Hey, why does everyone hate nurse practitioners?

[DogFaceMedic]

I've been following along. It really is disappointing to read that a field I had so much interest in (nursing) is not as promising as I once thought. I don't like the idea of needing to "teach myself"...and although I am not sure if medicine is enough of a passion to go to medical school, I am still entertaining that possibility.
I've had reservations about being an NP- actually, I wanted to go into nurse midwifery, because I am very interested in holistic care and I felt that being a CNM would reach that goal. I still do feel that way- but, I want to be competent and good at what I do. Although I feel that PAs and even doctors are less holistic than I prefer, I am more comfortable with their knowledge base and scope of practice.

Don't be discouraged about nursing. The increase in salaries for RNs has helped professionalize the field a great deal. Higher education for RNs -- as well as many other firelds -- is filled with those who can't do the job, end up teaching. My wife is an ICU RN and very successful, but she wants to go further and was frustrated by the limitations of FNP education and so is now a PA.

I think NPs may price themselves out of the market by making too many hoops and obstacles to jump through and over to start practicing. PA education is not perfect either, but des present more options.

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[horsenurse25]

I've been following along. It really is disappointing to read that a field I had so much interest in (nursing) is not as promising as I once thought. I don't like the idea of needing to "teach myself"...and although I am not sure if medicine is enough of a passion to go to medical school, I am still entertaining that possibility.
I've had reservations about being an NP- actually, I wanted to go into nurse midwifery, because I am very interested in holistic care and I felt that being a CNM would reach that goal. I still do feel that way- but, I want to be competent and good at what I do. Although I feel that PAs and even doctors are less holistic than I prefer, I am more comfortable with their knowledge base and scope of practice.

I really would not take what is said on an anonymous board frequented mainly by pre-med students very seriously.

The amount of mis-information on this board is what is truly scary.

You should shadow an NP, PA, or whatever it is you are thinking about doing to get a real perspective. In fact, shadow several, the more the better.

Whatever people on this board want to say, NP's are a highly respected and growing field of the health care. They are able to practice completely independently without any doctor supervision in almost half of the states already, and that number is probably going to grow. (I myself do not think this trend is good. I value and appreciate my collaboration with the physician I work with very, very much.)

At any rate, NPs and PAs are a hugely useful, qualified and valued members of the health team. Ask any REAL doctors and they will tell you so.

Common sense tells you so as well. If NP's were so 'untrained' and 'dangerous' then why do their numbers keep growing?
Why are they becoming so uniformly popular across the country?
Why are they becoming the client's choice for health care?? And finally, why are there no studies anywhere that say that NP vs MD care is dangerous or poor? In fact, all the literature and studies say exactly the opposite all over the globe.

If you want to know the benefits and positives of being a cat, don't bother asking a bunch of barking puppies!!!

 

[core0]

I really would not take what is said on an anonymous board frequented mainly by pre-med students very seriously.

The amount of mis-information on this board is what is truly scary.

You should shadow an NP, PA, or whatever it is you are thinking about doing to get a real perspective. In fact, shadow several, the more the better.

Have to agree here.

Whatever people on this board want to say, NP's are a highly respected and growing field of the health care. They are able to practice completely independently without any doctor supervision in almost half of the states already, and that number is probably going to grow. (I myself do not think this trend is good. I value and appreciate my collaboration with the physician I work with very, very much.)

At any rate, NPs and PAs are a hugely useful, qualified and valued members of the health team. Ask any REAL doctors and they will tell you so.

Common sense tells you so as well. If NP's were so 'untrained' and 'dangerous' then why do their numbers keep growing?
Why are they becoming so uniformly popular across the country?
Why are they becoming the client's choice for health care?? And finally, why are there no studies anywhere that say that NP vs MD care is dangerous or poor? In fact, all the literature and studies say exactly the opposite all over the globe.

NP vs. PA is extremely regional. It also changes by specialty and medical field. As far as studies, there is no well done study that shows any independent practice by NP's are the equivalent of physician care.

If you want to know the benefits and positives of being a cat, don't bother asking a bunch of barking puppies!!!

There is some good information here, but there also some of the same regurgitated mis-information. If you want to learn about NP's look at http://allnurses.com/forums/f34/ If you want to find out about PA's look at http://www.physicianassistantforum.com/forums/. You will find some serious disagreement within the professions. PA's master's vs bachelors. NP's direct entry vs. experience for NP's. All of this is healthy. Overall you should know all the pro's and con's of a profession before comitting two + years of your life and $50k+.

David Carpenter, PA-C

 

[deleted87716]

Why are they becoming the client's choice for health care??

"Clients...?"

I thought we took care of "patients?"

 

[SupergreenMnM]

I really would not take what is said on an anonymous board frequented mainly by pre-med students very seriously.

