Advanced Practice Provider....but how and which one!?

[NCmntngirl]

I know this is a super difficult question to answer and is specific to each person but hopefully someone can give me some insight. I’m a medical technologist (just graduated with my bachelors in 2018). My work involves analyzing flow cytometey results to determine if a patient had leukemia/lymphoma and what kind. My work is intetesting but extremely unique for someone with my degree. My SO is graduating with a PhD in 2 years and we’re planning to move for his future job, so basically my current position has an expiration date.
I want to be a medical provider one day. I love medicine and I need a challenge in my career. Working as a med tech isn’t challenging enough and I feel like I belong in an ICU somewhere actually doing things instead of just sitting in a lab or at a desk. I want to diagnose and treat and do procedures actually make decisions.
At this point, med school is a no for me. So it’s PA or NP (long term). But I have no patient care (only HCE) and we’ll be moving 2 years from now. I’m considering doing an ABSN starting in a year so we’ll both graduate within a few months of one another. Then I plan to work as an RN hopefully in an ICU for a few years before I go back for PA/NP. So my question is: which one??? And if I pick PA, is it a bad idea to get my RN next year? I’m so conflicted but I just know I want to be in health care and I want to be doing exciting things! Please help (sorry this was so long).

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[Noisewater-TDX]

Getting your RN isn't a bad idea for whichever route you take. But RN school is a pain the butt and may not be for you.

I would look into geting your EMT and go the PA route. With your exp as a MT I think PA programs would look favorably at you.

You just need ~1000 hours of patient contact.

 

[NCmntngirl]

Getting your RN isn't a bad idea for whichever route you take. But RN school is a pain the butt and may not be for you.

I would look into geting your EMT and go the PA route. With your exp as a MT I think PA programs would look favorably at you.

You just need ~1000 hours of patient contact.

I have considered that. I actually am certified as an EMT. I took the class in high school and did an online recert last year. The issue is I've never worked on an ambulance so I haven't had much luck finding a service that would take me in the area. Additionally, I make decent money right now, and I think switching over to EMT full time would about half my income. Maybe that's better than taking out loans for a year of school for ABSN, I haven't crunched the numbers. I guess maybe I was favoring the RN over really jumping ship onto an ambulance just in case my future schooling takes longer than I expect and I end up working in that patient care position longer than I intended. It's definitely something to consider though.

 

[Noisewater-TDX]

@NCmntngirl - gotcha. EMTs do make less, sadly. Based on your name i guess you would be going to WCU or App State for your ABSN?

 

[NCmntngirl]

@NCmntngirl - gotcha. EMTs do make less, sadly. Based on your name i guess you would be going to WCU or App State for your ABSN?

Good guess! I actually graduated from UNC and would apply to UNC's ABSN since I'm still in the area (just really like the mountains here haha)

 

[pamac]

I was an MT before I became a nurse, then went on through NP school. Planned to go to PA school originally, but also applied to RN school, and could start RN school a lot sooner than PA so I ran with that. Several aspects of becoming an NP spoke to me. If you can get in to PA school quickly, then you might want to consider it. The process to get in takes a year because you apply by a summer deadline and interview through fall and winter. You would start the following fall, and then have 2 years of full time training. If you get lucky and get into a state school, your cost of your program could be as cheap as $50,000, but you also have to account for the fact that you will not be working much or at all during those 2 years. Most programs Out there cost upwards of $100,000 though. You could try for a cheap school, but everyone wants to go to a cheap school, so the competition is higher.

I don’t think you would be really comfortable working during an ABSN program either, but if it’s one year (and not very expensive), then you might be in better shape. Then you can work through Np school. NP school can easily be as cheap as $30,000.

I didn’t attend an ABSN program. I went and got my RN while I worked full time (not everyone can do that either). But my work paid for my nursing school, which was already very cheap (<$10,000), and my BSN (<$16,000). My calculations when considering between PA school or NP school went something like this:
PA school would have taken 3 years if you count the year long application process. The cost would be $100,000 for school, $70,000 for living expenses for the 2 years I couldn’t work while in school, and $130,000 in lost income for the two years during school. Total is $300,000.

The nursing route for you could go something like this:

Go to a one year ABSN program. Let’s also go ahead and factor in a year for the application process just to be fair to compare alongside PA school. But I actually think you might be able to get started this coming fall if you are lucky. Anyway.... once you get your BSN, you could start NP school and be done in 2 years while you work. The time spent comes out to about 4 years. The cost comes out to $30,000 for the ABSN, and $25,000 for NP school. You won’t work for one year while in ABSN school because they really pack things in, so there’s $35,000 for living expenses. But you can work as a nurse and make about $140,000 for the two years of Np school. So the costs factored up leave you at +$50,000.

