New idea for NP/PA to MD

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vivalavie - If you spent less time on this forum and more time with the books you could be knocking out some of the prereqs and be on your way to med school.
 
jl13 said:
vivalavie - If you spent less time on this forum and more time with the books you could be knocking out some of the prereqs and be on your way to med school.
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Gee whiz, do you think I could really get into medical school??
 
vivalavie said:
http://www.lasalle.edu/grad/index.php?section=snhs&group=dnp&page=courses

Woah... this is disturbing. Where is the physiology? the pathophys? the pharm?

This reads more like a MPH program than a clinical doctorate. Even their genetics class reads like a freshman philosophy seminar. How can this be construed to prepare nurses for independent practice?

I had no idea nursing education was such a mess.
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The rest of us did know this, and have debated it on this forum often. That's why most of the people here didn't put much thought into their responses - because its been done plenty of times before.
 
vivalavie said:
Thanks for these links and for the discussion.

It's troubling to me that these courses are so vaguely titled, I can't comment on what these classes teach because their titles seem intended to obfuscate. I hope this does not mean for nursing education what you seem to be implying, but I don't know what to make of this. I have to say, this makes me reconsider my premise. I still wish we had someone who had gone through both the NP curriculum and MD curriculum so we could get to the bottom of this. But by providing course rosters that are not standardized or, to be frank, coherent, NP programs don't give me much to work with. For the moment, at least, I'm heading back to the drawing board.

Kaushik, if you, at some point, posted similar links and I missed them I'm sorry, but I couldn't find the exchange that you're talking about.
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I have posted this comparison many times before, but when I went back to check, it seems like I did not post it in this particular thread. My fault.

Here's an old post of mine with links and everything (I made a few changes based on recent discussion but, for the most part, it's the same as when it was originally posted):

"Here's a sample curriculum from a BSN-DNP program (at Duke): http://nursing.duke.edu/wysiwyg/down...t_MAT_Plan.pdf

You need 73 credits to go from a college degree to a doctorate. That turns out to be less than 3 years.

Research Methods (3 credits), Health Services Program Planning and Outcomes Analysis (3 credits), Applied Statistics (2 credits), Research Utilization in Advanced Nursing Practice (3 credits), Data Driven Health Care Improvement (4 credits), Evidence Based Practice and Applied Statistics I & II (7 credits), Effective Leadership (2 credits), Transforming the Nation's Health (3 credits), DNP Capstone (6 credits), Health Systems Transformation (3 credits), Financial Management & Budget Planning (3 credits).Population-Based Approach to Healthcare (3 credits), Clinical Pharmacology and Interventions for Advanced Practice Nursing (3 credits), Managing Common Acute and Chronic Health Problems I (3 credits), Selected Topics in Advanced Pathophysiology (3 credits), Diagnostic Reasoning & Physical Assessment in Advanced Nursing Practice (4 credits), Common Acute and Chronic Health Problems II (3 credits), Sexual and Reproductive Health (2 credits), Nurse Practitioner Residency: Adult Primary Care (3 credits), Electives (12 credits).

So, out of the 73 credits needed to go from BSN to DNP, a significant portion of courses are potentially not clinically useful. In addition, the number of required clinical hours is 612 hours (unless I miscounted something)!! Wow! And the NP program is designed the same way and requires 612 hours as well: http://nursing.duke.edu/wysiwyg/down...rriculum_2.pdf

Here are the curricula to several other programs:
It's kinda scary how inadequate that training is in order to practice medicine independently. You can't really count prior nursing experience as time practicing medicine because you weren't practicing medicine during that time nor were you thinking in a medical manner (ie. the way a physician would). Nursing clinical hours might help you transition into medicine but they are NOT a replacement for medical clinical hours.

Now, just for comparison, let's look at a med school curriculum. Here's an example from Baylor School of Medicine for M1/M2 (http://www.bcm.edu/osa/handbook/?PMID=5608) and for M3/M4 (http://www.bcm.edu/osa/handbook/?PMID=7463):

Patient, Physician, and Society-1 (4.5 credits), Patient, Physician, and Society-2 (6 credits), Bioethics (2.5 credits), Integrated Problem Solving 1 & 2 (10 credits).

Foundations Basic to Science of Medicine: Core Concepts (14.5 credits), Cardiovascular-Renal-Resp (11.5 credits), GI-Met-Nut-Endo-Reproduction (14 credits), General Pathology & General Pharmacology (6.5 credits), Head & Neck Anatomy (4.5 credits), Immunology (5 credits), Behavioral Sciences (6.5 credits), Infectious Disease (13 credits), Nervous System (14 credits), Cardiology (4.5 credits), Respiratory (3.5 credits), Renal (4 credits), Hematology/Oncology (5 credits), Hard & Soft Tissues (3 credits), Gastroenterology (4 credits), Endocrinology (3.5 credits), GU/Gyn (3 credits), Genetics (3 credits), Age Related Topics (2.5 credits).

