Have any of you had any run-ins with NPs, DNPs, PAs?

[CodeBlu]

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A friend of mine is on rotation at a major tertiary care center. She just called me balling her eyes out because some DNP chewed her out like she was her attending or something.

My friend had some clinical suspicion that something else was going on with her patient. DNP told her to stop looking for zebras and said something like "all you doctor types are the same." I won't get into details of that, but turns out she was right. Then the DNP threw her under the bus in front of the attending and said that she was careless and she missed it.

Attending got angry. But later on, sweet sweet vindication... my friend had already documented her clinical findings in the EMR.

Attending saw this note and then sought out the med student and asked for the story...

Anybody else have any run ins?

 

[FCMike11]

Sounds a little made up.

Sent from my SAMSUNG-SGH-I747 using Tapatalk 2

 

[CodeBlu]

Sounds a little made up.

Sent from my SAMSUNG-SGH-I747 using Tapatalk 2

Pre-med?

 

[normtheniner]

A friend of mine is on rotation at a major tertiary care center. She just called me balling her eyes out because some DNP chewed her out like she was her attending or something.

My friend had some clinical suspicion that something else was going on with her patient. DNP told her to stop looking for zebras and said something like "all you doctor types are the same." I won't get into details of that, but turns out she was right. Then the DNP threw her under the bus in front of the attending and said that she was careless and she missed it.

Attending got angry. But later on, sweet sweet vindication... my friend had already documented her clinical findings in the EMR.

Attending saw this note and then sought out the med student and asked for the story...

Anybody else have any run ins?

I've had an NP argue that she should be reimbursed the same amount for taking call that an attending would... I think its best to just nod your head and agree.

 

[WaylonS]

Pre-med?

You're still an M2, no?

 

[Wordead]

You're still an M2, no?

What part of this doesn't sound believable? This sounds pretty run of the mill to me.

 

[Nymphicus]

A friend of mine is on rotation at a major tertiary care center. She just called me balling her eyes out because some DNP chewed her out like she was her attending or something.

My friend had some clinical suspicion that something else was going on with her patient. DNP told her to stop looking for zebras and said something like "all you doctor types are the same." I won't get into details of that, but turns out she was right. Then the DNP threw her under the bus in front of the attending and said that she was careless and she missed it.

Attending got angry. But later on, sweet sweet vindication... my friend had already documented her clinical findings in the EMR.

Attending saw this note and then sought out the med student and asked for the story...

Anybody else have any run ins?

What happened next????

You can't leave out all the juicy details!!

 

[batch5000]

Someone needs to lay the smack down and put this little DNP in her place. Why is a DNP teaching a medical student anyway?

 

[mimelim]

Someone needs to lay the smack down and put this little DNP in her place. Why is a DNP teaching a medical student anyway?

Are you saying that DNPs have nothing to teach medical students?

 

[CodeBlu]

What happened next????

You can't leave out all the juicy details!!

The attending apologized (without actually saying I'm sorry). And he said that the DNP was particularly not fond of medical students and to try and avoid her for the rest of the rotation. And if something like this came up, to bow her head down and nod.

Someone needs to lay the smack down and put this little DNP in her place. Why is a DNP teaching a medical student anyway?

A lot of services have NPs/PAs to do a lot of the busy work (admits and such). The med student had a question, and she asked the NP for her opinion. She didn't want to jump the gun and go straight to the attending and be completely wrong.

 

[CodeBlu]

Are you saying that DNPs have nothing to teach medical students?

I will agree with you on this point. DNPs and NPs and even nurses in general have a great deal of knowledge. One thing I saw in particular that I really liked was when we do ICU rounds, the attending would ask the nurse "what do you think is going on? what is your impression?"

These nurses spend all their time with the patient. Where the attending does not have the time to do so.

I guess it's problematic when the mid-level feels like they have something to prove and they feel the need to put the med student down. That's just not cool. It fosters hate between the two health care professionals.

 

[badasshairday]

I just make them really uncomfortable. "Oh, is that what you think, DOCTOR?" I say it in a patronizing way. Usually gets my point across. Seasoned midlevels are great, I have learned quite a bit from them. The junior midlevels just starting out are usually very modest too, but if they start to act like a 'know it all' I get annoyed. It is like a 3rd or 4th year medical student acting like they know more than the residents.

