DNP student talks about how the program is a waste of time

[chajjohnson]

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http://www.np.reddit.com/r/nursing/comments/2kwk37/why_the_doctorate_of_nursing_practice_is_a_giant/

A DNP student on reddit writes about how he/she decided to become a DNP in order to learn more about pathophysiology and stuff to become a capable practitioner who could understand what physicians are doing, only to realize the DNP program is a complete sham, doesn't teach nearly enough pathophys, and is all about the title at the end. Not to mention that the "research" they have you do to become a "doctor" is total BS. A nice read and a refreshing perspective from someone who really seems to care about the patients first and foremost, not about perceived respect and autonomy.

I know we on SDN already preach this stuff everyday, but its nice to know that some people in the DNP program are capable of realizing what a joke their programs are. I love reading stuff like this because I really despise these programs also. Does anyone else know of any examples like this?

 

[cbrons]

k

 

[Psai]

Yeah there's this thing that's pretty similar, it's called med school

 

[Perrotfish]

No on thinks the 'Doctorate' part of the DNP is anything more than it is : a marketing scheme to take the title of doctor away from physicians. Physicians think that its a bogus attempt by NPs to establish parity with physicians, NPs think its attempt to eliminate a bogus distinction between two equivalent professions, but everyone knows its a marketing scheme.

Its not like trying to glom on to another profession is a new thing in Medicine. We're all still wearing white coats because someone decided that dressing like lab techs would make us look more scientific.

 

[DermViser]

No on thinks the 'Doctorate' part of the DNP is anything more than it is : a marketing scheme to take the title of doctor away from physicians. Physicians think that its a bogus attempt by NPs to establish parity with physicians, NPs think its attempt to eliminate a bogus distinction between two equivalent professions, but everyone knows its a marketing scheme.

Its not like trying to glom on to another profession is a new thing in Medicine. We're all still wearing white coats because someone decided that dressing like lab techs would make us look more scientific.

Yup, it's a well known phenomenon called degree creep.

 

[Successful BM]

It's actually quite refreshing reading the comments. If the sample population in this thread is any indication, the vast majority of NPs acknowledge that DNP programs are bogus. It's only the vocal minority that wants to make DNPs equivalent to MD/DOs.

 

[chajjohnson]

No on thinks the 'Doctorate' part of the DNP is anything more than it is : a marketing scheme to take the title of doctor away from physicians. Physicians think that its a bogus attempt by NPs to establish parity with physicians, NPs think its attempt to eliminate a bogus distinction between two equivalent professions, but everyone knows its a marketing scheme.

Its not like trying to glom on to another profession is a new thing in Medicine. We're all still wearing white coats because someone decided that dressing like lab techs would make us look more scientific.

By "no one" you are only referring to people in health care, specifically NPs and physicians. Of course these people know what a sham these programs are. The real problem is when the general public doesn't understand that 4 years of DNP school does not equal 4 years of clinical training. DNPs are using their program to leverage for autonomy and increased care privileges, while convincing the general public they are as good as physicians, and most people not in the know believe them.

The other big issue here is that many states are allowing DNPs to become independent practitioners, mostly as a "solution" to the primary care shortage. The politicians making these laws know DNPs are inferior and would probably never see them themselves, but because their constituents believe that DNPs are as good they are allowing them to become independent.

 

[Pacna]

The other big issue here is that many states are allowing DNPs to become independent practitioners, mostly as a "solution" to the primary care shortage. The politicians making these laws know DNPs are inferior and would probably never see them themselves, but because their constituents believe that DNPs are as good they are allowing them to become independent.

I will always support the removal of coercive forces. Physicians using the government to enforce their quasi-monopoly, however good for patient outcomes (which I think is reasonable to assume, but time will tell) is wrong. Hell, if chiropractors can tell people they can cure them of bed-wetting with a massage, then I don't see how even semi-trained medical professionals administering primary care is any kind of negative precedent.

People can choose for themselves whether to see a doc or not. I think choosing a shaman to treat your cancer over an oncologist is a hilariously/tragically bad idea, but it should be your choice, not mine. You know that woman who took her life today as a part of the Right to Die act? She still had to get "permission." It's about time we showed some real respect for patients and "let" them choose not only which physician to see, but whether to see physicians at all.

