Hello, nurse practitioner...

[SaintJude]

I went shadow some ob/gyn but I actually ended up shadowing a nurse practitioner b/c it turns out the ob/gyn is in like 2 days/week--the other days she's working somewhere else (?)

But most of the patients were coming in to see the doctor only to meet the nurse practitioner (w/ white coat & everything). The patients weren't even offered an explanation or a quick "oh, by the way Dr. X isn't here and you'll be seeing nurse x."

Is there this general trend going on in a lot of clinics were Dr. X is being equated to Nurse X?

How much do these NPs make?

Edit: And are these nurses actually liable for anything or does it fall on the non-present physicians?

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[Goblue89]

I went shadow some "ob/gyn" but I actually ended up shadowing a nurse practitioner b/c it turns out the ob/gyn is in like 2 days/week--the other days she's working somewhere else (?)

But most of the patients were coming in to see the doctor only to meet the nurse practitioner (w/ white coat & everything). The patients weren't even offered an explanation or a quick "oh, by the way Dr. X isn't here and you'll be seeing nurse x."

Is there this general trend going on in a lot of clinics were Dr. X is being equated to Nurse X?

How much do these NPs make?

And why would a nurse practitioner have to offer an explanation for doing their job? NP/PAs can see patients without a physician present and even prescribe medication. NPs make around the same as PAs. Someone with experience can easily make 6 figures.

 

[SaintJude]

Hahah--I'm not!

It's just like making an appointment with the President and the meeting with Hillary! Or, making an appointment to see the CEO and then you meet the secretary?

I mean, why can't they just be clear about it who you're setting up an appointment with? Why go the extra mile to make an illusion you're meeting the doctor when you clearly wont?

 

[theseeker4]

Hahah--I'm not!

It's just like making an appointment with the President and the meeting with Hillary! Or, making an appointment to see the CEO and then you meet the secretary?

I mean, why can't they just be clear about it who you're setting up an appointment with? Why go the extra mile to make an illusion you're meeting the doctor when you clearly wont?

Don't you know that NP's and PA's can do everything that DO's/MD's can do, but better, for less money, and with less schooling?

But seriously, do you know for sure that the patients didn't know they were going to be seeing the NP instead of the doctor for their appointment? That might have been something they were told when the set the time for their appointment, so no indication that the person they were seeing wasn't the doctor was necessary....

 

[SaintJude]

Don't you know that NP's and PA's can do everything that DO's/MD's can do, but better, for less money, and with less schooling?

But seriously, do you know for sure that the patients didn't know they were going to be seeing the NP instead of the doctor for their appointment? That might have been something they were told when the set the time for their appointment, so no indication that the person they were seeing wasn't the doctor was necessary....

The patients were clearly confused. Like "Wait, is Dr. X coming today? Are you going to be doing [x]? "

i asked her what she would recommend becoming NP or doctor...and she said NP

Are we being stupidly ambitious? If an interviewer asked you "Why not become an NP or PA?" what would you legitimately say?

 

[theseeker4]

The patients were clearly confused. Like "Wait, is Dr. X coming today? Are you going to be doing [x]? "

i asked her what she would recommend becoming NP or doctor...and she said NP

Are we being stupidly ambitious? If an interviewer asked you "Why not become an NP or PA?" what would you legitimately say?

Personally? I have no desire to limit myself. Sure, PA's and NP's can "do 90% of what doctors do", but why would I willingly limit myself to 90%? If I am going to make health care my career, I am not going to choose a career that puts myself always subject to someone else's oversight. Being a physician means you are the lead of the patient's care. I would not choose a career that would limit my potential within that field right out of the gate. I also refuse to limit my knowledge and training to that required of PA's or NP's, and I don't want to always have patients listen to me, and respond "well I want to hear what the doctor has to say..." which is exactly what MY response would be if a PA or NP treated a family member or myself.