 

[SpecterGT260]

I just make them really uncomfortable. "Oh, is that what you think, DOCTOR?" I say it in a patronizing way. Usually gets my point across. Seasoned midlevels are great, I have learned quite a bit from them. The junior midlevels just starting out are usually very modest too, but if they start to act like a 'know it all' I get annoyed. It is like a 3rd or 4th year medical student acting like they know more than the residents.

Not to imply that it is relevant, but what year of your program are you in? (or... generalization about progress would suffice). I couldn't really see a junior resident or intern saying something like that to a DNP.

 

[SpecterGT260]

The attending apologized (without actually saying I'm sorry). And he said that the DNP was particularly not fond of medical students and to try and avoid her for the rest of the rotation. And if something like this came up, to bow her head down and nod.



A lot of services have NPs/PAs to do a lot of the busy work (admits and such). The med student had a question, and she asked the NP for her opinion. She didn't want to jump the gun and go straight to the attending and be completely wrong.

Are there office politics to be concerned about with just calling the DNP out right then and there to the attending? I feel like there are no downsides if your friend had just set the record straight during rounds.

 

[CodeBlu]

I just make them really uncomfortable. "Oh, is that what you think, DOCTOR?" I say it in a patronizing way. Usually gets my point across. Seasoned midlevels are great, I have learned quite a bit from them. The junior midlevels just starting out are usually very modest too, but if they start to act like a 'know it all' I get annoyed. It is like a 3rd or 4th year medical student acting like they know more than the residents.

That's absolutely hilarious. Maybe not the nicest. I guess I would try taking the high road if it happened to me.

I remember doing an ICU pre-clinical thing (we have to fill up a certain amount of hours doing these things before 3rd year). The poor resident I was with got called down to emerg for an admit. Drug OD. We had no beds in ICU and were trying to make room for the patient. Long story short, the charge nurse was chewing out the resident.

"Ughhhhh, why can't you just take him upstairs already. This is the ED. He's taking up space. We don't have time for one-on-one care here. He's on a vent. Just take him upstairs already. Do you even know what you're doing?"

I was very surprised at the residents composure. She quietly turns around and tells the nurse that she would like to conduct her exam in peace. The nurse says "Sure, whatever {insert first name of resident."

Resident kicks back with... "It's Dr. {insert last name} to you."

 

[CodeBlu]

Are there office politics to be concerned about with just calling the DNP out right then and there to the attending? I feel like there are no downsides if your friend had just set the record straight during rounds.

There's a team of DNPs that works with this particular service... they're sort of protected by the attending. It's like his harem of DNPs...

 

[SpecterGT260]

There's a team of DNPs that works with this particular service... they're sort of protected by the attending. It's like his harem of DNPs...

 

[batch5000]

Not to imply that it is relevant, but what year of your program are you in? (or... generalization about progress would suffice). I couldn't really see a junior resident or intern saying something like that to a DNP.

Are there training environments where a DNP would have authority over a resident at any level?

 

[SpecterGT260]

Are there training environments where a DNP would have authority over a resident at any level?

Not that I am aware of, but it could be shaky in terms of office politics to chew out a long-term team member as "the new guy". Code just mentioned the attending protecting the NPs on his staff, this could translate into pissing off your attending by chewing out the NP even as a junior resident hypothetically, at least.

 

[GUH]

I just make them really uncomfortable. "Oh, is that what you think, DOCTOR?" I say it in a patronizing way. Usually gets my point across. Seasoned midlevels are great, I have learned quite a bit from them. The junior midlevels just starting out are usually very modest too, but if they start to act like a 'know it all' I get annoyed. It is like a 3rd or 4th year medical student acting like they know more than the residents.

I thought DNP's often insisted on being called "doctor".

 

[ArcGurren]

That's absolutely hilarious. Maybe not the nicest. I guess I would try taking the high road if it happened to me.

I remember doing an ICU pre-clinical thing (we have to fill up a certain amount of hours doing these things before 3rd year). The poor resident I was with got called down to emerg for an admit. Drug OD. We had no beds in ICU and were trying to make room for the patient. Long story short, the charge nurse was chewing out the resident.

"Ughhhhh, why can't you just take him upstairs already. This is the ED. He's taking up space. We don't have time for one-on-one care here. He's on a vent. Just take him upstairs already. Do you even know what you're doing?"

I was very surprised at the residents composure. She quietly turns around and tells the nurse that she would like to conduct her exam in peace. The nurse says "Sure, whatever {insert first name of resident."

