Doctor shortage- Who Should Fill the Gap?

[microbiofan]

I was just reading this report from CNN. What do you think?
http://money.cnn.com/galleries/2009/...ses/index.html

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[mig26x]

Doctors themselves. Nurses have a worse shortage problem than doctors and is not getting better, so imagine if we start moving nurses from bedside etc to close the doctors gap, then who is going to replace the nurses? the MA's?

Can PA's do it? probably, but can a 2 year curriculum be enough? physicians go through 4 med + 3 residency (working every week close to 70-80 hours).

If they are going to make NP's, DNP's and PA's equal as physician in terms of independence then government needs to 1- make med school cheaper 2- shorter in terms of years.

so doctors need to work something out to make primary care more attractive:
1- less paper work
2- better compensation
3- better loan repayment programs
and there is more than can be done.

 

[Paseo Del Norte]

That is the obvious answer. Only a doctor can really take over the role of a doctor. While I think midlevel providers have a place, I am not sure I feel comfortable having midlevel providers taking over all the patient responsibility that has traditionally been in the hands of a doctor.

While the PA curriculum is no doubt a tough and brutal experience, the several years spent in residency and fellowship are truly needed to gain an appreciation for patient diagnosis and management IMHO.

I look at it like this: I am a fairly intelligent guy, though some may argue. I have over a decade of healthcare experience and currently work as a flight nurse. I hold board certifications in emergency and flight nursing along with the typical alphabet soup. In addition, I have taken care of sick patients and have several years of ER and EMS experience under my belt. However, I am constantly stumped and alpha maled in some of the patient scenarios on various other forums. Once, I even missed a meningitis because I was focusing on travel history and possible exposure to Dengue fever.

However, with some online education and less than a 1,000 hours of clinical experience, I could be making these kinds of diagnostic and treatment decisions in the real world. I am simply not convinced this is enough experience to ensure I could provide adequate "primary" patient care.

Perhaps I have no business making these comments as I am not in a midlevel role and I am certainly not a physician. However, this is my uneducated opinion regarding the topic at hand. I think the solutions need to be focused on methods to ease the shortage of doctors. We nurses have our own problems, and I cannot see the DNP solving any of our major problems. Again, this is IMHO.

While I am absolutely an advocate for nursing and proud of what I do, I am not convinced easing this doctor shortage with non-physician providers is a good move.

 

[deleted6669]

doctors need to work something out to make primary care more attractive:
1- less paper work
2- better compensation
3- better loan repayment programs
.

agree with all of above. I think the 3 yr DO program at LECOM could be a good model for producing more primary care physicians faster. They do the same program as the 4 yr students but cut out a lot of vacation time(no summers off) as well as interview time because the students are all guaranteed residency slots in a primary care residency associated with the program so no need to take 3 months interviewing all over for a residency like many med students do.
during WW2 many medschools did a similar thing by streamlining their curriculum and cutting off a yr and producing excellent physicians. the current model could use such a tweak again and all that would suffer is some vacation and interview time. no content needs to be lost.

 

[fab4fan]

That is the obvious answer. Only a doctor can really take over the role of a doctor. While I think midlevel providers have a place, I am not sure I feel comfortable having midlevel providers taking over all the patient responsibility that has traditionally been in the hands of a doctor.

While the PA curriculum is no doubt a tough and brutal experience, the several years spent in residency and fellowship are truly needed to gain an appreciation for patient diagnosis and management IMHO.

I look at it like this: I am a fairly intelligent guy, though some may argue. I have over a decade of healthcare experience and currently work as a flight nurse. I hold board certifications in emergency and flight nursing along with the typical alphabet soup. In addition, I have taken care of sick patients and have several years of ER and EMS experience under my belt. However, I am constantly stumped and alpha maled in some of the patient scenarios on various other forums. Once, I even missed a meningitis because I was focusing on travel history and possible exposure to Dengue fever.

However, with some online education and less than a 1,000 hours of clinical experience, I could be making these kinds of diagnostic and treatment decisions in the real world. I am simply not convinced this is enough experience to ensure I could provide adequate "primary" patient care.

Perhaps I have no business making these comments as I am not in a midlevel role and I am certainly not a physician. However, this is my uneducated opinion regarding the topic at hand. I think the solutions need to be focused on methods to ease the shortage of doctors. We nurses have our own problems, and I cannot see the DNP solving any of our major problems. Again, this is IMHO.

