Family Medicine, Why not do Nurse Practitioner school

[GypsyHummus]

Currently, at the clinic I work at we have two Nurse Practitioners (NPs) that work independently in a primary care setting. My question is why would someone work their hind end off to get into medical school, take that dreaded MCAT, invest at the VERY LEAST (Lecom's 3 year program +3 years residency FM) 6 years of their post college life for Family medicine, when they could just as easily get a 4 year nursing degree and only have to spend 3 years post college to practice with autonomy?

Granted, this is just for family medicine, but since 20% of DOs go into family practice, doesn't the cost seem too high, especially since Nurses are fighting for more rights?

Then again, there is a salary difference, but I dont think nurse practice programs are 45K or more a year. Nurses can only make so much while physician reimbursement is different

Let me know your thoughts

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[Temperature101]

Currently, at the clinic I work at we have two Nurse Practitioners (NPs) that work independently in a primary care setting. My question is why would someone work their hind end off to get into medical school, take that dreaded MCAT, invest at the VERY LEAST (Lecom's 3 year program +3 years residency FM) 6 years of their post college life for Family medicine, when they could just as easily get a 4 year nursing degree and only have to spend 3 years post college to practice with autonomy?

Granted, this is just for family medicine, but since 20% of DOs go into family practice, doesn't the cost seem too high, especially since Nurses are fighting for more rights?

Then again, there is a salary difference, but I dont think nurse practice programs are 45K or more a year. Nurses can only make so much while physician reimbursement is different

Let me know your thoughts

80k salary vs 170k salary over 30 years is a huge difference plus the knowledge that FM MD/DO has as oppose to an ARNP is immense. The ability to open your own practice and the prestige associated with being physician is a world of difference. There are more stuff that I can name such as flexibility ect...

 

[gc91]

80k salary vs 170k salary over 30 years is a huge difference plus the knowledge that FM MD/DO has as oppose to an ARNP is immense. The ability to open your own practice and the prestige associated with being physician is a world of difference. There are more stuff that I can name such as flexibility ect...

This, especially the knowledge part.

 

[nico vazquez]

I struggled with this option and decided against entering a direct-entry NP program because there is too much uncertainity with the 2015 DNP mandate.

 

[jrporte3]

80k salary vs 170k salary over 30 years is a huge difference plus the knowledge that FM MD/DO has as oppose to an ARNP is immense. The ability to open your own practice and the prestige associated with being physician is a world of difference. There are more stuff that I can name such as flexibility ect...

This, especially the knowledge part.

+1

I have a sister-in-law who is an NP and she wishes she would have done the MD/DO route instead of NP for 1) the prestige, and 2) the ability to open her own practice, and the freedom to practice the way you want to rather than working for a physician....

 

[GypsyHummus]

+1

I have a sister-in-law who is an NP and she wishes she would have done the MD/DO route instead of NP for 1) the prestige, and 2) the ability to open her own practice, and the freedom to practice the way you want to rather than working for a physician....

I thought NP had sovereignty and it was the PAs that have to be under a physician.

 

[jrporte3]

Depends on the state... Each state has its own regulations. She lives in Utah and is under a physician

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[Instatewaiter]

Currently, at the clinic I work at we have two Nurse Practitioners (NPs) that work independently in a primary care setting. My question is why would someone work their hind end off to get into medical school, take that dreaded MCAT, invest at the VERY LEAST (Lecom's 3 year program +3 years residency FM) 6 years of their post college life for Family medicine, when they could just as easily get a 4 year nursing degree and only have to spend 3 years post college to practice with autonomy?

Granted, this is just for family medicine, but since 20% of DOs go into family practice, doesn't the cost seem too high, especially since Nurses are fighting for more rights?

Then again, there is a salary difference, but I dont think nurse practice programs are 45K or more a year. Nurses can only make so much while physician reimbursement is different

Let me know your thoughts

Quick answer: So that you know what you're doing

 

[gmcguitar4]

NP's can have their own practice in most states.

Also, they generally work 9-5. The ones I worked with in cardiology did at least..and cards isn't a 9-5 gig for the docs fo sho.

If you calculate their hourly rates compared to primary care docs...they don't do so bad.

 

[HM3]

OP, I have a serious question. What is the purpose of this thread? I see mostly erroneous replies by PREMEDs. Youre not going to get much objectivity here. You might want to actually observe NPs/DOs as a complete observer. That'd give you more insight.