Resident kicks back with... "It's Dr. {insert last name} to you."

Oooh lord. You never want to piss off a charge nurse, dude. I definitely have seen people get annoyed when some nurses try to lord over the resident, but that kind of nasty snark can come back to bite you real fast (I know you didn't do this but I'm using the generic "you"). Certainly it will get you into some deep poop if you try this with an OR nurse.

Also if the ED isn't able to provide a respiratory therapist and RN for somebody on a vent or somebody on pressors, there's something very wrong with that ED. Our school's ED has at least once or twice a day somebody requiring pressor support or ventilatory support and they get constant monitoring from the nurses station.

 

[45408]

Are there training environments where a DNP would have authority over a resident at any level?

Not exactly. See below.

Not that I am aware of, but it could be shaky in terms of office politics to chew out a long-term team member as "the new guy". Code just mentioned the attending protecting the NPs on his staff, this could translate into pissing off your attending by chewing out the NP even as a junior resident hypothetically, at least.

Bingo. The attending might like a certain NP/PA, so if you get on their bad side, it could make its way back to the attending. I work with one who is actually quite intelligent, but her fuse has gotten shorter and shorter, and she's often in a bad mood. I just tread kind of lightly, because I know she's got everyone's ear...

Oooh lord. You never want to piss off a charge nurse, dude. I definitely have seen people get annoyed when some nurses try to lord over the resident, but that kind of nasty snark can come back to bite you real fast (I know you didn't do this but I'm using the generic "you"). Certainly it will get you into some deep poop if you try this with an OR nurse.

You should never piss anyone off if possible, but I'll certainly take an authoritative tone if something needs to happen now. You always have to remember who is in a position of power. There's no point in yelling at some low-level individual who can't get what you need, so it's just better to go over their head. I'll periodically ask for the charge nurse or shift supervisor and tell her that yes, it is extremely important that we get this patient to the OR in the next half hour, and no, we can't wait.

 

[badasshairday]

Not to imply that it is relevant, but what year of your program are you in? (or... generalization about progress would suffice). I couldn't really see a junior resident or intern saying something like that to a DNP.

I haven't worked with DNP's. E Even if they were DNP, it would not matter. NP/PA only. Honestly, most are really nice, i've only had two bad experiences.

My friend at a large, well known, academic center has done sometihng similar to what I outlined in the SICU. He is an intern. The midlevels there really don't know squat from the stories he tells me. He said it is like working with 3rd year med students.

And for more perspective, the only midlevels I didn't like are NP's. PA's are all cool in my experience. Most NP's too, except for a few.

 

[badasshairday]

Not exactly. See below.


Bingo. The attending might like a certain NP/PA, so if you get on their bad side, it could make its way back to the attending. I work with one who is actually quite intelligent, but her fuse has gotten shorter and shorter, and she's often in a bad mood. I just tread kind of lightly, because I know she's got everyone's ear...

The only midlevels I have ever had a problem with were also somewhat not liked by attendings. Go figure.

 

[CodeBlu]

The only midlevels I have ever had a problem with were also somewhat not liked by attendings. Go figure.

What I don't understand... is why some of them act like doctors and try to put people down.

I don't want to sound cynical, but it's my belief that they wanted to be MDs/DOs and they couldn't get into med school.

One instance I had when I was a scribe and I was applying. One of the PAs was telling me that it was super competitive and that I wouldn't be able to do it. Then I got in. Then when I was talking about specialties and my interest in anesthesia, he said "you have to be in the top 5% of your class, it's way too competitive."

Stay tuned... haven't applied to residency yet. But I can definitely say that I am more motivated to get in now that he said I can't do it.

 

[badasshairday]

The worst experience I had was when I was a med student because I couldn't say anything. Some ENT NP was talking about referring some patient to rheum clinic and how the patient's mom did not want to see the fellow. She said "well she could see _____, NP, who knows more than the fellow anyways." I was sitting right there in the same room with the ENT attending. The ENT attending was like, "uh huh." Sort of in a dismissive way. Later that same day the doctor caught the NP making a pretty bad mistake on dosing antibiotics, something a med student would easily know, I smiled inside.

 

[badasshairday]

Just a disclaimer. I'd say I like 90% of midlevels. I really like the GI PA's that I interact with at my hospital as well as all the EM PA's. Amazing group, learned a lot from them.

