one big difference. IMHO, the average nurse's training and the average doctor's training differ fundamentally with the question "why". Mechanisms, pathways, pressures, volumes and forces seem to be less important in allied health training. Nurses learn alot of "what", but not alot of "why". So, they focus on protocol, systems, design and rules.

While a student, working with nurses with waaaay more experience and practical knowledge than me, I was continually surprised (and frustrated) with how infrequently they could answer "why" something was happening. They were especially unhelpful upon a 2nd "why" to the same situation. In my experience, nurses are great (sometimes better than doctors) at knowing "what" to do, but not so great at knowing "why".

Personally, my brain needs the "why" and generally HATES the "what". Protocols and rules with no meaning behind them drive me up the wall. I feel very fortunate that I have and get to use this knowledge for my career, but I NEED this as a patient. I think most patients need this, which is why most patients will probably gravitate toward docs rather than NP's (again, opinion here). Here's an example from my actual life just last week when my baby boy was born in respiratory distress:

Me: Why do you give fluids to neonates who are in respiratory distress?
Nurse: Because he is hypovolemic.
Me: Why is he hypovolemic?
Nurse: Because he was born in distress.
Me: (trying not to be rude) I don't understand how birth in distress leads to hypovolemia. They don't seem to be related to me, although I can see how you might have both on top of each other.
Nurse: I don't really know, either. We just always give fluids to newborns in resp. distress.
Me (to myself): Could someone PLEASE get me a f**ing doctor before you intubate my 1st born son?

This was a nurse with over 30 years Level 2 nursery care experience. And she was GREAT. TONS of practical knowledge. But what I needed right then was more "why" knowledge.

And yes, the boy's ok. We're bringing him home tomorrow, and didn't intubate. And no, I don't have an answer to my question yet (never had time to ask the doc).

Josh L.Ac. · Mar 26, 2006

Panda Bear said:
The text of the joke isn't important. Basically you start the story saying, "Last week I met a disc jockey (sailor, Marine, Methodist, or whatever)" and then you spin a story about all kinds of trouble involving any combination of hookers, bar fights, drugs, bankruptcy, and other serious troubles.

The punch line is, "And now I have one problem....how do I tell my mother I'm dating a disc jockey?"

Other funny punch lines to which the joke is almost unnecessary:

"The last thing I remember is the look on the poor monkey's face while he tried to put the cork back in the elephant's ass."

"For fifteen bucks I want you naked, dammit, naked!"

etc.

Long jokes are such a bore. I have a theory that if the punchline isn't funny all by itself then you should skip telling the joke.

To be honest, I thought you were going with one of those "...so I'll have a coke..." jokes, which made the PC part of me cringe.

deleted87716 · Mar 26, 2006

secretwave101 said:
I don't have an answer to my question yet (never had time to ask the doc).

Nutrition can be a problem if an infant is breathing so fast that he or she can't suck, swallow, and breathe simultaneously. Intravenous (IV) fluids provide hydration and will prevent the infant's blood sugar from dipping to dangerously-low levels.

As I'm not a neonatologist, I had to look it up. 😉

shemozart · Mar 26, 2006

Don't flame me if this already was mentioned and I just didn't see it in the flurry of posts....but if you are interested in practicing acupuncture as part of a well-rounded clinic practice someday, I would seriously consider going the family medicine route (it's not called GP any more - General Practice is just one year of internship with a license obtained, and Family Medicine is 3 years of training in a specific residency). Nowadays there are integrative medicine fellowships available for family medicine residents that stress acupuncture and like things....you could have an entire booming integrative medicine practice as well. Health care plans in my area pay for these treatments. I don't know of FNP's who do this.

I tend to gravitate towards one statement someone made earlier....DEVELOPING a thorough differential diagnosis is the big difference I think b/w MDs and those with less training. How can you know that you're missing something if you've never heard of it? Or at least to have enough clinical suspicion that something you're seeing doesn't fit a clinical pattern close enough for your taste and that it may be something rarer or not common....I think learning about (some of) the huge spectrum of disease over four years of med school and 3+ years of residency is the big advantage to MD/DO training.