 

[seminoma]

http://www.np.reddit.com/r/nursing/comments/2kwk37/why_the_doctorate_of_nursing_practice_is_a_giant/

A DNP student on reddit writes about how he/she decided to become a DNP in order to learn more about pathophysiology and stuff to become a capable practitioner who could understand what physicians are doing, only to realize the DNP program is a complete sham, doesn't teach nearly enough pathophys, and is all about the title at the end. Not to mention that the "research" they have you do to become a "doctor" is total BS. A nice read and a refreshing perspective from someone who really seems to care about the patients first and foremost, not about perceived respect and autonomy.

I know we on SDN already preach this stuff everyday, but its nice to know that some people in the DNP program are capable of realizing what a joke their programs are. I love reading stuff like this because I really despise these programs also. Does anyone else know of any examples like this?

Inb4 Reddit OP is a med student.

 

[Baller MD]

I will always support the removal of coercive forces. Physicians using the government to enforce their quasi-monopoly, however good for patient outcomes (which I think is reasonable to assume, but time will tell) is wrong. Hell, if chiropractors can tell people they can cure them of bed-wetting with a massage, then I don't see how even semi-trained medical professionals administering primary care is any kind of negative precedent.

People can choose for themselves whether to see a doc or not. I think choosing a shaman to treat your cancer over an oncologist is a hilariously/tragically bad idea, but it should be your choice, not mine. You know that woman who took her life today as a part of the Right to Die act? She still had to get "permission." It's about time we showed some real respect for patients and "let" them choose not only which physician to see, but whether to see physicians at all.

Your logic supports people's right not to vaccinate their kids.

 

[hallowmann]

I will always support the removal of coercive forces. Physicians using the government to enforce their quasi-monopoly, however good for patient outcomes (which I think is reasonable to assume, but time will tell) is wrong. Hell, if chiropractors can tell people they can cure them of bed-wetting with a massage, then I don't see how even semi-trained medical professionals administering primary care is any kind of negative precedent.

People can choose for themselves whether to see a doc or not. I think choosing a shaman to treat your cancer over an oncologist is a hilariously/tragically bad idea, but it should be your choice, not mine. You know that woman who took her life today as a part of the Right to Die act? She still had to get "permission." It's about time we showed some real respect for patients and "let" them choose not only which physician to see, but whether to see physicians at all.

She had to get permission because she was seeking a specific type of "treatment" from a physician. Last I checked we still have to determine whether certain treatments are permissible for certain patients. I don't think anyone would have complained or need to give her permission if she decided to commit suicide by her own means.

 

[chajjohnson]

I will always support the removal of coercive forces. Physicians using the government to enforce their quasi-monopoly, however good for patient outcomes (which I think is reasonable to assume, but time will tell) is wrong. Hell, if chiropractors can tell people they can cure them of bed-wetting with a massage, then I don't see how even semi-trained medical professionals administering primary care is any kind of negative precedent.

People can choose for themselves whether to see a doc or not. I think choosing a shaman to treat your cancer over an oncologist is a hilariously/tragically bad idea, but it should be your choice, not mine. You know that woman who took her life today as a part of the Right to Die act? She still had to get "permission." It's about time we showed some real respect for patients and "let" them choose not only which physician to see, but whether to see physicians at all.

You are putting way too much confidence in the average person's ability to critically examine scientific evidence regarding health care. The average person will believe anything anyone wearing a white coat says, and having more letters after your name is even better. Most people in a clinic don't have any idea of the qualifications or the education of the person examining them, they just believe what they say because they trust our healthcare system will only allow qualified people to take care of them. Not to mention the fact that DNPs are cheaper and have a shorter wait time, seeing a DNP is a no-brainer for most people because they assume they are as qualified as physicians.

The problem here is not in giving people a choice, the problem is that inferior options (naturopathy, chiropracty, DNP, etc) are being portrayed as equal to care by a physician. Because of this, patients are not given enough information to make a good choice.

 

[fancymylotus]

I should get an "opthalmic dispenser" license plate. lmao

http://dmv.ny.gov/custom-plates/optometristophthalmic-dispenseroptician

 

[W19]

I should get an "opthalmic dispenser" license plate. lmao

http://dmv.ny.gov/custom-plates/optometristophthalmic-dispenseroptician

Lol...