 

[GypsyHummus]

OP, I have a serious question. What is the purpose of this thread? I see mostly erroneous replies by PREMEDs. Youre not going to get much objectivity here. You might want to actually observe NPs/DOs as a complete observer. That'd give you more insight.

I have shadowed both MD and NP in the primary care setting (family practice), and I see very little difference, other than patient disappointment when they find out they are being seen by the nurse practitioner.

The purpose was to pose a question of why people who are interested in specifically family medicine, as 20% of DOs end up going that route, why they just dont go to NP school if they have all of the same privileges. It costs less, your out faster, very few call, and autonomy.

Is this why family medicine and general practice is slowly declining?

The only thing I have seen that the Doc does as opposed to the NP is preform minor procedures, such as lumpectomy. Other than that they have the same practice rights; prescribe medicine, diagnose.

 

[pattr]

The level of understanding as far as pathophysiology is definitely different. NPs, like you've stated, are equivalent in practice in the primary care setting as FP physicians in common, lower/moderate-complexity cases. However, when it comes to more complicated cases I believe the sheer volume and depth of experience DOs and MDs gain during the 2 years of clinical rotations in medical school and in their 3+ years of residency heavily outweigh that of NPs.

http://www.aafp.org/online/etc/medi...le.tmp/NP_Info_FP-NPTraining-Compare-4pgs.pdf

 

[gmcguitar4]

Yea with NP's...you deal with the SAME krap every day for eternity. Anything interesting/complicated goes to the doc. If you are fine with that then do it up.

 

[SpecterGT260]

I don't know what it is.... but these threads often increase my BP several points.

 

[Bacchus]

AAFP just put out a press release regarding how NPs should not be leading a team. That is the role of the physician: http://blogs.aafp.org/cfr/leadervoices/entry/nps_no_substitute_for_physician?sf6162267=1

You should also see this:

 

[SpecterGT260]

AAFP just put out a press release regarding how NPs should not be leading a team. That is the role of the physician: http://blogs.aafp.org/cfr/leadervoices/entry/nps_no_substitute_for_physician?sf6162267=1

You should also see this:

There is always something frustrating about oversight by someone less qualified than yourself. Be it legal, administrative, or NP led teams.... IMO there is already enough irritation for physicians just trying to do their jobs without adding more people who don't know how to make the call weighing in.

 

[Bacchus]

There is always something frustrating about oversight by someone less qualified than yourself. Be it legal, administrative, or NP led teams.... IMO there is already enough irritation for physicians just trying to do their jobs without adding more people who don't know how to make the call weighing in.

I agree. I'm at a very busy family med office right now in North Philadelphia. There are 3 attendings there. They also have ultrasound, EMG and chiropractic clinics in the office. Office hours are usually 8/9AM to 9PM at night Monday-Thursday with 8-4/5 on Friday and then 8-2 on Saturday.

The thing that puzzles me, is they have not hired an NP or PA to work in the practice. These attendings are busting their backs. With an NP, and I think this would be an appropriate situation, they'd have much less work. Let him or her see the sniffle cases and let chronic disease management up to the attendings.

Agreeing with you, I do understand how the team can be muddied. I do think the PCMH is a good idea, but the amount of paperwork that goes with it is too much. If you have the ancillary staff to carry out your wishes (referral requests, Rx's, lab slips, triage) then it works. Otherwise it creates too much paperwork.

 

[SpecterGT260]

I have no issue at all with hiring dNPs or PAs as support staff to help move patients through. However if any ever talked to me about wanting to practice solo I would tell them that I would be willing to write a glowing LOR for medical school.

 

[oms2]

nurses might have hands-on skills similar to the osce stuff in bates, but how many nurses have read robbins & cotran (path) or katzung (pharm) i.e. the whys and wherefores of how things work? how many nurses can pass usmle step 1? again, it's the knowledge base.

 

[Bacchus]

I have no issue at all with hiring dNPs or PAs as support staff to help move patients through. However if any ever talked to me about wanting to practice solo I would tell them that I would be willing to write a glowing LOR for medical school.

Touche. I'm actually surprised with how aggressive a stance the AAFP is taking. They're definitely not toeing a neutral line. Understandably so. I'd expect them to protect our interests and the best interest of patients.

 

[SpecterGT260]

Touche. I'm actually surprised with how aggressive a stance the AAFP is taking. They're definitely not toeing a neutral line. Understandably so. I'd expect them to protect our interests and the best interest of patients.