Fortunately it seems there are several PAs and NPs here too (and med students, PhDs, etc. ) But I do agree, don't ever swallow whole anything you read on a board.

The amount of mis-information on this board is what is truly scary.

You should shadow an NP, PA, or whatever it is you are thinking about doing to get a real perspective. In fact, shadow several, the more the better.

I think this is the best advice for deciding, either for PA, NP, or MD.

Whatever people on this board want to say, NP's are a highly respected and growing field of the health care. They are able to practice completely independently without any doctor supervision in almost half of the states already, and that number is probably going to grow. (I myself do not think this trend is good. I value and appreciate my collaboration with the physician I work with very, very much.)

I think the current number is about 10 states? Thats what my NP says Anyways OP, if you want total 'independence' don't do NP or PA. If you go into either thinking its 'just like a doc' then you'll be disappointed. I am very hopeful that the current lvl of independence for NPs is changed someday soon, though I realize economics makes that unlikely. Still, I wouldn't want an unsupervised PA, so why in the world would I want an unsupervised NP?

At any rate, NPs and PAs are a hugely useful, qualified and valued members of the health team. Ask any REAL doctors and they will tell you so.

I agree with this too, although I don't know if you'd say I'm a real dr yet ( only a PhD ) Both are very useful, I think the problem is the ones who don't know their limitations. This goes for docs too.

Common sense tells you so as well. If NP's were so 'untrained' and 'dangerous' then why do their numbers keep growing?

Economics.

Why are they becoming so uniformly popular across the country?
Why are they becoming the client's choice for health care?? And finally, why are there no studies anywhere that say that NP vs MD care is dangerous or poor? In fact, all the literature and studies say exactly the opposite all over the globe.

Agree, as long as its w/in their limited, supervised scope as a mid level, I don't know if any studies have ever specifically looked at it otherwise.

If you want to know the benefits and positives of being a cat, don't bother asking a bunch of barking puppies!!!

At the same time, it will be a rare cat who tells honestly about its own condition, cats are after all vane creatures

 

[core0]

"Clients...?"

I thought we took care of "patients?"

I thought lawyers had clients. I know I have patients.

David Carpenter, PA-C

 

[zenman]

I've been following along. It really is disappointing to read that a field I had so much interest in (nursing) is not as promising as I once thought. I don't like the idea of needing to "teach myself"...a

I guess you didn't know medical school/residency is "see one, do one, teach one!" If you can find knowledge yourself, which is what you'll be doing when you're on your own, you'll be "da man"...or in your case "da woman."

In any case, nursing, NP, PA, and medical education needs an overhaul, IMHO.

 

[brightness]

Hmm. I never thought of it that way. I guess what I was really trying to say (only I didn't know it) is that I want exposure to the knowledge necessary to successfully perform my job. As in, I want to know what I need to know so I can learn it. I have no problem with independant study/learning, but I want to be sure I am learning everything I need for my job.

 

[horsenurse25]

"Clients...?"

I thought we took care of "patients?"

Perhaps that is California terminology. (Oops, I gave my home state away!! ) I tend to work primarily in Geriatric and where I am we refer to our 'patients' as 'clients'. In fact, there is a growing PC trend to call all patients clients as technically they are. Health care is a profession and a service as well as a business....

SupergreenMnM - the Pearson report was just published for 2007 shows which states NPs are allowed to practice with no physician collaboration. There are currently 23, and more expected to join in the near future, including California, since our Terminator Guv just made his big speech about NPs in January.

Again, I believe NPs are mid level. And should be under collaboration with an MD.

But I also think there should be a bridging type of education for experienced health professionals at the Masters level in their own field to upgrade into the MD level when they have appropriate experience. For example, an experienced PA or NP who have been working for a set number of years (2,3?) should be able to take a 2 year degree to become an MD. It is silly to make them start all over from the beginning.

 

[horsenurse25]

In any case, nursing, NP, PA, and medical education needs an overhaul, IMHO.

I completely agree with you on this one.

 

[horsenurse25]

At the same time, it will be a rare cat who tells honestly about its own condition, cats are after all vane creatures

Vain they may be, but if I had their power to weight ratio, the ability to tone all my muscles perfectly and maintain that sleek feline figure with a single stretch rather than sweating like a pig on the treadmill, I would be pretty smug too!!


I just love the banana. I don't look that happy doing aerobics.

 

[silas2642]

Perhaps that is California terminology. (Oops, I gave my home state away!! ) I tend to work primarily in Geriatric and where I am we refer to our 'patients' as 'clients'. In fact, there is a growing PC trend to call all patients clients as technically they are. Health care is a profession and a service as well as a business....

SupergreenMnM - the Pearson report was just published for 2007 shows which states NPs are allowed to practice with no physician collaboration. There are currently 23, and more expected to join in the near future, including California, since our Terminator Guv just made his big speech about NPs in January.

Again, I believe NPs are mid level. And should be under collaboration with an MD.