While I am absolutely an advocate for nursing and proud of what I do, I am not convinced easing this doctor shortage with non-physician providers is a good move.

Your post pretty much sums up how I came to feel about becoming an NP and why I decided to pass up on it. And if you feel that way as a flight nurse, with all of the experience you have it really makes me wonder where these kids fresh out of school come up with the moxie to think that two or three years of ICU is going to give them enough experience to make them adequately prepared to practice independently.

For the record, you should be very proud of what you do. Just thinking about what you do scares me to death. I'm afraid to get on a jet, let alone a helicopter, not to mention one with a patient who's crashing. I don't mind pt's going bad, but I'm not a fan of the idea of caring for them up in the air.

 

[jbar]

I think the big prob that they are having with primary care is the kind of person who they are selecting for medical school. They are looking for people with research experience who did very well in basic science, and are very motivated to be "the best." From the people I know from pre med and now med school I have seen that many of these people are drawn to fields like neuro, surgery, optho etc. Yeah, the fact that primary care docs don't make much doesn't help. But the truth is most of these kids have imagined themselves as a cardiac surgeon or hematologist/oncologist since their sophmore year of college. Paying PMD more won't fix that, those people still are attracted to a level of complexity and acuity.

If you want more PMDs you need to identify people in college who have always wanted to be the family doc, the PMD and accept them into med school on the condition that they are required to enter primary care. Plenty of people who are now going to med schools overseas would have jumped at that offer.

 

[justme08]

I agree that if there's a shortage the educational requirements both in terms of time and debt need to be reevaluated. IMO, at my current point in life med school is out of the question and not because I lack the grades, motivation or brains, and not, as some posters have implied of midlevels, because I'm scared of Ochem - in fact I'm taking that next quarter. It just comes down to it's not a practical trade off for time and money given my age and family size.

So if there's a shortage I don't think they need to mess with the current system and end up lowering the pay of doctors (which I think will cause the applicant pool to dip a bit) but they should look at the way school is currently set up and the debt load.

 

[psychbender]

And if you feel that way as a flight nurse, with all of the experience you have it really makes me wonder where these kids fresh out of school come up with the moxie to think that two or three years of ICU is going to give them enough experience to make them adequately prepared to practice independently.

What's worse, is some of the people in direct-entry NP programs with no prior healthcare experience. My girlfriend is in one such program, and after seeing how much they are not being taught, it is quite aggravating to hear from her classmates how they can do everything the doctors can (and this is one of the top NP programs, producing the many varieties of NPs). In just 2.5 years, these people will go from zero healthcare experience to independent practitioners. For our patients' sake, I really wish more of our future NPs were folk like you and Paseo.

Emedpa - Who actually gets 3 months off for interviews? I thought my school was excessive giving us one full month of vacation during fourth year (two, if you elected to start fourth year early). As for shortened programs, one of my Pulm/CCM fellows last year came from a 7-year BS/MD program, and I know Duke compresses the first two years into a little over a year, so the idea definitely does have merit. However, I don't think too many schools will be enthusiastic about it, as it means they get to collect only three years of tuition.

 

[ArkansasRanger]

I think the big prob that they are having with primary care is the kind of person who they are selecting for medical school. They are looking for people with research experience who did very well in basic science, and are very motivated to be "the best." From the people I know from pre med and now med school I have seen that many of these people are drawn to fields like neuro, surgery, optho etc. Yeah, the fact that primary care docs don't make much doesn't help. But the truth is most of these kids have imagined themselves as a cardiac surgeon or hematologist/oncologist since their sophmore year of college. Paying PMD more won't fix that, those people still are attracted to a level of complexity and acuity.

If you want more PMDs you need to identify people in college who have always wanted to be the family doc, the PMD and accept them into med school on the condition that they are required to enter primary care. Plenty of people who are now going to med schools overseas would have jumped at that offer.

I agree. I'm interested in FP and EM and would love to go to med school and do the combined residency there, but because of the hoops they want me to jump through I'll most likely never do any of that. It's utter nonsense in my book - the requirements of med students you talk about. I think pinpointing applicants with those types of skills may in fact be why people claim to prefer NPs over MDs because those types are less likely to be socially communicative.