Assume you start working as a PA 2 years sooner than you can as an Np, and that comes out to about $200,000 in income that you’d earn. That brings down your -$300,000 PA route cost to -$100,000. So the back of the napkin cost indicates you would have $150,000 in your pocket if you became an NP vs a PA. For me, the numbers were even more compelling, and were more like $200,000.

Another issue for me was autonomy. Half of the states let NPs practice independently of physicians. No states allow PAs to be independent. I am in an independent state. I also wanted to work in psyche. Psyche NPs can easily make upwards of $140,000 as new grads. New grad PAs in my state make $90,000 whether they are in psyche or not. And they can’t go out and own their own practice. Lots of psyche NPs own their own practice and make quite a bit of money by hiring other NPs. Psyche is one of the easiest practices for NPs to own and operate, so you see that frequently. It’s alsonin huge demand. I wanted the option to do that because it offers a lot of freedom and opportunity. That’s something I would have never had as an NP. I know many psyche NPs that make over $200,000 without significant disruption to their lives. One friend of mine has a handful of patients to see per day and does very well working on their own.

I think you are right to look to get out of the lab. RN and NP school will be considerably easier for you than the typical nursing student due to your education. Life will be pretty good for you while in school if you take the nursing route.

 

[deleted480308]

You say you want to make the decisions in an ICU, but that doctor isn’t happening.

Those statements don’t really line up as the decision maker in the ICU is a doctor.

Why is that off the table?

 

[NCmntngirl]

Thank you @pamac for that thorough cost break down! There’s a lot that makes sense about the NP route. I guess at this point it’s just “can that degree get me in the type of position I want”.

@sb247 to answer your question, I understand that as an APP I would NOT be the end all be all decision maker for all things but I also thought that it was possible to work in the ICU and make decisions about treatment/diagnosis without the direct oversight of the physician (assuming you’re not on an excessively complicated case). If you’ve had other experiences, I’m definitely interested to to hear them because the place I really think I want to be is in the hospital, in an ICU. Med school is sort of off the table for me at this point because of my SO. We just both agree that we don’t want to have to move for med school to a place that wouldn’t be good for his job prospects and then be uprooted again for a residency and ultimately the work life balance that would come out of it all. Really interested though to hear about any experiences you’ve had in the ICU dynamic!

 

[deleted480308]

assuming you’re not on an excessively complicated case!

It’s the ICU. They are all complicated and you shouldn’t be the decision maker on any of them as a midlevel. If you want to give ICU level care you really should become a doctor

 

[NCmntngirl]

It’s the ICU. They are all complicated and you shouldn’t be the decision maker on any of them as a midlevel. If you want to give ICU level care you really should become a doctor

Okay, I guess I’m not understanding if you’re speaking legally or if your opinion is that NPs don’t belong in the ICU. Because there are “acute care nurse practitioners” that are intended to work in ED, ICU, etc. Although I’m sure it depends on which state and hospital you’re in.

 

[pamac]

It is his opinion. In my facility the NP hospitalists cover ICU. We are a big entity. An example of the extent to which they are involved: I once watched an NP run a code through the entire event, as well as inform the family of the patient expiring. That’s a reflection of the level of involvement that could easily exist for you, if that level of responsibility is extended by the powers that be.

 

[pamac]

I think you need to ask yourself why you feel like you need to be in an icu environment to feel satisfied. I can assure you that in just about any role as an NP, you will have plenty of people that fully rely on you for their wellbeing. You’ll also have folks waiting to sue you if you screw up.

There are plenty of folks that state that they want to be “in charge”. When I hear those kinds of comments from non front line healthcare workers or folks without health care experience, it’s clear that they don’t have much exposure to what really goes on in patient care.

 

[deleted480308]

View attachment 255117

Okay, I guess I’m not understanding if you’re speaking legally or if your opinion is that NPs don’t belong in the ICU. Because there are “acute care nurse practitioners” that are intended to work in ED, ICU, etc. Although I’m sure it depends on which state and hospital you’re in.

I am speaking of the knowledge and training appropriate for independence in that setting. Legality is a different discussion

 

[762513]

Thank you @pamac for that thorough cost break down! There’s a lot that makes sense about the NP route. I guess at this point it’s just “can that degree get me in the type of position I want”.

@sb247 to answer your question, I understand that as an APP I would NOT be the end all be all decision maker for all things but I also thought that it was possible to work in the ICU and make decisions about treatment/diagnosis without the direct oversight of the physician (assuming you’re not on an excessively complicated case). If you’ve had other experiences, I’m definitely interested to to hear them because the place I really think I want to be is in the hospital, in an ICU. Med school is sort of off the table for me at this point because of my SO. We just both agree that we don’t want to have to move for med school to a place that wouldn’t be good for his job prospects and then be uprooted again for a residency and ultimately the work life balance that would come out of it all. Really interested though to hear about any experiences you’ve had in the ICU dynamic!

