New idea for NP/PA to MD

[altap]

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The reality is that there are PAs who would like to practice independently . How many? Nobody knows (I suspect the majority of PAs) Knowing this, med orgs who are "supervising" the PA orgs. should see to it that the requests of PA orgs (name change, doctorate degree, etc.) are studied very carefully before approval or denial. Complacency could lead to disastrous results (just look at anesthesiology). If I were in a position, I would block the name change and doctorate degree and just let the status quo be.

 

[deleted6669]

If I were in a position, I would block the name change

fortunately you are not. The name change back to physician associate will happen. it's just a matter of time. count on it. >80% of pa's are in favor of this name change while most of us OPPOSE degree creep which is being forced on us by market pressures.
maybe a better use of your time would be trying to match to a residency slot...failing that you could apply to pa school yourself....some programs will take an fmg who can't match...

 

[lapelirroja]

The reality is that there are PAs who would like to practice independently . How many? Nobody knows (I suspect the majority of PAs) Knowing this, med orgs who are "supervising" the PA orgs. should see to it that the requests of PA orgs (name change, doctorate degree, etc.) are studied very carefully before approval or denial. Complacency could lead to disastrous results (just look at anesthesiology). If I were in a position, I would block the name change and doctorate degree and just let the status quo be.

LOL, um no. No one in my graduating class of 45 wants to practice independently. It is definitely not the "majority" of PAs who want to practice independently. It's actually the reason many of us chose to become PAs instead of applying to medical school... I WANT to be a dependent practitioner. I don't get why people don't understand that.

 

[Makati2008]

Hi! I'm a foreign medical graduate working as a RN (premed is BSN) here in the US. What are my chances of being accepted into a MPH program? Do I need to take the GRE? Could you please enlighten me on how I should go about the application process? -His first post last year.....

I am wondering why this guy is trolling around here. I am usually very objective with my post but today I am going to be a bit more subjective.

1.)Your an unmatched FMG(nothing wrong with that in itself). Your quite arrogant to have an MD worth less than single ply TP from my local grocery store
2.)Quit bashing my profession. Why don't you go worry about the NP problem. But oh wait--->Sadly as someone who is not even recognized as a Physician in my country has no say in my profession or the NP one so again please leave...
3.)Something to be said about your inability to match for FM....(Not a bash on FM at all. I hope to do it at an unopposed program for better training)
4.)Lastly, as long as there are PA's like myself going to medical school we won't someone like yourself hurt the PA profession its in our blood.

 

[PSYCHNP]

Hi! I'm a foreign medical graduate working as a RN (premed is BSN) here in the US. What are my chances of being accepted into a MPH program? Do I need to take the GRE? Could you please enlighten me on how I should go about the application process? -His first post last year.....

I am wondering why this guy is trolling around here. I am usually very objective with my post but today I am going to be a bit more subjective.

1.)Your an unmatched FMG(nothing wrong with that in itself). Your quite arrogant to have an MD worth less than single ply TP from my local grocery store
2.)Quit bashing my profession. Why don't you go worry about the NP problem. But oh wait--->Sadly as someone who is not even recognized as a Physician in my country has no say in my profession or the NP one so again please leave...
3.)Something to be said about your inability to match for FM....(Not a bash on FM at all. I hope to do it at an unopposed program for better training)
4.)Lastly, as long as there are PA's like myself going to medical school we won't someone like yourself hurt the PA profession its in our blood.

Why is it that whenever someone gives their opinion about PAs they are accused of being a troll? Yet when NPs are criticized that is not the case.

Probably an act of desperation by the PAs to eliminate anyone who gets in the way of their hidden agenda.

 

[altap]

To makati: If you do not concur with me, pls feel free to disagree. Sorry, but attacking me personally for trying to protect patients and medicine for lack of a better word is immature. Why am I so passionate about this? Simply bec. patients deserve the best and you can only achieve this when a physician (who has the best education and training) is at at the helm of a healthcare team. It is my opinion that changing the name of PA and giving a doctorate degree to PAs would undermine the authority/leadership of physicians in the healthcare team and this will in turn hurt patients and medicine. There is also the chance that a splinter grp within the PA org or the PA org itself would demand autonomy once they have the doctorate degree and name change. For the sake of patients and medicine, med orgs cannot afford to take a chance based upon these two possible scenarios.

I may be too old for residency but then again if I do not give up, if I work hard and if I pray a lot, I may be able to secure a spot. I hope you become a successful physician.

 

[Makati2008]

Why is it that whenever someone gives their opinion about PAs they are accused of being a troll? Yet when NPs are criticized that is not the case.

Probably an act of desperation by the PAs to eliminate anyone who gets in the way of their hidden agenda.

Why would I want to eliminate anyone with my supposed hidden agenda? I am in medical school to be a doctor so my agenda is not hidden in any aspect of the word but I want the PA profession to thrive and grow to the best of its ability.