IMO it is about time. Med school hammers the passive professionalism demeanor business into us daily and in the end we seem all too willing to bend over and take it when someone wants to encroach.

 

[zoner]

but the reality is, it is only a matter of time when NPs are going to be able to practice independently of course with a little more education which they can probably get while working as a NP. For example, just look at CRNA and how they can work independently in CA now. Anesthesiologists are all freaked out about that, just go into the gas forum.

 

[scpod]

When you look at it NP's can go to work with about 800 clinical hours. Family practice docs have something like 18,000 clinical hours by the time they leave residency. You cannot substitute that kind of experience. If you have never seen and managed complicated cases you don't even know where to begin.

The true lack of depth of NP's medical knowlege and clinical abilities doesn't really come to light until you have spent a few years in med school and residency yourself. As a lay person, one can look at an NP and think that they know a whole lot. A few of them who have been on the job for quite a few years actually do know a lot. But, you will not realize what kind of knowledge they really do lack until you are a physician yourself and have gone through the training. It takes them years on the job to get good at it.

Here's the other thing. Most NP's don't want to do primary care either. The majority want to specialize in something. And most of the one's who work here in the hospital don't have "cushy" 9 to 5 hours. They do the scut work that the specialists don't want to do themselves. They go to the ER and do admits and H and P's and dictate it all and the physician checks it and signs off on it. They do the consults and write the daily notes and do the discharges and d/c summaries while the physician checks it, makes and changes and signs the notes. They admit, discharge and go round on all the floor patients while the surgeon sits in the lounge and waits for the next case to be ready in the OR. They take call at night, answering all the silly floor calls and wake up the attending only when it's really necessary. It's not a real glamorous life in a lot of cases.

 

[jl lin]

but the reality is, it is only a matter of time when NPs are going to be able to practice independently of course with a little more education which they can probably get while working as a NP. For example, just look at CRNA and how they can work independently in CA now. Anesthesiologists are all freaked out about that, just go into the gas forum.

As well they should be. No one in my family is going under w/o anesthesiologist back-up. Shooy, I interview those doing anesthesia ahead of time. I have done this for my children. If the CRNA or anesthesiologist did not like it, oh well. I know what I had to go through to get them. Sorry.

 

[jl lin]

When you look at it NP's can go to work with about 800 clinical hours. Family practice docs have something like 18,000 clinical hours by the time they leave residency. You cannot substitute that kind of experience. If you have never seen and managed complicated cases you don't even know where to begin.

The true lack of depth of NP's medical knowlege and clinical abilities doesn't really come to light until you have spent a few years in med school and residency yourself. As a lay person, one can look at an NP and think that they know a whole lot. A few of them who have been on the job for quite a few years actually do know a lot. But, you will not realize what kind of knowledge they really do lack until you are a physician yourself and have gone through the training. It takes them years on the job to get good at it.

Here's the other thing. Most NP's don't want to do primary care either. The majority want to specialize in something. And most of the one's who work here in the hospital don't have "cushy" 9 to 5 hours. They do the scut work that the specialists don't want to do themselves. They go to the ER and do admits and H and P's and dictate it all and the physician checks it and signs off on it. They do the consults and write the daily notes and do the discharges and d/c summaries while the physician checks it, makes and changes and signs the notes. They admit, discharge and go round on all the floor patients while the surgeon sits in the lounge and waits for the next case to be ready in the OR. They take call at night, answering all the silly floor calls and wake up the attending only when it's really necessary. It's not a real glamorous life in a lot of cases.

The first part, while true, I am not so sure that the encroachment will stop. It may depend upon what happens with HCR.

The last part you wrote sounds like eternal internship, lol. One of the peds cardiac NPs in a children's heart unit seemed OK making $108,000 working 3 nights a week covering the unit. Three nights and that didn't include her per diem job. Seems wrong somehow.

 

[zoner]

As well they should be. No one in my family is going under w/o anesthesiologist back-up. Shooy, I interview those doing anesthesia ahead of time. I have done this for my children. If the CRNA or anesthesiologist did not like it, oh well. I know what I had to go through to get them. Sorry.

huh?

 

[DrBumblebee]

When you look at it NP's can go to work with about 800 clinical hours. Family practice docs have something like 18,000 clinical hours by the time they leave residency. You cannot substitute that kind of experience. If you have never seen and managed complicated cases you don't even know where to begin.