But I'm biased as an MD. I hope you come to a decision that makes you feel good about yourself and that you feel happy with. FYI, one guy in my med school class didn't go to college until he was in his 30s and graduated from med school in his 40s! He was awesome - he had kids and did it all. You've already done a lot - in med school interviews you would have more to talk about than most applicants! 😀

secretwave101 · Mar 26, 2006

KentW said:
Nutrition can be a problem if an infant is breathing so fast that he or she can't suck, swallow, and breathe simultaneously. Intravenous (IV) fluids provide hydration and will prevent the infant's blood sugar from dipping to dangerously-low levels.

Yeah, but the nurse said it was the respiratory distress that CAUSED the hypovolemia. Or possibly d/t the presumed in utero distress. I can understand IV fluids as precautionary measures (and his BG was 17 (!)...so we needed the line for glucose). But she said he was hypovolemic BEFORE they started the fluids (didn't look that way to me, incidentally) and they said the low fluid status was related to his distress.

So, your answer kinda works, but I'm still unclear on exactly what the fluids were about. Of course, I would've started them too. But I was curious (even in my hyper-worried state) about how distress related to hypovolemia.

deleted87716 · Mar 26, 2006

secretwave101 said:
So, your answer kinda works, but I'm still unclear on exactly what the fluids were about.

It's not my answer. Again, I'm not a neonatologist. More information here.

billydoc · Mar 26, 2006

Hey Josh!I'm following you on this board from allnurses.com. I'm known there as "PAPADOC" (don't know why I chose this over this one 😕 )
Anyway, as a licensed acupuncturist myself, and as RN for over 15 yrs, I was also very tempted to go NP or CRNA route. For me it would've been much shorter, and pretty much for free if I wanted to inslave myself in some medical center for several years again. I hope I can talk here without being ripped to sreads, as always happens on the nursing forums. Somebody said it. They just don't know what they don't know, very opinionated, and politically strong, but still....just being ignorant and plain wrong. If you search my previous posts you'll see how much I've struggled with the same dilemma, but in the end, there is no easy way out. Despite of all the problems, and callenges in today's healthcare, tere is nothing, absolutely nothing that comes close to a real medical education. I can only hope that insurance monopoly will be somehow deregulated, and doctors, not some clueless hacks with MBAs will be making the informed decisions with the patients,for the patients again. For now...just go to the medical school. You will NEVER be happy with "just like a doctor, only better" degree, which is full of political indoctrination.
Good Luck
(pm me if you'd like)

RonaldColeman · Mar 27, 2006

secretwave101 said:
This is one of those arguments that really has no conclusion. You'll get polarized opinions depending on whom you're asking. Objectively, it's very difficult for me to accept that someone who's put SO much less on the line than I have all these years, is equivalent to me in their ability to care for patients. Either I got seriously ripped off, or they're FOS. Naturally, I'm inclined to argue for the latter just for my own sanity.

But, in trying to remove my own emotions about this issue, I believe there's one big difference. IMHO, the average nurse's training and the average doctor's training differ fundamentally with the question "why". Mechanisms, pathways, pressures, volumes and forces seem to be less important in allied health training. Nurses learn alot of "what", but not alot of "why". So, they focus on protocol, systems, design and rules.

While a student, working with nurses with waaaay more experience and practical knowledge than me, I was continually surprised (and frustrated) with how infrequently they could answer "why" something was happening. They were especially unhelpful upon a 2nd "why" to the same situation. In my experience, nurses are great (sometimes better than doctors) at knowing "what" to do, but not so great at knowing "why".

Personally, my brain needs the "why" and generally HATES the "what". Protocols and rules with no meaning behind them drive me up the wall. I feel very fortunate that I have and get to use this knowledge for my career, but I NEED this as a patient. I think most patients need this, which is why most patients will probably gravitate toward docs rather than NP's (again, opinion here). Here's an example from my actual life just last week when my baby boy was born in respiratory distress:

Me: Why do you give fluids to neonates who are in respiratory distress?
Nurse: Because he is hypovolemic.
Me: Why is he hypovolemic?
Nurse: Because he was born in distress.
Me: (trying not to be rude) I don't understand how birth in distress leads to hypovolemia. They don't seem to be related to me, although I can see how you might have both on top of each other.
Nurse: I don't really know, either. We just always give fluids to newborns in resp. distress.
Me (to myself): Could someone PLEASE get me a f**ing doctor before you intubate my 1st born son?