 

[ArkansasRanger]

I agree that if there's a shortage the educational requirements both in terms of time and debt need to be reevaluated. IMO, at my current point in life med school is out of the question and not because I lack the grades, motivation or brains, and not, as some posters have implied of midlevels, because I'm scared of Ochem - in fact I'm taking that next quarter. It just comes down to it's not a practical trade off for time and money given my age and family size.

So if there's a shortage I don't think they need to mess with the current system and end up lowering the pay of doctors (which I think will cause the applicant pool to dip a bit) but they should look at the way school is currently set up and the debt load.

I agree with you. I hate physical sciences minus geology which is ok although granted I've never had geophyscis or geochem which I'd certainly hate. A lot of potentital premeds falter with o-chem, physics, and all that. I certainly don't understand why because most med students and doctors would tell you that wholely those courses have little bearing on anything further down the road. I really don't think a course of chemical science is what signifies the intellect necessary to become a doctor.

I'm also not EVER going to quit work and go back to school full-time for premed, prePA, or preAnything all of which are nothing but time consuming gambles more likely to end up in not getting accepted than actually getting in.

 

[fab4fan]

What's worse, is some of the people in direct-entry NP programs with no prior healthcare experience. My girlfriend is in one such program, and after seeing how much they are not being taught, it is quite aggravating to hear from her classmates how they can do everything the doctors can (and this is one of the top NP programs, producing the many varieties of NPs). In just 2.5 years, these people will go from zero healthcare experience to independent practitioners. For our patients' sake, I really wish more of our future NPs were folk like you and Paseo.

As if nursing education hasn't been dumbed down enough, now we have the "direct-entry" crowd to contend with. I keep hoping I get smacked by a semi before I get too old and sick to need medical care and wind up in the hand of one of these "practitioners."

 

[oldbearprofessor]

agree with all of above. I think the 3 yr DO program at LECOM could be a good model for producing more primary care physicians faster. They do the same program as the 4 yr students but cut out a lot of vacation time(no summers off) as well as interview time because the students are all guaranteed residency slots in a primary care residency associated with the program so no need to take 3 months interviewing all over for a residency like many med students do.
during WW2 many medschools did a similar thing by streamlining their curriculum and cutting off a yr and producing excellent physicians. the current model could use such a tweak again and all that would suffer is some vacation and interview time. no content needs to be lost.

Actually, three year programs didn't die out until the early 1980's. I graduated from a three year MD program, beginning in July and finishing in May with no summer breaks and no vacations. I can't speak at all for LECOM's program, but I can say with certainty that the overwhelming majority of students I went to school with hated going the three years straight. As an aside, I loved it, but I was very, very rare in that. Shortly after I finished, the school went to 4 years.

Lots of reasons for this, mostly related to the need to have some break time and to have time to make decisions, do sub-I's, etc. Also, again, I can't speak for LECOM, but I believe that if expanded, this would cause problems with students who wish to explore other areas. Also, primary care is multiple fields and extra time is needed during the fourth year to explore which primary care field you are interested in, remembering that IM and peds have a large % of folks who will not ultimately be primary care docs.

Regardless, just wanted to cast one vote as someone who did the 3 years and doesn't think that is a good idea for widespread expansion.

 

[bradt9881]

.... However, I don't think too many schools will be enthusiastic about it, as it means they get to collect only three years of tuition.

A question. Do the med schools charge for tuition for the summers you have off? If so, they would make it back going straight through by charging for the summer semester, similar to what I had to do for PA school ($8750 per semester, 3 semesters per year for 28 months total when you added the preceptorship).

But as the last poster said, it didn't make for a very fun time of it.

 

[greytmedic]

A question. Do the med schools charge for tuition for the summers you have off? If so, they would make it back going straight trhough by charging for the summer semester, similar to what I had to do for PA school ($8750 oer semester, 3 semesters per year for 28 months total when you added the preceptorship).

But as the last poster said, it didn't make for a very fun time of it.

The only summer I have off during med school is between 1st and 2nd year. Between 2nd and 3rd year we have off 6 weeks for Step 1 but go back early enough in the summer we pay summer tuition. Between 3rd and 4th year we get two weeks and pay summer tuition. During 4th year we get 4 weeks off for interviewing, but we can schedule certain elective rotations during interview season that are more lenient on taking off a couple extra days for traveling and interviewing.

