ARNP Vs. MD/DO

[Zywie]

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There is a huge difference in what they can do clinically. There is maybe less difference in some states and only in a few specialities (like primary care). But overall, a large difference currently.

Training is vastly different. Like not even remotely similar.

Yes they have a doctorate. But if the training is really worthy of that title...there's quite some debate. Even if it is a legitimate doctorate, it's a bit misleading in a healthcare situation. Primarily due to the lay use of the word Doctor in those settings. Lawyers have a doctorate but no one calls them Doctor. So it's primarily semantics, but there's probably something to the thought that it can be harmful in Heath care.

It's unfortunate it's becoming an us vs them situation because there's value in the idea of a nurse practitioner. Some of the medical training is probably unnecessary in a lot of situations...and cost being a considerations...it makes sense to delegate some tasks. But the nurse lobbying, explosion of questionable programs, and more autonomy has led to quite the backlash from physicians.

I have a friend who is a lawyer and will always refer to himself as a doctor whenever our buddy who is a PA is around. My friend that is a PA is always throwing around fancy medical terms in regular conversation and it gets annoying so to rib him a bit the lawyer friend is always telling him to "leave that to the real doctor" or, my favorite is, when the PA has to sign a receipt and my lawyer friend grabs it and says "Wait, just let me sign it. Doesn't a real doctor have to sign off for you any way?"

 

[iqe2010]

I would never want a NP to be in charge of my healthcare or any of my loved ones' health.

The knowledge just isn't there. Sorry.

The argument can be made that those who major in the natural sciences (biology, chemistry, etc) know more about the human body on a molecular level than the typical RN.

 

[Psai]

First of all, nobody practices medicine this way lol. I have never seen somebody see an x-ray report showing this, followed by a "hey i'll discharge you with a diagnosis of pulmonary edema and no antibiotics or anything else". I think I did an adequate job at disproving your point that NP's have worse outcomes compared to physicians. Just look at those studies. For your N=3 or whatever it is of NP's being bad providers, I can provide you with an N=3 that shows NP provided better care than a physician did, and in some instances, diagnosed things that the physician could not diagnose.

1. We had a guy come in with a "string" sensation in the back of his throat and the NP saw him in the ER b/c it was listed as a "Foregn body sensation". He complained of a voice change the past year and half as well. She did an x-ray soft tissue of his neck, found that his trach was deviated slightly and narrow. Proceeded to CT scan him, found what the radiologist found concerning for lymphoma. Enlarged lymph nodes pressed against his vocal cords causing the voice change. Later PAN scan showed mets to the brain, and they attributed the string sensation as a hallucination. All of the physicians in the ER said that they would not have done the X-ray and further testing and would've written it off as psych because he has an extensive psych history.

2. Instance 2, patient followed-up to the ER for some random complaint of chronic back pain, but had a huuuuuge lonstanding h/o SI with attempt. When reviewing the PMHx, the NP saw him in the office multiple times the past 3-4 years, adjusted his meds (no consult made to the attending per multiple notes), and he had not had SI/depressive episode for 2 years.

3. Another PA who worked in the children's ER had a kid who had 4 days of URI sx with a vague headache. Since it was atypical and just sounded bizarre, he went with his gut, CT'ed his head, which showed a pineal gland tumor. Later oncology note stated that this explained his headaches. The physician overseeing the CHER at that time said that they would've chalked the headache up to the URI. Hell my NP dermatologist diagnosed me with a condition that affects 1 in a million and all the MD/DO's reviewed the case at Grand Rounds agreed and gave her mad props for it because they wouldn't have thought twice about it being a simple folliculitis and would've thrown me antibiotics rather than going through with a a punch biopsy.

Point is, yes NP's and PA's will not have the same knowledge base as physicians do, which is why the burden of more complex patients falls to physicians. But at the same time to think that PA's and midlevels have no place in Medicine and think that they harm patient care is absolute nonsense and BS. The future is actually pointing to a larger prevalance of midlevels in practice, esp outpatient practice. Keeping that attitude will get you absolutely **** on during your career in medicine and will probably lend you to be one of the more hated physicians in the community.

Moral of the story: order non-indicated testing in everyone because you never know what the radiologist or pathologist will diagnose for you. Thanks scribe

 

[hopefulERdoc251]

Moral of the story: order non-indicated testing in everyone because you never know what the radiologist or pathologist will diagnose for you. Thanks scribe

1. Soft tissue neck x-ray to rule out foreign body. Once he saw the trach deviated and the patient was complaining of voice changes the past however many months, he jumped at the CT scan. Not too much of a jump

2. No diagnostic testing needed on this one

3. That's clinical experience. How many doctors will throw a random scan at somebody because something doesn't seem right or their symptoms are vague and atypical. More often than not you'll find doctors doing this. But I'm sure you're well aware of this since you are a medical student, you don't need a scribe to reiterate this to you.

Also....you must be loved by your peers, professors, and coworkers eh? That's ok, radiology and pathology are still viable fields for you 🙂

 

[7331poas]

Can we lock this thread too. It's just nurses trying to incite arguments.

 

[Psai]

1. Soft tissue neck x-ray to rule out foreign body. Once he saw the trach deviated and the patient was complaining of voice changes the past however many months, he jumped at the CT scan. Not too much of a jump

2. No diagnostic testing needed on this one

3. That's clinical experience. How many doctors will throw a random scan at somebody because something doesn't seem right or their symptoms are vague and atypical. More often than not you'll find doctors doing this. But I'm sure you're well aware of this since you are a medical student, you don't need a scribe to reiterate this to you.

Also....you must be loved by your peers, professors, and coworkers eh? That's ok, radiology and pathology are still viable fields for you 🙂

Lmao go away nurse

 

[hopefulERdoc251]

Lmao go away nurse

lmfao bruh I'm starting med school next year

 

[7331poas]

lmfao bruh I'm starting med school next year

who cares. just close the thread

 

[tantacles]

This thread really isn't germane to the mission of pre-allo. Closing.