This was a nurse with over 30 years Level 2 nursery care experience. And she was GREAT. TONS of practical knowledge. But what I needed right then was more "why" knowledge.

And yes, the boy's ok. We're bringing him home tomorrow, and didn't intubate. And no, I don't have an answer to my question yet (never had time to ask the doc).

Great post! Very true. Working with an NP can be a very frustrating experience. As medical students, we are taught to think. Nurses are simply taught what to do without an understanding of the science behind it. Why do you give diabetics ACE inhibitors for hypertension? NP: Because that's what you do. MD: Because it protects the kidneys. How does one administer anasthesia? MD: Rapidly inducing drug, maintenance drug, etc. CRNA: red bottle, green bottle, blue bottle. Some people downplay the importance of this difference in knowledge. What they forget is that it is this more intimate understanding of medicine that allows MDs to not only treat patients according to current algorithms (like nurses), but to also carry out the research that generates and later improves/modifies/updates these algorithms (unlike nurses). The more you allow nurses to take over patient care, the more you push out those who can carry out the research that will improve medical care. Nurses, at best, maintain the status quo; doctors improve it.

earwig · Apr 3, 2006

Did you know that ARNPs do not take any recertification exams? They are certified once upon graduation from the program and keep themselves "updated" by submitting CMEs. Physician assistants, on the other hand, are required to take recertification exams every 6 years in addition to 100 hours of CME every 2 years.
My point is that the nursing boards do not care if the ARNPs maintain their fund of knowledge.

deleted6669 · Apr 5, 2006

earwig said:
Did you know that ARNPs do not take any recertification exams? They are certified once upon graduation from the program and keep themselves "updated" by submitting CMEs. Physician assistants, on the other hand, are required to take recertification exams every 6 years in addition to 100 hours of CME every 2 years.
My point is that the nursing boards do not care if the ARNPs maintain their fund of knowledge.

DID YOU ALSO KNOW THAT NP'S HAVE 2 DIFFERENT LICENSING BOARDS WITH 2 DIFFERENT TESTS AND ALL NP'S ARE ELIGIBLE FOR BOTH TESTS. DIDN'T PASS ONE? THAT'S OK, TAKE THE OTHER.....THE NP STUDENTS I KNOW SCHEDULE BOTH TESTS UP FRONT AND THEN CREDENTIAL WITH THE ORGANIZATION GRANTING THE HIGHER SCORE.......

doctorsquared · Apr 6, 2006

How about Dental School. It's only 4 years and you already know how to stick people with needles!

prairiedog · Apr 19, 2006

emedpa said:
DID YOU ALSO KNOW THAT NP'S HAVE 2 DIFFERENT LICENSING BOARDS WITH 2 DIFFERENT TESTS AND ALL NP'S ARE ELIGIBLE FOR BOTH TESTS. DIDN'T PASS ONE? THAT'S OK, TAKE THE OTHER.....THE NP STUDENTS I KNOW SCHEDULE BOTH TESTS UP FRONT AND THEN CREDENTIAL WITH THE ORGANIZATION GRANTING THE HIGHER SCORE.......

Really, I always thought the ANCC and AANP provided certification exams for NPs. When did they start to provide a license? What do the states Boards of Nursing think about these organizations granting a license?

deleted6669 · Apr 19, 2006

prairiedog said:
Really, I always thought the ANCC and AANP provided certification exams for NPs. When did they start to provide a license? What do the states Boards of Nursing think about these organizations granting a license?

fine, my bad........2 different certification pathways, either of which makes someone eligible to apply for a state license in any state.

iviikoivi · May 4, 2006

doctorsquared said:
How about Dental School. It's only 4 years and you already know how to stick people with needles!

I knew how to stick myself with needles when I was young... no degree needed TYVM

billydoc · May 5, 2006

iviikoivi said:
I knew how to stick myself with needles when I was young... no degree needed TYVM

Yep! By the same logic...you knew how to [self]medicate yourself. Thus, no medical degree needed

Raven Feather · May 18, 2006

RonaldColeman said:
Great post! Very true. Working with an NP can be a very frustrating experience. As medical students, we are taught to think. Nurses are simply taught what to do without an understanding of the science behind it. Why do you give diabetics ACE inhibitors for hypertension? NP: Because that's what you do. MD: Because it protects the kidneys. How does one administer anasthesia? MD: Rapidly inducing drug, maintenance drug, etc. CRNA: red bottle, green bottle, blue bottle. Some people downplay the importance of this difference in knowledge. What they forget is that it is this more intimate understanding of medicine that allows MDs to not only treat patients according to current algorithms (like nurses), but to also carry out the research that generates and later improves/modifies/updates these algorithms (unlike nurses). The more you allow nurses to take over patient care, the more you push out those who can carry out the research that will improve medical care. Nurses, at best, maintain the status quo; doctors improve it.