So my dear I have no reason to be "desperate". This person(alt) is acting as though they have a medical license to practice here in the USA when in fact he does not and he is trying to inject into the MLP-Physician debate when he doesn't have a leg to stand on. If you look at the board during this debate, if an attending has something to say I respect his or her position and I don't say anything due to it being the opinion of a practicing attending physician who does have some say in my scope of practice.

I think why a lot of people don't feel that way about posters when NP are criticized is due to NP's wanting independent practice(I know the majority don't). Also some NP's seem to be in positions that only a doc should be covering (for ex. see the Mary Mundinger appointed to the Board of Certification in Emergency Medicine post in the EM section)

To ALT-Again, I normally don't say anything to a attending physician, but since you are being negative against my profession without being able to practice along side a good PA as a mentor/SP then its a bit irritating to see your negativity about my profession on multiple occasions. That is why I am coming off so negative. Again I have no hidden agenda, I want to become a doc, and help my profession as well. I hope you match and do rural FM if you truly want to help people, but let me ask you-if you cannot match would you become a PA or a DNP.

 

[altap]

To makati: I'm pro PA or any midlevel for that matter as long as they practice under the supervision of a physician.

 

[jackets5]

I think the point of this whole thread has sorely been missed. I'm a med student (albeit a lowly first year) and I actually think it is a good idea! Let's be honest - it takes a ton of work to be a doctor, nobody is arguing or trying to get around that. It is not the majority of nurses/NPs/PAs that have the drive (or the desire, or the ability) to try to get there. For those who do, why not give them the option of taking our tests? If NPs/PAs are able to pass steps I and II why not consider letting them into residency programs? I do believe there should be required courses - the material would obviously be covered on the exams. I think it is totally feasible to have a 1-2 year fast track (f pre-reqs are already done) + residency for mid level providers. I don't see the harm in it.Those tests are extremely challenging, it is not really possible to slip though the cracks. Many med students and docs can be very condescending... ( I would bet $ that the posters sounding off are male!) There are several people in my class that worked as CNAs or MAs before coming to med school - people in these positions are usually expected to be totally incapable and incompetent, obviously not the case with my classmates. As mush as doctors like to believe that they (we) are the smartest folks around, that is just a ridiculous assumption. People make career choices for a million reasons.

Is medical training much more difficult than NP/PA training? yes.
Do doctors know a crap load more than NPs/PAs? you bet.

Is this because every person who becomes a doctor is intrinsically brighter, smarter, more capable, special, beautiful than every person that becomes a nurse? No, sorry, it doesn't.

Please get off your high horses. I can admit that clinically any nurse that has been working for a while knows a hell of a lot more that I do right now. That, of course, will change in the not too distant future. The road to medicine is long and hard. If someone wants to put him or herself though that - and can pass the standardized measures of his or her ability and competency - why not let them?

Problem with NP's and PA's (who are much, much better trained than NP's) is that they can to an extent tell you what something is clinically BUT cant tell you why it is happening. That why is a big big thing in being a MD or a DO. Knowing why something is happening allows you to think of all the consequential medical issues that may arise from that.

 

[Siggy]

Midlevels wanting a "bridge program" because they didn't want to go to medical school in the first place are like illegal aliens wanting a special path to citizenship because the current path is just too hard.

Sorry, there's already a path into medicine for midlevels, it's called medical school.

 

[zenman]

Problem with NP's and PA's (who are much, much better trained than NP's) is that they can to an extent tell you what something is clinically BUT cant tell you why it is happening. That why is a big big thing in being a MD or a DO. Knowing why something is happening allows you to think of all the consequential medical issues that may arise from that.

What about those consequential medical issues where for example, symptoms are hypothetically modulated by certain areas of the brain or when you prescribe a med where the mechanism of action is unknown. Do you know what is happening? 😉

 

[zenman]

Midlevels wanting a "bridge program" because they didn't want to go to medical school in the first place are like illegal aliens wanting a special path to citizenship because the current path is just too hard.

Sorry, there's already a path into medicine for midlevels, it's called medical school.

I doubt most midlevels want a bridge. I can only imagine those wanting it are those who became a midlevel then decided they really wanted to be a physician in the first place. I started out making over $100k in my first job as a new grad with no debt load and writing off my education. Do I care if I'm top dog...no! How long will it take most physicians to catch up, if ever?

 

[Charles_Carmichael]

I doubt most midlevels want a bridge. I can only imagine those wanting it are those who became a midlevel then decided they really wanted to be a physician in the first place. I started out making over $100k in my first job as a new grad with no debt load and writing off my education. Do I care if I'm top dog...no! How long will it take most physicians to catch up, if ever?

Nursing midlevels don't seem to want even a bridge. They want to be outright recognized as equivalent/superior to physicians.

 

[Siggy]

I doubt most midlevels want a bridge. I can only imagine those wanting it are those who became a midlevel then decided they really wanted to be a physician in the first place. I started out making over $100k in my first job as a new grad with no debt load and writing off my education. Do I care if I'm top dog...no! How long will it take most physicians to catch up, if ever?

...and don't get me wrong. There's nothing wrong with being a midlevel, just like there's nothing wrong with being any other profession or trade in health care. The problem comes when some, even if a minority, want a short cut because of their experience, which may or may not be applicable to the practice of medicine.