 

[Pacna]

Your logic supports people's right not to vaccinate their kids.

I don't agree. People are not free to harm their children (or anyone else, for that matter), only themselves.

She had to get permission because she was seeking a specific type of "treatment" from a physician. Last I checked we still have to determine whether certain treatments are permissible for certain patients. I don't think anyone would have complained or need to give her permission if she decided to commit suicide by her own means.

No doubt that physicians are obligated to be certain in situations like this for a moral decision to be made by the physician. I'm suggesting that the patient should not have to pursue

You are putting way too much confidence in the average person's ability to critically examine scientific evidence regarding health care. The average person will believe anything anyone wearing a white coat says, and having more letters after your name is even better. Most people in a clinic don't have any idea of the qualifications or the education of the person examining them, they just believe what they say because they trust our healthcare system will only allow qualified people to take care of them. Not to mention the fact that DNPs are cheaper and have a shorter wait time, seeing a DNP is a no-brainer for most people because they assume they are as qualified as physicians.

The problem here is not in giving people a choice, the problem is that inferior options (naturopathy, chiropracty, DNP, etc) are being portrayed as equal to care by a physician. Because of this, patients are not given enough information to make a good choice.

I agree with everything you said except your last sentence and your conclusion. People (in the US, for the most part) have all of human knowledge at their fingertips. You strip people of respect and moral responsibility when you suggest that they do not have the mental capacity to critically think well enough to make informed decisions. Certainly there are exceptions, but those people are relatively few and relatively easily identified (mentally handicapped, intoxicated, etc).

But my point is not that I have a solution. I am pointing out a fundamental wrong inherent in today's model of medicine. Physicians maintain their privileged position through the coercive force of government. Individually, they are highly valuable and typically moral experts which only fools would ignore, but as a group, they have the most stunning disrespect for the people they care for.

My stepfather tried acupuncture to try to alleviate the pain stemming from spinal stenosis. I didn't petition the government to regulate what the acupuncturist could say or do. My stepfather has the capacity to make his own choices and do his own research (and he'd tell you himself that he's not the brightest bulb). There is no question in my mind (again, this remains untested) that patients will receive poorer care in the hands of a DNP. That's their decision. If established medicine is superior, it will be chosen through natural competition. On the other hand, I'd have no problem (personally) seeing a DNP for small things like vaccinations or prescription refills.

 

[darklabel]

I prefer NPs over doctors when it comes to primary care because they generally have more time available, tend to be more open, communicative, understanding, and thoughtful about social and community factors in connection with one's health. However, how much education do we really need shoved down our throats' about how socioeconomics and culture affect the body? If the DNP had reached its full potential of being a MEDICAL EDUCATION to supplement the NURSING FOUNDATIONS that I have already studied for 6 years, then it would be an excellent addition to what is already an incredible profession.

This crap is ridiculous. First off nurses can fully get an MD education if they wanted to (and plenty do) so I don't see why DNP has to mirror MD schools, when the alternative already exists. Or oh wait, it's because it is easier to get into a DNP program than to work hard to get into an MD or DO program. We have studied for 8+ years so idk how your 6 years is any different (including a watered down version of our pre-reqs).

Also, I'm sick of hearing how DNP's are God's angels and listen to the patient and are in tune with one's health vs the community and blah blah blah. Seriously, medical students have to learn the amount of **** we do as well as learn all the fluffy stuff they do as well starting as a first year and on.

But whatever, everyone deserves the autonomy of a physician with half the work these days.

/rant

 

[chajjohnson]

I agree with everything you said except your last sentence and your conclusion. People (in the US, for the most part) have all of human knowledge at their fingertips. You strip people of respect and moral responsibility when you suggest that they do not have the mental capacity to critically think well enough to make informed decisions. Certainly there are exceptions, but those people are relatively few and relatively easily identified (mentally handicapped, intoxicated, etc).

But my point is not that I have a solution. I am pointing out a fundamental wrong inherent in today's model of medicine. Physicians maintain their privileged position through the coercive force of government. Individually, they are highly valuable and typically moral experts which only fools would ignore, but as a group, they have the most stunning disrespect for the people they care for.