Sounds like the OB/GYN needs to better communicate with her patients. It is one thing to schedule appointments for your patients with a mid-level, but that is something that shouldn't be a surprise for the patient when the nurse walks into the room.

I also wouldn't put any stock in whether an NP says you should choose being an NP over a doctor. If you want to be a physician, go to med school. Don't worry about whether mid-levels think you should be a doctor or a nurse/PA.

 

[MrTambourineMan]

Personally? I have no desire to limit myself. Sure, PA's and NP's can "do 90% of what doctors do", but why would I willingly limit myself to 90%? If I am going to make health care my career, I am not going to choose a career that puts myself always subject to someone else's oversight. Being a physician means you are the lead of the patient's care. I would not choose a career that would limit my potential within that field right out of the gate. I also refuse to limit my knowledge and training to that required of PA's or NP's, and I don't want to always have patients listen to me, and respond "well I want to hear what the doctor has to say..." which is exactly what MY response would be if a PA or NP treated a family member or myself.
.

I was asked this in a few of my interviews and this is essentially how I responded as well.

 

[gettheleadout]

...so you stayed and shadowed the NP?

 

[SaintJude]

Thank you!!

 

[SpecterGT260]

And why would a nurse practitioner have to offer an explanation for doing their job? NP/PAs can see patients without a physician present and even prescribe medication. NPs make around the same as PAs. Someone with experience can easily make 6 figures.

this is a perfect resposne....
IF the OP had suggested at all what you appear to be responding to

the question was: if a pt makes an appt with a physician, and is not offered an explanation as to why they are being seen by a nurse instead of the physician, is this ok?

The answer is no. An explanation is needed because it is important that the patients expectations are respected. If they expected an MD and got an NP or DNP they need to be informed and have any questions/concerns addressed otherwise the DNP, the clinic, and possibly the physician could be sued.

Now, if these were regular patients, they may already be aware of the situation and this could explain why there was no explanation given while the OP was there.

Try to read and not just respond to your own tangential side-thoughts and emotional subtexts, please

 

[SpecterGT260]

The patients were clearly confused. Like "Wait, is Dr. X coming today? Are you going to be doing [x]? "

i asked her what she would recommend becoming NP or doctor...and she said NP

Are we being stupidly ambitious? If an interviewer asked you "Why not become an NP or PA?" what would you legitimately say?

she sounds like an NP with a chip on her shoulder. Many do. Also many do not and are great to have in the clinic. Of those that do, they should be put on bed pan duty before their extra gumption results in someone getting hurt.

Her recommendation is either a reflection of her own personal preference (which is OK, MD is not right for all people and NP is right for some) or a way to validate her choices via recruitment (which is not ok as it gives false impressions).

 

[SpecterGT260]

...so you stayed and shadowed the NP?

this didnt occur to me until it was directly spelled out.

 

[MedBound1]

It's actually not a bad idea to shadow an NP if you're unsure of your interest in medicine, though this experience is more appropriate in high school so you can make an informed decision between a nursing and non-nursing major in college that will put you on the path to become an NP, or not.

I agree with this. More perspective is never a bad thing.

The choice of MD vs. Other is largely a personal choice in which a huge number of factors come into play. Everyone should not, and does not, want to be an MD. In addition, not all that want to be an MD, end up being an MD. Therefore, it is impossible when someone says that they'd rather be a NP to pick out exactly why.

 

[BoondocksDoc]

i asked her what she would recommend becoming NP or doctor...and she said NP

Are we being stupidly ambitious? If an interviewer asked you "Why not become an NP or PA?" what would you legitimately say?