Sb247 hates midlevels. You may not want his advice. There is a growing group of APC's who work in ICU's. I have done rotations there as an NP student. You present the patient during rounds, explain your plan of care, and then the attending makes adjustments or not. In my system the APC's do have some autonomy to make some decisions, and always have an intensivist to fall back on. I think it's a great role, I'm excited for you that you want to go into it. I would recommend NP just like pamac said, for financial reasons. Good luck to you!

 

[NCmntngirl]

@IknowImnotadoctor and @pamac im glad to hear NPs can be found in ICUs! And just to clarify, when I said I wanted to make decisions, I didn’t really mean I was the sole person in charge or that I didn’t want to work on a team where I sometimes carried out the orders of someone else. I completely acknowledge an NP is not a doctor and there will be plenty of situations where I need help or advice or guidance. As for why ICU? Honestly I’m not 100% sure. I’m hoping that once I’m working as an RN I can explore those different areas and find out if I really do want that environment or not. I just know that I’ve never been interested in outpatient/family practice. I worked in the hospital core lab and felt more desire to stay in a hospital setting, but who knows, that would change once I get to experience it.

 

[762513]

@IknowImnotadoctor and @pamac im glad to hear NPs can be found in ICUs! And just to clarify, when I said I wanted to make decisions, I didn’t really mean I was the sole person in charge or that I didn’t want to work on a team where I sometimes carried out the orders of someone else. I completely acknowledge an NP is not a doctor and there will be plenty of situations where I need help or advice or guidance. As for why ICU? Honestly I’m not 100% sure. I’m hoping that once I’m working as an RN I can explore those different areas and find out if I really do want that environment or not. I just know that I’ve never been interested in outpatient/family practice. I worked in the hospital core lab and felt more desire to stay in a hospital setting, but who knows, that would change once I get to experience it.

I loved every minute of my many years as a RN in the ICU. Make sure you get an acute care NP cert, that will help you get hired there. Sounds like you’re on track, good luck and enjoy!

 

[precisiongraphic]

If you have not shadowed a doctor in an ICU, I would suggest that strongly as a course of action before you go to school. And then try to find a critical care NP to shadow. There are NPs in NICUs and PICUs too. You should also shadow a PA.

You could also get your BSN/RN and become a CRNA (certified registered nurse anesthetist). You might want to shadow a CRNA if you can. In order to get into CRNA school, applicants need a least a year (or two) in an ICU. The best CRNAs have so much experience with critical patients that they can spot problems (patients declining) before they become issues. CRNA school is 3 years and you can't work during it.

@IknowImnotadoctor and @pamac im glad to hear NPs can be found in ICUs! And just to clarify, when I said I wanted to make decisions, I didn’t really mean I was the sole person in charge or that I didn’t want to work on a team where I sometimes carried out the orders of someone else. I completely acknowledge an NP is not a doctor and there will be plenty of situations where I need help or advice or guidance. As for why ICU? Honestly I’m not 100% sure. I’m hoping that once I’m working as an RN I can explore those different areas and find out if I really do want that environment or not. I just know that I’ve never been interested in outpatient/family practice. I worked in the hospital core lab and felt more desire to stay in a hospital setting, but who knows, that would change once I get to experience it.

 

[NCmntngirl]

@precisiongraphic that sounds very cool! I will look into the CRNA situation too. I’m trying to find shadowing options but so far my family/friend connections have only led me to family practice. It’s been difficult to find any NPs to shadow when the hospital doesn’t have a system set up for connecting you with someone. I’m hoping once I start volunteering on a nursing unit I’ll be able to meet someone and if I get into RN school I’m sure I’ll start making those connections!

 

[PULCCMNP]

It’s the ICU. They are all complicated and you shouldn’t be the decision maker on any of them as a midlevel. If you want to give ICU level care you really should become a doctor

You sound bitter and like a person who doesn’t even work in a ICU to give an opinion

I’m a critical care NP that has been trained to work in the ICU. I have full autonomy... if fact we typically share the same load as our attendings. I do my own lines, intubations, chest tubes, LPs, thoracentesis etc... We as group bring money to the hospital in an safe and effective way while decreasing mortality (we have articles). We also make a high base salary with excellent benefits, more than most PCP. Don’t listen to people when they say we don’t belong here when in fact we do! There are articles that even state we perform better then resident teams. Most people don’t like to here that but it’s the truth. Of course there are expectations to everything... there MDs that don’t belong in the ICU such as our Hospitalist attendings which we banned. There are NP/PA that doesn’t belong either.

