After undergrad, midlevel education: Go PA or go NP?

[Paseo Del Norte]

I just flew a 20 year old kid with bilateral femur fractures and a subdural hematoma, and as I was setting up our ventilator, I was already thinking about this guys diet. LOL

Nursing is allot like the Army. As a medic in the Army, I remember every unit had it's own nomenclature for the exact same concept. I still remember the "Ranger Saline Lock" to this day. Obviously, it was a saline lock with a "tactical" plug that allowed quick access for IV fluids if needed. It was the same thing we used, but the Rangers got to call it the "Ranger Saline Lock."

Same concept with nursing. You see a patient with a subdural hematoma, and a nurse may see a patient with ineffective cerebral tissue perfusion. Same problem with a bit of nursing flare added for effect.

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[lapelirroja]

I only listed the last two years because they are part of the professional phase while the others are not.

You also failed to notice the third professional year which includes more coursework in clinical knowledge and practice. But nice try.

My whole entire point is that it is utterly ridiculous to say that PAs are less educated than NPs. If anything, the NP is the more variable product due to no real true standards in the educational process and certification. I believe it was said on another thread that sometimes it's not even required for an NP to take a certification exam. There are good and bad providers in any profession (MD/DO/PA/NP) but its laughably erroneous and maddening to say that PAs have anything but a rigorous, standardized education process which produces a more standard product than NPs. ARC-PA and NCCPA maintain that and if a program isn't up to snuff, you better believe they are going on probation or losing accreditation.

 

[ArkansasRanger]

I just flew a 20 year old kid with bilateral femur fractures and a subdural hematoma, and as I was setting up our ventilator, I was already thinking about this guys diet. LOL

Nursing is allot like the Army. As a medic in the Army, I remember every unit had it's own nomenclature for the exact same concept. I still remember the "Ranger Saline Lock" to this day. Obviously, it was a saline lock with a "tactical" plug that allowed quick access for IV fluids if needed. It was the same thing we used, but the Rangers got to call it the "Ranger Saline Lock."

Same concept with nursing. You see a patient with a subdural hematoma, and a nurse may see a patient with ineffective cerebral tissue perfusion. Same problem with a bit of nursing flare added for effect.

Yeah, that's kind of what I was hinting at. Instead of just stating a guy with a known history of emphysema a nurse wrote "impaired gas exchange."

 

[Khaos05]

Well, I'll throw in my experience.

I'm due to graduate in May 2010 from college with my bachelor's in nursing. I can tell you that I feel that a good bit of my time has been wasted with nursing theory, pt teaching, and a lot of "call the dr." answers. I feel like i've been taught for 3 years to know the s/sx and know when to call the dr. and then be ready to set up his supplies for him/her - kinda sucks.

I just chimed in on this thread to decide between PA vs. MD. People who are hardcore about nursing are kind of like nursing nazis. They think nursing is the be all, end all and that "medicine" is bad. I posted things about PA on my nursing schools message board and was told to quit posting "while I was ahead".

All in all - i'm done with nursing after i graduate. I want to do something scientific and medicinal not theory!

 

[235750]

Well, I'll throw in my experience.

I'm due to graduate in May 2010 from college with my bachelor's in nursing. I can tell you that I feel that a good bit of my time has been wasted with nursing theory, pt teaching, and a lot of "call the dr." answers. I feel like i've been taught for 3 years to know the s/sx and know when to call the dr. and then be ready to set up his supplies for him/her - kinda sucks.

I just chimed in on this thread to decide between PA vs. MD. People who are hardcore about nursing are kind of like nursing nazis. They think nursing is the be all, end all and that "medicine" is bad. I posted things about PA on my nursing schools message board and was told to quit posting "while I was ahead".

All in all - i'm done with nursing after i graduate. I want to do something scientific and medicinal not theory!

You're making a lot of generalizations here, and while I'd love to go through them all I simply don't have the time, so I'll just say this

People who are passionate about their work are not necessarily 'nazis'. If you love something, do it, and do it well. It you're an RNs/LPNs/CNAs, whatever, you should be proud of the nursing tradition and role it plays in medicine.

