Why so many undergraduate premedical students are worried about this is beyond me. Like can you seriously not stand that someone who does the same thing as a physician (in many cases) would want the same prestige? Why do premeds act so bothered that they might not get to have ~all~ the prestige as a physician? Grow up. Most NPs are seasoned nurses who decide to go back to school at some point, they are knowledgeable and competent because they capitalize on years of experience in medical settings. They are very intelligent people and fellow caregivers who deserve respect. Why is this so irksome? I don't get it. You're not even a doctor yet. Get a better attitude toward other members of the healthcare team, you will be spending a lot of time with them, and trust me (I've been one for years), they can smell an arrogant physician from a mile away. You don't want your bad attitude to effect the quality of care you are able to deliver, and it will.
It's not about prestige at all, it's about someone who has not received an adequate amount or quality of training needed to treat patients independently seeing patients independently without supervision. Additionally, "years of experience in medical settings" aren't a valid argument to say someone can treat patients independently. I worked with patient care technicians who had been in the field for 20 years. Do you think that qualifies PCTs to treat patients independently?
Additionally, saying that a nurse is skilled enough to practice independently because they went back to school and got their NP shows a fundamental lack of knowledge in the focus of education between nurses and physicians. We're just not taught to do the same things. This is incredibly obvious if you ever took a "chemistry for nursing" or any other hard science class "for nurses" in UG and then go to med school. The depth of knowledge required isn't even remotely close. Many say that "NPs get that level of training though!!" The problem is you're trying to teach someone to be a physician who doesn't have the foundational knowledge necessary to really understand the upper level clinical knowledge that physicians know. It's like trying to teach thermodynamics to a person that's never taken Gen Chem. You can teach them the algorithm, but they're not going to have the understanding of the actual processes which went into creating those algorithms, and they won't know when they can or should deviate from the algorithm. Even then, most NPs I've met don't even have a solid understanding of the "algorithm" itself. I'll give you an example from my clinical rotations:
My 3rd year FM rotation was outpatient with a group who had myself, another med student, and 4 NPs (2 at a time, got new ones halfway through) rotating in their clinic. 3 of the NPs had over a decade of experience in nursing before going back and getting their NP degree, and the other was relatively inexperienced (basically straight through to get her NP). All 4 were nearing the end of their required clinical hours for their degree, so they would be legally certified to practice independently in the following couple months. On that rotation, we'd see patients in the rooms ourselves, tell our attendings what we thought the diagnosis was, and then give a treatment plan. Both myself and the other medical student made some mistakes, but typically had the right diagnosis and when we got something wrong we'd rarely make the same mistake again. With 3 of the 4 NPs, they were not only consistently wrong, they'd make the same mistakes over and over (suggesting antibiotics, specifically Z-paks for viral infections/when not indicated, giving steroids alone for bronchial infections which had persisted for weeks, etc). The most egregious error was when we had a 70 year old guy who'd had a sinus/bronchial infection for 10+ days and met all the CURB-65 criteria. His in-house x-ray showed obvious lobar consolidation (aka bacterial pneumonia). Both NPs (who had decades of nursing experience) suggested Medrol + an antibiotic and were debating which antibiotic to give (neither even suggested giving mulitple antibiotics, and one even initially questioned if he should get abx, cuz let's pick this guy to fight Abx resistance...). Meanwhile, the other med student and I are asking whether we needed to call an ambulance to transport this guy to the hospital or whether his wife could take just take him. After the guy left, our attending laid into the NP students, as anyone with even basic clinical knowledge should know this guy NEEDED immediate hospitalization. She even went so far as to suggest they not work independently as she was afraid there was a high chance they'd seriously harm future patients.
That attending actually told the medical students separately that she regularly takes NP students in her clinic and it's very rare to find one she'd trust as to work with patients independently. She even went so far as to say the only reason she trained NP students was because she knows they'll go practice independently in her state whether they're actually qualified to or not, and she'd rather them get some proper training than none at all. Of the 4 NP students we worked with that month, there was only 1 I would even remotely consider allowing to see patients without physician supervision, and she was actually the only one who didn't want to practice independently. I've unfortunately seen the same thing with many other NPs I've worked with. The ones who are legitimately smart enough to practice independently don't want to. They know their limits and are more than happy to take the larger paycheck and not deal with the liability of practicing independently, while the ones who insist they're smart enough to practice independently on the same level as physicians simply aren't.
Also, not all NPs are seasoned, high-quality nurses anymore. There is a big NP boom right now. I know people who are not even in nursing school yet and are pre-NP. They want to get straight there. Not necessarily a bad thing, but times have changed. Aren't there truncated, subpar programs being offered now? I would worry about those.
The lack of standardization in NP education is a huge issue, and a primary driving force behind why physicians don't like the idea of nurses practicing independently. There are numerous programs where a person can get their degree online. There are programs that only require 500 hours of clinical experience and a research project (no actual didactic or formal clinical education) to gain the NP. Then there are programs that are legitimate, but don't take into account the gap in pre-clinical knowledge between nursing school and medical school. A large part of this stems from the fact that nurses and physicians are trained to do different jobs, and it's foolish to think that simply obtaining a "graduate level" degree qualifies a nurse to have the same responsibilities as a physician.
If you want the same prestige then do the same training. There are no shortcuts. I’ve also never met a good NP that thought they did the same things as a physician. The good ones always understand the limits of their knowledge.
This cannot be emphasized enough, and it doesn't just pertain to nurses. The most intelligent nurses know when they're outside their scope of practice/are beyond their limits. The same goes for a PCP and knowing when they can manage a patient vs. needing to refer to a specialist. In my experience, the nurses yelling about how they can be just as good family practitioners as physicians are the ones who shouldn't be doing it. Meanwhile, the brightest NPs I've met are more than happy to work under supervision, have little to no personal liability, and collect their fattened NP paycheck without any of the extra risk (and keep a more reasonable lifestyle).