As far as pay, who cares? I'm not going into medicine for the money because it is relatively bad pay for the effort provided. However, relatively bad pay for the effort is not the same as relative to everyone else, and physicians make a good amount of money relative to most other people. I'm going into medicine because I enjoy it, and ultimately, that is the best reason to go into any profession.

 

[deleted6669]

Sorry, there's already a path into medicine for midlevels, it's called medical school.

sorry, there's already a 3 yr bridge for pa's into medical school. it's called lecom apap.
http://www.lecom.edu/pros_pathways.php/accelerated-physician-assistant-pathway-apap/76/0/1955/17899

 

[Siggy]

Do you honestly think a 3 year program with no breaks (the two month summer vacation between OMS1 and OMS2 is taken up by 2 primary care clerkships) with full time coures load is anywhere to what the OP was requesting?

Additionally, outside of the entrance requirments and that half the students aren't committed to primary care, how is this program structured any differently than the 3 year Primary Care Scholars Program is structured?

http://www.lecom.edu/pros_pathways.php/how-the-primary-care-scholars-curriculum-works/76/0/1955/7534

 

[deleted6669]

I agree that this is very different than what the op had in mind.
the advantage in applying to apap as a pa is that you are competing against a much smaller pool of applicants and the mcat is more of a pass/fail check box( set at >22) than "did you get a 28 or a 32?". also the program will allow some flexibility with prereqs for the right candidate although once in the program you will be competing with regular students with standard preparation during the first yr.

 

[Siggy]

Just a priori I highly doubt that the MCAT will be a pass/fail for the PA->DO program. There's only 22 spots and I'm sure that there's going to be a ton of PAs who are going to want to go through the program. As demand drastically outstrips supply, the effective minimum goes up. Plenty of medical schools have minimum GPAs or MCAT scores lists, but I wouldn't want to chance applying with a score at the posted minimum.

 

[deleted6669]

in time that may be the case but initially I think they are looking more at quality applicants with good hce than just at the #s. I know someone accepted to the program for next yr who has a great gpa and good experience(>10 yrs) but a low mcat.
also more DO programs are looking at emulating this model. my local program is considering a pa bridge as early as next yr(which I may attend...).

 

[Starpower]

... is that they can to an extent tell you what something is clinically BUT cant tell you why it is happening. That why is a big big thing in being a MD or a DO. Knowing why something is happening allows you to think of all the consequential medical issues that may arise from that.

Uhh ... huh? Besides being more mindful of using strange grammar, I'd appreciate it if you could a) cite some examples of what you're talking about, or b) cite some references. Otherwise, kindly keep your propaganda to your self.

 

[vivalavie]

hrmm, don't know why all the med students/pre-meds are so down on this idea. Do you think the education of an NP and a physician don't overlap AT ALL? I agree that a lot more education needs to happen to bring them up to a physician's level, but saying they don't warrant some kind of program abbreviation after their long clinical and educational paths seems kind of dense.

And the OPs intentions are so obviously pure, there's not a hint of ego in his/her post, s/he just wants more primary care physicians for those who need them most. Telling nurses to go to medical school will NOT solve the deficit of physicians in the US. This should be obvious. The number of medical students is capped by the number of medical school slots.

Another path to becoming a physician should be established, it should be rigorous and by the end the former NP should be on par with any medical school graduate. It would be tough to work out a good curriculum and ensure equal evaluation and abilities, but it is clearly possible.

 

[Charles_Carmichael]

hrmm, don't know why all the med students/pre-meds are so down on this idea. Do you think the education of an NP and a physician don't overlap AT ALL? I agree that a lot more education needs to happen to bring them up to a physician's level, but saying they don't warrant some kind of program abbreviation after their long clinical and educational paths seems kind of dense.

And the OPs intentions are so obviously pure, there's not a hint of ego in his/her post, s/he just wants more primary care physicians for those who need them most. Telling nurses to go to medical school will NOT solve the deficit of physicians in the US. This should be obvious. The number of medical students is capped by the number of medical school slots.

Another path to becoming a physician should be established, it should be rigorous and by the end the former NP should be on par with any medical school graduate. It would be tough to work out a good curriculum and ensure equal evaluation and abilities, but it is clearly possible.

NP/DNP education is not even close to physician education. Don't delude yourself. There's barely any overlap.

Telling nurses to go to medical school if they want to be physicians is the right thing to say. PAs have far similar education to physicians and even they have to go to medical school in order to be physicians, whether by the traditional route or by the new PA-to-DO bridge. Why should nursing midlevels, who have significantly less training, be allowed an exception?

Also, the number of physicians is not restricted by the number of medical school spots. You can open up a million new med schools and it will not have much of an impact on graduating physicians. The number of residency spots is what limits the number of physicians. And these residency spots are not increasing at the same level as med school spots are. Nursing midlevels also don't have any incentive to stay in primary care. If that were the case, why do you see NP/DNP "residencies" popping up in lucrative fields like dermatology and cardiology?