Speaking of which, I don't think the calling the dr. is a part that's unique to nursing. In medical school we are constantly referring to experienced (ie attending) docs, as well as specialists. A part of medical training will always be learning where your boundaries are, no matter how advanced it is. While it's true that RNs have more of an assisting role, they play a vital part in the hospital/heathcare setting ,and we'd be lost without them.

Besides wasn't this thread about choosing between a NP or PA? When did we get talking about MD/DOs?

To the OP: my vote is for PA school!!!

 

[jbar]

Speaking of which, I don't think the calling the dr. is a part that's unique to nursing. In medical school we are constantly referring to experienced (ie attending) docs, as well as specialists.

It may be a normal part of clinical work, but I get the impression that the poster is getting the answer of "oh, you don't need to understand what this means, other than call the doctor." While in medical school I've never been told that the answer to a question is above my level of understanding because the specialist/attending etc will deal with it.

Maybe that's not what the poster is saying but that's the vibe I get.

 

[235750]

It may be a normal part of clinical work, but I get the impression that the poster is getting the answer of "oh, you don't need to understand what this means, other than call the doctor."

I am not sure what you are saying here. You seem to agree with what I am saying, yet at the same time not?

Let me give an example so I am not misunderstood. I want to be a psychiatrist so I follow one around whilst he does consultations at a local ED. While the EM doc is capable of learning the same skills as the psychiatrist and vice versa, the practical answer to their everyday problems of not understanding all aspects of medicine is simply to say: "the answer to this question is beyond my current understanding, and I will therefore arrange a referral/consult. I do not have to know this material."

This answer is common to all physicians.

While in medical school I've never been told that the answer to a question is above my level of understanding because the specialist/attending etc will deal with it.

It is true that a physician would never tell another doctor (or student doctor) that he or she is incapable of learning their particular specialty. It is just simply impossible to know all fields of medicine to the highest degree of expertise simultaneously.

Your med school, my med school, and every med school acknowledges these facts and does teach you this principle. It's part of a very important oath we all take. I know the promise not to 'cut for stone' seems rather obtuse and archaic, but I believe the modern interpretation is sound and very applicable here.

My point was, wanting to be free of deferring to others is not a sound reason to apply to medical school. We will always be deferring to others because of a lack of understanding, so get used to it!

 

[chman]

Some people need to get a life. This is part of the reason why America's system is broken; people of multiple health-care professions feel the need to one-up the other, that's sad.

I am probably going the PA or MD route, yet do I have contempt for advanced practice nurses? No. I just find that it is not for me, but that does not mean that I have to spend my time bringing them down. In fact, I would think that it would be easy for the two to get along considering that many PA's were once nurses.

Lets come together, and not flex muscles on an internet board meant for sharing ideas.

 

[Paseo Del Norte]

Some people need to get a life. This is part of the reason why America's system is broken; people of multiple health-care professions feel the need to one-up the other, that's sad.

I am probably going the PA or MD route, yet do I have contempt for advanced practice nurses? No. I just find that it is not for me, but that does not mean that I have to spend my time bringing them down. In fact, I would think that it would be easy for the two to get along considering that many PA's were once nurses.

Lets come together, and not flex muscles on an internet board meant for sharing ideas.

I am going to assume you are new to healthcare. You seem to be falling into a "feelings" trap. The situation at hand is not about how to get along or putting a profession down. In fact, it's nothing personal. I can say this as a nurse.

The crux of this argument is about having people with less education and clinical experience taking over and billing for total primary care. Absolute truth here; there are NP's who have total indi practice. No consultation, no chart reviews, no working with a doc, nadda. This is the crux of the discussion.