I also forgot we get two weeks off during 1st, 2nd, 3rd, and 4th year for Christmas/winter break. And one week off during 1st year for spring break.

 

[jbar]

The problem with a three year MD/DO is that you risk burning out people right before they get gobsmacked with a 3 year residency that also has almost no breaks. The PAs I know who are in those year round programs justtify it by saying that they just have to push hard for 2.5 years and then they are out working and making bucks, that logic doesn't apply to the MD. It's a marathon not a sprint.

As to the pre med courses I'm sorta torn. I think they need to change the required classes but should still be science heavy. Biochem should be stressed over orgo, stats rather than calculus. But there are people who have diseases of the urea cycle, there are drugs that interfere with the ATP synthasis. I think doctors should be able to understand how these disorders work and there just isn't time during med school for people to learn that stuff if they haven't taken bio or chem in college.

The other thing is that as much as I hate the pre med courses, you have to weed out people somehow. About 50,000 people take the MCATs for about 20,000 US med school spots, and that just are the people who finished the pre med classes. If you don't have those classes then what are you picking med students on? Just their essays? Their GRE scores? All on the interview (where bias has a much bigger chance to come into play). The truth is that those pre med courses are tough, but they really aren't any tougher then medical school. And the people I know who were failing bio would have gotten creamed in med school. It isn't about how relevent the physics is to medicine, it is the applicant showing that the can absorb large amounts of knowledge quickly and use it in often stressful situations.

I think if you want more PMDs ad coms need to change how they rate applicants experience. Right now the seem to get much more excited about applicants who worked in a lab or did some hot shot project, not so interested in those who worked with a local PMD. Applicants know this and plan their projects accordingly. If Ad coms gave more preference to those who had experience in primary care as pre meds I think you would see a shift in what people are going into.

 

[psychbender]

A question. Do the med schools charge for tuition for the summers you have off? If so, they would make it back going straight trhough by charging for the summer semester, similar to what I had to do for PA school ($8750 oer semester, 3 semesters per year for 28 months total when you added the preceptorship).

But as the last poster said, it didn't make for a very fun time of it.

Depends. My school was four years straight, no summers off, billed twice a year. We had three weeks off between first and second year, a month between second and third for boards (which most of us took about two weeks after class ended, anyway), and a month between third and fourth which most used for more board studying. However, we did also have a week off between each block (which were anywhere from 4-10 weeks in length) to ease the pain.

I think if you want more PMDs ad coms need to change how they rate applicants experience. Right now the seem to get much more excited about applicants who worked in a lab or did some hot shot project, not so interested in those who worked with a local PMD. Applicants know this and plan their projects accordingly. If Ad coms gave more preference to those who had experience in primary care as pre meds I think you would see a shift in what people are going into.

Some do this already. My school had a very primary care focus, and tried like hell to recruit people who they thought would enter those fields. Consequently, we had a lot of people from more rural areas who had some work experience with a PCM than we had lab wizards (had a fair number of those, too, though). Overall, I think it worked out well for them, as we had a boatload of people that went in to IM, FM, EM, and Peds.

 

[DO2Be2013]

agree with all of above. I think the 3 yr DO program at LECOM could be a good model for producing more primary care physicians faster. They do the same program as the 4 yr students but cut out a lot of vacation time(no summers off) as well as interview time because the students are all guaranteed residency slots in a primary care residency associated with the program so no need to take 3 months interviewing all over for a residency like many med students do.
during WW2 many medschools did a similar thing by streamlining their curriculum and cutting off a yr and producing excellent physicians. the current model could use such a tweak again and all that would suffer is some vacation and interview time. no content needs to be lost.