Okay, I'm a nurse about to enter med school who would not be seen by a NP for various reasons that I won't go into, however, do not fool yourself...many nurses do know a lot about the "WHYS"--not as much as doctors but to me, knowing that ace inhibitors are prescribed to diabetics because it actually helps with blood flow to the kidneys, would be common knowledge. When I was pursuging my nursing degree we did have to take pathophysiology, pharmacology with MOA etc--that is what I loved the most. I think some must lose what they learn or something, or can't apply what they did learn
to the clinical setting. I dunno. I was suprised the other night when I had to work on the cardiovascular ICU unit (I work on ICU stepdown). My patient's HR was in the high 40s, blood pressure was high, and I had saw that a day prior her nitro gtt was d/c'd. I don't know if it was because she became too hypotensive or not--that info wasn't passed. But anyway, this freaking nurse saw that my pt's BP was like 185 systolic and was like, "Hmmm, DR. X was in today, I don't know why he didn't put her on Lopressor or something." I looked at her in amazment, "Ummmm, lopressor might not be that good, dear, lopressor is a beta blocker, it will further decrease the HR." And this was a CVICU nurse!!! She should have known that. It is SOOOO frustrating. But, I know that all nurses aren't that clueless.

Sinnman · May 19, 2006

Raven Feather said:
Okay, I'm a nurse about to enter med school who would not be seen by a NP for various reasons that I won't go into, however, do not fool yourself...many nurses do know a lot about the "WHYS"--not as much as doctors but to me, knowing that ace inhibitors are prescribed to diabetics because it actually helps with blood flow to the kidneys, would be common knowledge. When I was pursuging my nursing degree we did have to take pathophysiology, pharmacology with MOA etc--

Let me know how you feel about this AFTER medical school. I guarantee you that your opinion will change drastically. The difference in education is laughable.

I've said this a million times: The scariest thing about the NPs is that they don't know how much they don't know.

BTW, not to flame you but... I have a personal interest in the whole ACEI for diabetic renal disease and it is very complicated and multifactorial and has many proposed mechanisms that have nothing to do with blood flow and/or pressure. "Helping with blood flow" is like saying that amiodarone calms the heart, sort of right but doesn't really mean anything. Again, not trying to start an argument but that example of common knowledge actually illustrates my earlier statement.

Raven Feather · May 19, 2006

Sinnman said:
Let me know how you feel about this AFTER medical school. I guarantee you that your opinion will change drastically. The difference in education is laughable.

I've said this a million times: The scariest thing about the NPs is that they don't know how much they don't know.

BTW, not to flame you but... I have a personal interest in the whole ACEI for diabetic renal disease and it is very complicated and multifactorial and has many proposed mechanisms that have nothing to do with blood flow and/or pressure. "Helping with blood flow" is like saying that amiodarone calms the heart, sort of right but doesn't really mean anything. Again, not trying to start an argument but that example of common knowledge actually illustrates my earlier statement.

I don't the least bit feel flamed. I was just taught/told by a Pharm D that ACEI helps to preserve blood flow to the kidneys, what is your answer? I do not in any way claim that I have the knowledge of a physician--I know I don't at this point and I'm not supposed to, I am a nurse. I also know that I'm sure med school patho etc, is WAAAY more intense and in-depth than what I got in nursing--I don't claim that it is so I doubt my feelings would change regarding nursing courses vs. med school courses. Nurses are trained to be nurses, not doctors. What I am claiming is that not all nurses (generally) are just doers ie, that they know to do X or Y if this happens but without understanding the rationale. Many do, just not as much as/as in-depth as a physician.