 

[zenman]

Here’s two courses from NOVA university that should tell you what nursing is:

“Introduction to Professional Nursing

This course introduces the student to the roles of the professional nurse including provider of care, manager of care, advocate, teacher, researcher, leader and member of the profession. The history of nursing and how society views the nursing profession are discussed. The student is introduced to the concepts of the Neuman's Systems Model as a theory of practice, as well as ethical and legal principles, medical terminology, socio-cultural concepts, and political principles guiding the profession. (2 credit hours: 2 didactic/0 clinical)

Foundations of Professional Nursing Practice

This course introduces the entry level student to the culture and practice of nursing. It examines the holistic concepts of individuals, environment, health and nursing. It focuses on system variables of an individual including the physiological, psychological, social, cultural, cognitive and spiritual domains. The important themes of primary, secondary, and tertiary prevention-as-intervention modalities; the client system's reaction to interpersonal, intrapersonal and extrapersonal stressors; and critical thinking are integrated throughout the course to prepare the students for practice. Students are introduced to health promotion, the legal and ethical issues, and contemporary trends in health care that impact nursing practice. The course provides fundamental nursing concepts, skills and techniques of nursing practice and a firm foundation for more advanced areas of study. (6 credits: 3 didactic/3 clinical)”

From NOVA University

When I was getting my masters in nursing we used the Neuman Systems Model. I actually liked it as I understood the purpose of theory and knew that all professions are theory driven. It might have been a bit much for me and a partner to have to develop a new model of nursing but it certainly didn’t kill me and I didn’t waste time whining.

“A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.”

http://www.currentnursing.com/nursing_theory/application_Betty_Neuman's_model.htm

This is about psychological theories but is useful to increase your knowledge:

‘There are numerous psychological theories that are used to explain and predict a wide variety of behaviors. What exactly is the purpose of having so many psychological theories? These theories serve a number of important purposes.
• Theories provide a framework for understanding human behavior, thought, and development. By having a broad base of understanding about the how's and why's of human behavior, we can better understand ourselves and others.

• Theories create a basis for future research. Researchers use theories to form hypotheses that can then be tested.

• Theories are dynamic and always changing. As new discoveries are made, theories are modified and adapted to account for new information.”

http://psychology.about.com/od/developmentecourse/a/dev_purpose.htm

Now, if you are bad-mouthing theories and going the PA or MD route to avoid them you might want to ask someone if the words “medical” & “theories” ever appear together.

Any program that offers the masters degree should add courses that many of you are bitching about. There is a reason for that but I’ll let you figure it out.

Trade school teaches you just what you need to do to do a specialized job. They probably don’t even teach you how to spell “theory!”

 

[jbar]

We're in agreement. I understand that a part of medicine is not being able to master all fields. I was just referring to the poster who seemed frustrated that in training he/she was being told "just call the doctor," rather than getting an explanation of the disease, or how it would be managed etc.

 

[Miss Mab]

. I was just referring to the poster who seemed frustrated that in training he/she was being told "just call the doctor," rather than getting an explanation of the disease, or how it would be managed etc.

That's interesting that this was your take as I had a completely different interpretation. My perspective probably comes from graduating a BSN program where "just call the doctor" was the annoyingly pat answer to any number of hypothetical situations. But here's where we differ and I'm curious if the OP of the statement was referring to a frustration along the same line.

The problem wasn't, for us anyhow, that we weren't educated on different diseases, their treatments and management, the appropriate tests and interventions likely to follow or what abnormal values or findings you might expect--thereby also indicating a need to have an awareness of what would be normal---or even what could be most appropriate first line pharmacologically, etc.
(And please no one misinterpret what I'm saying as if I belive this knowledge were in any way equal to or in depth as further graduate or traditional medical school training. Duh...it's not)
So it generally wasn't any lack of understanding that would prompt these 'call the doc' answers but instead the answer was ultimately the required reponse to any question simply given the role. And perhaps rightly so but a different concern.
Instead, the frustration would come from having undergone this extensive learning process and then finally fully grasping the understanding that beside knowing it for yourself and by extension potentially helping the patient(granted, big win) that ultimately to call the doctor will always be the only action to take.

I'm anticipating a great misinterpretation of my thoughts but it is what it is. I posted once before that I thought many nursing schools actually undertake TOO indepth education for the role and was handily shot down but I think there's something to that. I actually hated my well known nursing school for all of the popular knocks on their accompanying agenda, etc. but I have to say they afforded me an excellent education. I just don't get why the best basic programs try to be something they're not. What's the point? You end up with frustrated nurses brought along to somehow expect a different reality and a generally ignorant larger community who lack any awareness of exactly what, if anything substantial at all, is being taught there.