And, finally, your statement that "another path to becoming a physician should be established, it should be rigorous and by the end the former NP should be on par with any medical school graduate" is, in my personal opinion, just downright ridiculous. If you want to be "on par with a medical school graduate," go to medical school. A path to becoming a physician already exists. It's called medical school and residency. It has a proven track record. There is absolutely no need to create a similar-but-different path towards becoming a physician. If you create a curriculum that would produce graduates with the same level of competency as board-certified physicians, you know what you get? Medical school + residency.

 

[vivalavie]

Kaushik: You make some good points, but let me see if I can address your concerns.

I would propose a bridge similar to the PA-DO bridge for NPs with a few key differences.

They would be responsible for learning or relearning almost everything a medical student has to learn, but focused for primary care. I believe it was the OP who suggested that graduates of such a program would have to go into primary care and I think this is an excellent idea. There are already MD programs like this that cut the program down to three years, if you could subtract the redundancies between nursing school and medical school (though you assert these are minimal) I'm sure you could at least reduce the program length a few more months. Add to that some kind of reduced residency based on years of prior clinical work and I think you have a viable program that would help alleviate the dearth of primary care physicians.

I think you'd agree that this isn't an exemption of any kind and could produce the same caliber MDs as those that come out of traditional medical schools. NPs going down this path would want to work in primary care, and because of their previous exposure and concentrated direction it only makes sense that they enter an accelerated and directed program.

I think your concern about residency spots is valid, but since the only ones really being squeezed out are foreign grads and I REALLY don't wanna get into a debate about IMGs I'll leave that to better minds 🙂

Edit: Any idea why residency spots are not increasing quickly enough? Seems like a no brainer, cheap labor for hospitals, more primary care docs, what's with that? Sorry to go off topic, just curious.

 

[Siggy]

hrmm, don't know why all the med students/pre-meds are so down on this idea. Do you think the education of an NP and a physician don't overlap AT ALL? I agree that a lot more education needs to happen to bring them up to a physician's level, but saying they don't warrant some kind of program abbreviation after their long clinical and educational paths seems kind of dense.

Sure it does. So does the education of vets, ODs, DPTs, DDMs, and all other health care fields. The question is, "What overlaps, and is that section that overlaps covered in sufficient depth to give credit?" If all that overlaps is the basics, then you might as well complete the whole course.

And the OPs intentions are so obviously pure, there's not a hint of ego in his/her post, s/he just wants more primary care physicians for those who need them most. Telling nurses to go to medical school will NOT solve the deficit of physicians in the US. This should be obvious. The number of medical students is capped by the number of medical school slots.

Pure intentions doesn't mean it's a good idea.

Since the biggest reason for the cap is the number of clinical training spots, how does a bridge program address a lack of spots? Isn't it essentially stealing from one profession to add to another? Aren't nurses always harping about the "nursing shortage?" Since medicine and nursing are separate fields (something that nurses are always quick to point out), why should nurses require less time in clerkship learning how to act like a physician?

Another path to becoming a physician should be established, it should be rigorous and by the end the former NP should be on par with any medical school graduate. It would be tough to work out a good curriculum and ensure equal evaluation and abilities, but it is clearly possible.

"Rigorous" and "part time distance learning for working NPs," which was what the OP was requesting do not go together.

Why should NPs get a special pathway compared to other health care fields?

As mentioned earlier, there's a "nursing shortage" too. Shouldn't there be a pathway from physician to NP to assist with the nursing shortage?

 

[VA Hopeful Dr]

Edit: Any idea why residency spots are not increasing quickly enough? Seems like a no brainer, cheap labor for hospitals, more primary care docs, what's with that? Sorry to go off topic, just curious.

$$$

 

[vivalavie]

Siggy, also good points.

While I think distance learning will play an increasing role in the future, medicine is very much steeped in tradition and will probably be slower to change than most. I think there's nothing wrong with this, turning out good doctors is a matter of life or death, so any new program has to be well proven before it can be adopted. In this sense, I agree that the OPs initial plan was a bit unrealistic, but I think what I proposed is still viable.

In regards to the nursing shortage... sure, but you should know the difference that one physician in the sticks can make. Nurses really need a physician around to be effective and if we have nurses who are in these underserved areas and willing to make the transition to physician then we should make that as easy as possible while maintaining the same educational standards.

 

[Charles_Carmichael]

Siggy, also good points.

While I think distance learning will play an increasing role in the future, medicine is very much steeped in tradition and will probably be slower to change than most. I think there's nothing wrong with this, turning out good doctors is a matter of life or death, so any new program has to be well proven before it can be adopted. In this sense, I agree that the OPs initial plan was a bit unrealistic, but I think what I proposed is still viable.

In regards to the nursing shortage... sure, but you should know the difference that one physician in the sticks can make. Nurses really need a physician around to be effective and if we have nurses who are in these underserved areas and willing to make the transition to physician then we should make that as easy as possible while maintaining the same educational standards.

Still don't see why NPs/DNPs need a bridge to become physicians.