 

[deleted480308]

You sound bitter and like a person who doesn’t even work in a ICU to give an opinion

I’m a critical care NP that has been trained to work in the ICU. I have full autonomy... if fact we typically share the same load as our attendings. I do my own lines, intubations, chest tubes, LPs, thoracentesis etc... We as group bring money to the hospital in an safe and effective way while decreasing mortality (we have articles). We also make a high base salary with excellent benefits, more than most PCP. Don’t listen to people when they say we don’t belong here when in fact we do! There are articles that even state we perform better then resident teams. Most people don’t like to here that but it’s the truth. Of course there are expectations to everything... there MDs that don’t belong in the ICU such as our Hospitalist attendings which we banned. There are NP/PA that doesn’t belong either.

Comparing yourself to a resident isn’t the issue. An NP shouldn’t be independent of an attending physician. That’s inappropriate even if you are well paid

 

[762513]

You sound bitter and like a person who doesn’t even work in a ICU to give an opinion

I’m a critical care NP that has been trained to work in the ICU. I have full autonomy... if fact we typically share the same load as our attendings. I do my own lines, intubations, chest tubes, LPs, thoracentesis etc... We as group bring money to the hospital in an safe and effective way while decreasing mortality (we have articles). We also make a high base salary with excellent benefits, more than most PCP. Don’t listen to people when they say we don’t belong here when in fact we do! There are articles that even state we perform better then resident teams. Most people don’t like to here that but it’s the truth. Of course there are expectations to everything... there MDs that don’t belong in the ICU such as our Hospitalist attendings which we banned. There are NP/PA that doesn’t belong either.

This poster hates midlevels. His past statements have proven he’s genuinely ignorant of the roles of the NP/PA. You’re wasting your time in a debate with him. He’s not teachable.

 

[precisiongraphic]

Currently 22 of the 50 states allow NPs full practice authority while an additional 17 allow reduced authority practice with the remaining having "restricted" practice. This poster is expressing his opinion that no state at all should have full or partial practice authority. It's tilting at windmills and does nothing except to inflame divisions and increase divisiveness to continually state on this board that it is "inappropriate" for NPs to practice independent of physicians.

I don't have a dog in the fight (although I do have 3 MDs, 2 RNs and one NP in my family). But given that NPs aren't going anywhere, it gets real old listening to the same post over and over on a board that is FOR conveying information to RNs/NPs/PAs. This sub-forum is to provide information to people who have questions and the opinion given by SB is usually tangential or extraneous to the questions being asked.

Maybe it's good for potential NPs to see how caustic and negative some MDs are. And I hope that MDs holding those opinions work in a restricted practice state and don't talk down to all the NPs and future NPs around them. But that's tilting at windmills too.

You sound bitter and like a person who doesn’t even work in a ICU to give an opinion

I’m a critical care NP that has been trained to work in the ICU. I have full autonomy... if fact we typically share the same load as our attendings. I do my own lines, intubations, chest tubes, LPs, thoracentesis etc... We as group bring money to the hospital in an safe and effective way while decreasing mortality (we have articles). We also make a high base salary with excellent benefits, more than most PCP. Don’t listen to people when they say we don’t belong here when in fact we do! There are articles that even state we perform better then resident teams. Most people don’t like to here that but it’s the truth. Of course there are expectations to everything... there MDs that don’t belong in the ICU such as our Hospitalist attendings which we banned. There are NP/PA that doesn’t belong either.

Comparing yourself to a resident isn’t the issue. An NP shouldn’t be independent of an attending physician. That’s inappropriate even if you are well paid

This poster hates midlevels. His past statements have proven he’s genuinely ignorant of the roles of the NP/PA. You’re wasting your time in a debate with him. He’s not teachable.

 

[PULCCMNP]

Comparing yourself to a resident isn’t the issue. An NP shouldn’t be independent of an attending physician. That’s inappropriate even if you are well paid

Sorry to break it to you buddy... but that’s the way it is. Lol.

 

[PULCCMNP]

This poster hates midlevels. His past statements have proven he’s genuinely ignorant of the roles of the NP/PA. You’re wasting your time in a debate with him. He’s not teachable.

There’s a lot of hate to NP/PA. No we don’t think we are better or are we trying to replace MDs but we do have a role in medicine whether people like it or not. I’m highly trained in my position and I know what it takes to take care of critical patients.

 

[deleted480308]

Currently 22 of the 50 states allow NPs full practice authority while an additional 17 allow reduced authority practice with the remaining having "restricted" practice. This poster is expressing his opinion that no state at all should have full or partial practice authority. It's tilting at windmills and does nothing except to inflame divisions and increase divisiveness to continually state on this board that it is "inappropriate" for NPs to practice independent of physicians.

I don't have a dog in the fight (although I do have 3 MDs, 2 RNs and one NP in my family). But given that NPs aren't going anywhere, it gets real old listening to the same post over and over on a board that is FOR conveying information to RNs/NPs/PAs. This sub-forum is to provide information to people who have questions and the opinion given by SB is usually tangential or extraneous to the questions being asked.