For only the M1/M2 years at Baylor, there's 162.5 total credits. Out of these 162.5 credits, very little is potentially clinically irrelevant material.

Core Clerkships during M3 (useful clinical training): Medicine (24 credits, 12 weeks), Surgery (16 credits, 8 weeks), Group A selective (8 credits, 4 weeks), Psychiatry (16 credits, 8 weeks), Neurology (8 credits, 4 weeks), Pediatrics (16 credits, 8 weeks), Ob/Gyn (16 credits, 8 weeks), Family & Community Medicine (8 credits, 4 weeks), Clinical Half-Day (includes Clincal Application of Radiology, Clinical Application of Pathology, Clinical Application of Nutrition, Clinical Evidence Based Medicine, Longitudinal Ambulatory Care Experience, and Apex -- 23 credits).

So, without even taking into consideration M4 electives and required subinternships (which are usually in Medicine and Surgery), medical students already have a far superior medical training than NPs or DNPs. Other examples of med school curricula:
You can get a BSN to DNP in about 3 years according to many programs I've looked at. Medicine involves 4 years of medical school and a minimum of 3 years of residency before allowing independent practice. Here's the math:

BSN to DNP: 2.5 - 3 years of training; longer if courses taken part-time; 600-1000 clinical hours!
BS/BA to MD/DO: 4 years med school + 3-5 years residency: 7-11 years of training; not possible part-time; clinical hours > 17000"
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I hope you understand why some of us have been reacting the way we have. Your same argument has been brought forth several times before and it's frustrating pointing out the flaws in that argument again and again and again and again. Like VA said, most of us arguing against you here have seen this kind of stuff before and have a somewhat decent idea as to the vaaaaaaaast difference in training between nursing midlevels and physicians. That's why I can never see an NP/DNP to MD/DO accelerated bridge ever materializing.
 
Kaushik said:
I have posted this comparison many times before, but when I went back to check, it seems like I did not post it in this particular thread. My fault.

Here's an old post of mine with links and everything (I made a few changes based on recent discussion but, for the most part, it's the same as when it was originally posted):

I hope you understand why some of us have been reacting the way we have. Your same argument has been brought forth several times before and it's frustrating pointing out the flaws in that argument again and again and again and again. Like VA said, most of us arguing against you here have seen this kind of stuff before and have a somewhat decent idea as to the vaaaaaaaast difference in training between nursing midlevels and physicians. That's why I can never see an NP/DNP to MD/DO accelerated bridge ever materializing.
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To you and VA hopeful, it's all good, just trying to educate myself. I definitely see where you guys are coming from now.
 
vivalavie said:
To you and VA hopeful, it's all good, just trying to educate myself. I definitely see where you guys are coming from now.
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That's fair, and I think many folks around here (myself included) do jump on new people a bit hard. We have our reasons, but its still not very polite of us.
 
hey do you guys think the OP made it to the federal level or do you think somebody finally told her the Prozac needed to be cut in half?!?!
 
Kaushik said:
I have posted this comparison many times before, but when I went back to check, it seems like I did not post it in this particular thread. My fault.

Here's an old post of mine with links and everything (I made a few changes based on recent discussion but, for the most part, it's the same as when it was originally posted):

I hope you understand why some of us have been reacting the way we have. Your same argument has been brought forth several times before and it's frustrating pointing out the flaws in that argument again and again and again and again. Like VA said, most of us arguing against you here have seen this kind of stuff before and have a somewhat decent idea as to the vaaaaaaaast difference in training between nursing midlevels and physicians. That's why I can never see an NP/DNP to MD/DO accelerated bridge ever materializing.
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That's a really good synopsis of the incredible difference between the nursing programs and medicine. And this is the reason I dropped out of a nursing program a few years ago to complete my undergrad as pre-med. I could not stand the disposition many of the instructors had agaisnt physicians. And many times I was thinking way over the heads of both the book and instructor. Just a bad combo that made me realize I had been trained to think like a physician, not a nurse.

I have had the pleasure training multiple Vanderbilt NP students on their preceptorship 280 hour clinical rotations (Cardiology) I have nothing but fear for these BS to NP (bridge) students graduating. They have absolutely ZERO clinical/nursing experience. I have to say, something in the way of actual RESIDENCY is needed for these new NP's before being allowed to go into "practice". Measly 280 hour preceptorships are a joke and a half, most of them have the "Deer In The Headlight" looks when they start and even until the last of the 280 hours.

P.A.'s come out of school much better prepared than NP's, period.
 