The true lack of depth of NP's medical knowlege and clinical abilities doesn't really come to light until you have spent a few years in med school and residency yourself. As a lay person, one can look at an NP and think that they know a whole lot. A few of them who have been on the job for quite a few years actually do know a lot. But, you will not realize what kind of knowledge they really do lack until you are a physician yourself and have gone through the training. It takes them years on the job to get good at it.

Here's the other thing. Most NP's don't want to do primary care either. The majority want to specialize in something. And most of the one's who work here in the hospital don't have "cushy" 9 to 5 hours. They do the scut work that the specialists don't want to do themselves. They go to the ER and do admits and H and P's and dictate it all and the physician checks it and signs off on it. They do the consults and write the daily notes and do the discharges and d/c summaries while the physician checks it, makes and changes and signs the notes. They admit, discharge and go round on all the floor patients while the surgeon sits in the lounge and waits for the next case to be ready in the OR. They take call at night, answering all the silly floor calls and wake up the attending only when it's really necessary. It's not a real glamorous life in a lot of cases.

Then, how about that nursing schools would declare that they'll provide 18,000 clinical hours for their nursing students just to come to a shoulder-by-shoulder level with family medicine residents to start to work? They may give them "online" pharmacology and anatomy lessons even while they're working just to amalgamate that deficiency "on paper", as well...

As you can see, this is a lost fight from the start before the lay men, if you argue using that type of logic. It only takes a fast and sharp regulation with binding laws to draw the borders for everyone for good and shut this stupid fight off.

It's an unfortunate truth that most of the insurance firms along with these "mean" healthcare settings and private practice owners just don't wanna pay for a primary care physician (PCP) at a level a physician deserves. How to pump the fear onto the physician world? As easy as supporting the nurse's existence as a "works-like-a-physician-paid-at-a-fraction" entity.

Where are those highly selective medical schools to protest their graduates' rights? Where are those highly selective residency programs? Oh, they've already been paid, and they're off the hook. It's now PCP's own problem to handle...

 

[qwerty2012]

It is like why not going to 2 years of CC then transfer over? Economically it is wise but not a lot of ppl would do it because of troubles and so on.

 

[SpecterGT260]

It is like why not going to 2 years of CC then transfer over? Economically it is wise but not a lot of ppl would do it because of troubles and so on.

what is like that?..... DNP training? no it isnt...

for the CC debate, what is being asked is "have you demonstrated a reasonable ability handle being trained"

However DNP is a terminal degree. Once there they have no further training. Any and all shortcuts inevitably produce a substandard product.

 

[jl lin]

huh?

Huh, what?

 

[dudeliness]

Interesting debate. Depends on how much you want to know I guess...
I don't think that being a NP necessarily has to limit your medical knowledge, but I do think that you would have to do a lot more work on your own to learn more. Just my thoughts...

 

[SpecterGT260]

Interesting debate. Depends on how much you want to know I guess...
I don't think that being a NP necessarily has to limit your medical knowledge, but I do think that you would have to do a lot more work on your own to learn more. Just my thoughts...

Its kind of a monkeys with typewriters and Shakespeare sort of thing.... the purpose of formal education is to cram more in to you than you would likely achieve on your own

 

[primadonna22274]

Someone on the team needs to know all the extra esoteric BS that MD/DOs know. The knowledge gap in basic sciences is IMMENSE and directly related to breadth and depth of Ddx. Physicians are trained to think of everything. Yes, common things are common, but not all that walks into a typical FM office is common.
I've been a PA for 12 yr. Now a 2nd-yr DO student and amazed at how much my knowledge base has grown in just over a year. Case in point: I had to take my PA recert exam this week (once every 6 yr to maintain NCCPA certification). My last score in 2006 was good--about 620 I think (85th %ile IIRC). I didn't study at all for this exam Monday--had a cardio final and too much other stuff to consume my energy--and I scored 800. 99th %ile. They stop scoring at 800....
Directly correlates to deeper and broader knowledge base acquired over the past year in med school.