Maybe it's good for potential NPs to see how caustic and negative some MDs are. And I hope that MDs holding those opinions work in a restricted practice state and don't talk down to all the NPs and future NPs around them. But that's tilting at windmills too.

Sorry to break it to you buddy... but that’s the way it is. Lol.

I’m well aware of the reality. I love a good midlevel because they really can help more patients be seen when properly supervised. We only disagree on scope of practice.

 

[762513]

There’s a lot of hate to NP/PA. No we don’t think we are better or are we trying to replace MDs but we do have a role in medicine whether people like it or not. I’m highly trained in my position and I know what it takes to take care of critical patients.

It isn’t just that sb247 states as fact his opinion about how healthcare ought to be run. It’s also that he genuinely doesn’t seem to understand big concepts in healthcare. We once delved into what actually takes place between a midlevel and their supervising or collaborating physician. The most eye opening thing he said in that conversation was that even if the collaborating physician was 50 miles away and had not spoken to the midlevel in a year about patient care, that physician was still the provider of the care, not the NP/PA. As I stated before, he’s not teachable.

 

[Splenda88]

Comparing yourself to a resident isn’t the issue. An NP shouldn’t be independent of an attending physician. That’s inappropriate even if you are well paid

We are living in a wild wild west these days...

 

[pamac]

In half of states, NPs are doing just fine without being attached to a physician in a subservient and outdated relationship.

 

[Drug_life]

This poster hates midlevels. His past statements have proven he’s genuinely ignorant of the roles of the NP/PA. You’re wasting your time in a debate with him. He’s not teachable.

I know this post is going to get so much hate but I just have to say it. This entire thread irks me BAD. HOW is sb247 ignorant to the role of NP/PA in the ICU? How is he wrong in saying that midlevels should not be independent of an attending in one of the most complex high acuity settings in the hospital? How many blocks did you spend in the different ICUs and off-service rotations with nephrology, cards, pulm, anesthesia etc. to master critical care content? Because the board certified intensivist had a handful during medical school, another 1-2 dozen during residency and an additional 2-3 years of it full time in fellowship while living, breathing, eating and sleeping critical care medicine. Did you get that type of exposure during your NP program? How about during the DNP programs ethics lecture (sorry had to throw that one in there )?

See the problem is this. It takes years to become an expert in this type of setting and NP/PA programs do not prepare you to be the expert due to the fact that they are short and not very rigorous programs. I'm not saying that you can't practice high level critical care as a NP/PA. I am sure PULCCMNP is excellent and his medical center is lucky to have him/her. But unfortunately, a lot of midlevels aren't at the same level as PULCCMNP and there is no certification that separates him/her from the less experienced (or no experienced) NP who just graduated with full scope independence. And quite frankly, that is freaking horrifying.

 

[762513]

I know this post is going to get so much hate but I just have to say it. This entire thread irks me BAD. HOW is sb247 ignorant to the role of NP/PA in the ICU? How is he wrong in saying that midlevels should not be independent of an attending in one of the most complex high acuity settings in the hospital? How many blocks did you spend in the different ICUs and off-service rotations with nephrology, cards, pulm, anesthesia etc. to master critical care content? Because the board certified intensivist had a handful during medical school, another 1-2 dozen during residency and an additional 2-3 years of it full time in fellowship while living, breathing, eating and sleeping critical care medicine. Did you get that type of exposure during your NP program? How about during the DNP programs ethics lecture (sorry had to throw that one in there )?

See the problem is this. It takes years to become an expert in this type of setting and NP/PA programs do not prepare you to be the expert due to the fact that they are short and not very rigorous programs. I'm not saying that you can't practice high level critical care as a NP/PA. I am sure PULCCMNP is excellent and his medical center is lucky to have him/her. But unfortunately, a lot of midlevels aren't at the same level as PULCCMNP and there is no certification that separates him/her from the less experienced (or no experienced) NP who just graduated with full scope independence. And quite frankly, that is freaking horrifying.

It wasn't about his ICU comment, it was about the broader premise of all of his comments for years. I actually agree with you completely no midlevel should be independent in an ICU.

SB247 states his opinion as fact, and young people who are trying to decide their future take his opinion as such and it steers them away from paths that might be good for them. He's been doing this for years, across many, many different threads. The ICU post isn't a part of it, you just happened to come in during that particular post of his.

 

[pamac]

NPs shouldn’t need to enter into an employment relationship with a physician in order to work. It’s a strange way to practice, especially in our age. That’s my issue. States that have done away with that relationship, and called it independence, haven’t fared worse because of it. I’m not aware of anyone on here suggesting that NPs or PAs are as well trained as physicians.

With all the compelling training that physicians rightfully point to, why feel so threatened? How much of your piece of the pie is at risk here? Are physicians hitting the unemployment lines?