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Simann said:
Just a bad combo that made me realize I had been trained to think like a physician, not a nurse.
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Can you elaborate on how physicians think? I believe I saw a book titled, "How Doctors Think" recently at a bookstore. Save me some money would you?
 
zenman said:
Can you elaborate on how physicians think? I believe I saw a book titled, "How Doctors Think" recently at a bookstore. Save me some money would you?
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1. Continue your education, go to medical school. No other way around it.
2. Work one on one with a physician for a few years, be his shadow.
3. Some good quick reads:
http://psychologyofmedicine.blogspot.com/2011/03/think-like-doctor-winner-nytimescom.html

http://www.erbook.net/another point of view regarding nurses.htm

http://medscape.typepad.com/thedifferential/2008/12/the-difference.html

Not a book, but you get the picture:
http://dialogues.rutgers.edu/vol_01/pdf_files/j_laor.pdf

the_more_you_know.jpg
 
I'll check out that long pdf later as I'm traveling. All I'm getting here is that you memorize a lot of stuff and then try to remember it later, or have alot of reference sources. How do you think when you're in front of a patient?😕
 
At first when I started reading this thread I was upset because as an MD/DO, you work your ***** off making it through medical school. Becoming a physician is a life-time process that starts literally from when you attend college. There is no possible way that anybody can learn all the medical material that is required to practice medicine in a part-time/after work or weekend setting.

As a medical student you study an avg of 8-12 hrs EVERY single day, let me repeat that (EVERY SINGLE DAY), maybe you will give yourself a 1-2 day break right after a shelf exam, but the next day you're back on the grind studying like you did for the MCAT. Except that the MCAT is just a small sample of how much information a medical student should know for just one exam (1-2 weeks worth of knowledge), and that doesn't even compare to how much a medical student is suppose to know for the USMLE... much less for a Board Exam as a resident. Let me re-emphasize, a physician studies all the time, there is no end.

I just wanted to say thank you Kaushik for giving some perspective on this issue and just because somebody has "clinical" experience in the hospital does not translate to the core curriculum medical students must endure every single day to not only pass but graduate from medical school.

There is a reason why becoming a physician is so hard, why the degree costs so much and why we get mad when we see other people wearing long white coats, claim they know as much or even more then the doctors who are the ones who treat the patients and have the ultimate patient responsibilities.

I apologize if this post further exacerbates the notion that physicians are cocky or arrogant but the hard truth is that becoming a physician takes years of working hard and training and there will never be a substitute for that formula.

-R
 
Paseo Del Norte said:
I know, I know... it's rather inconvenient doing all that school. I understand your concern because I've found doing six extra semesters of full time school quite inconvenient and often wonder why having a degree in nursing does not entitle me to "fast track" my way to a degree in respiratory therapy.

The problem I have with this theoretical programme is that nurses on the average do not have near the scientific nor the clinical preparation to think about some online quickie course. In my humble non-physician opinion of course. In fact, the respiratory folks laughed at the amount of chemistry I took as a student nurse. This would be the amount of chemistry required for many of the NP programmes I've seen.

To add insult to my injured pride, I spent the first part of my respiratory student experience learning about better living through Schrodinger.
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Lol! Your last sentence was pretty funny (re: Schrodinger). I'm a respiratory therapist, so I know what you're going through. Although, I didn't start as a nurse in the first place. I think the problem with fast tracking sometimes is that you don't know where people excel or are weak in. Let's face it, just because you took the class doesn't mean you REALLY mastered it or understood it.. most of the time, I find students know just enough to take the test. However, I think there SHOULD be a way to give an assessment at different modules so that if a student is excelling, then they can either test (written/practical) out to skip the module altogether. ...Just my own two cents of course.
 
I've known many a stupid nurse as well as many dangerously incompetent doctors. But like it or not NP's & PA's are taking over primary care and are going into many specialty areas as well, by not allowing them into the club they are simply going off and creating their own. And they are gaining more independence all the time. Once the New practice doctorate for them is in place they will be completely autonomous by taking and proving they can pass the MD minimum standard testing. Then they will not just be limited to practicing primary care but any specialty they want barring surgery. So what has all the intolerance and arrogance cost, it will cost you everything. There are Tons of MD's where I live that now have to advertise cuz they have lost all their patients, cuz they treated so arrogantly and guess who they are all going to now. Throw your fits and stomp your feet, but you already lost the battle and you have no one to blame but that person in the mirror.
 
janejkus said:
Once the New practice doctorate for them is in place they will be completely autonomous by taking and proving they can pass the MD minimum standard testing. Then [NPs] will not just be limited to practicing primary care but any specialty they want barring surgery. So what has all the intolerance and arrogance cost, it will cost you everything. There are Tons of MD's where I live that now have to advertise cuz they have lost all their patients, cuz they treated so arrogantly and guess who they are all going to now. Throw your fits and stomp your feet, but you already lost the battle and you have no one to blame but that person in the mirror.
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Ha. Now who are the arrogant ones: the people who think that to care others you need tens of thousand of hours of clinical experience or the people who think they can cut corners and only spend 500 hours in training?