But I also think there should be a bridging type of education for experienced health professionals at the Masters level in their own field to upgrade into the MD level when they have appropriate experience. For example, an experienced PA or NP who have been working for a set number of years (2,3?) should be able to take a 2 year degree to become an MD. It is silly to make them start all over from the beginning.

But the thing that you're not taking into account is, you don't know what you don't know. I think that you're kind of assuming that a lot of NP education is parallel to physician education, and I don't think that's true at all. I find it hard to believe that pathophysiology taught at medical school is going to be the same as it is taught at NP school or that the rotations for an NP are going to be the same for a medical student. It just seems that doctors tend to be harder on future MD's/DO's on the wards than they do future NP's. If you went to medical school, I think that you would be somewhat shocked to find out how much you thought you knew, but in fact didn't.

There isn't a fast track to becoming a doctor-- there aren't any shortcuts. If you want a medical degree, go to medical school. Period. Don't think that you can become an NP/PA first and then all of a sudden you're halfway to becoming a doctor; it doesn't work that way. The system is the way it is because they want to make sure that everyone has the same basic solid foundation they need to become competent physicians.

 

[deleted87716]

In fact, there is a growing PC trend to call all patients clients as technically they are.

Sounds more like a way to trivialize the importance of the traditional doctor-patient relationship, or perhaps to conceal the fact that one is engaging in the practice of medicine. Either way, not a good thing.

 

[SupergreenMnM]

Perhaps that is California terminology. (Oops, I gave my home state away!! ) I tend to work primarily in Geriatric and where I am we refer to our 'patients' as 'clients'. In fact, there is a growing PC trend to call all patients clients as technically they are. Health care is a profession and a service as well as a business....

SupergreenMnM - the Pearson report was just published for 2007 shows which states NPs are allowed to practice with no physician collaboration. There are currently 23, and more expected to join in the near future, including California, since our Terminator Guv just made his big speech about NPs in January.

Thanks, I'll try to get my "paws" on it

Again, I believe NPs are mid level. And should be under collaboration with an MD.

Me too, just scared now that so many states think otherwise!

But I also think there should be a bridging type of education for experienced health professionals at the Masters level in their own field to upgrade into the MD level when they have appropriate experience. For example, an experienced PA or NP who have been working for a set number of years (2,3?) should be able to take a 2 year degree to become an MD. It is silly to make them start all over from the beginning.

I think the other posters pointed out the problem with this. Especially for NP the difference in even basic science knowledge from an MD is huge. The problem would be...what would you skip? You'd need the clinical years and the residency of course, and mid levels don't have the science education so you would need the 2 science years (and probably more, since there are prerequesite science courses as well). In the end for say and advanced nurse you still end up needing the same 4 years of med school, maybe more since I haven't met any nurses who have equal science backgrounds in order to do the first two years (College level: 1 year of Calculus, Physics, Biology, Chemistry (both inorganic and organic, generally at the junior/senior level) Biochemistry are mins, most also have microbiology, pathology, genetics, cell/molecular biology, college level physiology, and often neuro and immuno as well.

Coolest smileys ever: especially useful for describing bb discussions.

 

[fab4fan]

Perhaps that is California terminology. (Oops, I gave my home state away!! ) I tend to work primarily in Geriatric and where I am we refer to our 'patients' as 'clients'. In fact, there is a growing PC trend to call all patients clients as technically they are. Health care is a profession and a service as well as a business....

SupergreenMnM - the Pearson report was just published for 2007 shows which states NPs are allowed to practice with no physician collaboration. There are currently 23, and more expected to join in the near future, including California, since our Terminator Guv just made his big speech about NPs in January.

Again, I believe NPs are mid level. And should be under collaboration with an MD.

But I also think there should be a bridging type of education for experienced health professionals at the Masters level in their own field to upgrade into the MD level when they have appropriate experience. For example, an experienced PA or NP who have been working for a set number of years (2,3?) should be able to take a 2 year degree to become an MD. It is silly to make them start all over from the beginning.

That's another one of those stupid customer service gobbeldy-gook ideas. Sick people are patients, not clients.

 

[horsenurse25]

Coolest smileys ever: especially useful for describing bb discussions.

Where did you find that one???!!! It is GREAT! My other favorite


Anyways, I dunno. It seems there is no pleasing everyone. But whatever we want or believe, the bottom line is that there is a global shortage of healthcare providers, especially nurses. Things are going to have to change.

I know this is going to upset a lot of people, and I am truly not trying to be an *sshole. But most MDs nowadays do very little more than treat minor ailments and refer every thing else. Especially GPs. Perhaps it is time for an overhaul. For specialists, there can be no shortcuts... but for GPs and some other areas...well we can already see what is happening...