Not exactly accuracte. I interviewed at LECOM-Erie and seriously contemplated the primary care scholars pathway, asking lots of questions of a current student in the program as well as of the staff. And they do not take the same program of study as the four year students. Yes, the preclinical coursework is identical, just condensed from 24 months down to 20 due to cutting vacations. But the clinical work is actually much less for PCSP students. Traditional students complete 23 clerkship periods over two years (including one month of vacation for interviews, not three) while PCSP students complete only 16 clerkships in 15 months. They cut out pretty much all electives and selectives leaving what would be considered only the "core" clerkships in any other program. In fact, it was my own mother (a family practice physician) who talked me out of this program once she realized that they cut corners on the clinical training. Here's the link to their curriculum: http://www.lecom.edu/pros_pathways.php

Also, PCSP students aren't guranteed a primary care residency anywhere. I talked with a second-year student last spring who was preparing to take the COMLEX and enter the match in the same year. He had no idea what program he would end up in and in fact expressed a little uncertainty as to how the PCSP students would be received by program directors since no cohorts had actually graduated yet and had no track record of matching. I'm sure they could all get into Millcreek's FP program as a last resort but that's true of probably any graduating LECOM student. It's hardly competitive. This student was aiming for a few specific programs and was definitely sweating getting in.

 

[group_theory]

Your post pretty much sums up how I came to feel about becoming an NP and why I decided to pass up on it. And if you feel that way as a flight nurse, with all of the experience you have it really makes me wonder where these kids fresh out of school come up with the moxie to think that two or three years of ICU is going to give them enough experience to make them adequately prepared to practice independently.

You and Paseo Del Norte are smart - you guys know what you don't know. The scary practitioners are those who do not know what they do not know. They are the one that will mess up, and by the time they recognize that something is wrong or they need help, it may be too late.

Sometimes I wonder if the purpose of education is to teach what you don't know, as well as teach you what you didn't know that you didn't know (sorry if I'm sounding like Donald Rumsfeld). As I progress further in my training, I'm constantly amazed at what I don't know (that I should know) and feel like I'm constantly playing catchup in my education. In this age where patients are living longer, with more complex diseases, I cannot see how someone without extensive healthcare experience can be a true PCP and be able to manage the range of conditions that can present in the outpatient settings. From an internal medicine aspect, I'm sending patients home from the ward service with complex follow-ups, all to be orchestrated by the PCP (I usually call the PCP prior to discharge to discuss these patients). Recently in the NICU, I help discharged a few ex-micropremies who have been in the NICU for 100+ days - they have multiple pediatric subspecialty follow-ups, are on NICU-type formulas - and will need frequent visits to their PCPs. Some also have genetic disorders. I just don't see how someone who is a direct-entry NP or a brand new PA (without prior healthcare experience prior to PA school) can adequately be their PCP.

 

[ArkansasRanger]

The problem with a three year MD/DO is that you risk burning out people right before they get gobsmacked with a 3 year residency that also has almost no breaks. The PAs I know who are in those year round programs justtify it by saying that they just have to push hard for 2.5 years and then they are out working and making bucks, that logic doesn't apply to the MD. It's a marathon not a sprint.

As to the pre med courses I'm sorta torn. I think they need to change the required classes but should still be science heavy. Biochem should be stressed over orgo, stats rather than calculus. But there are people who have diseases of the urea cycle, there are drugs that interfere with the ATP synthasis. I think doctors should be able to understand how these disorders work and there just isn't time during med school for people to learn that stuff if they haven't taken bio or chem in college.

The other thing is that as much as I hate the pre med courses, you have to weed out people somehow. About 50,000 people take the MCATs for about 20,000 US med school spots, and that just are the people who finished the pre med classes. If you don't have those classes then what are you picking med students on? Just their essays? Their GRE scores? All on the interview (where bias has a much bigger chance to come into play). The truth is that those pre med courses are tough, but they really aren't any tougher then medical school. And the people I know who were failing bio would have gotten creamed in med school. It isn't about how relevent the physics is to medicine, it is the applicant showing that the can absorb large amounts of knowledge quickly and use it in often stressful situations.

I think if you want more PMDs ad coms need to change how they rate applicants experience. Right now the seem to get much more excited about applicants who worked in a lab or did some hot shot project, not so interested in those who worked with a local PMD. Applicants know this and plan their projects accordingly. If Ad coms gave more preference to those who had experience in primary care as pre meds I think you would see a shift in what people are going into.