Their training is so ridonkulously dissimilar to that of physician training that they essentially have to go through the entire medical training curriculum to come out as equivalent to physicians. And that path already exists: med school + residency. It's pretty simple, really.

There's absolutely no reason whatsoever for an NP/DNP-to-MD/DO bridge. Especially considering PAs receive far superior training compared to NPs/DNPs. I would fully vouch for more PA-to-MD/DO programs before an NP/DNP-to-physician program even enters my thoughts.

 

[vivalavie]

Still don't see why NPs/DNPs need a bridge to become physicians.

Their training is so ridonkulously dissimilar to that of physician training that they essentially have to go through the entire medical training curriculum to come out as equivalent to physicians. And that path already exists: med school + residency. It's pretty simple, really.

There's absolutely no reason whatsoever for an NP/DNP-to-MD/DO bridge. Especially considering PAs receive far superior training compared to NPs/DNPs. I would fully vouch for more PA-to-MD/DO programs before an NP/DNP-to-physician program even enters my thoughts.

I'd say a need for such a bridge does exist for a couple reasons:

1) these people are willing to commit to primary care, and the country needs this
2) they want to do it, they are frustrated, and they deserve to have a place to go when they are no longer satisfied with the limitations of their practice. Want NPs and DNPs and people who lack the training to do what doctors do to stop encroaching on physician territory? give them a bridge to the MD.
3) I honestly think the caliber of doctor coming out of these programs would be extremely high. There would be fierce competition to get into them among NPs and the graduates will have an interesting vantage point from which to view health care.

Side note: think I just realized why the PA bridge is to a DO, DOs have all those unfilled residency spots! Might make sense to make the nurse bridge a DO too, in that case. Since these spots are unfilled, you'd be increasing the number of docs without squeezing anybody out!

I dunno, I like this whole idea. It'd be good for nurses who feel like they've hit a dead end, good for docs who are tired of hearing them complain, good for patients who need primary care docs and good for the whole health care system that just needs more qualified professionals who care about what they do. I don't know if I can convert you guys, but I think, all in all, this just makes a whole lot of sense.

 

[Buckeye4life]

Side note: think I just realized why the PA bridge is to a DO, DOs have all those unfilled residency spots! Might make sense to make the nurse bridge a DO too, in that case. Since these spots are unfilled, you'd be increasing the number of docs without squeezing anybody out!

No, it's because the person who designed the curriculum was a PA who went through LECOM's first medical school class and realized that PA's didn't need some of the rotations 3rd and 4th yr in order to graduate.

 

[vivalavie]

No, it's because the person who designed the curriculum was a PA who went through LECOM's first medical school class and realized that PA's didn't need some of the rotations 3rd and 4th yr in order to graduate.

Huh, interesting. Well, it's still a nice consequence of the DO route. They're increasing the number of practicing physicians while avoiding the residency cap they'd come against if they all went the ACGME route, thus squeezing out IMGs.

 

[Charles_Carmichael]

I'd say a need for such a bridge does exist for a couple reasons:

1) these people are willing to commit to primary care, and the country needs this
2) they want to do it, they are frustrated, and they deserve to have a place to go when they are no longer satisfied with the limitations of their practice. Want NPs and DNPs and people who lack the training to do what doctors do to stop encroaching on physician territory? give them a bridge to the MD.
3) I honestly think the caliber of doctor coming out of these programs would be extremely high. There would be fierce competition to get into them among NPs and the graduates will have an interesting vantage point from which to view health care.

Side note: think I just realized why the PA bridge is to a DO, DOs have all those unfilled residency spots! Might make sense to make the nurse bridge a DO too, in that case. Since these spots are unfilled, you'd be increasing the number of docs without squeezing anybody out!

I dunno, I like this whole idea. It'd be good for nurses who feel like they've hit a dead end, good for docs who are tired of hearing them complain, good for patients who need primary care docs and good for the whole health care system that just needs more qualified professionals who care about what they do. I don't know if I can convert you guys, but I think, all in all, this just makes a whole lot of sense.

Again, there's absolutely no need whatsoever for an NP/DNP-to-MD/DO bridge. Nursing midlevels will face the same headaches as PCPs do...how is this going to make NPs/DNPs magically become PCPs? For example, increasing the independence of nursing midlevels has not increased their practice in rural areas that are in need of PCPs (Freed GL, Dunham KM, Lamarand KE, Loveland-Cherry C, Martyn KK. Pediatric nurse practitioners: roles and scope of practice. Pediatrics 2010;126:846-850 and American Medical Association GeoMapping Initiative. Chicago: AMA, 2008.).

Not only that, if nursing midlevels were interested solely in filling in this primary care gap, there wouldn't be an influx of NP/DNP dermatology, cardiology, etc "residencies." Sure seems like they like the lucrative specialties as much as physicians do.

So, I'll repeat myself again. There is absolutely no need at all for an NP/DNP-to-physician bridge. PAs are much better suited for such a bridge than nursing midlevels could ever be. So why would medicine dip into the NP/DNP field when there are already better trained midlevels who are far more suited to bridge into becoming physicians? It makes no logical sense.