As for microbiology, chemistry, etc. I was a Bsc Chem major. (and math minor which just about killed me ) and I have not really found any benefits to that education in my practice. Now patho, of course. Anatomy, absolutely. The rest...I would argue no.

I suppose I am trying to say that when does it become education for education's sake??

 

[horsenurse25]

That's another one of those stupid customer service gobbeldy-gook ideas. Sick people are patients, not clients.

What is in a name?
Doesn't matter to me what they wish to be called.

However, I do work in geriatrics quite a bit and it just seems a little less negative to call them clients. At first I scoffed at the idea as well, until I got used to it.

And it is increasingly obvious to me that healthcare is definitely a business, so might as well call a spade a spade I suppose. After all, when people have a choice of where to go for a service, they become clients...

 

[SupergreenMnM]

Where did you find that one???!!! It is GREAT! My other favorite


Anyways, I dunno. It seems there is no pleasing everyone. But whatever we want or believe, the bottom line is that there is a global shortage of healthcare providers, especially nurses. Things are going to have to change.

I know this is going to upset a lot of people, and I am truly not trying to be an *sshole. But most MDs nowadays do very little more than treat minor ailments and refer every thing else. Especially GPs. Perhaps it is time for an overhaul. For specialists, there can be no shortcuts... but for GPs and some other areas...well we can already see what is happening...

Disagree, at least with the FPs that I've experience with, have never met a real GP (do they still license true GPs?)

As for microbiology, chemistry, etc. I was a Bsc Chem major. (and math minor which just about killed me ) and I have not really found any benefits to that education in my practice. Now patho, of course. Anatomy, absolutely. The rest...I would argue no.

You are unique, I haven't met a single np who has the science, I imagine though if you were to go to MD school you would find in the first two years how useful those courses are, my bet is you haven't experienced the need yet as an NP because of your scope of practice, which obviously would be different if we are talking the whole bridging to medical school thing.

Oh, the smileys you can find at http://smiliesftw.com/browse.php ...along with lots of ones you probably never wished to know existed.

 

[Bandit]

" But most MDs nowadays do very little more than treat minor ailments and refer every thing else. Especially GPs"

This is a ridiculous statement. This shows so very little insight to actual medicine its not funny. It is wrong and insulting to the men and women that dedicate thier lives to the less "flashy" specialty of family medicine.

It might make some of you feel "enlightened and insightful" but you are not.

Just another example of people not lifting their own, but attempting to knock down and destroy the "oposition" a a tactic very familiar in politics. Ignorant and wrong.

and PS--I am NOT in family med

 

[alpha62]

Why don't we just take it step further and call them " Johns " because the gov't is trying to turn us into a bunch of ****** anyway.

What is in a name?
Doesn't matter to me what they wish to be called.

However, I do work in geriatrics quite a bit and it just seems a little less negative to call them clients. At first I scoffed at the idea as well, until I got used to it.

And it is increasingly obvious to me that healthcare is definitely a business, so might as well call a spade a spade I suppose. After all, when people have a choice of where to go for a service, they become clients...

 

[SupergreenMnM]

 

[lawguil]

Anyways, I dunno. It seems there is no pleasing everyone. But whatever we want or believe, the bottom line is that there is a global shortage of healthcare providers, especially nurses. Things are going to have to change.

I believe the nursing organization has done a great job of complicating the nursing shortage with their literature on appropriate nursing ratio's and the like. I personally think that nurses should work within the provisions of nursing as it were known. This would in some way help address the nursing shortage and leave medicine for those educated in the medical model.

I know this is going to upset a lot of people, and I am truly not trying to be an *sshole. But most MDs nowadays do very little more than treat minor ailments and refer every thing else. Especially GPs. Perhaps it is time for an overhaul. For specialists, there can be no shortcuts... but for GPs and some other areas...well we can already see what is happening...

Truly, a short sighted statement. A great example of what you don't know. The ability to identify, treats, and manage a wide spectrum of disease in all age groups is a specialty of its own.

As for microbiology, chemistry, etc. I was a Bsc Chem major. (and math minor which just about killed me ) and I have not really found any benefits to that education in my practice. Now patho, of course. Anatomy, absolutely. The rest...I would argue no.

I suspect with the training that a nurse or advance practice nurse has, a nurse may not appreciate the value and importance of the natural and clinical sciences. The fact is medicine's foundation is in the natural sciences.

I suppose I am trying to say that when does it become education for education's sake?

I think I understand the education for education's sake comment, but I'm not entirely sure this is the case in medicine. Remember, the pre-requisite courses for medical school are only the most basic natural science courses. It's merely a sampling of the basic sciences. As chemistry major, you can probably appreciate that general chemistry and org. chem are merely fluff courses for the chem major (although they can be very challenging courses). Nursing doesn't have the requirements of medical school because the education only covers the surface of clinical sciences.