I'd rather fight with a dog than undergo the rest of the prereqs I have to take, and I'd do so eagerly to go to medical school and be happy as a lark over becoming a primary care physician years afterwards. Regardless of what is done the medical school admissions process is grossly ******ed. Factors are overlooked that will make a successful doctor in favor of kids that had the time and convenience to sit through class and research lab. I don't have the time nor the desire for any of that short of medical school itself. I most likely, despite attempts and wishful thinking, will never get in because such practices bring out the nonconformist in me as well as a lot of hostility. From the outside looking in it really appears that none of it is at all grounded in reality. I'm not looking to get rich. I just want a job where I can learn something that interests me and apply it in order to do some good out there. I do that now though in a different respect. I'm from Arkansas. Geez, if you make 60k per year here you can be rather comfortable. I don't care about making a name for myself nor the reputation of schools and research institutions. This is just something I want to do, and I can't justify (to me) throwing away everything I've worked so hard for on such a gamble. I like my job now, but there is one thing I'd rather do on top of this, and my preferred training would be FP, EM, or both. Most people don't get what they want out of life it seems so I can survive happily doing this I guess. Maybe I should.

 

[ArkansasRanger]

You and Paseo Del Norte are smart - you guys know what you don't know. The scary practitioners are those who do not know what they do not know. They are the one that will mess up, and by the time they recognize that something is wrong or they need help, it may be too late.

Sometimes I wonder if the purpose of education is to teach what you don't know, as well as teach you what you didn't know that you didn't know (sorry if I'm sounding like Donald Rumsfeld). As I progress further in my training, I'm constantly amazing at what I don't know (that I should know) and feel like I'm constantly playing catchup in my education. In this age where patients are living longer, with more complex diseases, I cannot see how someone without extensive healthcare experience can be a true PCP and be able to manage the range of conditions that can present in the outpatient settings. From an internal medicine aspect, I'm sending patients home from the ward service with complex follow-ups, all to be orchestrated by the PCP (I usually call the PCP prior to discharge to discuss these patients). Recently in the NICU, I help discharged a few ex-micropremies who have been in the NICU for 100+ days - they have multiple pediatric subspecialty follow-ups, are on NICU-type formulas - and will need frequent visits to their PCPs. Some also have genetic disorders. I just don't see how someone who is a direct-entry NP or a brand new PA (without prior healthcare experience prior to PA school) can adequately be their PCP.

Human ego. If I were in a position like that- and I'm not saying I want to be I'm just illustrating - I'd gladly defer to another clinician who could become the PCP.

 

[275079]

I'd rather fight with a dog than undergo the rest of the prereqs I have to take, and I'd do so eagerly to go to medical school and be happy as a lark over becoming a primary care physician years afterwards. Regardless of what is done the medical school admissions process is grossly ******ed. Factors are overlooked that will make a successful doctor in favor of kids that had the time and convenience to sit through class and research lab. I don't have the time nor the desire for any of that short of medical school itself. I most likely, despite attempts and wishful thinking, will never get in because such practices bring out the nonconformist in me as well as a lot of hostility. From the outside looking in it really appears that none of it is at all grounded in reality. I'm not looking to get rich. I just want a job where I can learn something that interests me and apply it in order to do some good out there. I do that now though in a different respect. I'm from Arkansas. Geez, if you make 60k per year here you can be rather comfortable. I don't care about making a name for myself nor the reputation of schools and research institutions. This is just something I want to do, and I can't justify (to me) throwing away everything I've worked so hard for on such a gamble. I like my job now, but there is one thing I'd rather do on top of this, and my preferred training would be FP, EM, or both. Most people don't get what they want out of life it seems so I can survive happily doing this I guess. Maybe I should.

Fortune favors the brave.

 

[DO2Be2013]

Why don't we give MS-IV's unrestricted practice rights to fill this gap. They have more education/training than a direct-entry NP grad. Two years of didactics and a year (2000-2500+ hours) of clinicals, plus passage of a rigorous board exam.

 

[ArkansasRanger]

Why don't we give MS-IV's unrestricted practice rights to fill this gap. They have more education/training than a direct-entry NP grad. Two years of didactics and a year (2000-2500+ hours) of clinicals, plus passage of a rigorous board exam.

Well, that sounds like a PA to me, lol.

I can see it now. An accident happens and in rushes someone shouting "I'm a fourth year medical student. I'm here to help."