The bigger issue is the failure of nursing education to standardize in any meaningful way--and this is from basic programs on up through the whole DNP proliferation. It's been stated ad nauseum that it isn't only those outside of professional nursing who hold legitimate educational concerns. However, it probably helps to possess a more realistic view of what currently is in existence if/when advocating for any sort of overhaul of the system. The whole baby out w/the bathwater idea...

 

[chman]

I am going to assume you are new to healthcare. You seem to be falling into a "feelings" trap. The situation at hand is not about how to get along or putting a profession down. In fact, it's nothing personal. I can say this as a nurse.

The crux of this argument is about having people with less education and clinical experience taking over and billing for total primary care. Absolute truth here; there are NP's who have total indi practice. No consultation, no chart reviews, no working with a doc, nadda. This is the crux of the discussion.

Really.... That's interesting. However, I have some problems with that argument. First, any provider that does not document, whether an MD or NP etc., is legally obligated to document their cases. If someone is not doing that it is illegal. Period.

Secondly, that's fine if there is a discussion about that, but that is not what has been going on on this board. What has been happening is that people are putting the other profession down for no real reason, many of whom appear to have no experience.

You can tell me that I am being soft, whining, etc. But the fact is that this kind of attitude is not limited to this board. It is prevalent throughout the health system. Bickering amongst one another is not good for the patient, and I hope that you, "as a nurse" can see that.

Lastly, although I feel that NP's should not own their own practice, I also feel that they, along with other mid levels, provide a service that is not being satisfied otherwise. I.E., primary care. If MD's, you, or others feel threatened by mid levels doing primary care in our most under-served populations; If care was already available, and affordable, this would not be happening. The fact is that physicians do not want to do primary care in rural and inner city areas. Mid levels help to fill this gap.

 

[Charles_Carmichael]

Really.... That's interesting. However, I have some problems with that argument. First, any provider that does not document, whether an MD or NP etc., is legally obligated to document their cases. If someone is not doing that it is illegal. Period.

Secondly, that's fine if there is a discussion about that, but that is not what has been going on on this board. What has been happening is that people are putting the other profession down for no real reason, many of whom appear to have no experience.

You can tell me that I am being soft, whining, etc. But the fact is that this kind of attitude is not limited to this board. It is prevalent throughout the health system. Bickering amongst one another is not good for the patient, and I hope that you, "as a nurse" can see that.

Lastly, although I feel that NP's should not own their own practice, I also feel that they, along with other mid levels, provide a service that is not being satisfied otherwise. I.E., primary care. If MD's, you, or others feel threatened by mid levels doing primary care in our most under-served populations; If care was already available, and affordable, this would not be happening. The fact is that physicians do not want to do primary care in rural and inner city areas. Mid levels help to fill this gap.

You really ought to read around before you make posts. No one has randomly attacked another profession. People, however, are questioning the training, or lack thereof, provided by NP/DNP programs. Raising valid concerns isn't just "bickering." Questioning the NP/DNP curricula doesn't mean you're personally insulting every NP out there.

 

[chman]

You really ought to read around before you make posts. No one has randomly attacked another profession. People, however, are questioning the training, or lack thereof, provided by NP/DNP programs. Raising valid concerns isn't just "bickering." Questioning the NP/DNP curricula doesn't mean you're personally insulting every NP out there.

I should be more specific, you're right. I am really only talking about a couple of people. However, I still stand by my original point that the general disdain from one health care professional to another is counter-productive. I realize that I am in the minority here, that's o.k. But I stand by my points if someone wants to argue those issues with me; first being primary care, I will be happy to do so.

 

[psychbender]

The fact is that physicians do not want to do primary care in rural and inner city areas. Mid levels help to fill this gap.

This right here...also very annoying. I cannot tell you how many times I have heard it, and it is a completely BS argument. I know plenty of docs (including nearly everyone that went FM or Peds in my medschool class...and a fair number of those going into subspecialties) that want to practice in rural/underserved areas. In my limited experience, midlevels do not want to work there, either, and merely use that argument as an excuse to gain increased practice rights, and move into the cities where the doctors tend to go, as well.

