DNPs will eventually have unlimited SOP

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How does the government just allow the nursing boards to have free reign like that? What's the point of licensing then, if one profession can just start giving out licenses allowing their members to perform the work of another profession? Why even have boards or licenses?

Because the nursing lobby is good at brib--er, offering "campaign contributions" to the right people. AMERICA

 

[Lokhtar]

How does the government just allow the nursing boards to have free reign like that? What's the point of licensing then, if one profession can just start giving out licenses allowing their members to perform the work of another profession? Why even have boards or licenses?

Well, physicians also self-regulate.....

 

[valkener]

Not only is the nursing lobby superior and powerful, physicians are down-right pathetic at lobbying.

Physicians have taken the role of "do no evil" and hope for the best by staying out of politics and "focusing on the patient."

It's time to put the fut down, mild-level encroachment is happening every day and the boundaries are less clear than ever.

 

[deleted6669]

How does the government just allow the nursing boards to have free reign like that? What's the point of licensing then, if one profession can just start giving out licenses allowing their members to perform the work of another profession? Why even have boards or licenses?

the np's claim they don't practice medicine, they practice "advanced nursing" (which is whatever they say it is whether that be anesthesiology, critical care, dermatology, etc).

 

[Rendar5]

This quote is ridiculous. I am a 4th year medical student just finishing my IM Sub-I. There was a 2nd year PA student there who will be a "midlevel" in a few short months. My medical knowledge and clinical/procedural skills DESTROY her in EVERY way. I knew more than her in EVERY area of medicine, and she commonly came to me for advice in her workups. There is absolutely no comparison between her education and mine. A 4th year medical student clearly commands a greater fund of medical knowledge than any midlevel could hope to have.

Congratulations on being able to destroy a PA student as a med student. That's not the apt comparison. The average midlevel isn't usually fresh from school, and they won't compare to the averge doctor, who also isn't fresh from school. But the average midlevel is usually better than the person still in school or just graduate from school because they've been working for awhile.

I still work with residents every days, and junior residents still fail to have the clinical acumen, speed, and overall ability to manage patient care that experienced midlevels have. And they have very little clue that they're not that good yet. It's not until someone's a senior resident that they realize how much of an "idiot" they were as an intern or as a medical student. I promise you, as soon as you start 2nd year in your field, you will look at the interns and think "oh my god, that was me last year"

 

[cbrons]

organized medicine has zero control over np's or nurses as they self regulate under the boards of nursing.
pa's are regulated by boards of medicine. we can't just decide tomorrow " pa's can now do brain surgery solo". if one np program found 1 neurosurgeon to train them as primary surgeons they could then put out a statement that "np's practice cutting edge neurosurgery" and set up a residency in which neurosurg np's train neurosurg np's. it would just take 1 hospital to privilege them and voila, np's doing neurosurgery supported by crna's .
check this out:
http://www.ena.org/media/PressReleases/Pages/ANCC and ENA Announce New Portfolio.aspx
compare that to the steps a pa needs to take to qualify to take the certificate of added qualifications exam in emergency medicine:
http://www.nccpa.net/Emergencymedicine.aspx
note in both of the above who validates the procedural requirements.....

NPs will eventually be doing faux surgical residencies. All who say it will never happen dont realize the upside down topsy turvey world we live in. The only Q is who will the turncoats be that train them.

It's time to put the fut down, mild-level encroachment is happening every day and the boundaries are less clear than ever.

I agree

 

[deleted6669]

pa's also have available residencies but the pa's in these residencies are taught by physicians to augment their services, not replace them. pa's are taught to first assist in the o.r. for example, not to be the primary surgeon.
pa residencies/fellowships/postgrad programs here for those interested:
www.appap.org

 

[kpcrew]

I actually know a few folks who tried for years to get into pa school then applied md to their state schools and got in their first cycle. it works both ways. the schools look for different things. md/do want stellar grades/research/high mcats, etc. while pa programs want different prereqs and place a lot of value on significant prior high level paid medical experience. a guy with a 4.0 and a first author publication based on ms level basic science research but zero pt care experience probably won't get into pa school. a 10 yr paramedic with 2 tours in Afghanistan and a 3.5 with a bs in medical anthropology and 2 yrs teaching paramedics probably won't get into med school.

you can relax now shrunek

 

[peteB]

Well, physicians also self-regulate.....