 

[KinasePro]

The NP's I've met have generally been kind and helpful, but seem to only have the knowledge level of an MS3/4. They were fluent and competent, but would completely defer to residents and attendings for complicated assessments and plans.

PA's have been uniformly great, I've enjoyed working with them and learning from them. PA students on the other hand...

 

[CodeBlu]

Just a disclaimer. I'd say I like 90% of midlevels. I really like the GI PA's that I interact with at my hospital as well as all the EM PA's. Amazing group, learned a lot from them.

Agreed. I really liked all of the other PAs I interacted with. They were pretty awesome. Definitely taught me a lot.

However, I do think there is a really big difference between PAs and NPs. PAs learn medicine. NPs learn nursing and then they tack on some treatment algorithms with a bit of basic science.

 

[CodeBlu]

The NP's I've met have generally been kind and helpful, but seem to only have the knowledge level of an MS3/4. They were fluent and competent, but would completely defer to residents and attendings for complicated assessments and plans.

PA's have been uniformly great, I've enjoyed working with them and learning from them. PA students on the other hand...

Do tell...

 

[survivordo]

Can't say I mind having NP/PA's on the service, especially as an intern, less scut for me!! Luckily the few that I have encountered have been great. They are definitely "know their role" type of people. It is interesting to see my knowledge/ability slowly creep up on their's and begin to surpass it. You can definitely tell that they are comfortable deferring to the senior level residents.

Survivor DO

 

[KinasePro]

Do tell...

My main gripes with PA students are that they're always whining about their schedules and generally their egos far surpass their abilities.

I used to volunteer with senior PA students at our free clinics as an M1. Like all other M1s at that stage in training, I was awkward and inefficient. Instead of being helpful and capitalizing on the (countless) teaching moments, the PAs would try to look good at every opportunity. "ORLY? you haven't learned how to treat xyz yet? Lolz." Just an annoying crowd in my experience.

Something happens after they graduate though. Once certified, they suddenly become very professional and gracious to ******* med students like myself

 

[FutureInternist]

What I don't understand... is why some of them act like doctors and try to put people down.

Since that is the only time they will likely have any perceived or real rank over you.
Once you graduate they have to answer to you
Same thing applies to nurses vs younger, hotter female med students 😀

 

[ArcGurren]

You should never piss anyone off if possible, but I'll certainly take an authoritative tone if something needs to happen now. You always have to remember who is in a position of power. There's no point in yelling at some low-level individual who can't get what you need, so it's just better to go over their head. I'll periodically ask for the charge nurse or shift supervisor and tell her that yes, it is extremely important that we get this patient to the OR in the next half hour, and no, we can't wait.

Authoritative can be done in a polite way though; saying "it's Dr. ___ to you" is pretty rude.

 

[ArcGurren]

The NP's I've met have generally been kind and helpful, but seem to only have the knowledge level of an MS3/4. They were fluent and competent, but would completely defer to residents and attendings for complicated assessments and plans.

PA's have been uniformly great, I've enjoyed working with them and learning from them. PA students on the other hand...

I've never had a single gripe with any PA student I've rotated with. Most of them have been very pleasant, very intelligent, and generally as competent as any M3/4.

 

[FCMike11]

What I don't understand... is why some of them act like doctors and try to put people down.

I don't want to sound cynical, but it's my belief that they wanted to be MDs/DOs and they couldn't get into med school.

One instance I had when I was a scribe and I was applying. One of the PAs was telling me that it was super competitive and that I wouldn't be able to do it. Then I got in. Then when I was talking about specialties and my interest in anesthesia, he said "you have to be in the top 5% of your class, it's way too competitive."

Stay tuned... haven't applied to residency yet. But I can definitely say that I am more motivated to get in now that he said I can't do it.

But why is that your belief?

 

[FCMike11]

Pre-med?

It isn't necessary to of completed any medical school to comment on this story.


I'm confused too....someone else mentioned it. You put a lot of emphasis on the fact the she is a DNP, but she also mentioned "you doctor types"? She didn't want to be called doctor?

Honestly, first hand from friends doing the schooling, NP is a bit of a joke to me...I have a friend who has done everything online, and will set up her clinical hours at her leisure. I am not trying to lobby for NP's by posting this, just a bit annoying that the purpose of this thread appears to be for bashing on midlevels.

 

[yehhhboiii]

This is the allopathic section. It is necessary to have completed some medical school to comment here.