 

[SpecterGT260]

Someone on the team needs to know all the extra esoteric BS that MD/DOs know. The knowledge gap in basic sciences is IMMENSE and directly related to breadth and depth of Ddx. Physicians are trained to think of everything. Yes, common things are common, but not all that walks into a typical FM office is common.
I've been a PA for 12 yr. Now a 2nd-yr DO student and amazed at how much my knowledge base has grown in just over a year. Case in point: I had to take my PA recert exam this week (once every 6 yr to maintain NCCPA certification). My last score in 2006 was good--about 620 I think (85th %ile IIRC). I didn't study at all for this exam Monday--had a cardio final and too much other stuff to consume my energy--and I scored 800. 99th %ile. They stop scoring at 800....
Directly correlates to deeper and broader knowledge base acquired over the past year in med school.

it is n=1, but I choose to believe this is the norm

 

[GUH]

NP's do not have full autonomy in all states.

While I work with nurses and have a great deal of respect for the profession, one of the main reasons I'm applying to medical school is to be able to work autonomously in whatever state I can earn a license. (In retrospect, I probably would have gone dental but it's too late now so whatever)

 

[TriagePreMed]

Because I don't want to be a nurse and want to be trained in the medical model and have the ability to practice independently in all 50 states.

 

[GypsyHummus]

Because I don't want to be a nurse and want to be trained in the medical model and have the ability to practice independently in all 50 states.

I think that it wont be long till nurse practitioners get full practice rights. How long did it take for the osteopaths to get full licensing rights?

 

[gc91]

I think that it wont be long till nurse practitioners get full practice rights. How long did it take for the osteopaths to get full licensing rights?

A long time. But that's also because Osteopathic medicine has evolved so much since Andrew Still's day.

 

[DrBumblebee]

DOs have always been physicians along side with MDs.. There used to be nurses at then, too.

 

[sena]

.

 

[sena]

Depends on the state... Each state has its own regulations. She lives in Utah and is under a physician

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NP's don't have to be under a physician in Utah. I know a 2 of them who run their own clinic (In association with a hospital), as well sole ER provider in a rural hospital. All without physician oversight.

 

[TriagePreMed]

I think that it wont be long till nurse practitioners get full practice rights. How long did it take for the osteopaths to get full licensing rights?

So what? I want licensing by the time I begin practicing. I don't want to maybe have license at some point in the future. Yes, it took Osteopathic Physicians a long time to get full rights. I don't see the point. If I were in those times, I'd apply for an MD degree only. It's as simple as that.

 

[NurWollen]

Another thing is that most med students don't know what specialty they want to pursue when they start med school. Maybe they go into it thinking they want to be a family practitioner then decide they want to be an ENT... it would kind of suck to be half-way done with the NP route and figure that out.

Another reason is knowledge. One of the major reasons I want to pursue medicine so bad is to have the scientific knowledge they have- because I love science. On the other hand, I wanted to do something that allows me to directly apply my knowledge on a day to day basis (which led me away from a research career.) For me, medicine fits these interests better than other fields.

 

[FrkyBgStok]

I think that it wont be long till nurse practitioners get full practice rights. How long did it take for the osteopaths to get full licensing rights?

I really think you guys are looking at this the wrong way. People talk about NPs and PAs encroaching on the physicians turf. That is total crap. It is a problem with the system. They aren't encroaching and I will explain.

Let's ranking difficulty from 1-20 with one being the hardest and 20 being the easiest. I am going to be very broad for point clarity so nobody be offended. Anyway, let's say the physician training gives you the difficult rating from 1-10, NP/PA is from 5-15, and nurses from 10-20. The proper balance would be physicians doing most of their work in the 2-3 range, NPs doing most of their work in the 7-8 range and nurses doing their work in the 13-16 range. That would be a good balance. Unfortunately, with the system as it is, most doctors are doing their work in the 5-7 range, most NP/PAs are in the 8-9 range, etc. So yes, NPs and PAs are doing more and that is a good thing but we need them to do more so we as physicians (when we get there) can do our work in a range that isn't encroachable. Not only does this provide better care for more people, it does it cheaply, efficiently, and with everyone understanding their role in the healthcare team.

So as you can see, I am an incredible super genius.

 

[dudeliness]

I really think you guys are looking at this the wrong way. People talk about NPs and PAs encroaching on the physicians turf. That is total crap. It is a problem with the system. They aren't encroaching and I will explain.