I will have to agree, however, that NPs and RNs (many of them anyway) don't know how much they don't know. I know my knowledge is limited but I'd have to disagree that I don't have any rationale.

secretwave101 · May 20, 2006

Sinnman said:
ACEI for diabetic renal disease and it is very complicated and multifactorial and has many proposed mechanisms that have nothing to do with blood flow and/or pressure. "Helping with blood flow" is like saying that amiodarone calms the heart, sort of right but doesn't really mean anything. Again, not trying to start an argument but that example of common knowledge actually illustrates my earlier statement.

You beat me to the punch. Many medical types know that ACEI's are "helpful to the kidney" in diabetic renal disease.

But why?

If my kidneys are failing due to my diabetes, and someone is giving me an ACE inhibitor, it will really help me on the reassurance front if that person can tell me more than "this stuff helps renal blood flow". Is it because they decrease aldosterone production and thus Na and thus H20 retention? Or is it due to the vasodilatory effects of increased bradykinin? What about effects on the afferent and efferent tubules (I think I remember learning that there was some predilection for ACE for one or the other)?

Does all this arcane information matter to patient care? Maybe not. But when I'm sick, for some reason, these things matter to me.

And maybe it really DOES matter for patient care. If it IS in fact reduced sodium that we're working for with the ACEI's (I know this isn't the main reason for ACEI's in DRF, but hypothetically speaking), and I understand how the drug helps reduce this electrolyte in my system, perhaps I'll be more inclined to help it along by staying compliant with my diet. I think the more a patient understands about what is happening with his/her health care, the more likely they will be to get involved. Understanding comes from knowledge that can really only be gotten by extensive schooling.

Heme/Onc · Jun 9, 2006

This is the way that I see it.

1. Many of the research that has been done on this topic is questionable......from the designs to who is doing it.

2. Outcomes are comparable because most of what is looked at is routine "bread and butter" primary care stuff. You pay the doctor to rule out very important things, not only to treat common ills. Therefore, even if one of the MD/DOs caught a zebra while conducting the study.....it is uncommon enough to not have a statistically significant effect on outcomes. But just wait until the lawyers get a hold of someone who confused congestive heart failure for pneumonia.

3. If my mother had hypertension, diabetes, kidney disease and something else you bet your ass that I am sending her to a good primary care doc and not some NP. You know why? Because who wants to risk a major miss or mistreatment.

4. Always bet on the side of caution when dealing with patients. A janitor who was trained as an army medic for two years would probably suprise the hell out of you but when something bad happens you want the Doc around. Always bet on the side of caution.....these are precious human lives people.

Josh L.Ac. · Jun 9, 2006

This thread has raised several good points as well as pointing out the logical contradiction that I was proceeding under. I am an acupuncturist and the concept of a MD/DO practicing acupuncture with 300 hours of training makes my skin crawl. Sure there was fluff to my 3 1/2 year master's degree program, but we spent more than 300 hours practicing our needling on each other before we even started to see patients. The idea that somebody with no acupuncture needling experience and a measly 300 hours of instruction, regardless of the fact that they are a doctor, is completely absurd.

Well, I was using the same logical to justify the short path for being a FNP. But in comparison to my earlier example, the training to be a FNP is much longer than 300 hours. If I continue on my current path, it will be about 3 1/2 years before I would be a FNP. During that time, I would also have two years of working full time as a RN, which should help with the experience. So, in comparison to being a MD or a DO, there shouldn't be that much difference, right?

No. I just started my pathophysiology class and it is very basic. Many times in the text a disease would be discussed and then it would read something like this:

"BLAH BLAH BLAH has the ability to disrupt some key enzyme systems."

That's it. No further explanation. Obviously I am speaking from my limited experience and perspective, but it seems like knowing the specific mechanisms of how a disease works might make pharmacology make a little bit more sense. Sigh.

Since the accelerated nursing program is pretty much paid for, and since it is too late to apply to medical school this year, I am going to complete the program. I'm sure it will be a very positive experience and I might even decide I like being a manurse so much that I want to be a FNP.

But on the forefront of my mind is going to be all of the issues raised on this thread [and elsewhere]. At this stage, the choice that would be the best professionally is quite obvious. If the situation allows, after I graduate from the accelerated BSN, I will go to medical school. But if the financial and/or emotional cost to my family is going to be too great, then I'll be content to be a FNP. If I end up going that route, then I have promised myself that I will practice under a physician for at least several years until it is deemed that I am ready to practice on my own.