 

[mvenus929]

Someone needs to lay the smack down and put this little DNP in her place. Why is a DNP teaching a medical student anyway?

We had NPs (I dunno if they were DNPs or not, I didn't bother to ask) teaching us in OB/GYN, and on surgery. In fact, in one of the surgery clinics I worked in, we would often present to the NP over the attending... the attending only cared if the NP couldn't talk to the patient appropriately (one patient had a hernia that needed repair and the NP got the attending to explain the films to her) or if it was an initial visit. We were actually assigned to work with the NPs in GYN clinic. I'm not sure if it was better working with the NP or the residents--neither of my GYN clinic days were very good.

 

[45408]

The NP's I've met have generally been kind and helpful, but seem to only have the knowledge level of an MS3/4. They were fluent and competent, but would completely defer to residents and attendings for complicated assessments and plans.

PA's have been uniformly great, I've enjoyed working with them and learning from them. PA students on the other hand...

Hit or miss. Some of them are extremely good, and some are just incorrigibly bad.

 

[ArcGurren]

Hit or miss. Some of them are extremely good, and some are just incorrigibly bad.

Like most medical students, I would imagine...

 

[link2swim06]

As a med student I might not know more than a NP/PA with 5+ years of experience, however, every PA/NP student so far is pretty clueless. Including those graduating this may.

 

[Armadillos]

had a run in with a NP the other day at my primary care doctor's office...

I was sick and his schedule was jammed full for the next few days, so I just just showed up and got seen by the group's NP that day, it was amazing.

 

[sonofva]

my program trains PAs at the same site as the medical school, and at another site in another part of the state...the ones that train at the medical school are dynamite, the ones that train away are garbage...

 

[MediCynical]

had a run in with a NP the other day at my primary care doctor's office...

I was sick and his schedule was jammed full for the next few days, so I just just showed up and got seen by the group's NP that day, it was amazing.

cool story bro

 

[Lys Ile Glu Leu]

This is the allopathic section. It is necessary to have completed some medical school to comment here.

Is it?

Whoops! I just did. 😱

Should the propriety of one posting somewhere not be determined by the quality of what it adds to a discussion? You post in the pre-_____ forums, right? To think a premed couldn't say anything meaningful on the simple basis of not having yet matriculated is an oversimplified thought. These threads aren't all about things beyond our knowledge or understanding.

 

[Wordead]

Is it?

Whoops! I just did. 😱

Should the propriety of one posting somewhere not be determined by the quality of what it adds to a discussion? You post in the pre-_____ forums, right? To think a premed couldn't say anything meaningful on the simple basis of not having yet matriculated is an oversimplified thought. These threads aren't all about things beyond our knowledge or understanding.

The previous pre-med posted that the story sounded made up, which was based on...literally nothing. So yes, premeds can theoretically say something meaningful but somehow never do.

Don't worry, you'll become just as snooty when you get into med school. Circle of life.

 

[Lys Ile Glu Leu]

The previous pre-med posted that the story sounded made up, which was based on...literally nothing. So yes, premeds can theoretically say something meaningful but somehow never do.

Don't worry, you'll become just as snooty when you get into med school. Circle of life.

My prior comment wasn't to defend that. There are plenty of premed idiots. Just the basic premise of what yehhhboii (sp?) said.

As for me, I typically just check these threads out because they're very informative. Consider these posts anomalies.

😀

 

[Armadillos]

cool story bro

that was my point, this whole thread is pretty pointless.

 

[duckie99]

My friend had some clinical suspicion that something else was going on with her patient. DNP told her to stop looking for zebras and said something like "all you doctor types are the same." I won't get into details of that, but turns out she was right. Then the DNP threw her under the bus in front of the attending and said that she was careless and she missed it.

1. this NP is a douche and I would not want to work with her.

2. med students, especially new ones, often do look for zebras because that is what they know based on step 1 studying. Common things are common is what I would say. For example, a htn crisis is far more likely to be due to med noncompliance than a pheochromocytoma

3. In my experience I have interacted with NPs and PAs they have been generally nice. I've had a couple who are simply douchy non-compassionate people who only care about themselves but they haven't been extremely rude to me. I've interacted with several NP and PA students. They are all much lower quality than any med student in every facet.

4. Once you become a resident and see the NP/PA in action with patients it becomes blatantly obvious they cannot replace a physician. So don't worry about it.