Yeah but they don't give themselves the authority to do things outside the scope of medicine. Nursing boards are giving nurses the authority to go outside the scope of nursing and practice medicine.

 

[peteB]

NPs will eventually be doing faux surgical residencies. All who say it will never happen dont realize the upside down topsy turvey world we live in. The only Q is who will the turncoats be that train them.


[/B]

I agree

If they are willing to pay big bucks for the training they will surely find a large number of surgeons willing to do it.

 

[peteB]

Not only is the nursing lobby superior and powerful, physicians are down-right pathetic at lobbying.

Physicians have taken the role of "do no evil" and hope for the best by staying out of politics and "focusing on the patient."

It's time to put the fut down, mild-level encroachment is happening every day and the boundaries are less clear than ever.

Also, there are some spineless physician traitors who not only won't stand up against the mid-levels but are actually supporting them. Haven't heard of any mid-levels supporting physicians, though. No wonder they are gaining on us.

 

[calvnandhobbs68]

I actually know a few folks who tried for years to get into pa school then applied md to their state schools and got in their first cycle. it works both ways. the schools look for different things. md/do want stellar grades/research/high mcats, etc. while pa programs want different prereqs and place a lot of value on significant prior high level paid medical experience. a guy with a 4.0 and a first author publication based on ms level basic science research but zero pt care experience probably won't get into pa school. a 10 yr paramedic with 2 tours in Afghanistan and a 3.5 with a bs in medical anthropology and 2 yrs teaching paramedics probably won't get into med school.

I actually think the second guy would have a decent chance of getting into medical school if he got around a 30 mcat...I think you discount the number of nontraditional students in medical school.

 

[peteB]

I actually know a few folks who tried for years to get into pa school then applied md to their state schools and got in their first cycle. it works both ways. the schools look for different things. md/do want stellar grades/research/high mcats, etc. while pa programs want different prereqs and place a lot of value on significant prior high level paid medical experience. a guy with a 4.0 and a first author publication based on ms level basic science research but zero pt care experience probably won't get into pa school. a 10 yr paramedic with 2 tours in Afghanistan and a 3.5 with a bs in medical anthropology and 2 yrs teaching paramedics probably won't get into med school.

Most people who apply to med school also have a lot of patient experience. I have several classmates who have both long histories as paramedics and also served in the military as medics. Med school isn't just looking for grades and research. People who have zero patient experience also usually have close to zero chance of getting into med school.

 

[munchymanRX]

Most people who apply to med school also have a lot of patient experience. I have several classmates who have both long histories as paramedics and also served in the military as medics. Med school isn't just looking for grades and research. People who have zero patient experience also usually have close to zero chance of getting into med school.

Tell that to a good chunk of my class.

 

[peteB]

Tell that to a good chunk of my class.

I don't know about your class, or your school's admissions requirements, but pretty much everyone in my class came in with a good deal of patient experience. We have a lot of non-trads too.

 

[deleted6669]

I don't know about your class, or your school's admissions requirements, but pretty much everyone in my class came in with a good deal of patient experience. We have a lot of non-trads too.

DO program? they tend to be more receptive to older students with significant life experience/prior careers in medicine. If I ever went back I would go the DO route.

 

[SpecterGT260]

I don't know about your class, or your school's admissions requirements, but pretty much everyone in my class came in with a good deal of patient experience. We have a lot of non-trads too.

Same here

 

[deleted6669]

I actually think the second guy would have a decent chance of getting into medical school if he got around a 30 mcat...l.

I think you discount the difficulty in getting a 30 mcat 10 yrs out of school while working full time and raising a family. doable but very tough. you have to relearn(or learn for the first time if you never did it beofre) all the material needed to do well on the mcat.