Of course this whole conversation is irrelevant if my fiance's acupuncture practice takes off to the point where it is no longer economically justified for me to go to nursing or medical school - meaning we could both have full patient loads.

But if anyone wants to add something new to the conversation, feel free. I especially like to hear how some of you were able to do medical school and residency with small children at home.

Edit: problems with flow since I am cooking my famous chili and got off track.

megsMS · Jun 9, 2006

Good for you! I'm glad that you were able to formulate your own opinion (I have to admit, I'm especially glad that it's partially on my side of the fence, too). It is hard to form opinions on this subject with such strong emotions from each side. Good luck with whatever you choose. However, please just let me beg of you one thing. If you pursue the NP route, please continue to work with a physician for all of your career, not just a few years. Those things that you miss out on by not going to medical school really do count and even several years working side-by-side with a physician does not give you that knowledge or the clinical skills of a residency program. This would truly be the best option for the safety of your patients and your peace of mind, as well as the admiration of those who pursued medical degrees and see that you are trying to do the best for your patients by not overstepping your limits. Again, good luck in what you decide to do.

Also, just so you know, there was a member of my class whose wife had twins about 1 month into medical school. He managed to be a big part of their lives and is a wonderful father. He also did well in school. He and his wife opened up their own business last year (our second year), and he commutes 1 hour to school every day!! Isn't that amazing? It is hard, it requires prioritizing, but it can be done. PM me if you have any questions on anything that I could help you out with.

Josh L.Ac. said:
This thread has raised several good points as well as pointing out the logical contradiction that I was proceeding under. I am an acupuncturist and the concept of a MD/DO practicing acupuncture with 300 hours of training makes my skin crawl. Sure there was fluff to my 3 1/2 year master's degree program, but we spent more than 300 hours practicing our needling on each other before we even started to see patients. The idea that somebody with no acupuncture needling experience and a measly 300 hours of instruction, regardless of the fact that they are a doctor, is completely absurd.

Well, I was using the same logical to justify the short path for being a FNP. But in comparison to my earlier example, the training to be a FNP is much longer than 300 hours. If I continue on my current path, it will be about 3 1/2 years before I would be a FNP. During that time, I would also have two years of working full time as a RN, which should help with the experience. So, in comparison to being a MD or a DO, there shouldn't be that much difference, right?

No. I just started my pathophysiology class and it is very basic. Many times in the text a disease would be discussed and then it would read something like this:

"BLAH BLAH BLAH has the ability to disrupt some key enzyme systems."

That's it. No further explanation. Obviously I am speaking from my limited experience and perspective, but it seems like knowing the specific mechanisms of how a disease works might make pharmacology make a little bit more sense. Sigh.

Since the accelerated nursing program is pretty much paid for, and since it is too late to apply to medical school this year, I am going to complete the program. I'm sure it will be a very positive experience and I might even decide I like being a manurse so much that I want to be a FNP.

But on the forefront of my mind is going to be all of the issues raised on this thread [and elsewhere]. At this stage, the choice that would be the best professionally is quite obvious. If the situation allows, after I graduate from the accelerated BSN, I will go to medical school. But if the financial and/or emotional cost to my family is going to be too great, then I'll be content to be a FNP. If I end up going that route, then I have promised myself that I will practice under a physician for at least several years until it is deemed that I am ready to practice on my own.

Of course this whole conversation is irrelevant if my fiance's acupuncture practice takes off to the point where it is no longer economically justified for me to go to nursing or medical school - meaning we could both have full patient loads.

But if anyone wants to add something new to the conversation, feel free. I especially like to hear how some of you were able to do medical school and residency with small children at home.

Edit: problems with flow since I am cooking my famous chili and got off track.

megsMS · Jun 9, 2006

I'm sorry but I just have to say one more thing. I just love you people on this forum. It makes me feel better that there are other people out there who have sense and strong morals. Please remember all of these thoughts and feelings that you have now...it will be up to people like us to put a stop to this nonsense.

sophiejane said:
I'm only a 3rd year medical student, but even in my limited experience, I've seen plenty of patients who have been screwed up by a well-meaning NP. End up with huge abcesses in the ER, or other problems that could have been easily averted by a more thorough exam, a better-developed differential. I've had a number of patients tell me they will never again trust an NP.