 

[Splenda88]

I am wondering what kind of training NP go thru when most of these people do not understand simple basic science concepts... Are chem and physics needed to get into NP school?

Or maybe we should revamp med education and take out a bunch of unnecessary things... Either you need a good foundation of basic science to practice medicine or you don't. If NPs are treating patients with the acid-base imbalance and can't tell you the definition of an acid or base, do physicians need to understand these concepts in depth as we do?

I am not sure what are the answers to these questions... I feel like med school prepares us to be both clinicians and scientists when 90%+ of us will be clinicians.


Nothing against NP since one my spouse best friend is going to NP school now... but boy!

 

[pamac]

That’s an interesting point that I’ve given a lot of thought to over the last few months in regard to medical schools possibly revamping the way they deliver medical education. That was on my mind in the context of reading about 3 year medical schools and wondering if they challenged the status quo much. I’ve never been to medical school, and would think that those kinds of discussions within the physician community have happened before, and will continue to emerge as technology changes the landscape of education delivery. I wouldn’t say that NP schools have any kind of edge in terms of remotely educating students, and nobody in the physician realm would believe me if I did say that, but I do believe that in terms of sheer delivery of material, online education is great in most regards. There isn’t a quick give and take, but I’ve learned that with the world at my fingertips, I can quickly look up an answer to a question instead of losing out by not being able to interact with faculty immediately by asking them. Surely there are the purists that insist that there’s merit to driving into campus, hunting for parking, walking to class, sitting in an uncomfortable chair, and traveling at the speed of the slowest student that is willing to ask a question. I’d rather throw on my earphones in my lazy boy in my home office and start in on my studies.

Again, I’m for nurse independence mostly from an employment standpoint. It’s just strange in our day to have the White night physician, and the Np and PA squires running around with their livelihood dependent upon the whim of a doctor for them to be able to do something that they seem to do fine doing in independent states. Where the discussion takes on a more frustrating bent is when the critics insist that its not mostly about angling for power over another individual for their own purposes. Nursing is it’s own profession. The delivery model is changing from small practices to integrated, corporately aligned entities. I think that lends better towards having providers be independent.

 

[Splenda88]

The problem in the physician community is that the people that are in charge (I call them the old guards) insist for things to stay the way they are. Some of them even think working 70+ hrs/wk for 3 years is not good enough to become a competent IM doc. One thing you always hear from them is that "when I was in residency" blah blah blah... They don't even get that time has changed and technology has revolutionized a lot of things.

I am in the firm opinion that 11 years to become a PCP is too long and we can revamp med school curriculum and residency (3 prereqs +3 med school +2+ residency) to cut that time to 8 years, but I am in the minority in the medical community for these changes.

 

[Tiran145]

I am wondering what kind of training NP go thru when most of these people do not understand simple basic science concepts... Are chem and physics needed to get into NP school?

Or maybe we should revamp med education and take out a bunch of unnecessary things... Either you need a good foundation of basic science to practice medicine or you don't. If NPs are treating patients with the acid-base imbalance and can't tell you the definition of an acid or base, do physicians need to understand these concepts in depth as we do?

I am not sure what are the answers to these questions... I feel like med school prepares us to be both clinicians and scientists when 90%+ of us will be clinicians.


Nothing against NP since one my spouse best friend is going to NP school now... but boy!

Nurses take chemistry as pre read for nursing school. Although an intro course is all that is required at least they have a foundation. I would not go so far as to say they don’t know what acids and bases are.

 

[deleted480308]

The problem in the physician community is that the people that are in charge (I call them the old guards) insist for things to stay the way they are. Some of them even think working 70+ hrs/wk for 3 years is not good enough to become a competent IM doc. One thing you always hear from them is that "when I was in residency" blah blah blah... They don't even get that time has changed and technology has revolutionized a lot of things.

I am in the firm opinion that 11 years to become a PCP is too long and we can revamp med school curriculum and residency (3 prereqs +3 med school +2+ residency) to cut that time to 8 years, but I am in the minority in the medical community for these changes.

Are you a primary care doctor?

 

[Splenda88]

Nurses take chemistry as pre read for nursing school. Although an intro course is all that is required at least they have a foundation. I would not go so far as to say they don’t know what acids and bases are.

Knowing acids and bases in term of pH does not mean that you understand acid-base... As I said before, nothing against nurses but I just feel like you guys/gals rely on a pattern of recognition too much.

A clear example comes to mind last month... I admitted a patient with acute symptomatic cocaine intoxication... Patient was very tachy... The charge nurse approached me and asked why don't (not why can't) you give him beta blocker, I explained to her in simple terms the reason and she then turned around telling the RN who was taking care of the patient call my resident because I don't want to give the patient beta blocker.

 

[Splenda88]

Are you a primary care doctor?

I am a PGY1 IM resident...