 

[peteB]

DO program? they tend to be more receptive to older students with significant life experience/prior careers in medicine. If I ever went back I would go the DO route.

No, MD program.

 

[peteB]

I think you discount the difficulty in getting a 30 mcat 10 yrs out of school while working full time and raising a family. doable but very tough. you have to relearn(or learn for the first time if you never did it beofre) all the material needed to do well on the mcat.

Sure it's hard, but if you can't get the learning done, then I don't think you're in a position to handle the work of med school either.

 

[SpecterGT260]

No, MD program.

Same here

 

[peteB]

the np's claim they don't practice medicine, they practice "advanced nursing" (which is whatever they say it is whether that be anesthesiology, critical care, dermatology, etc).

Is that what they tell patients too? Or do they tell them they practice medicine?

 

[SpecterGT260]

Sure it's hard, but if you can't do it, then I don't think you're in a position to handle the work of med school either.

Is venture to say its easier.... depending on what you have been doing with your time, that is. If I ever get really bored I may try to pull a few practice mcats to see if the test taking strategerizing they teach us here has an impact vs what I scored on them a few years ago. The mcat is pretty heavy on critical thinking

 

[calvnandhobbs68]

I think you discount the difficulty in getting a 30 mcat 10 yrs out of school while working full time and raising a family. doable but very tough. you have to relearn(or learn for the first time if you never did it beofre) all the material needed to do well on the mcat.

Well if you can't study for the MCAT and raise a family you're not going to be able to go to medical school and raise a family...

 

[peteB]

Is venture to say its easier.... depending on what you have been doing with your time, that is. If I ever get really bored I may try to pull a few practice mcats to see if the test taking strategerizing they teach us here has an impact vs what I scored on them a few years ago. The mcat is pretty heavy on critical thinking

You also need to actually remember info from science classes. It's not only critical thinking. Do you still remember physics and orgo?

 

[SpecterGT260]

You also need to actually remember info from science classes. It's not only critical thinking. Do you still remember physics and orgo?

Quite a bit of it. And cramming the kinematics equations would not be difficult. The synthesis of information happens at a ridiculously increased rate in med school. You should know this. Would you be worried about memorizing the half page of physics equations necessary for the old test?

 

[peteB]

Quite a bit of it. And cramming the kinematics equations would not be difficult. The synthesis of information happens at a ridiculously increased rate in med school. You should know this. Would you be worried about memorizing the half page of physics equations necessary for the old test?

Now that you mention it, I guess not. But cramming all that orgo is still daunting.

 

[xenotype]

There is no reason for both NP and PA to exist. PA is obviously a far superior training system. The government is encouraging competition between the NP and PA models to fill the provider role while "saving costs". Medicine and nursing need to be separate fields.

Sure it's hard, but if you can't get the learning done, then I don't think you're in a position to handle the work of med school either.

Interestingly, I would argue that the average PA student's academic performance is similar to or just under that of the average DO student. MD performance tends to be a standard deviation above. How much intelligence does medicine really take? Does it really take a 250 on step 1 to do Dermatology well? Does it really take a 208 on step 1 to do Neurology well?

 

[deleted6669]

Well if you can't study for the MCAT and raise a family you're not going to be able to go to medical school and raise a family...

there is also the small matter of working rotating shifts 50 hrs/week at the same time....
I'm doing it now while working on an academic doctorate in global health and this is likely far easier than trying to cram for the mcats.

 

[deleted6669]

Interestingly, I would argue that the average PA student's academic performance is similar to or just under that of the average DO student.

probably true although the folks going through the pa to do bridge program at lecom right now are doing BETTER across the board than the traditional track DO students...although this is a self-selected group of pa gunners who took the chance to apply to the first class of the first bridge program....probably all cream of the crop students....

 

[peteB]

How much intelligence does medicine really take? Does it really take a 250 on step 1 to do Dermatology well? Does it really take a 208 on step 1 to do Neurology well?

I don't think medicine takes a huge amount of intelligence to do well. Maybe an SD above average, yes, but not much more than that.