Regarding your primary argument about attacking other professions, you really need to read more on this site, and see that the crux of the argument revolves around a relative lack of clinical and hard-science didactic training in most advanced nursing programs. Seven hundred to one thousand clinical hours does not make one a competent, independant provider of medical care (most med and PA students will do that many hours within their first 3-4 months of rotations, alone). This is a very valid complaint, and bringing it up is part of having a discussion or argument, and you should not construe it as bickering and complaining.

 

[chman]

You really ought to read around before you make posts. No one has randomly attacked another profession. People, however, are questioning the training, or lack thereof, provided by NP/DNP programs. Raising valid concerns isn't just "bickering." Questioning the NP/DNP curricula doesn't mean you're personally insulting every NP out there.

I also did read the entire thread before responding. I am also going into PA or MD, so I really do not have any interest to protect.

 

[Amgen1]

Lastly, although I feel that NP's should not own their own practice, I also feel that they, along with other mid levels, provide a service that is not being satisfied otherwise. I.E., primary care. If MD's, you, or others feel threatened by mid levels doing primary care in our most under-served populations; If care was already available, and affordable, this would not be happening. The fact is that physicians do not want to do primary care in rural and inner city areas. Mid levels help to fill this gap.

I find this argument to be questionable. I have yet to see any data that indicates that NP/ PAs practice in rural and underserved areas at a higher percentage than physicians.

The majority of midlevels practice in metropolitan areas in fairly large medical centers. They have innately no greater desire to practice in an underserved area than a physician.

Whether or not a person practices in a rural/ underserved area largely depends on where that person was raised and where they have trained.

Hence the large push in medical schools to have people who come from rural/ underserved areas and provide loan repayment for physicians to return to those areas

 

[chman]

This right here...also very annoying. I cannot tell you how many times I have heard it, and it is a completely BS argument. I know plenty of docs (including nearly everyone that went FM or Peds in my medschool class...and a fair number of those going into subspecialties) that want to practice in rural/underserved areas. In my limited experience, midlevels do not want to work there, either, and merely use that argument as an excuse to gain increased practice rights, and move into the cities where the doctors tend to go, as well.

Regarding your primary argument about attacking other professions, you really need to read more on this site, and see that the crux of the argument revolves around a relative lack of clinical and hard-science didactic training in most advanced nursing programs. Seven hundred to one thousand clinical hours does not make one a competent, independant provider of medical care (most med and PA students will do that many hours within their first 3-4 months of rotations, alone). This is a very valid complaint, and bringing it up is part of having a discussion or argument, and you should not construe it as bickering and complaining.

Well If physicians really wanted to do these jobs then they would. They are not, hence the problem. There are programs of loan forgiveness and such, so if the money argument is brought into play that is what I have to say.

I have done a lot of reading on this issue, and volunteer in an inner city clinic, so I would appreciate if you would not assume that I am ignorant on the issue, or that I have not read others comments.

If you look at some of my previous posts you will see that I agree that NP's should not have their own practice, and I also agree that their training lacks hard science, hence why I am going the PA or MD route.

I believe that NP programs should only let those in who have the clinical experience to back it up. That is the main problem in my opinion. However, I do feel that NP's/PA's play an important role in primary care.

I will look for some data regarding NP's in rural and inner city populations.

 

[chman]

Here is a study done on the states of California and Washington.

According to this it goes PA's, NP's, MD's, in our rural and inner city populations.

<http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1466573>

 

[Paseo Del Norte]

Well If physicians really wanted to do these jobs then they would. They are not, hence the problem. There are programs of loan forgiveness and such, so if the money argument is brought into play that is what I have to say.

I have done a lot of reading on this issue, and volunteer in an inner city clinic, so I would appreciate if you would not assume that I am ignorant on the issue, or that I have not read others comments.

If you look at some of my previous posts you will see that I agree that NP's should not have their own practice, and I also agree that their training lacks hard science, hence why I am going the PA or MD route.

I believe that NP programs should only let those in who have the clinical experience to back it up. That is the main problem in my opinion. However, I do feel that NP's/PA's play an important role in primary care.

I will look for some data regarding NP's in rural and inner city populations.