My stepfather tried acupuncture to try to alleviate the pain stemming from spinal stenosis. I didn't petition the government to regulate what the acupuncturist could say or do. My stepfather has the capacity to make his own choices and do his own research (and he'd tell you himself that he's not the brightest bulb). There is no question in my mind (again, this remains untested) that patients will receive poorer care in the hands of a DNP. That's their decision. If established medicine is superior, it will be chosen through natural competition. On the other hand, I'd have no problem (personally) seeing a DNP for small things like vaccinations or prescription refills.

Have you spent much time with people outside of your undergrad science and med school classes? Most of my med school class, me included, doesn't really understand the metrics going into measuring patient care and health care efficiency. You think the average person off the street is going to be able to look at a clinical study and gain any valuable info from that? The fact is, understanding clinical data is almost impossible for anyone who hasn't spent years studying medical science. All of the papers out there saying DNPs are just as good as physicians use sub-standard, BS metrics, but you would only know that if you had an MD or similar degree. If the average person reads a study like that they will think that DNPs have been proven as effective as physicians, when that is far from the truth. It is not the patient's job to interpret clinical data to see who is a capable provider. It should be the job of our healthcare system to not allow misleading info like that to be published.

The people who believe in homeopathy and not vaccinating their children were given the freedom to choose for themselves based on information they had read. Do you really think that is the best option? You act like everyone will use rational, critical thinking when deciding on their medical care, but that is not how people work. Plus, most people aren't even equipped with the educational background to understand any of this stuff. Have you ever tried to speak with a high-school dropout about their health care? They understand literally nothing, except for what they hear on TV from Dr. Oz. Expecting them to do extensive research on treatments and make well-informed decisions is crazy. Besides, most people don't want the responsibility of figuring this stuff out on their own. They believe that is what the healthcare system is for.

 

[W19]

Also, I'm sick of hearing how DNP's are God's angels and listen to the patient and are in tune with one's health vs the community and blah blah blah. Seriously, medical students have to learn the amount of **** we do as well as learn all the fluffy stuff they do as well starting as a first year and on.

But whatever, everyone deserves the autonomy of a physician with half the work these days.

/rant

Half of the work? I suggest you take a look at the curriculum of some of the best NP schools. My cousin became an NP and she never took chemistry or true biology classes... Again, maybe these courses are not important to be an effective clinician... I don't know... I have to wait until I become an attending to at least appreciate the importance of these basic science classes...

 

[Pacna]

Have you spent much time with people outside of your undergrad science and med school classes? Most of my med school class, me included, doesn't really understand the metrics going into measuring patient care and health care efficiency. You think the average person off the street is going to be able to look at a clinical study and gain any valuable info from that? The fact is, understanding clinical data is almost impossible for anyone who hasn't spent years studying medical science. All of the papers out there saying DNPs are just as good as physicians use sub-standard, BS metrics, but you would only know that if you had an MD or similar degree. If the average person reads a study like that they will think that DNPs have been proven as effective as physicians, when that is far from the truth. It is not the patient's job to interpret clinical data to see who is a capable provider. It should be the job of our healthcare system to not allow misleading info like that to be published.

The people who believe in homeopathy and not vaccinating their children were given the freedom to choose for themselves based on information they had read. Do you really think that is the best option? You act like everyone will use rational, critical thinking when deciding on their medical care, but that is not how people work. Plus, most people aren't even equipped with the educational background to understand any of this stuff. Have you ever tried to speak with a high-school dropout about their health care? They understand literally nothing, except for what they hear on TV from Dr. Oz. Expecting them to do extensive research on treatments and make well-informed decisions is crazy. Besides, most people don't want the responsibility of figuring this stuff out on their own. They believe that is what the healthcare system is for.

I don't suggest that removing force from the equation will equate to better patient outcomes. In fact, I indicated twice that I thought the opposite would be true (agreed with your assumption)! I only assert that it is the moral thing to do.

 

[Jwalker]

This is self inflicted. Primary care settings with MDs doing paperwork in the back while they have 4 NPs see the actual patients are very prevalent in my state and are becoming the norm. No one to blame but themselves.

 

[Promethean]

I don't suggest that removing force from the equation will equate to better patient outcomes. In fact, I indicated twice that I thought the opposite would be true (agreed with your assumption)! I only assert that it is the moral thing to do.