In the end, that's really the difference. Doctors know the full range of differentials and have the experience to spot and treat the zebras, not just the horses.

If it's not mild intermittent asthma, mild GERD, seasonal allergic rhinitis, gastroenteritis without complications, or bacterial vaginosis (I'm even not so sure about the last one)...I wouldn't trust it to an NP. There are just too many things that can and do go wrong with all of these common diagnoses.

Hypertension, diabetes, most infectious disease, heart failure, COPD...the thought of NPs treating this stuff regularly makes me shudder...I've seen NPs royally screw up kids, pregnant ladies, old people, you name it. If you are comfortable acting like a doc without a physician's license, I guess no one is stopping you, but you need to be up front with your patients about what you are and are not comfortable treating. The problem is that so many times, something walks in the door looking for all the world like a common problem, but it's cancer, or something equally life-threatening, and your limited experience and education will keep you from diagnosing it correctly, but your ego might not let you consult a doctor for clarification or second opinion, especially if you are in private "practice".

If you can do that and still sleep at night, go for it. If I was in your shoes, I'd stick to accupuncture or go for an MD or DO.

Being able to write scripts does not a doctor make.

Flame away, nurses. I've earned it. But I stand behind what I say because patients have related these stories to me and I'm not making it up.

Sinnman · Jun 10, 2006

Josh, nice post. All I can tell you is to go to medical school if that's where your heart is. I know too many people who settled and regret their decision. Many go back to medical school later when it really is more difficult. I'm sure you've read my posts on the subject before. I was in a similar situation and I completely understand your thoughts and concerns.

I was intimidated by medical school; the hours, the work, the debt, the time, the impact on my marriage, etc. I tried to convince myself that being a NP was the best and easiest decision and that I could be just like a doctor. The reality hit me like a ton of bricks the more advanced nursing classes I took. Medical school is vastly different from any advanced nursing school. It's exactly what I wanted and needed. I now actually understand the body, biochemistry, physiology and pharmacology at a level that makes a doctor able to be a thinker rather than just a doer.

Medical school is a lot of work and a lot of hours and you will accrue a lot of debt but I would do it all over again in a minute. I loved medical school. I felt that I had a deeper appreciation for what I was learning than most others in my class because I knew what it was like to not have that opportunity. The hours you put it studying are long but when you are doing it because you want to learn and you enjoy it, it's like a spending time on a hobby or something else you really enjoy.

Lots of people go through medical school with spouses and children. In some ways I think it's actually easier. Just plan wisely and borrow enough money. It's really not that bad.

Another piece of advice, you said you are worried about the toll medical school will take on your marriage. Thats a good concern, but what about the toll of doing something you dont like for the rest of your life or regretting not taking an opportunity that was available to you? I can personally assure you that I am much happier now than I was and that has been reflected in my marriage. My wife says frequently that our marriage was never as strong as it was in my first two years of medical school. Ironic, huh?

You get one shot a life. Time is going to pass the same whether youre a nurse, NP, or doctor. Don't be that 50 year old man that looks back and thinks "what if?"

If youre serious, Id bail on the NP stuff and put all of resources into getting in to med school.

Good luck.

Faebinder · Jun 15, 2006

Raven Feather said:
Okay, I'm a nurse about to enter med school who would not be seen by a NP for various reasons that I won't go into, however, do not fool yourself...many nurses do know a lot about the "WHYS"--not as much as doctors but to me, knowing that ace inhibitors are prescribed to diabetics because it actually helps with blood flow to the kidneys, would be common knowledge. When I was pursuging my nursing degree we did have to take pathophysiology, pharmacology with MOA etc--that is what I loved the most. I think some must lose what they learn or something, or can't apply what they did learn
to the clinical setting. I dunno. I was suprised the other night when I had to work on the cardiovascular ICU unit (I work on ICU stepdown). My patient's HR was in the high 40s, blood pressure was high, and I had saw that a day prior her nitro gtt was d/c'd. I don't know if it was because she became too hypotensive or not--that info wasn't passed. But anyway, this freaking nurse saw that my pt's BP was like 185 systolic and was like, "Hmmm, DR. X was in today, I don't know why he didn't put her on Lopressor or something." I looked at her in amazment, "Ummmm, lopressor might not be that good, dear, lopressor is a beta blocker, it will further decrease the HR." And this was a CVICU nurse!!! She should have known that. It is SOOOO frustrating. But, I know that all nurses aren't that clueless.