This actually raises a question for me. I've never been a medical student, obviously. However, would a fourth year be as competent as a new PA? Likely. I've only seen a few med students, yet they seemed more interested in keeping their white coat clean than anything else and overall appeared lost as a goose but probably due to the new environment as they were both brand new to clinicals. That's not a slam. It's just observation that I made in the emergency department a couple of times. I've never actually seen them work. However, television, and I'm aware I just used the t-word, often makes medical students seem not too bright. I wonder how much efficacy they actually bring to the table - 4th years thus fresh minted PAs also. Hypothetically, if a third year med student finished out the year, quit school, and was allowed to take PA tests would he be a functional PA, i.e. would he have the skills and knowledge base? Just curious.

 

[jbar]

I was thinking about this the other day. The truth is they are just as well trained if not more so than a new PA graduate. For the good of the profession it is probably best not to have a situation where med students could quit after 3 years and make $80,000 as a PA, simply because those people would not be going on to fill residency spots. That would help short term but you would have less finished docs coming out the pipeline at the end.

 

[Charles_Carmichael]

Why don't we give MS-IV's unrestricted practice rights to fill this gap. They have more education/training than a direct-entry NP grad. Two years of didactics and a year (2000-2500+ hours) of clinicals, plus passage of a rigorous board exam.

I argued this the other day in the allnurses forum and they weren't too pleased with me saying that. It seems like they see years spent as a nurse compensating for the lack of clinical hours practicing medicine. It doesn't make sense to me at all since medicine and nursing are two separate things that require you to think differently.

 

[Paseo Del Norte]

Not all nurses ( no pun intended )on that site are sold on this NP independant practice concept. I could type my song and dance yet again, but I am feeling unmotivated tonight.

 

[Charles_Carmichael]

Not all nurses ( no pun intended )on that site are sold on this NP independant practice concept. I could type my song and dance yet again, but I am feeling unmotivated tonight.

Oh don't get me wrong. I wasn't just going on there and randomly saying that. It was in a thread where people were happy with what the article suggested. I do feel like the majority of nurses do not think the way Mundinger et al. do.

 

[fab4fan]

I argued this the other day in the allnurses forum and they weren't too pleased with me saying that. It seems like they see years spent as a nurse compensating for the lack of clinical hours practicing medicine. It doesn't make sense to me at all since medicine and nursing are two separate things that require you to think differently.

Gee. I wonder why that post didn't go over well at allnurses.com. Are you sure you haven't been banned for life for merely suggesting such a thing?

I've been a nurse for 24 years. I've worked in a lot of areas, but I still don't think it would be enough for me to be a mid-level. I'd rather be a really sharp nurse and leave the diagnosing and prescribing to someone else. We still need a few good nurses, or so I'm told. (Not that I'd go back to working in the hospital, though.)

 

[Paseo Del Norte]

I do think it is good to have people like Fab4fan and I who can give a balanced RN point of view. I am not opposed to APN's and PA's; however, a strong physician presence is required. This independant practice stuff is pretty scary IMHO. The prudent NP should want to work very closely with a physician.

 

[Charles_Carmichael]

Gee. I wonder why that post didn't go over well at allnurses.com. Are you sure you haven't been banned for life for merely suggesting such a thing?

I've been a nurse for 24 years. I've worked in a lot of areas, but I still don't think it would be enough for me to be a mid-level. I'd rather be a really sharp nurse and leave the diagnosing and prescribing to someone else. We still need a few good nurses, or so I'm told. (Not that I'd go back to working in the hospital, though.)

You know, I'm kinda surprised that I haven't been banned yet actually. But I have been posting with links, examples, etc. and have been refraining from name-calling and things of that nature. I think that's basically the only thing protecting me there.

 

[microbiofan]

Oh don't get me wrong. I wasn't just going on there and randomly saying that. It was in a thread where people were happy with what the article suggested. I do feel like the majority of nurses do not think the way Mundinger et al. do.

I pasted the article's link in this forum. I work for a NP as a medical assistant. I was trying to make up my mind on what I wanted to do. NP or PA?


She showed me the article from allnurses.com. I was leaning towards PA because of my experience as a medical assistant and NOT wanting to work in a hospital in LTC.

I made up my mind, and opting for NP. It was not the article! It was an PA student in this forum helped in my decision. Thank you ForeverLaur!!!!!

 

[Paseo Del Norte]

That is great, and nothing wrong with wanting to pursue advanced practice nursing. However, this whole concept of independent medical practice and in essence, the replacement of the traditional IM/FP physician is the crux of this thread.