Let’s be clear! We've never tested the outcomes and efficiency where we allow a nurse practitioner to care for the same types of complex patients that physicians care for including the procedures, work load and various environments. I think anybody would love to see a comparison of the entry level physician v. the entry level nurse practitioner. It would be like Michael Jordan playing basketball against Michael Jackson. Not even close!


[/QUOTE]

 

[horsenurse25]

Why don't we just take it step further and call them " Johns " because the gov't is trying to turn us into a bunch of ****** anyway.

Cute!!


I know this is going to upset a lot of people, and I am truly not trying to be an *sshole. But most MDs nowadays do very little more than treat minor ailments and refer every thing else.

I knew that statement would make a lot of you guys angry, and I am truly not trying to belittle a profession. ANY profession. But I stand by that statement, It is a fact, and if it makes you angry, then so be it. The ability to identify, treat and manage disease is indeed a speciality, but I just do not believe it needs to be soley reserved for the MDs only. If the MD feels there is something that needs looking at, they refer. Exactly what the mid-levels do!!

BANDIT - how on earth is that insulting? The everyday, humdrum ailments... that is what many nurses dedicate their lives to every day. It is the corner stone of health care and arguably the most important. It is front line medical care. And often the first stop for many with a potentially serious illness. The ability to spot this and channel it into appropriate areas is critical.

I am not speaking of specialists of course, perhaps I did not make that clear. Specialists are, well, special.

At any rate, this is all a pointless argument.
Progress is happening as progress will and we will simply have to roll with the punches and do the best we can individually for the people who count on us. Meanwhile we all seem to be happy in our respective fields. There is room for all of us you guys!!

But don't worry, as an NP I know my place .

Now it has been fun, but I am off to a medical (yes, I said medical!! ) conference for the rest of the week, and then a weeks well earned vacation (Disneyland with the kids don't 'cha know ) and am signing off for a while. (Just didn't want you guys to think you chased the big bad meanie out of the building... )

(I think I am becoming addicted to smilies... SupergreenMnM..what a great site. But I'm glad my kids were at school when I opened it...!)

 

[horsenurse25]

Let's be clear! We've never tested the outcomes and efficiency where we allow a nurse practitioner to care for the same types of complex patients that physicians care for including the procedures, work load and various environments. I think anybody would love to see a comparison of the entry level physician v. the entry level nurse practitioner.

[/quote]


Couldn't help but one last remark.

Lawguil - I agree that the MD has more training. I have never in my posts said I agree with the independent practice idea. But a collaborative partner.

As far as I am concerned the idea of NPs is NOT to deal with the complex, but to deal with the UTI type afflictions as one other poster charming put it.... why on earth not??

I would wager a HUGE percentage of people come into their doctor's office with minor, easily identifiable problems. In fact I know this is true in our clinic. For crying out loud, many of our clients are geriatrics (most actually) and some of them are in and out several days a week like popcorn. If I suspect something is up, I immediately talk to my MD and he is there. Otherwise, I handle the day to day.

Isn't that a dream relationship for both of us???
He gets to do complex, 'scary' things and I get to spend time with the 'clients' / 'patients' whatever (something I really enjoy doing), and make them feel like they are really being listened to. Often I have caught something that the doctor actually missed because I had the TIME to do so.

Now I really am signing off for a bit. I am certain that you guys will find ways to pick my posts apart some more but as far as I am concerned, Mickey says HI!! (I need a Mickey Mouse smilie...)

 

[Bandit]

"I think anybody would love to see a comparison of the entry level physician v. the entry level nurse practitioner. "

Again--ridiculous!!!! This would never happen because it would humiliate and ruin the NP profession. End of story--not debatable. The statement alone exposes the authors grasp on medicine.

sorry folks. My last few posts would lead one to believe I am a bomb throwing troll but that is simply not the case. But these claims are groundless and unfounded.

 

[deleted87716]

I knew that statement would make a lot of you guys angry

*Snort.*

Not even a little bit.

 

[fab4fan]

What is in a name?
Doesn't matter to me what they wish to be called.

However, I do work in geriatrics quite a bit and it just seems a little less negative to call them clients. At first I scoffed at the idea as well, until I got used to it.

And it is increasingly obvious to me that healthcare is definitely a business, so might as well call a spade a spade I suppose. After all, when people have a choice of where to go for a service, they become clients...

And I would say that by buying into calling healthcare a business and calling patients "clients," you're doing healthcare a disservice. Being in a hospital isn't being on a cruise ship and it shouldn't be treated as such. Yes, we should try to make people more comfortable, but let's have a dose of reality here.

I don't know whether to be irritated with you or feel sorry for you. You've definitely drunk the Kool-Aid, that's for sure.

 

[Tired]

And I would say that by buying into calling healthcare a business and calling patients "clients," you're doing healthcare a disservice. Being in a hospital isn't being on a cruise ship and it shouldn't be treated as such. Yes, we should try to make people more comfortable, but let's have a dose of reality here.