You are an idealist, which is great. I am not knocking it by naming it, since I am one, too. But ideals can conflict, with each other and with reality, so it is important to temper them with practicality.

You value personal freedom as an absolute good, and rank its importance above public health. You would rather see people injured by their choices than limit their freedom to make those choices. A lot of people find it immoral to accept widespread harm to result from unrestricted freedom. They think that the benefits of setting some parameters on behavior outweigh the harm this does. Either position taken to its natural extreme would alienate everyone on the other side, so there has to be some compromise so that we can get along with one another. This is my friendly reminder to everyone that it is election day for many of us, so it is your chance to exercise your right to attempt to inflict your preferences upon the republic. =)

 

[Promethean]

Back to the topic! As for the value of the DNP? This is going to be long, but it is a topic near and dear to me, and OP was looking for more like this:

I didn't finish my BSN because of what nursing education turns into beyond the Diploma/Associates level. Those underrated two year programs are intensely focused on clinical care of patients, you know, nursing. I thought that continuing my education as a nurse would make me better at caring for patients. Instead, I found that the programs veer sharply away from clinical practice, and begin to be about administration, "research," and otherwise escaping from bedside care of patients. The coursework became a lot of paperwork and no additional clinical enhancement. I was 11 credits from completing it, but I couldn't make myself do one more literature review project dressed up as research. To get the bachelor's degree that I need to matriculate, I instead enrolled in an online business administration program that required me to do an extra 90 credits, which was made easier than 11 credits of nursing because it wasn't just busywork. I actually learned some things of value to my future practice.

I have friends in NP programs who are in despair because they thought that they would get more of a clinical education. While there has been a review of topics previously covered in their first 2-4 years of nursing education, they also have had their time wasted with many projects and papers that bear no relevance to patient care. Even their clinical component involves doing "literature reviews on best practices that could be implemented to solve problems identified by hospital administration" ...an unnecessary distraction from learning how to manage the care of patients. DNP just seems to be more of the same, but without any pretense of clinical training. I am left to conclude that the good NPs that I know got that way through their own initiative, in spite of their programs.

The best RNs, for doing the actual, dirty, terribly undervalued work of nursing, are the ones from Diploma or Associates programs. They get more clinical training than 4 year university nurses, and they don't think they are too good to care for patients. But, they are told that they aren't qualified enough, aren't educated enough, that to be worthy as a nurse, they need to get on the nursing degree treadmill. The hospital wants to be able to brag that all of their nurses are BSNs or better, as if that is a quality measure. The more we hold up number of years of study as the sole measure of value, the more pressure we add to this system to continue. A diploma-trained nurse is more prepared to work than one that went to a BSN program to get their RN, right out of the door. From that point on, years of experience are what improve the quality of a nurse, not years of further education.

I'm getting out of the profession entirely because I don't want to be pushed away from the bedside. Advancement up the nursing ladder leads inexorably away from patient care. It is emotionally and physically demanding work that is done under a barrage of disrespect from patients, administration, and many of the other professionals with whom we work. (Just today, I was berated by one doctor for not knowing where another doctor was, and then when the errant one showed up, he also abused me for not having left my post to find him to tell him that the first one had wanted him. I'm not either's secretary and they both have phones. I'm expected to be the adult and forgive all the little slights, to refocus these grown men on the fact that we are all here for the patient, and could we get back to the job at hand, please.) Even so, even with every annoyance and frustration, every filthy thing that is my problem to clean, every transfer I have to do alone... I love taking care of patients. I love helping them. And most avenues of nursing education would only take that away from me.

(Some advanced practice RNs do eventually get back to patient care in their practice, but I don't want to do all that is required along the way, just to end up still in a subordinate role. And while there are places where I could practice independently in those roles, I wouldn't feel confident to do without a more clinically rigorous program than the one's I've seen.)