Clinical medicine sucks in a lot of very intelligent people who could probably benefit society more in some other way, like doing research and finding cures or designed advanced technology.

 

[calvnandhobbs68]

there is also the small matter of working rotating shifts 50 hrs/week at the same time....

Yeah but you also have unlimited time to study for the MCAT at that point...you could study on the weekends for a year if you wanted to. Not true for school.

My real point was that I don't think MD schools are as hostile to non-traditional students as you made it sound. I also don't think they're as accepting of students with no clinical experience as you made it sound.

 

[deleted6669]

Yeah but you also have unlimited time to study for the MCAT at that point...you could study on the weekends for a year if you wanted to. Not true for school.

My real point was that I don't think MD schools are as hostile to non-traditional students as you made it sound. I also don't think they're as accepting of students with no clinical experience as you made it sound.

could be, although from what I have seen a 38 yr old paramedic with a 26-28 mcat and a 3.5 gpa is MUCH more likely to get into a DO than an MD program.
I'm sure there is a lot of variability as well between schools. my state md program is filled with 22 yr old wunderkid biochem majors with summer research internships who have never lived in a house or apt their parents didn't pay for.

 

[link2swim06]

could be, although from what I have seen a 38 yr old paramedic with a 26-28 mcat and a 3.5 gpa is MUCH more likely to get into a DO than an MD program.

Thats a low mcat score for MD schools. I think that is the problem, not that the MD schools don't want him due to his age.

We have plenty of non-traditionals in our class.

 

[peteB]

could be, although from what I have seen a 38 yr old paramedic with a 26-28 mcat and a 3.5 gpa is MUCH more likely to get into a DO than an MD program.
I'm sure there is a lot of variability as well between schools. my state md program is filled with 22 yr old wunderkid biochem majors with summer research internships who have never lived in a house or apt their parents didn't pay for.

Well MD schools do stress academic achievement much more than other schools. That's just the way it is. Our schools want people who can thrive academically. But it doesn't matter how old you are or what background you're coming from. You don't have to be 22 to get in. I know plenty of people who are much older and came from other careers, including paramedics. But yes, they did have to make high grades and MCAT scores as well, and they all did, even though they had families and jobs and other responsibilities.

 

[deleted6669]

Thats a low mcat score for MD schools. I think that is the problem, not that the MD schools don't want him due to his age.

We have plenty of non-traditionals in our class.

correct me if I'm wrong here but won't a 3.5 gpa/28 mcat get you into the vast majority of DO programs? if you applied to 5 isn't likely you would get at least 1 acceptance and probably several?

 

[SpecterGT260]

Interestingly, I would argue that the average PA student's academic performance is similar to or just under that of the average DO student.

I think you are correct here.

MD performance tends to be a standard deviation above. How much intelligence does medicine really take? Does it really take a 250 on step 1 to do Dermatology well? Does it really take a 208 on step 1 to do Neurology well?

No.... Derm is not harder, it is just more desirable. As such programs use the only readily available metric for exclusion - USMLE.

And there are many definitions of what "well" means. One could argue that middle-skilled workers would provide a more efficient system. i.e. "well". Another argument could be made to say that only the absolute best is what is reasonable for health. There may very well be diminishing returns in terms of how much benefit the patient body receives with increasing selectivity for physicians. The question becomes when is a diminished return "too diminished" to be of value?

 

[SpecterGT260]

correct me if I'm wrong here but won't a 3.5 gpa/28 mcat get you into the vast majority of DO programs? if you applied to 5 isn't likely you would get at least 1 acceptance and probably several?

Yes. Even some MD programs, although the likelihood of that is becoming somewhat low.