I think physicians would work these positions; however, in my anecdotal experience it is hard to make a good living as a rural FP. My personal physician is an internist and he works nearly every day of the week. He pulls long days at his practice, then turns around and pulls all nighters at the local ER for extra cash.

If rural FP was more appealing, I imagine more people would work in this area. Therefore I simply cannot accept your argument of "doctors should work in this area." That is like saying I as a RN should work med/surge and long term care, when I know I can make much more with fewer hours as a traveler in specialty areas (ER and remote medicine in my case).

I think we agree on many concepts, and I am not opposed to a NP per say. (Provided there is physician involvement like a PA.) However, many of the DNP proponents have a much more aggressive agenda. This agenda is what many people on this site, including nurses, oppose.

Regarding the profession attacks. Yes, there are a few people on this site who tend to go over board and berate nursing. However, the same concept occurs on nurse specific sites as well. It does not excuse this behavior; however, I realize I will deal with it while realizing the crux of the situation is where I find common ground.

Regarding the clinical experience remark: I do not want to retype one of my earlier posts; however, clinical experience as a bedside nurse is not equivalent to experience as a diagnostician. Note, I did not put my nursing experience down; however, it is not the same concept. Therefore, a nurse with 20 years of experience may be a great nurse with an incredible base of knowledge; however, this does not translate into independent provider experience. The only way to obtain the said experience is by having it as part of your education.

 

[chman]

I think physicians would work these positions; however, in my anecdotal experience it is hard to make a good living as a rural FP. My personal physician is an internist and he works nearly every day of the week. He pulls long days at his practice, then turns around and pulls all nighters at the local ER for extra cash.

If rural FP was more appealing, I imagine more people would work in this area. Therefore I simply cannot accept your argument of "doctors should work in this area." That is like saying I as a RN should work med/surge and long term care, when I know I can make much more with fewer hours as a traveler in specialty areas (ER and remote medicine in my case).

I think we agree on many concepts, and I am not opposed to a NP per say. (Provided there is physician involvement like a PA.) However, many of the DNP proponents have a much more aggressive agenda. This agenda is what many people on this site, including nurses, oppose.

Regarding the profession attacks. Yes, there are a few people on this site who tend to go over board and berate nursing. However, the same concept occurs on nurse specific sites as well. It does not excuse this behavior; however, I realize I will deal with it while realizing the crux of the situation is where I find common ground.

Regarding the clinical experience remark: I do not want to retype one of my earlier posts; however, clinical experience as a bedside nurse is not equivalent to experience as a diagnostician. Note, I did not put my nursing experience down; however, it is not the same concept. Therefore, a nurse with 20 years of experience may be a great nurse with an incredible base of knowledge; however, this does not translate into independent provider experience. The only way to obtain the said experience is by having it as part of your education.

I think that we agree more than not. I disagree on a couple points though.

First where I agree. DNP programs, to be sure, have an agenda. That is without question. Nursing lobbying is somewhat out of control at times. Nurses should not pretend to be doctors; period. I also agree that they should be supervised, that just makes sense when it comes to life and death decisions. I would hope that most NP's realize the scope of their abilities and act accordingly. Yes, nurses are guilty of the attacks as well, the phrase "nurses eat their youg," comes to mind.

It is true that there is a large gap in salary for physicians in primary care as oppose to other specialties. This issue should, and needs, to be addressed if we are ever to fix our health system. But I also believe that NP's and PA's can help to fill the gap. I will also say that money is not everything, too many physicians go into medicine for the money, not the patient or their pation for their work. I believe this it the main reason why there is a lack of primary care, money.

If I go to medical school I plan on doing primary care. Lets calculate this.

220,000 in student loans.
min. 7 years of intangible value.

By the time I start paying the loans back, lets say they are at 280-300k.

Lets say my salary is 150,000.

Even if I don't take up one of the many programs of loan forgiveness that are available to MD's that want to work primary care.

I'm o.k with this. I would pay 50,000 a year for the six years it took to pay it back. I would still be ahead income wise then if I took up a none medical profession.

Doctors could go into primary care, many just get dollar signs in their eyes.

 

[Charles_Carmichael]

I think that we agree more than not. I disagree on a couple points though.