Huh, interesting. Well, it's still a nice consequence of the DO route. They're increasing the number of practicing physicians while avoiding the residency cap they'd come against if they all went the ACGME route, thus squeezing out IMGs.

You seem a little confused about residencies. A lot of DOs do pursue ACGME residencies. There are not enough DO residencies to accommodate all graduating DOs. And it doesn't look like the DO residency spots are likely to increase significantly in the near-future either.

 

[vivalavie]

Kaushik:

1) my proposal was for an NP-MD bridge that could only lead to a residency in primary care (much like the pre-existing 3 year MD programs, but further concentrated and suited for the transition from nursing to doctor...ing). So while your concerns about nurses not going into primary care are valid they are not applicable in this situation, nurses pursuing this path would HAVE to go into primary care.

2) I am not "confused". I am fully aware that many DOs pursue ACGME residencies and that there are not enough spots for all DOs if they suddenly all decided to pursue AOA residencies. This does not change the fact that every year there are more than a thousand unfilled AOA residency spots that go unfilled precisely because DOs often prefer ACGME residencies. Filling these spots with students from a bridge program would increase the number of practicing physicians.

I have no problem with the PA bridge or with increasing it, but nurses are frustrated and want a path, too. If they are willing to commit to primary care I think there's no reason not to create such a program.

Anyway, we seem to be rehashing the same arguments. I hope I've addressed your concerns but it seems unlikely that a change in opinions is imminent. I'm willing to agree to disagree, but I hope if such a program does emerge in the future you will be a bit more receptive to it based on our discussion.

 

[Charles_Carmichael]

1) my proposal was for an NP-MD bridge that could only lead to a residency in primary care (much like the pre-existing 3 year MD programs, but further concentrated and suited for the transition from nursing to doctor...ing). So while your concerns about nurses not going into primary care are valid they are not applicable in this situation, nurses pursuing this path would HAVE to go into primary care.

My concern wasn't just that they don't seem to be interested in primary care. The bigger concern was that NP/DNP training is not even remotely close to medical training. So, these NPs/DNPs basically have to do all 4 years of medical school (unlike PAs who receive better basic science and clinical training). So, there's absolutely no need for a "bridge." There's nothing to bridge there in the first place. See what I'm saying?

2) I am not "confused". I am fully aware that many DOs pursue ACGME residencies and that there are not enough spots for all DOs if they suddenly all decided to pursue AOA residencies. This does not change the fact that every year there are more than a thousand unfilled AOA residency spots that go unfilled precisely because DOs often prefer ACGME residencies. Filling these spots with students from a bridge program would increase the number of practicing physicians.

I'm glad you're not confused. We'll fill these spots with FMGs and IMGs who have gone through medical training before dipping into the pool of NPs/DNPs who want a bridge program. In a few years, the number of AMGs will be greater than the number of residency spots available anyways. So, there's an even greater incentive not to initiate any NP/DNP-to-physician bridges.

I have no problem with the PA bridge or with increasing it, but nurses are frustrated and want a path, too. If they are willing to commit to primary care I think there's no reason not to create such a program.

Just because nurses are frustrated about not having a bridge program doesn't mean one has to be created. They can go through the regular prereqs, med school, and residency just like the vast majority of premeds. Next thing I know, you're going to say that plumbers are frustrated and want a plumbing-to-physician bridge also.

There's no reason to create an NP/DNP-to-physician bridge, like I have mentioned repeatedly, because NP/DNP training is only remotely similar to physician training. NPs/DNPs essentially have to learn everything a traditional med student does, so there's no need for a bridge. They just need to go through med school and residency.

If they're not willing to put in the effort (which is what the current trend seems to suggest), that's a whole other matter...

Anyway, we seem to be rehashing the same arguments. I hope I've addressed your concerns but it seems unlikely that a change in opinions is imminent. I'm willing to agree to disagree, but I hope if such a program does emerge in the future you will be a bit more receptive to it based on our discussion.

I truly hope that an NP/DNP-to-physician bridge never comes to fruition. If you want to be a physician, as a nurse or nursing midlevel, go through med school and residency. We're not going to make shortcuts for you. It's that simple.

 

[PSYCHNP]

My concern wasn't just that they don't seem to be interested in primary care. The bigger concern was that NP/DNP training is not even remotely close to medical training. So, these NPs/DNPs basically have to do all 4 years of medical school (unlike PAs who receive better basic science and clinical training). So, there's absolutely no need for a "bridge." There's nothing to bridge there in the first place. See what I'm saying?



I'm glad you're not confused. We'll fill these spots with FMGs and IMGs who have gone through medical training before dipping into the pool of NPs/DNPs who want a bridge program. In a few years, the number of AMGs will be greater than the number of residency spots available anyways. So, there's an even greater incentive not to initiate any NP/DNP-to-physician bridges.



Just because nurses are frustrated about not having a bridge program doesn't mean one has to be created. They can go through the regular prereqs, med school, and residency just like the vast majority of premeds. Next thing I know, you're going to say that plumbers are frustrated and want a plumbing-to-physician bridge also.