Make no mistakes, there are midlevel providers who are absolutely convinced that they can replace the presence of a physician. No collaborative agreement, no chart reviews, no supervision, notta.

 

[foreverLaur]

I made up my mind, and opting for NP. It was not the article! It was an PA student in this forum helped in my decision. Thank you ForeverLaur!!!!!

Your welcome. Less competition!!

 

[microbiofan]

Your welcome. Less competition!!

YOU'RE welcome...not your welcome. Use your spell check smart a**. I know I'll make it if I wanted to go into a PA program.

I also know that I would get picked first. Unlike you, I got a lot more medical experience.

I work full time with two doctors and a nurse in an uderserved community of L.A.

I also graduated college with a 4.0. I'm trilingual in Armenian and Spanish

In deed, YOU'RE no competition!!!! Go work on your self-esteem instead of your legs. Your stupid picture projects how much in need of attention YOU'RE...and what kind of attetion.

 

[VassarLiberal]

Go work on your self-esteem instead of your legs.

But, by God, are those gorgeous legs...

Cough, 'scuse me.

I don't see the issue as one of replacing the FP physician. Rather, at least for the PA profession, it is one of extending their ability to provide effective care by adding a second set of supervised, medical-model educated hands.

 

[foreverLaur]

YOU'RE welcome...not your welcome.

Ha, that was just for you. I am glad you picked up on it and took the time to reply.

And stating all your qualifications is only necessary if you need to convince yourself you are good enough, so maybe you ought to work on your own self-esteem too.

If you aren't applying to PA school, then you aren't competition, regardless of your statistics. I'm also not worried about being accepted. When I am ready, I'll get there and the ride will be worth it.

 

[zenman]

YOU'RE welcome...not your welcome. Use your spell check smart a**. I know I'll make it if I wanted to go into a PA program.

I also know that I would get picked first. Unlike you, I got a lot more medical experience.

I work full time with two doctors and a nurse in an uderserved community of L.A.

I also graduated college with a 4.0. I'm trilingual in Armenian and Spanish

In deed, YOU'RE no competition!!!! Go work on your self-esteem instead of your legs. Your stupid picture projects how much in need of attention YOU'RE...and what kind of attetion.

What's an "uderserved" area? Shortage of bovines?

 

[fab4fan]

What's an "uderserved" area? Shortage of bovines?

FWIW, there's another misspelling in there.

Where have you been shaman man? Our unit has been so crazy; the other day I blurted out that we needed either an exorcist or a shaman, and then I thought of you.

Where you at?

 

[zenman]

FWIW, there's another misspelling in there.

Where have you been shaman man? Our unit has been so crazy; the other day I blurted out that we needed either an exorcist or a shaman, and then I thought of you.

Where you at?

Currently in Cleveland, TN for a few more days before heading home to Bangkok, after visiting Rush University in Chicago. Been spending time with female Shipibo shamans in Amazon, then Utah with other shamans. Looks like I didn't miss much here, ha, ha....

 

[microbiofan]

Hey, that’s not your job! I hired “foreverLaur” to check my spelling. Gosh! I’m bored!!! Time to post.

 

[fab4fan]

Currently in Cleveland, TN for a few more days before heading home to Bangkok, after visiting Rush University in Chicago. Been spending time with female Shipibo shamans in Amazon, then Utah with other shamans. Looks like I didn't miss much here, ha, ha....

Now I've heard everything. Shamans in Utah!

Yes indeed, it's same old, same old here. You could come back years later and we'd still be fighting over "You got peanut butter in my chocolate," "You got chocolate in my peanut butter" never getting it that both go together quite nicely (if you catch my meaning).

 

[fab4fan]

Hey, that’s not your job! I hired “foreverLaur” to check my spelling. Gosh! I’m bored!!! Time to post.

There was your first mistake!

 

[zenman]

Now I've heard everything. Shamans in Utah!

Yes indeed, it's same old, same old here. You could come back years later and we'd still be fighting over "You got peanut butter in my chocolate," "You got chocolate in my peanut butter" never getting it that both go together quite nicely (if you catch my meaning).

Shamans are everywhere...stay alert! Seems like I'm always partnering up with physicians, counselors and psychologists, though. Wish I could partner up with "real" people sometime. Oh wait, I did a couple times during the three weeks in Utah.