 

[deleted6669]

And there are many definitions of what "well" means. One could argue that middle-skilled workers would provide a more efficient system. i.e. "well". Another argument could be made to say that only the absolute best is what is reasonable for health. There may very well be diminishing returns in terms of how much benefit the patient body receives with increasing selectivity for physicians. The question becomes when is a diminished return "too diminished" to be of value?

agree. we all know folks with 4.0 gpa's, 40 mcats, great usmle's, etc who should not be allowed to work with people because they lack the ability to empathize with the human condition in any way. I used to work at a place with an fp residency that had such a guy. brilliant on paper but totally worthless in clinic and not liked by anyone he ever came into contact with, attendings, support staff, or patients, yet on paper he is the ideal candidate to pursue a medical career or match to any specialty. they almost failed him every yr of residency for non-academic reasons and many patient complaints but he did graduate and is in practice today torturing the unwary...he used to do things like tell dying patients it was their own fault and they deserved what they were getting because of the choices they made earlier in life...true, but you don't say that to someone's grandfather when the whole family is at the bedside........

 

[xenotype]

agree. we all know folks with 4.0 gpa's, 40 mcats, great usmle's, etc who should not be allowed to work with people because they lack the ability to empathize with the human condition in any way. I used to work at a place with an fp residency that had such a guy. brilliant on paper but totally worthless in clinic and not liked by anyone he ever came into contact with, attendings, support staff, or patients, yet on paper he is the ideal candidate to pursue a medical career or match to any specialty. they almost failed him every yr of residency for non-academic reasons and many patient complaints but he did graduate and is in practice today torturing the unwary...he used to do things like tell dying patients it was their own fault and they deserved what they were getting because of the choices they made earlier in life...true, but you don't say that to someone's grandfather when the whole family is at the bedside........

I don't like a few of the people in my class but none of them are that bad. Med school tends to screen out people like that aggressively at the interview stage. I would say that is an extreme exception. Most med students are friendly and outgoing, but tend to be driven and competitive. Many MD programs are in a position to stat ***** if they wanted to, but only a few choose to do so.

 

[SpecterGT260]

agree. we all know folks with 4.0 gpa's, 40 mcats, great usmle's, etc who should not be allowed to work with people because they lack the ability to empathize with the human condition in any way. I used to work at a place with an fp residency that had such a guy. brilliant on paper but totally worthless in clinic and not liked by anyone he ever came into contact with, attendings, support staff, or patients, yet on paper he is the ideal candidate to pursue a medical career or match to any specialty. they almost failed him every yr of residency for non-academic reasons and many patient complaints but he did graduate and is in practice today torturing the unwary...he used to do things like tell dying patients it was their own fault and they deserved what they were getting because of the choices they made earlier in life...true, but you don't say that to someone's grandfather when the whole family is at the bedside........

That goes both ways. I think clinical skill and intelligence are correlated in most people. I also think intelligence and scores are correlated. Obviously there will be people who are not well predicted by these measurements.

Basically, what I was getting at is that the previous statement was about how "minimal" is "minimally competent". It really isnt as if you hit some magic plateau where suddenly we dub thee proficient and you can venture forth as a doctor. "Minimally competent" is a cost/benefit line. Minor fluctuations will have nearly no clinical impact, but with a large enough sample size it isnt unreasonable to say that minor differences in scores can significantly correlate to differences in outcomes, even if they are slight.

 

[cbrons]

As far as non trads go, I've seen a lot of 26 or 27+ year olds at my (M.D.) school who are just starting out. I think it is becoming less and less common to see MD students who just finished undergrad. I think the average matriculation age is 24 or 25. Not sure, perhaps someone could verify that.

 

[deleted6669]

That goes both ways. I think clinical skill and intelligence are correlated in most people. I also think intelligence and scores are correlated. Obviously there will be people who are not well predicted by these measurements.

Basically, what I was getting at is that the previous statement was about how "minimal" is "minimally competent". It really isnt as if you hit some magic plateau where suddenly we dub thee proficient and you can venture forth as a doctor. "Minimally competent" is a cost/benefit line. Minor fluctuations will have nearly no clinical impact, but with a large enough sample size it isnt unreasonable to say that minor differences in scores can significantly correlate to differences in outcomes, even if they are slight.