I think folks are getting confused about where the "client" reference is coming from.

In medicine, patients are patients, that's what they're called.

In nursing, which has embraced a "customer-service" model of medicine, they are called clients, not patients.

It's not a "California" thing (that's just silly, no one should have bought into that), it's a difference between the philosophies of nursing and medicine.

 

[zenman]

Let's be clear! We've never tested the outcomes and efficiency where we allow a nurse practitioner to care for the same types of complex patients that physicians care for including the procedures, work load and various environments. I think anybody would love to see a comparison of the entry level physician v. the entry level nurse practitioner. It would be like Michael Jordan playing basketball against Michael Jackson. Not even close!

I'd love to see comparison of MD v. Special Forces Medics.

 

[deleted87716]

I'd love to see comparison of MD v. Special Forces Medics.

No fair...everyone looks better in a uniform.

 

[zenman]

And I would say that by buying into calling healthcare a business and calling patients "clients," you're doing healthcare a disservice. .

Are you telling me you don't think healthcare is a business??

 

[Northerner]

Again, I believe NPs are mid level. And should be under collaboration with an MD.

What the hell does "under collaboration" mean? Like a mix between "under supervision" and "in collaboration"?

But I also think there should be a bridging type of education for experienced health professionals at the Masters level in their own field to upgrade into the MD level when they have appropriate experience. For example, an experienced PA or NP who have been working for a set number of years (2,3?) should be able to take a 2 year degree to become an MD. It is silly to make them start all over from the beginning.

Wow. Scary that you think this way. Not everyone's cut out to be a doctor lady.

I knew that statement would make a lot of you guys angry, and I am truly not trying to belittle a profession. ANY profession. But I stand by that statement, It is a fact, and if it makes you angry, then so be it.

Don't flatter yourself. No one cares what you think. We do lose respect for you and question the profession you're speaking on behalf of, though. Nice work.

At any rate, this is all a pointless argument.
Progress is happening as progress will and we will simply have to roll with the punches and do the best we can individually for the people who count on us. Meanwhile we all seem to be happy in our respective fields. There is room for all of us you guys!!

How quaint. There's a threat hidden in there. "Progress is happening as progress will" = "If you don't give us practice rights, we'll just take them." Expect all the resistance of a conscientious profession.

 

[fab4fan]

I think folks are getting confused about where the "client" reference is coming from.

In medicine, patients are patients, that's what they're called.

In nursing, which has embraced a "customer-service" model of medicine, they are called clients, not patients.

It's not a "California" thing (that's just silly, no one should have bought into that), it's a difference between the philosophies of nursing and medicine.

Not this nurse. I call my patients "patients."

 

[chimichanga]

I think folks are getting confused about where the "client" reference is coming from.

In medicine, patients are patients, that's what they're called.

In nursing, which has embraced a "customer-service" model of medicine, they are called clients, not patients.

It's not a "California" thing (that's just silly, no one should have bought into that), it's a difference between the philosophies of nursing and medicine.

shhhocking response

 

[fab4fan]

Are you telling me you don't think healthcare is a business??

Not in the way it's being looked at today. Of course it has to be a business to some degree, but not the Disney-based, "Is there anything else I can do for you? I have the time" simpering servitude mentality that's being forced on us lately. Yes, you really do have to do that nasty prep for your colonoscopy. I'm sorry that makes you unhappy, and sure, you can try Hospital X the next time if you're so vexed, but that's how it is.

There's too much of a focus on the business aspect these days and not enough on the healthcare.

 

[deleted87716]

Are you telling me you don't think healthcare is a business??

Healthcare is a business, as is the operation of a medical practice, but the doctor-patient relationship is not defined by a simple exchange of cash for services. A physician's responsibility to his/her patients transcends economics. That's what differentiates "patients" from "clients."

 

[burntcrispy]

I'm sitting here on call trying to entertain myself here on SDN. This thread seems to have gotten way off topic much like all other threads on SDN. My take on FPs: They are great for what they do. I work with them and am mostly pleased with their work.

Now, as far as physicians being overeducated (who needs Chem, micro, etc), that's just rediculous. The poster surely couldn't be serious. I think that really shows the difference between physicians and "midlevels". Medicine is a science. Much of what we practice based on these principles.

I was a nurse for 6 years before going to medical school. I remember taking my prerecs thinking that much of it was a waste of time. Well, the prerecs are just a preview of what you get in medical school. In medical school you start out learning anatomy, molecular/cellular biology, genetics, micro, etc. You then broaden that into learning the body systems and how these "basic" sciences pertain to them. By the end of your second year of medical school you know how to treat a disease and the reason the treatment works down to the MOLECULAR level. It is just mindblowing how much information you learn in those 2 years. (and how quickly you have to learn it. We covered almost a full college semester of biochem in just 4 days of medical school) Then you go on the wards and learn how to apply the information that has been given to you. Then you go on to residency for 3-8+ years hone in the skills for your specialty. Is this the equivalent of an NP program where you write countless papers on Nursing theory? Riiiiiight.