 

[W19]

I'm getting out of the profession entirely because I don't want to be pushed away from the bedside. Advancement up the nursing ladder leads inexorably away from patient care. It is emotionally and physically demanding work that is done under a barrage of disrespect from patients, administration, and many of the other professionals with whom we work. (Just today, I was berated by one doctor for not knowing where another doctor was, and then when the errant one showed up, he also abused me for not having left my post to find him to tell him that the first one had wanted him. I'm not either's secretary and they both have phones. I'm expected to be the adult and forgive all the little slights, to refocus these grown men on the fact that we are all here for the patient, and could we get back to the job at hand, please.) Even so, even with every annoyance and frustration, every filthy thing that is my problem to clean, every transfer I have to do alone... I love taking care of patients. I love helping them. And most avenues of nursing education would only take that away from me.

(Some advanced practice RNs do eventually get back to patient care in their practice, but I don't want to do all that is required along the way, just to end up still in a subordinate role. And while there are places where I could practice independently in those roles, I wouldn't feel confident to do without a more clinically rigorous program than the one's I've seen.)

I used to work in a hospital setting and I sometimes really felt sorry for the nurses... The abuse you guys/gals are able to tolerate is unbelievable.

 

[Promethean]

I used to work in a hospital setting and I sometimes really felt sorry for the nurses... The abuse you guys/gals are able to tolerate is unbelievable.

It isn't possible if you let your own ego get in the way. You have to stay focused on the mission, the patient.

The problem with that is when everyone gets so good at tolerating the intolerable for the sake of the mission, that they forget that doing so was supposed to be a stopgap measure. That is when you get an entrenched culture where chronic misbehavior is tolerated and passive acceptance is rewarded.

 

[Jabbed]

The comments on that article are pretty interesting. There's pretty unanimous disregard for the DNP programs by the students themselves:

"I should've been a PA."
"This is why I'm bailing on advanced nursing practice and going to medical school. I really would do DNP if it had any fortitude.... it's a real shame. It's nothing personal against NPs, I just would prefer the extra education."

"What I'm saying is a paramedic with 5 years of paramedic experience understood pathophysiology better than the master's prepared nurse practitioners that were supposed to be teaching us."
"Can confirm. Am a paramedic in an accelerated MEPN program. My paramedic skills/pharm/patho/practical real life patient care training >>>> masters level nurse skills training. However... I can now write in APA like a mofo"

"I agree with a lot of what you said. I am a masters prepared FNP and I was absolutely HORRIFIED with my NP program. It was a complete joke and not clinically based. The professors were so lazy they barely even taught, all they did was break us up into groups and assign each group a topic and then we were supposed to 'teach eachother'. We barely even learned what diagnostic tests to order for what. I now feel like I am a competent NP (5 years out of school) but the first few years were scary and almost all of my education and NP skills were self taught. I agree the DNP is a 'fluffy' degree, basically since PTs and MDs have doctorates they just came out with a silly way to make us sound higher educated. What they need to do is really work on creating better NP educators which will in turn created better NP programs."

 

[Pacna]

You are an idealist, which is great. I am not knocking it by naming it, since I am one, too. But ideals can conflict, with each other and with reality, so it is important to temper them with practicality.

You value personal freedom as an absolute good, and rank its importance above public health. You would rather see people injured by their choices than limit their freedom to make those choices. A lot of people find it immoral to accept widespread harm to result from unrestricted freedom. They think that the benefits of setting some parameters on behavior outweigh the harm this does. Either position taken to its natural extreme would alienate everyone on the other side, so there has to be some compromise so that we can get along with one another. This is my friendly reminder to everyone that it is election day for many of us, so it is your chance to exercise your right to attempt to inflict your preferences upon the republic. =)

I don't value personal freedom as an absolute good. Murderers are "personally free" until they get caught. I value the principle of non-aggression as an absolute good, something I would be breaking by voting.

~60%+ of people vote for Nobody every year. That's who I'm voting for. Nobody is my candidate who wins every year, and yet you force your candidate, who was not supported by the majority, on us. Friendly reminder my ass.

 

[Psai]

This is self inflicted. Primary care settings with MDs doing paperwork in the back while they have 4 NPs see the actual patients are very prevalent in my state and are becoming the norm. No one to blame but themselves.

It's not self inflicted. It's the reality of trying to keep your doors open in the face of onerous government regulations and mandates such as the purchase of an expensive and crappy emr with declining reimbursements and a sicker, older population

You've obviously spent zero time actually trying to run a private practice

 

[fancymylotus]

It's not self inflicted. It's the reality of trying to keep your doors open in the face of onerous government regulations and mandates such as the purchase of an expensive and crappy emr with declining reimbursements and a sicker, older population

You've obviously spent zero time actually trying to run a private practice

what a ****ing headache that is, even in the dental world.