First where I agree. DNP programs, to be sure, have an agenda. That is without question. Nursing lobbying is somewhat out of control at times. Nurses should not pretend to be doctors; period. I also agree that they should be supervised, that just makes sense when it comes to life and death decisions. I would hope that most NP's realize the scope of their abilities and act accordingly. Yes, nurses are guilty of the attacks as well, the phrase "nurses eat their youg," comes to mind.

It is true that there is a large gap in salary for physicians in primary care as oppose to other specialties. This issue should, and needs, to be addressed if we are ever to fix our health system. But I also believe that NP's and PA's can help to fill the gap. I will also say that money is not everything, too many physicians go into medicine for the money, not the patient or their pation for their work. I believe this it the main reason why there is a lack of primary care, money.

If I go to medical school I plan on doing primary care. Lets calculate this.

220,000 in student loans.
min. 7 years of intangible value.

By the time I start paying the loans back, lets say they are at 280-300k.

Lets say my salary is 150,000.

Even if I don't take up one of the many programs of loan forgiveness that are available to MD's that want to work primary care.

I'm o.k with this. I would pay 50,000 a year for the six years it took to pay it back. I would stille be ahead income wise then if I took up a none medical profession.

Doctors could go into primary care, many just get dollar signs in their eyes.

There are no salaries in private practice, as far as I understand. How much you make depends on how many patients you see, procedures you do, etc. And reimbursement rates are pretty low for PCPs. So, you're already starting off with a low "salary."

After that, you also have to take into consideration the cost of overhead, malpractice insurance, etc. This will take away from your income even more.

Then, you might come to realize that you can't afford to pay off $50,000 in loans every year because of unexpected costs, needing to have a family, etc. All in all, it's very likely that it's going to take much longer for you to repay your loans.

 

[Charles_Carmichael]

Doctors could go into primary care, many just get dollar signs in their eyes.

I'm going to go ahead and call BS on that. Primary care is a mess right now with low reimbursement, NPs/DNPs pushing for more and more independent rights, having to see many patients in order to make a decent amount of money, etc. Many people just don't want to deal with this BS and it makes sense. Sure, for some people, money may be the primary motivation, but I doubt that it is for the majority. Don't just make blanket statements like that; it's similar to how NPs argue that all physicians are greedy and thus, don't want NPs/DNPs to have independent practice rights.

 

[chman]

I'm going to go ahead and call BS on that. Primary care is a mess right now with low reimbursement, NPs/DNPs pushing for more and more independent rights, having to see many patients in order to make a decent amount of money, etc. Many people just don't want to deal with this BS and it makes sense. Sure, for some people, money may be the primary motivation, but I doubt that it is for the majority. Don't just make blanket statements like that; it's similar to how NPs argue that all physicians are greedy and thus, don't want NPs/DNPs to have independent practice rights.

I am sure that it is not all physicians that think that way, of course not. But the fact is, for a many reasons, MD's are not going into primary care. Pointing the finger at NP's is not going to solve the problem. If anything, HMO's, Medicare, Insurance, Malpractice insurance, are more of an issue. You're right, primary care is the rotten apple of our health system with many complicated issues. Yet, I still believe what I said, many MD's do not go into primary because they will not have the lifestyle that they went to medical school for, aka big house, nice car, hot wife etc.

 

[fab4fan]

I think physicians would work these positions; however, in my anecdotal experience it is hard to make a good living as a rural FP. My personal physician is an internist and he works nearly every day of the week. He pulls long days at his practice, then turns around and pulls all nighters at the local ER for extra cash.

If rural FP was more appealing, I imagine more people would work in this area. Therefore I simply cannot accept your argument of "doctors should work in this area." That is like saying I as a RN should work med/surge and long term care, when I know I can make much more with fewer hours as a traveler in specialty areas (ER and remote medicine in my case).

I think we agree on many concepts, and I am not opposed to a NP per say. (Provided there is physician involvement like a PA.) However, many of the DNP proponents have a much more aggressive agenda. This agenda is what many people on this site, including nurses, oppose.