Physicians are taught to think in scientific terms. I remember having a NP student rotating with us on wards when I was in medical school. She couldn't participate in our discussions about the patients in any meaningful way because she had no idea what we were talking about. (all of that unnecessary science and whatnot )

As far as the FPs: Sure lots of them refer but they know WAY more than you seem to understand. Being a physician, you treat mostly "bread and butter" cases: UTIs, Colds, etc. But the physician is paid to catch the zebras which many times if caught early means the difference between a treatable disease and a terminal disease. How can you catch zebras if you have no idea what they are, how they present, the variations on a presentation, the natural progression of the disease, the available treatments, the prognosis, etc?

Well, you guys have fun debating on if "midlevels" are equipt to function as physicians. From being a nurse and having lots of friends in the NP programs (I know the cirriculum quite well) I can honestly say you have no idea how much you just do not understand about medicine. If you would like to be an independant provider perhaps you should look into going to medical school so you can have the proper knowledge base. That's exactly what I did and I can't tell you how happy I am that I went back. At our medical school in just about every other class there is either a PA or NP who decided to go to medical school for a proper education. I've even met a few CRNAs who went back for the MD. If you've got the time and the intelligence to make it I would strongly suggest doing it. It will be the best decision of your life!!!!!!!!

Burntcrispy, MD

 

[deleted87716]

This thread seems to have gotten way off topic much like all other threads on SDN.

Given the original subject of this particular thread, however, I can't say I'm disappointed.

 

[fab4fan]

This is where my dilemma lies. I'm bored as a nurse, but at a point that going to med school is not an option. I thought about going the NP route but I have misgivings about that, and the above post really outlined why. Lots of room for missing zebras due to not having all the fundamentals. For a certainty I wouldn't want to be an independent practitioner.

What to do, what to do...

 

[fab4fan]

Given the original subject of this particular thread, however, I can't say I'm disappointed.

KentW: Watching the sparks fly, safe inside his Starbucks mug.

 

[Taurus]

horsenurse25,

 

[chimichanga]

Tired can sell his nurse rants...Yea, we're not worthy...

However, count me in w/ fab4 (as another nurse that):

1) understands that he only knows a fraction of what a doc does
2) prefers a doc to manage my care
3) knows his role
4) is happy there
5) has a doc's back, if he has the pt's best interest in mind, not his own (This does happen, more than I'd like - are all docs like this, NO...get over yourself-Tired; they do exist...so do bad nurses...blah blah blah...)
6) is good at math...I incur next to no financial liability as compared to you, work 3 days a week, and make over 120K...I'll take it...(see #4)

BTW, the college where I currently teach, wants to use the term "client"...I ignore this crap...My students call a spade a spade.

I'm with you guys here...

 

[Chronic Student]

Disclaimer: This is just my opinion.

I'm gonna have to call BS on the entire shortcut to MD thing.

I'm a PA and can only speak to PA education, which I thought was fairly decent.

However, I was an MT (Bachelor of Science in the lab) before going to PA school and had a lot of background in pathophys and the other basic sciences. We took multiple courses in clinical chem, hematology, microbiology, immunology, molecular biology, immunohematology, UA and body fluids, parasitology, coagulation, biochemistry, etc.

In PA school they did a good job of covering basic pathophys, but it was the fine detail that was cut out and that fine detail is what makes an MD.

When I did rotations and interacted with the med students I was very aware of how much more basic science they knew than I did. I could follow conversations on almost all topics, but the finer points I did not grasp. Even with both my background and my PA education.

I really don't think our rotations were very different from those the med students had. It's really the basic sciences where the difference lies.

Furthermore, I think most of us would agree that a solid foundation is what is needed to put things into proper context and I do think that the med students got a little more out of their rotations due to a deeper understanding of what they were seeing.

Do I think that there are some PA's out there who could skip a year or two of medical school and make fantastic doctors.

Absolutely.

However, I think those folks are few and far between and there are just not enough of them to justify a different entry pathway to becoming an MD.

Once again, just my personal opinion.

-Mike

 

[Tired]

Tired can sell his nurse rants...Yea, we're not worthy...

Which rant would that be? My experience with nurses cited in a previous thread? Or do you disagree with my assessment of where the word "client" started getting in to health care?

It's hard to tell what you're talking about, so let's see what you say later in your post.

BTW, the college where I currently teach, wants to use the term "client"...I ignore this crap...My students call a spade a spade.

Oh, so you agree with me on this point. Good to know.

5) has a doc's back, if he has the pt's best interest in mind, not his own (This does happen, more than I'd like - are all docs like this, NO...get over yourself-Tired; they do exist...so do bad nurses...blah blah blah...)