 

[deleted480308]

Knowing acids and bases in term of pH does not mean that you understand acid-base... As I said before, nothing against nurses but I just feel like you guys/gals rely on a pattern of recognition too much.

A clear example comes to mind last month... I admitted a patient with acute symptomatic cocaine intoxication... Patient was very tachy... The charge nurse approached me and asked why don't (not why can't) you give him beta blocker, I explained to her in simple terms the reason and she then turned around telling the RN who was taking care of the patient call my resident because I don't want to give the patient beta blocker.

In fairness to midlevels, that story was about an RN.

They aren’t as trained as a midlevel. Neither should be unsupervised but they aren’t the same

 

[deleted480308]

I am a PGY1 IM resident...

And you honestly feel with a year less med school that you would be 100% independent in skill level in 14 months?

 

[Splenda88]

And you honestly feel with a year less med school that you would be 100% independent in skill level in 14 months?

PGY2 in my programs are calling the shots with very minimal supervision right now... A Canadian who graduated from my school did a 2-year FM program in Canada and is working in NY right now.

They can re-structure med school to 18+18 months with the last 4-6 months of rotations like sub I for people who are going into primary care. It probably won't work the way the curriculum is right now, but it might work with some tweaking.

 

[deleted480308]

PGY2 in my programs are calling the shots with very minimal supervision right now... A Canadian who graduated from my school did a 2-year FM program in Canada and is working in NY right now.

They can re-structure med school to 18+18 months with the last 4-6 months of rotations like sub I for people who are going into primary care. It probably won't work the way the curriculum is right now, but it might work with some tweaking.

I think it’s possible you are undervaluing the oversight the attendings are actually doing, there may be minimal personal discussion but if they are any good as attendings there is absolutely still a lot of supervision

 

[Splenda88]

In fairness to midlevels, that story was about an RN.

They aren’t as trained as a midlevel. Neither should be unsupervised but they aren’t the same

I know and understand RN and NP are not the same. I took my time to explain to that charge nurse why I am not using beta blocker and cited a study to impress you because you are cute , you still went around and tried to undermine me without even trying to absorb what I said...

 

[Splenda88]

I think it’s possible you are undervaluing the oversight the attendings are actually doing, there may be minimal personal discussion but if they are any good as attendings there is absolutely still a lot of supervision

When resident (PGY2) overall plan of care has not changed that much, they must be doing something right...

It's possible that I am undervaluing supervision, but I feel like the last 2 PGY2 residents I worked with were very good to the point that the attendings did not add much to or change their plan of care...

 

[762513]

I am wondering what kind of training NP go thru when most of these people do not understand simple basic science concepts... Are chem and physics needed to get into NP school?

Or maybe we should revamp med education and take out a bunch of unnecessary things... Either you need a good foundation of basic science to practice medicine or you don't. If NPs are treating patients with the acid-base imbalance and can't tell you the definition of an acid or base, do physicians need to understand these concepts in depth as we do?

I am not sure what are the answers to these questions... I feel like med school prepares us to be both clinicians and scientists when 90%+ of us will be clinicians.


Nothing against NP since one my spouse best friend is going to NP school now... but boy!

NP's usually don't have as solid of a science foundation than MD's. However, we are still required to take A&P1/2, micro, patho, physics. I hear people tell me that the science nurses do are "survey" courses. This is untrue, as I've taken them both at well respected universities and then when the courses aged out I had to retake them in the nursing curriculum, they are identical. As far as one poster one time said that he overheard an NP not know what acid/base was, this person was probably trolling, and even if one person one time heard one NP say something they interpreted that way, it's not proof of anything. The science requirements for nursing and therefore NP school are known quantities.

 

[Splenda88]

NP's usually don't have as solid of a science foundation than MD's. However, we are still required to take A&P1/2, micro, patho, physics. I hear people tell me that the science nurses do are "survey" courses. This is untrue, as I've taken them both at well respected universities and then when the courses aged out I had to retake them in the nursing curriculum, they are identical. As far as one poster one time said that he overheard an NP not know what acid/base was, this person was probably trolling, and even if one person one time heard one NP say something they interpreted that way, it's not proof of anything. The science requirements for nursing and therefore NP school are known quantities.

I don't know all the NP school curricula, and prereqs required to get into NP school but where I did my undergrad and also where I attended med school, NP only needs one general chemistry class... Of course, there might be NP that took gen chem1/2, orgo 1/2, biology 1/2 and even biochem or genetics... But I was told that where I did my undergrad and med school are typical of what NP schools require...

I have nothing against NP, but I think that if you are fighting for no supervision, there should be a barrier to entry and standardized education so people know where the floor is (so to speak)...

Med school and most importantly residency are standardized in the US...

NP and PA are gonna have some competitions in the near future as some states are thinking about doing what Missouri did... That assistant physician thing.