There's no reason to create an NP/DNP-to-physician bridge, like I have mentioned repeatedly, because NP/DNP training is only remotely similar to physician training. NPs/DNPs essentially have to learn everything a traditional med student does, so there's no need for a bridge. They just need to go through med school and residency.

If they're not willing to put in the effort (which is what the current trend seems to suggest), that's a whole other matter...



I truly hope that an NP/DNP-to-physician bridge never comes to fruition. If you want to be a physician, as a nurse or nursing midlevel, go through med school and residency. We're not going to make shortcuts for you. It's that simple.

I read this post but find it hard to take someone who just took a few pre-reqs seriously.

Since it is obvious that folks like this want to close the door to a bridge program for NPs, I hope more and more states grant them independent practice.

Probably just another one of them pre-med students who have come to the reality that they will have to settle to become a family practice MD.

 

[Makati2008]

I read this post but find it hard to take someone who just took a few pre-reqs seriously.

Since it is obvious that folks like this want to close the door to a bridge program for NPs, I hope more and more states grant them independent practice.

Probably just another one of them pre-med students who have come to he reality that they will have to settle to become a family practice MD.

1.) I agree premeds shouldn't interject too much BUT see below
2.)No offense. Your a Psycho-Np. I wouldn't let you or your kind come near me with a 10ft pool. I have had too many missed dx by NPs hence its why I became a PA before a Doc. MLP(NP) independence needs to be SHUT DOWN. I would say allow a bridge for NPs to come about only if they meet or exceed the PA educational standards(before you bring up that you were a nurse for xyears which gives you more insight than a PA student, I will disagree with you. I have friends that I love to death that have become NP's and they cannot read EKG's, suture, or do other simplistic procedures that I was trained to do as a PA-S. Also they were able to go to school part time, PA's do not have this option-there maybe a rogue program or two doing it but not the majority)
3.)No offense a FM doc(whch I am choosing to do which is why I am a tad offended) will run circles around you days upon end. Especially the older docs. When your training and residency can match that of a doc come back but otherwise please keep your feeling to yourself.

As usual I apologize for any typos in this. Busy as usual. Studying Virology(and I know for a fact that NP virology aint as tough as this lol)

From the lowly future FM doc,
E PA-C

 

[Dwindlin]

1.) I agree premeds shouldn't interject too much BUT see below

Why? Because he/she is a pre-med? That's ignorant. The medical field isn't some mystical unknown. You don't have to be in it to understand it. I was a freaking music major before switching to medicine, and before so I had done enough research to get an idea of what it would be like, and (here's the shocker) I was right.

It doesn't take an attending (who could honestly have their head in the sand about health policy just as easily as anyone) to have an opinion on whether or not bridges/independent practice for mid-levels is a terrible idea.

 

[Makati2008]

Why? Because he/she is a pre-med? That's ignorant. The medical field isn't some mystical unknown. You don't have to be in it to understand it. I was a freaking music major before switching to medicine, and before so I had done enough research to get an idea of what it would be like, and (here's the shocker) I was right.

It doesn't take an attending (who could honestly have their head in the sand about health policy just as easily as anyone) to have an opinion on whether or not bridges/independent practice for mid-levels is a terrible idea.

1.)I say this because unless you work with a MLP in some sort of capability for an extended period of time you don't know what they are able to in my opinion. I base that on BEING A MLP and now BEING in medical school(I say it like this due to your attitude.) Let me ask you have you worked with us? I would respect your opinion? Please interject without the attitude and I promise I will do it the same.
2.)If the poster was in medical school and had been around MLPs then I would take his opinion without reservations because he would have a solid foundation to base it on. And I don't mean shadowing. I mean actually working side by side with a MLP(PA or NP).

Best of luck to you.

 

[VA Hopeful Dr]

Why? Because he/she is a pre-med? That's ignorant. The medical field isn't some mystical unknown. You don't have to be in it to understand it. I was a freaking music major before switching to medicine, and before so I had done enough research to get an idea of what it would be like, and (here's the shocker) I was right.

It doesn't take an attending (who could honestly have their head in the sand about health policy just as easily as anyone) to have an opinion on whether or not bridges/independent practice for mid-levels is a terrible idea.

Actually, I would disagree with this statement. Have you ever tried to explain what med school is like to someone not in it? They rarely truly understand.

I would also suggest that until you have the knowledge and the experience of working with midlevels, you might not want to start talking about what they know and don't know or can/can't do.

 

[Starpower]

Why? Because he/she is a pre-med? That's ignorant. The medical field isn't some mystical unknown. You don't have to be in it to understand it. I was a freaking music major before switching to medicine, and before so I had done enough research to get an idea of what it would be like, and (here's the shocker) I was right.

It doesn't take an attending (who could honestly have their head in the sand about health policy just as easily as anyone) to have an opinion on whether or not bridges/independent practice for mid-levels is a terrible idea.