Never once did I suggest that there are no bad docs, yet you persistently try to put these words in my mouth. Why don't you quote me? Oh, because it's just easier to make things up to discredit me, rather than actually hear what I say.

Read through my previous posts. I rail on my classmates who have a poor work ethic, I get disgusted with the practice habits of some of my professors, and I freely admit to the errors I have made. I, like the rest of medicine, engage in a constant process of introspection and self-evalutation. The medical community doesn't get offended at criticism, because that's how we get better at what we do.

But oh, better not say anything about the nurses, because there's always someone like you to take professional critiques as personal insults . . .

 

[chimichanga]

In my defense, I don't troll the alllo forums... Yes, I have crossed over to your "side" But I have been nothing, if not respectful when over there. You come here intermittently, and throw stones...

I'll give you all of what you said above...I'm again, not worthy...

You have clearly drawn the line in the sand (on this forum)...I know where you fall on the food chain...

I respect that...Get that!

You repeatedly come here to throw in your 1 and 1/2 cents on the nursing side...You don't know what you don't know....

I can't walk a mile in your shoes (they are too big for me, do you get that??)
And you can't walk in mine...

we need each other...

I have no interest in discrediting you...You have experienced, and heard about bad nurses, I have experienced, and heard about bad docs...It's a wash...

I appreciate your passion, it's better than apathy...My apologies...I am dealing with a community of overbearing docs, and apathetic nurses...I have LIVED the shoe on the other foot...

I'm tired of the drama...Here we are, living out the drama that goes on everywhere...I'll admit my faults, and I'll thank you to do the same...

Where does that leave us???

Thinking about ourselves, rather than the patient/client/dingus/whatever you want to call him...

 

[chimichanga]

Tired,

I was just "trolling" over your most recent posts...

You are a passionate person...We need more of that, EVERYWHERE!

Thank God for that...

I think we'd make believers out of each other...

NICE!!!

 

[FoughtFyr]

Are you telling me you don't think healthcare is a business??

No, I think it shouldn't be.

To quote Osler on a topic quite germane to the hijack of this thread (from: Osler W. On the educational value of the medical society. In: Aequanimitas with other addresses to Medical Students, Nurses & Practitioners of Medicine. 3rd ed. Philadelphia. PA:Blakiston, 1932):

"But the more serious problem relates to the education of the practitioner after he has left the schools. The foundation may not have been laid upon which to erect an intellectual structure, and too often the man starts with a total misconception of the prolonged struggle necessary to keep the education he has, to say nothing of bettering the instruction of the schools. As the practice of medicine is not a business and can never be one,' the education of the heart—the moral side of the man—must keep pace with the education of the head. Our fellow creatures cannot be dealt with as man deals in corn and coal; 'the human heart by which we live' must control our professional relations. After all, the personal equation has most to do with success or failure in medicine, and in the trials of life the fire which strengthens and tempers the metal of one may soften and ruin another." {emphasis added}​

But then Olser was the master...

- H

 

[chimichanga]

my head just exploded after reading that...

wow

I really am not worthy, whomever the hell Osler was...

 

[chimichanga]

Yes, he's referring to PAs, but his point is well taken: (from Dr Disa, MD plastics guy, pimped on this site)

SDN: What impact do mid-level providers have on your day-to-day practice?

D: They have a positive impact. We have three Physician Assistants with us, and we’re hiring a fourth. They are an outstanding resource, and without them it would be difficult to do what we do. I think it’s a great field to get in to.

 

[zenman]

This is where my dilemma lies. I'm bored as a nurse, but at a point that going to med school is not an option. I thought about going the NP route but I have misgivings about that, and the above post really outlined why. Lots of room for missing zebras due to not having all the fundamentals. For a certainty I wouldn't want to be an independent practitioner.

What to do, what to do...

Bored was I also...and never plan to set foot in another hospital...except to visit. Why don't you investigate what I'm doing...training as a shaman? Now think before you think I'm fricken nuts! Our sessions have been full of nurses (probably bored) and physicians, psychologists and other healthcare providers. Last summer I was teamed up with an MD/Ph.D (cell biology) who said he and many of his peers were sick and tired of not really being able to help people. Last month, I teamed up with a vascular surgeon. Both these guys were in their 50s so had been in practice a few years. There were other docs present but these were the only ones I actually had a chance to work with. There was also a physics professor there but I only got to speak to her briefly. She did say that she was going to be doing some presentations on how shamanism and physics interact...and possibly a book.

Now I can respect anyone who wants to devour biochem or any of the natural sciences but jeez....also study how the mind affects the body. Once you know this, you...if like me...will almost puke when you glance at a medical textbook!

Just think...you'll really be an independant practitioner and most of your patients/clients will have already seen a physician.

Now, where's my damn rattle and smudge stick

Am I bored...are you kidding?