 

[762513]

I don't know all the NP school curricula, and prereqs required to get into NP school but where I did my undergrad and also where I attended med school, NP only needs one general chemistry class... Of course, there might be NP that took gen chem1/2, orgo 1/2, biology 1/2 and even biochem or genetics... But I was told that where I did my undergrad and med school are typical of what NP schools require...

I have nothing against NP, but I think that if you are fighting for no supervision, there should be a barrier to entry and standardized education so people know where the floor is (so to speak)...

Med school and most importantly residency are standardized in the US...

You're right that there are things that need to be fixed in NP education, but it's important to remain factual, otherwise it's just trolling and !@#$ posting.

 

[pamac]

I don't know all the NP school curricula, and prereqs required to get into NP school but where I did my undergrad and also where I attended med school, NP only needs one general chemistry class... Of course, there might be NP that took gen chem1/2, orgo 1/2, biology 1/2 and even biochem or genetics... But I was told that where I did my undergrad and med school are typical of what NP schools require...

I have nothing against NP, but I think that if you are fighting for no supervision, there should be a barrier to entry and standardized education so people know where the floor is (so to speak)...

Med school and most importantly residency are standardized in the US...

NP and PA are gonna have some competitions in the near future as some states are thinking about doing what Missouri did... That assistant physician thing.

NPs are unsupervised in half of the states. They aren’t fighting for independence, they already have it, and it’s working out ok. Now it’s a matter of continued expansion, and that tends to happen at a rate of one or two states per year. Nothing is rolling that back.

The reason the “assistant physician” role isn’t going to be something eagerly pursued by folks who didn’t make the cut for full medical practice is because nobody wants to go through medical school and it’s expense and time commitment only to have physicians treat them like PAs. They have front row seats already to see how fun it is to have physicians try to treat non physicians like “midlevels”. Most of those folks had designs on doing that themselves before they couldn’t reach that bar. And I don’t think the physician community as a whole wants another group of non-physicians to wring their hands about. If what docs are saying about how critical the full medical training experience is, then I guess anything less than that is a danger to public health, right? But apart from that, it’s a role that nobody dreams of falling into, and that’s tough to diligently self promote something that nobody really wants to do in the first place. That kind of dogged self promotion is what it takes to sway legislatures.

I have all the medical prerequisite coursework and then some. Knocked them out while initially intending to attend dental school. It’s helpful for providing the insight that Np curriculum lacks, but I know that NPs and Np students seems to thrive clinically despite what they lack, but I’m mostly exposed to what I work in, and that is psyche. The topic of the ICU environment keeps coming up, and maybe it’s a lot different there, but that’s also the place, along with ER, that lends very well towards supervision. Just about anything outpatient, most of the concern seems to center upon competition concerns. But regardless, the work really doesn’t require a feudalistic supervisory arrangement. If physicians want to hire NPs and draw up a contract that essentially puts their Np employees in a subservient role, go ahead. It should be their choice to enter into that.

 

[deleted480308]

NPs are unsupervised in half of the states. They aren’t fighting for independence, they already have it, and it’s working out ok. Now it’s a matter of continued expansion, and that tends to happen at a rate of one or two states per year. Nothing is rolling that back.

The reason the “assistant physician” role isn’t going to be something eagerly pursued by folks who didn’t make the cut for full medical practice is because nobody wants to go through medical school and it’s expense and time commitment only to have physicians treat them like PAs. They have front row seats already to see how fun it is to have physicians try to treat non physicians like “midlevels”. Most of those folks had designs on doing that themselves before they couldn’t reach that bar. And I don’t think the physician community as a whole wants another group of non-physicians to wring their hands about. If what docs are saying about how critical the full medical training experience is, then I guess anything less than that is a danger to public health, right? But apart from that, it’s a role that nobody dreams of falling into, and that’s tough to diligently self promote something that nobody really wants to do in the first place. That kind of dogged self promotion is what it takes to sway legislatures.

I have all the medical prerequisite coursework and then some. Knocked them out while initially intending to attend dental school. It’s helpful for providing the insight that Np curriculum lacks, but I know that NPs and Np students seems to thrive clinically despite what they lack, but I’m mostly exposed to what I work in, and that is psyche. The topic of the ICU environment keeps coming up, and maybe it’s a lot different there, but that’s also the place, along with ER, that lends very well towards supervision. Just about anything outpatient, most of the concern seems to center upon competition concerns. But regardless, the work really doesn’t require a feudalistic supervisory arrangement. If physicians want to hire NPs and draw up a contract that essentially puts their Np employees in a subservient role, go ahead. It should be their choice to enter into that.

You keep misrepresenting the argument as turf protection. It’s been said clearly multiple times that most physicians don’t think a midlevel is educated/trained enough to warrant independent practice. It’s a patient safety concern

 

[pamac]

No it’s not. As I said before, half of states have independent Nps. The sky hasn’t fallen.