Let's ranking difficulty from 1-20 with one being the hardest and 20 being the easiest. I am going to be very broad for point clarity so nobody be offended. Anyway, let's say the physician training gives you the difficult rating from 1-10, NP/PA is from 5-15, and nurses from 10-20. The proper balance would be physicians doing most of their work in the 2-3 range, NPs doing most of their work in the 7-8 range and nurses doing their work in the 13-16 range. That would be a good balance. Unfortunately, with the system as it is, most doctors are doing their work in the 5-7 range, most NP/PAs are in the 8-9 range, etc. So yes, NPs and PAs are doing more and that is a good thing but we need them to do more so we as physicians (when we get there) can do our work in a range that isn't encroachable. Not only does this provide better care for more people, it does it cheaply, efficiently, and with everyone understanding their role in the healthcare team.

So as you can see, I am an incredible super genius.

Hmm, interesting point. Thanks super genius!

 

[MedPR]

I really think you guys are looking at this the wrong way. People talk about NPs and PAs encroaching on the physicians turf. That is total crap. It is a problem with the system. They aren't encroaching and I will explain.

Let's ranking difficulty from 1-20 with one being the hardest and 20 being the easiest. I am going to be very broad for point clarity so nobody be offended. Anyway, let's say the physician training gives you the difficult rating from 1-10, NP/PA is from 5-15, and nurses from 10-20. The proper balance would be physicians doing most of their work in the 2-3 range, NPs doing most of their work in the 7-8 range and nurses doing their work in the 13-16 range. That would be a good balance. Unfortunately, with the system as it is, most doctors are doing their work in the 5-7 range, most NP/PAs are in the 8-9 range, etc. So yes, NPs and PAs are doing more and that is a good thing but we need them to do more so we as physicians (when we get there) can do our work in a range that isn't encroachable. Not only does this provide better care for more people, it does it cheaply, efficiently, and with everyone understanding their role in the healthcare team.

So as you can see, I am an incredible super genius.

This. Also, I don't care what your pre-med opinion is of what your future specialty will be. Chances are you will not end up in that specialty. In other words, if you do NP/PA because "well I want to do FM anyway so I might as well same some time and money" you are locking yourself into something you have very little experience with.

 

[GypsyHummus]

This. Also, I don't care what your pre-med opinion is of what your future specialty will be. Chances are you will not end up in that specialty. In other words, if you do NP/PA because "well I want to do FM anyway so I might as well same some time and money" you are locking yourself into something you have very little experience with.

Yes I understand that. But for someone who goes through medical school and finds out Family medicine is for them, whats the point when insurance companies can reimburse Nurse practitioners for a fraction of the cost that they can reimburse physicians.

I see family medicine phasing out if Nurses continue to get more autonomy, and get the so called "doctorate" degree. Does anyone else share this thought?

 

[MedPR]

Yes I understand that. But for someone who goes through medical school and finds out Family medicine is for them, whats the point when insurance companies can reimburse Nurse practitioners for a fraction of the cost that they can reimburse physicians.

I see family medicine phasing out if Nurses continue to get more autonomy, and get the so called "doctorate" degree. Does anyone else share this thought?

What's the point of what? Hindsight is 20/20, but once they complete their MD/DO there is no reason to stop being a physician.

I don't see that happening. There are already DNPs and the shortage of primary care physicians is as prevalent as ever.

Edit: Also, I personally would not be comfortable going to see a DNP/NP/PA for something I would normally see a physician for. The level of education and amount of clinical experience is not comparable.

 

[GypsyHummus]

What's the point of what? Hindsight is 20/20, but once they complete their MD/DO there is no reason to stop being a physician.

I don't see that happening. There are already DNPs and the shortage of primary care physicians is as prevalent as ever.

Edit: Also, I personally would not be comfortable going to see a DNP/NP/PA for something I would normally see a physician for. The level of education and amount of clinical experience is not comparable.

But the same can be said for nurse anesthesia and whats happening now. Nurse anesthesiologists are slowly starting to phase into the hospital systems, and at a much cheaper rate to reimburse than the physicians. Why have five anesthesiologists on staff when you can have to anesthesiologist and three certified nurse anesthesiologist. I see it being even worse for primary care because it's cheaper than anesthesiology.

 

[MedPR]

But the same can be said for nurse anesthesia and whats happening now. Nurse anesthesiologists are slowly starting to phase into the hospital systems, and at a much cheaper rate to reimburse than the physicians. Why have five anesthesiologists on staff when you can have to anesthesiologist and three certified nurse anesthesiologist. I see it being even worse for primary care because it's cheaper than anesthesiology.

Wait, there are nurse anesthetists flying solo in ORs? That's crazy...