So I'm applying in this next cycle and actually was previously on an NP track. Here are the bullet points:
+ NPs don't have the same training, but provide equivalent care for many uncomplicated cases (routine prenatal, well-child, etc).
+ NPs should be clearly identifying themselves and patients should be making appointments with MD or NP.
+ NP practice varies by state, but they definitely are liable and responsible for their care. Some states have fully independent practice as PCP while others require collaborating (and liable) MD.
+ Both NP and PA are reasonable routes instead of medical school, especially if you want to work outpatient, part-time or have time for a family. Many specialties have more specific differences (ie midwifery vs OB).
+ In my opinion the biggest difference overall is cultural. How much do you care about that 10%? Which specialties interest you? Would you rather navigate the hierarchy of medicine or the scope of practice of nursing?
+ Unfortunately any discussion of above tends to raise egos on all sides (ie med students who feel NPs usurped the role and should be on "bedpan duty" vs NPs who think they are just as trained as a doc.) I think many folks feel defensive of their own choices and it takes some sorting through to find the right answer for you.

Hope that's helpful. Feel free to pm for more detailed info.

 

[SpecterGT260]

So I'm applying in this next cycle and actually was previously on an NP track. Here are the bullet points:
+ NPs don't have the same training, but provide equivalent care for many uncomplicated cases (routine prenatal, well-child, etc).
+ NPs should be clearly identifying themselves and patients should be making appointments with MD or NP.
+ NP practice varies by state, but they definitely are liable and responsible for their care. Some states have fully independent practice as PCP while others require collaborating (and liable) MD.
+ Both NP and PA are reasonable routes instead of medical school, especially if you want to work outpatient, part-time or have time for a family. Many specialties have more specific differences (ie midwifery vs OB).
+ In my opinion the biggest difference overall is cultural. How much do you care about that 10%? Which specialties interest you? Would you rather navigate the hierarchy of medicine or the scope of practice of nursing?
+ Unfortunately any discussion of above tends to raise egos on all sides (ie med students who feel NPs usurped the role and should be on "bedpan duty" vs NPs who think they are just as trained as a doc.) I think many folks feel defensive of their own choices and it takes some sorting through to find the right answer for you.

Hope that's helpful. Feel free to pm for more detailed info.

I like this post

although the reference to my post indicates you need to read more carefully next time but overall good work

 

[SaintJude]

Actually BoondocksDoc, thanks a lot! That was very helpful. I'm actually definetely interested in practicing in the US, but then also at some point in Europe and abroad. Even if it means being paid less, most Europeans are very adamant making a distinction about nurse vs. doctor care , so that's yet another personal reason form me.

 

[TheMightySmiter]

It's very common for primary care and OB/GYN practices to have nurse practitioners or PAs do most of the general workup such as physicals and annual exams. OP, I'm not surprised that you ran into an NP at the OB/GYN practice. I am surprised that they had you shadow the NP if you specified that you wanted to shadow the physician, but as other posters have mentioned, it is actually a good thing to shadow different areas of health care to know for sure that medicine is the only one you want to do.

 

[BoondocksDoc]

although the reference to my post indicates you need to read more carefully next time but overall good work

Thanks for the thumbs up and for being understanding. The quote from you might have been a poor choice bc I was more trying to illustrate a general pattern of how NPs are viewed. (Search SDN for NP and you will see...)

Feel free to post more questions and I'll try to answer!

 

[BoondocksDoc]

I'm actually definetely interested in practicing in the US, but then also at some point in Europe and abroad. Even if it means being paid less, most Europeans are very adamant making a distinction about nurse vs. doctor care , so that's yet another personal reason form me.

One of the reasons I switched to MD is because I want to do a lot of global work. NPs definitely work abroad (and in some countries have an even bigger role.) That said, it's fairly complicated to navigate vs an MD from US can definitely practice in any clinic/hospital in the world. Not sure about Europe specifically but definitely a good consideration!

 

[NightGod]

Are we being stupidly ambitious? If an interviewer asked you "Why not become an NP or PA?" what would you legitimately say?

It all boils down to two words for me: autonomy and surgery. You can experience a certain measure of both as a PA/NP, but you're only going to get the full measure as an MD/DO.