Definitely come back after second year med school and tell us if you still think ACE inhibitors are given to diabetics to 'increase blood flow to the kidneys'. Your answer should be a paragraph of several benefits. :luck:

Raven Feather · Jun 16, 2006

Faebinder said:
Definitely come back after second year med school and tell us if you still think ACE inhibitors are given to diabetics to 'increase blood flow to the kidneys'. Your answer should be a paragraph of several benefits.

Now don't go misquoating me. 😛 I never said it *increased* blood flow--I said it *helped* and *help preserve*. I was taught that in pharm by a Pharm D. Sure it is in general terms, but there is really no need for a nurse to know all the nitty gritty. So are you saying the Pharm D is wrong?

But anyway, I'm sure I will have waay more in-depth knowledge about this soon enough in med school!

JohnnyOU · Jun 16, 2006

Reminds me of one of those 40-somethings who still lives with mom and is positive his band is gonna "make it".

Josh L.Ac. said:

Hard24Get · Jun 16, 2006

ramonaquimby said:
considering your fiance is on board with either decision, i agree with the person that hinted that the decision is basically "do i want to go to nursing school or medical school?" it really is no contest, despite what the nurses may say - yes it's nice to be able to write a couple standard scripts and hang a shingle, but being a doctor is a whole different ball game. so much more analytical thinking involved, hence, so much more fulfilling!!! if the time/money is the real thing holding you back, i will throw out the option of PA school. at least their training is more in line with physicians than nurses. though again, i will state that they are not doctors either (though some seem to act like they are!). i'd much prefer seeing you go the PA route than the NP route...

but MD is best 😉

Sorry, I know I'm really rude, but I have to say I would trust an NP over a PA. I have seen way to much ignorance and dangerous misses. The fact that their training is more similar only leads most of them to the misconception that they really are doctors, and they have screwed up many a family member. Basically, I think if there is any question, don't go for the PA or NP because it just wouldn't be fulfilling.

Josh L.Ac. · Jun 16, 2006

JohnnyOU said:
Reminds me of one of those 40-somethings who still lives with mom and is positive his band is gonna "make it".

One of the characters from Boondock Saints, one of the best B movies of all time.

Edit: thanks for everyone's replies, especially Sinnman.

mysophobe · Jun 16, 2006

Hard24Get said:
Sorry, I know I'm really rude, but I have to say I would trust an NP over a PA. I have seen way to much ignorance and dangerous misses. The fact that their training is more similar only leads most of them to the misconception that they really are doctors, and they have screwed up many a family member. Basically, I think if there is any question, don't go for the PA or NP because it just wouldn't be fulfilling.

Now see, I feel the exact opposite. I've had experience with PAs and NPs, and I have seen a much larger gap in knowledge with the NPs. I've discussed pretty basic topics with them and had to explain a lot of things you'd think was common sense, whereas the PAs either learned it in school or researched it on their own. I guess it depends on where you are.

deleted87716 · Jun 18, 2006

mysophobe said:
Now see, I feel the exact opposite...I guess it depends on where you are.

No, it depends on the individual PA/NP. The reason there is so much variability in knowledge is because "extender" programs rely on applicants having considerable health care experience prior to starting school, and they further expect that graduates will get considerable "OJT" (on the job training) after they finish. This is quite different from medical school and residency, which are very standardized these days.

Heme/Onc · Jun 18, 2006

KentW said:
No, it depends on the individual PA/NP. The reason there is so much variability in knowledge is because "extender" programs rely on applicants having considerable health care experience prior to starting school, and they further expect that graduates will get considerable "OJT" (on the job training) after they finish. This is quite different from medical school and residency, which are very standardized these days.

Good point, I totally agree with the above statement. And of course there are skilled, professional, and well read PA/NPs out there who are invaluable to the health care field. However, we have to allow certain privileges (as a society) based on averages of a profession. The standardized and lengthy education process of a primary care physician ensures that the vast majority are better suited for independent practice, which is simply not the case for the vast majority of PA/NPs. One year of practicing as an PA/NP is not equivalent to the intense educational experience of one year of residency training.

Sorry for another "FNP vs. MD GP" threads, but...

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