Regarding the profession attacks. Yes, there are a few people on this site who tend to go over board and berate nursing. However, the same concept occurs on nurse specific sites as well. It does not excuse this behavior; however, I realize I will deal with it while realizing the crux of the situation is where I find common ground.

Regarding the clinical experience remark: I do not want to retype one of my earlier posts; however, clinical experience as a bedside nurse is not equivalent to experience as a diagnostician. Note, I did not put my nursing experience down; however, it is not the same concept. Therefore, a nurse with 20 years of experience may be a great nurse with an incredible base of knowledge; however, this does not translate into independent provider experience. The only way to obtain the said experience is by having it as part of your education.

Ditto.

 

[chman]

I think that I have come to the following conclusions, they were all my position when I started posting on this thread, and nothing has changed. I just want to stop contributing to this as there is another thread 13 pages long on the same topic, as well as others.

1. NP's have a place in primary care, IMO, but should be supervised by a physician.

2. It is obvious that the DMP is part of an agenda that nursing lobbying is promoting.

3. In order for DNP programs to be credible, they need to maintain a standard course of study, including more clinical and diagnostic classes.

4. There are many reasons for physicians not to go into primary, however I still feel that money is a deciding factor for many.

To the OP. Go with PA for the better education, and to avoid this mess.

 

[turtle8787]

If I go to medical school I plan on doing primary care. Lets calculate this.

220,000 in student loans.
min. 7 years of intangible value.

By the time I start paying the loans back, lets say they are at 280-300k.

Lets say my salary is 150,000.

Even if I don't take up one of the many programs of loan forgiveness that are available to MD's that want to work primary care.

I'm o.k with this. I would pay 50,000 a year for the six years it took to pay it back. I would still be ahead income wise then if I took up a none medical profession.

Doctors could go into primary care, many just get dollar signs in their eyes.

This is an entirely unrealistic scenario. First if you want to pay it back in 6 years, then it would be more than 60000 a year at the current stafford rate (6.8%). Next student loan payments aren't tax deductible for a 150000 salary.

So lets estimate state and federal taxes for a single individual at 150000 income bracket to be about 28%. That means you have 108K after taxes.

108 - 60K (student loans)= 48K

You also need to save the maximum amount for retirement (currently 16500 for a 401K), considering you are starting your career almost 10 years after others started saving and physicians don't get pensions.

48-16= 32K

During med school I'm living off 15K a year, so its possible to live off this. But during med school I'm a single guy who doesn't own a car and frequently eats ramon noodle. I would hope that when I become an attending I can afford a nicer place to rent, a car, more nutritious food, and start a family (including saving for kids' college). All these goals will start to get difficult with 32K. So yes, something does have to give to get more students to choose primary care.

 

[chman]

This is an entirely unrealistic scenario. First if you want to pay it back in 6 years, then it would be more than 60000 a year at the current stafford rate (6.8%). Next student loan payments aren't tax deductible for a 150000 salary.

So lets estimate state and federal taxes for a single individual at 150000 income bracket to be about 28%. That means you have 108K after taxes.

108 - 60K (student loans)= 48K

You also need to save the maximum amount for retirement (currently 16500 for a 401K), considering you are starting your career almost 10 years after others started saving and physicians don't get pensions.

48-16= 32K

During med school I'm living off 15K a year, so its possible to live off this. But during med school I'm a single guy who doesn't own a car and frequently eats ramon noodle. I would hope that when I become an attending I can afford a nicer place to rent, a car, more nutritious food, and start a family (including saving for kids' college). All these goals will start to get difficult with 32K. So yes, something does have to give to get more students to choose primary care.

You have some good points. However, I was over-estimating how much I would take out. I also put no aid into the problem nor scholarships etc. But I am sure that we could meet somewhere in the middle as I am sure there can be add on's and deducts either way. Thanks for the feedback.

 

[wellthereitgoes]

Makes sense? Australian NP:
[YOUTUBE]http://www.youtube.com/watch?v=3yU5XQC_F6A[/YOUTUBE]

 

[deleted6669]

sounds like a fast track position in this country although 8-10 pts/shift is very slow. more typical in an 8 hr fast track setting would be 25-35 pts.
I had a slow rotation through a fast track the other day and saw 32 in 8 hrs.