I understood your point. I was just introducing another variable that is hard to measure. anyone can fake being nice at an interview for a few hrs.
I do agree that the vast majority of med students are nice folks. there are a few in every class however who should have been screened out based on personality alone as being unfit to practice medicine. the same is true of pa school. I once had a student with a prior phd in microbiology who thought he was superior to everyone; patients, attendings, etc. I failed his ***** back to whatever lab he crawled out of...

 

[Unzbuzzled]

Back to the OP: I don't care what the initials are behind your name, whether it's MD, DO, DNP, whatever. If you go through the same number of clinical training hours as MDs, I'll call you a doctor and have no qualms about you doing surgery. But don't tell me that DNPs with their current curricula are going to be doing complex surgical procedures any time soon. There are very strict governing bodies regulating what constitutes a competent surgeon, and current DNPs don't fit the bill. I don't think DNPs as it sits will ever do surgery. The only thing I see happening is midlevels (like DNPs as we know them) doing more primary care work, and real physicians doing specialist work.

 

[peteB]

Back to the OP: I don't care what the initials are behind your name, whether it's MD, DO, DNP, whatever. If you go through the same number of clinical training hours as MDs, I'll call you a doctor and have no qualms about you doing surgery. But don't tell me that DNPs with their current curricula are going to be doing complex surgical procedures any time soon. There are very strict governing bodies regulating what constitutes a competent surgeon, and current DNPs don't fit the bill. I don't think DNPs as it sits will ever do surgery. The only thing I see happening is midlevels (like DNPs as we know them) doing more primary care work, and real physicians doing specialist work.

Unfortunately the governing bodies that regulate surgeons have no control over DNPs, as DNPs are regulated by nursing boards exclusively. (I learned this today) If the nursing boards can convince legislators that they are qualified to perform surgery, they can do it. They have a very strong lobby and they're good at coming up with studies that show their supposed competence, so I wouldn't put it past them.

 

[SpecterGT260]

I understood your point. I was just introducing another variable that is hard to measure. anyone can fake being nice at an interview for a few hrs.
I do agree that the vast majority of med students are nice folks. there are a few in every class however who should have been screened out based on personality alone as being unfit to practice medicine. the same is true of pa school. I once had a student with a prior phd in microbiology who thought he was superior to everyone; patients, attendings, etc. I failed his ***** back to whatever lab he crawled out of...

I agree. You'd be surprised, though, how many people are so clueless about how to fake it that they still look like asses in the interview I have heard some interesting interview question answers from faculty.

 

[SpecterGT260]

Unfortunately the governing bodies that regulate surgeons have no control over DNPs, as DNPs are regulated by nursing boards exclusively. (I learned this today) If the nursing boards can convince legislators that they are qualified to perform surgery, they can do it. They have a very strong lobby and they're good at coming up with studies that show their supposed competence, so I wouldn't put it past them.

Certain things constitute a chasm for them in terms of education. They can weasel in on the clinical stuff because that is what their education focuses on, and fortunately we are healthy enough as a society that their diminished education doesnt post a significant threat to most patients. That wouldn't be true for surgery.

 

[peteB]

Certain things constitute a chasm for them in terms of education. They can weasel in on the clinical stuff because that is what their education focuses on, and fortunately we are healthy enough as a society that their diminished education doesnt post a significant threat to most patients. That wouldn't be true for surgery.

So is surgery the "last stand" for MDs? Geez, I wish I had done better on my Step 1.

 

[SpecterGT260]

So is surgery the "last stand" for MDs? Geez, I wish I had done better on my Step 1.

Surgery matches at average step1 scores. It will be the last to go for sure. But I don't think physician practice will really be encroached upon too much. Even if we give full practice rights to these other disciplines, those patients with insurance will still prefer a physician 9 times out of 10.

 

[peteB]

Surgery matches at average step1 scores. It will be the last to go for sure. But I don't think physician practice will really be encroached upon too much. Even if we give full practice rights to these other disciplines, those patients with insurance will still prefer a physician 9 times out of 10.

Do you really think so? I feel like their propoganda is pretty effective. I've seen many patients who call their NP "my doctor". Do you think most patients will really know the difference in a decade or two?