 

[fancymylotus]

I don't value personal freedom as an absolute good. Murderers are "personally free" until they get caught. I value the principle of non-aggression as an absolute good, something I would be breaking by voting.

~60%+ of people vote for Nobody every year. That's who I'm voting for. Nobody is my candidate who wins every year, and yet you force your candidate, who was not supported by the majority, on us. Friendly reminder my ass.

still pissed that mittens didn't win. nobama and his nobamacare, just ugh

 

[Pacna]

still pissed that mittens didn't win.

Haha. Said no one ever.

 

[Baller MD]

Haha. Said no one ever.

still pissed that mittens didn't win.

 

[fancymylotus]

still pissed that mittens didn't win.

I like you

 

[fancymylotus]

GOP 4 seats away from senate majority! Let's GO

 

[Siggy]

GOP 4 seats away from senate majority! Let's GO

Which will still result in practically nothing. A simple majority won't result in the repeal of Obama Care.

 

[fancymylotus]

Which will still result in practically nothing. A simple majority won't result in the repeal of Obama Care.

Wishful thinking >< don't rain on my parade Eeyore 🙂

 

[Baller MD]

Which will still result in practically nothing. A simple majority won't result in the repeal of Obama Care.

Yeah but at least they'll give him hell during his last 2 years as presidente.

 

[Baller MD]

I like you

I like you too.

Why can't more female med students be like you (ie NOT omg everyone should get free health care and we should work for free). Totally srs.

 

[fancymylotus]

I like you too.

Why can't more female med students be like you (ie NOT omg everyone should get free health care and we should work for free). Totally srs.

I'm sure some of them are like me, but they choose to hide behind the "lets work for nothing and save the world" crap bc it "sounds good" and "looks empathetic" or whatever. Real life (and private practice/running a business) kicks those thoughts out of your head really fast.

 

[Jwalker]

It's not self inflicted. It's the reality of trying to keep your doors open in the face of onerous government regulations and mandates such as the purchase of an expensive and crappy emr with declining reimbursements and a sicker, older population

You've obviously spent zero time actually trying to run a private practice

No one put a gun to their head and forced them to hire NPs. I hear PAs are pretty good at what they do.
Like I said. Self inflicted.

 

[DermViser]

This is self inflicted. Primary care settings with MDs doing paperwork in the back while they have 4 NPs see the actual patients are very prevalent in my state and are becoming the norm. No one to blame but themselves.

You obviously know nothing in terms of a private practice primary care office and what is needed just to keep the lights on in the world of increasing regulatory burden, ever decreasing reimbursement, and increasing documentation requirements to get reimbursed. While it's easy as a medical student to blame primary care physicians themselves, you are 100% wrong.

How would hiring PAs vs. NPs make any difference?

 

[Jwalker]

You obviously know nothing in terms of a private practice primary care office and what is needed just to keep the lights on in the world of increasing regulatory burden, ever decreasing reimbursement, and increasing documentation requirements to get reimbursed. While it's easy as a medical student to blame primary care physicians themselves, you are 100% wrong.

How would hiring PAs vs. NPs make any difference?

I think you're arguing a different point than I am. But to put it on a very broad/general/politically incorrect way - PAs are more of an ally whereas NPs are more of an enemy to the primary care doc.

 

[DermViser]

I think you're arguing a different point than I am. But to put it on a very broad/general/politically incorrect way - PAs are more of an ally whereas NPs are more of an enemy to the primary care doc.

PAs are only an ally bc they fall under the medical board in terms of licensing and they are designed specifically to be under physicians - without which they can not practice. NPs fall under the nursing board and thus are under no control from the medical board. It's not like PAs are running to primary care in droves - they want to be specialists also. The govt. is the one dictating that more patients be seen by midlevels. Don't blame docs who are only trying to keep their private practice afloat for that.

Primary care physicians are only adjusting to the reality rather than fight every battle like Don Quixote.