Oh and by the way, Mary Mundinger had the DNPs at columbia take a watered down version of step 3. The thought was that she could prove how strong NP education was. So she took arguably the best NP school, made a national spectacle out of it (so you know everyone studied hard for it) and half the NPs failed it despite having a lower score needed to pass than the interns have for Step 3.

Oh and Interns don't have time to study for step 3 so they basically show up and take it. 95% pass it on the first attempt.
 
just stating fact you can call it arrogance if that makes you feel better but the truth is all actions have reactions, and inaction produces consequences.
 
janejkus said:
I've known many a stupid nurse as well as many dangerously incompetent doctors. But like it or not NP's & PA's are taking over primary care and are going into many specialty areas as well, by not allowing them into the club they are simply going off and creating their own. And they are gaining more independence all the time. Once the New practice doctorate for them is in place they will be completely autonomous by taking and proving they can pass the MD minimum standard testing. Then they will not just be limited to practicing primary care but any specialty they want barring surgery. So what has all the intolerance and arrogance cost, it will cost you everything. There are Tons of MD's where I live that now have to advertise cuz they have lost all their patients, cuz they treated so arrogantly and guess who they are all going to now. Throw your fits and stomp your feet, but you already lost the battle and you have no one to blame but that person in the mirror.
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While this post is crude, I think you have a point in here somewhere. The AMA has truly dropped the ball on this and I really don't see how they can stop the nurses from gaining more and more independence. After all, the nurses have basically come in and said "Hey, I can do the same job as an MD more cheaply and with less training"… and they are winning the public (and legislature) over with this (seemingly absurd) argument. After all, perception is reality... and if people/lawmakers/whoever perceive midlevels as competent individuals who are equivalent to MDs, this will become reality. Somehow the AMA has not been able to fight back very well against the nurses, despite the fact that that physician's have far more rigorous training by any objective measure.

I think it has a bit to do with arrogance, yes. The AMA should follow the nursing lobby's lead and focus on winning over the public and lawmakers. It doesn't matter how right you are if the public doesn't believe you. Also, you guys should seriously stop bashing nurses - all it does is make you look like you're playing defense and that the nurses have the upper hand (which is kind of true, frankly). It also makes you look petty and arrogant when you bitch and moan over the color/length of someone's coat or if they refer to themselves as "doctor"- a stereotype physician's really can't afford to be reinforcing right now.

Think about it, the public loves nurses. They are the most trusted profession. Bashing them wins you no friends...

I guess what I'm trying to say is that you guys should stop playing defense and start playing smart. Stop bashing nurses. The public likes nurses. Instead focus on winning over the public by playing up what an MD/DO brings to the table that a nurse never could. That's got to be easy, right? I mean seriously, I don't get how physician's have let this issue get away from them, you have like double (or three times) the training as a midlevel... it should be easy to prove that a physician has much more to offer. Make it about what physicians do for the public that no one else can do NOT what nurses are too incompetent to do.

It doesn't matter if the nurse is called doctor or if she/he wears a white coat when they have the public convinced they can do the same job as you for less money. Get your priorities straight, docs!
 
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Well I guess I killed the thread, lol. I find it interesting that no one has a response. I've seen many a poster on here rant and rave about midlevels... but no one has an opinion about how MDs/DOs can fight back in a way that could actually help their cause? Am I completely off base? Do physicians bash nurses at their own peril or is the whole "who gets to call themselves doctor" conversation really going to help change lawmakers' minds about NPs?
 
maybenot said:
Well I guess I killed the thread, lol. I find it interesting that no one has a response. I've seen many a poster on here rant and rave about midlevels... but no one has an opinion about how MDs/DOs can fight back in a way that could actually help their cause? Am I completely off base? Do physicians bash nurses at their own peril or is the whole "who gets to call themselves doctor" conversation really going to help change lawmakers' minds about NPs?
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The AMA, as generally ineffective of an organization as it is, *has* been attempting to do this. They've published series of studies and reports that explain the differences between MD training and NP training. It was fairly comprehensive, well sourced, and IMO fairly convincing.

The NP's response? The AMA shouldn't be allowed to participate in this discussion, and if they continue to do so, we'll sue them for anti-trust violations.

And the NP's are winning because the politicians have decided that having nurses act as physicians will save money. And no amount of evidence that suggests otherwise will change their minds, because politicians are wed to their philosophical viewpoints (and those of their lobbyists), no matter how wrong they are.

I'm not sure if doctors are really bashing nurses. Med students and residents on this board may be venting frustration at times, but the majority of us who have long white coats really don't give a crap one way or the other. We do get annoyed though, when non-physicians start representing themselves as "doctor" in the hospital.
 
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