 

[Promethean]

I think you're arguing a different point than I am. But to put it on a very broad/general/politically incorrect way - PAs are more of an ally whereas NPs are more of an enemy to the primary care doc.

More unwarranted nurse-bashing?

You know what I have noticed? Since finding out that I was applying to medical school... forget even accepted, just applying, some physicians who have been very adversarial to me have suddenly turned into mentors, pimping me in clincial situations as if I were one of their residents. I'm precisely the same person I was for those years before... just now they consider me an up and coming member of their guild rather than a member of the enemy camp.

Speaking of self-inflicted: maybe that us vs. them mentality is part of the problem. Even a little mutual respect would go so far.

EDIT: If you want to criticise the education provided by many NP programs, I will agree with you. But categorical demonization of other professionals because of your own insecurities? Lame.

 

[Jwalker]

PAs are only an ally bc they fall under the medical board in terms of licensing and they are designed specifically to be under physicians - without which they can not practice. NPs fall under the nursing board and thus are under no control from the medical board. It's not like PAs are running to primary care in droves - they want to be specialists also. The govt. is the one dictating that more patients be seen by midlevels. Don't blame docs who are only trying to keep their private practice afloat for that.

Primary care physicians are only adjusting to the reality rather than fight every battle like Don Quixote.

That's dandy and all. I still maintain that a practice can be kept afloat without 4 NPs. You're free to disagree

 

[DermViser]

That's dandy and all. I still maintain that a practice can be kept afloat without 4 NPs. You're free to disagree

So what do you want? 4 PAs instead? It's a distinction without a difference.

 

[W19]

So what do you want? 4 PAs instead? It's a distinction without a difference.

4 PAs or NPs per physician! That seems to be profit driven to me... My cousin keeps his practice afloat with no midlevels... He is not convinced that they should practice medicine at all.

 

[DermViser]

4 PAs or NPs per physician! That seems to be profit driven to me... My cousin keeps his practice afloat with no midlevels... He is not convinced that they should practice medicine at all.

You are free as a primary care physician (who does not do procedures) to see patients from 8 am to 6 pm, with all the ridiculous documentation, preauthorizations, lab followups, call backs keeping you long after hours to finish. I do not criticize outpatient primary care physicians who feel burned out from a lifestyle standpoint and cut back on the number of patients they see, while still having to stay afloat. It's any wonder concierge/direct pay medicine has taken off (much to the chagrin of the govt. I'm sure). I realize we'll disagree, you see them as being selfish or "profit driven", I don't.

 

[Jabbed]

4 PAs or NPs per physician! That seems to be profit driven to me... My cousin keeps his practice afloat with no midlevels... He is not convinced that they should practice medicine at all.

The general heart of the issue in those situations is that if you have high fixed costs and increasingly smaller marginal profits (not diminishing returns, just smaller ones), then the only way to keep your practice afloat is by increasing your own efficiency and hiring mid-levels to do mid-level work. There's absolutely nothing wrong with that from a medical or financial standpoint. The issue is that patients invariably receive more face time with the NP than they do with the MD/DO. The doctor is seen as someone that's always inaccessible and therefore disinterested in the patient. The NP, however, is always there for the patient. This is exactly the point where a wedge is driven between the patient-physician interaction, and the patient becomes more inclined to trust the NP's judgement over the physician's.

 

[W19]

You are free as a primary care physician (who does not do procedures) to see patients from 8 am to 6 pm, with all the ridiculous documentation, preauthorizations, lab followups, call backs keeping you long after hours to finish. I do not criticize outpatient primary care physicians who feel burned out from a lifestyle standpoint and cut back on the number of patients they see, while still having to stay afloat. It's any wonder concierge/direct pay medicine has taken off (much to the chagrin of the govt. I'm sure). I realize we'll disagree, you see them as being selfish or "profit driven", I don't.

If a physician can supervise 4 midlevel providers without exposing him/herself to malpractice lawsuits, good for him/her... I won't do it however.

 

[DermViser]

If a physician can supervise 4 midlevel providers without exposing him/herself to malpractice lawsuits, good for him/her... I won't do it however.

He's not really supervising. It's not like he's looking over their shoulder. It's essentially post-visit chart review. They are free to expose their medical license to that level of malpractice. Personally, it would be something I would be very uncomfortable with.