I agree with you, on most levels. While of course people who work around others of certain positions are perhaps better aware of their modalities (at least in so far as individually), it doesn't take a genius (or an Attending) to know what's up. And actually, there are probably many here who probably have little to no idea of what NP education does or doesn't actually consist of. Working with a NP who misdiagnosed means zilch, statistically speaking. I know Doctors who've misdiagnosed, does that mean all Doctors are this or that? Of course not. Try and stay objective, people.

That all being said, I have looked into NP programs and know what they're taught, and there is no way that they should be licensed to practice independently. To work independently, that's one thing. But to operate independently without access to the full scope of knowledge that Doctors possess is nothing short of driving blindsighted, imo.

One more thing, be careful in grouping NPs and PAs together when speaking of bridges and independent practice. First off, PAs are taught in the medical model (Doctors have much input into their accreditation) and NPs are taught in the nursing model (their accreditation comes from Nursing groups). So, bridge consideration is not the same between the two. Also, PAs are not lobbying for independent practice, NPs are.

 

[Dwindlin]

1.)I say this because unless you work with a MLP in some sort of capability for an extended period of time you don't know what they are able to in my opinion. I base that on BEING A MLP and now BEING in medical school(I say it like this due to your attitude.) Let me ask you have you worked with us? I would respect your opinion? Please interject without the attitude and I promise I will do it the same.
2.)If the poster was in medical school and had been around MLPs then I would take his opinion without reservations because he would have a solid foundation to base it on. And I don't mean shadowing. I mean actually working side by side with a MLP(PA or NP).

Best of luck to you.

After deciding I wanted to pursue medicine MLP was a path I considered (PA specifically), I researched the schooling, their scope, in generally what their roles entail in my state. I felt I had a pretty good understanding of all that all before having ever had ANY personal experience what so ever. My experience since then have only confirmed what I believed, and why I decided to pursue med school instead of PA school.

Now, before someone tries to turn this into a MLP bash it isn't. My issue is with people disregarding someones opinion because of their status, in reality you have no idea what their experiences are. My apologies for the snarky comments...this is one of those things that just gets to me.

Actually, I would disagree with this statement. Have you ever tried to explain what med school is like to someone not in it? They rarely truly understand.

I would also suggest that until you have the knowledge and the experience of working with midlevels, you might not want to start talking about what they know and don't know or can/can't do.

I disagree with the bolded. I think people understand just fine. I guess it comes down to what do you mean understand? I find it hard to believe that someone can't imagine something that is difficult, and school like.

And as to the second part, you can know what they are and are not allowed to do, it is in their scope which is typically published on most state websites. Now as to what they know/or are capable of yes your right, the only way to know that is work with them...but that still doesn't apply to the job as a whole...because we've all seen good/bad docs, nurses, medics, waiters/waitresses, etc, etc...

 

[Makati2008]

I agree with you, on most levels. While of course people who work around others of certain positions are perhaps better aware of their modalities (at least in so far as individually), it doesn't take a genius (or an Attending) to know what's up. And actually, there are probably many here who probably have little to no idea of what NP education does or doesn't actually consist of. Working with a NP who misdiagnosed means zilch, statistically speaking. I know Doctors who've misdiagnosed, does that mean all Doctors are this or that? Of course not. Try and stay objective, people.

That all being said, I have looked into NP programs and know what they're taught, and there is no way that they should be licensed to practice independently. To work independently, that's one thing. But to operate independently without access to the full scope of knowledge that Doctors possess is nothing short of driving blindsighted, imo.

One more thing, be careful in grouping NPs and PAs together when speaking of bridges and independent practice. First off, PAs are taught in the medical model (Doctors have much input into their accreditation) and NPs are taught in the nursing model (their accreditation comes from Nursing groups). So, bridge consideration is not the same between the two. Also, PAs are not lobbying for independent practice, NPs are.

Points well taken. I see you changed your signature? Did you earn your stripes(C). If so congrats.

E.

 

[Makati2008]

After deciding I wanted to pursue medicine MLP was a path I considered (PA specifically), I researched the schooling, their scope, in generally what their roles entail in my state. I felt I had a pretty good understanding of all that all before having ever had ANY personal experience what so ever. My experience since then have only confirmed what I believed, and why I decided to pursue med school instead of PA school.

Now, before someone tries to turn this into a MLP bash it isn't. My issue is with people disregarding someones opinion because of their status, in reality you have no idea what their experiences are. My apologies for the snarky comments...this is one of those things that just gets to me.




I disagree with the bolded. I think people understand just fine. I guess it comes down to what do you mean understand? I find it hard to believe that someone can't imagine something that is difficult, and school like.

And as to the second part, you can know what they are and are not allowed to do, it is in their scope which is typically published on most state websites. Now as to what they know/or are capable of yes your right, the only way to know that is work with them...but that still doesn't apply to the job as a whole...because we've all seen good/bad docs, nurses, medics, waiters/waitresses, etc, etc...

Don't see your opinion as a bash at all. Thanks for clarifying earlier. I guess too I get a little irritated at people making fun of family practice docs. They are the gate keepers and one saved my life so I am eternally grateful and want to be one.

Anyway we both got to pass boards and get the hell outta medical school.

good luck,
E.

 

[deleted6669]

Points well taken. I see you changed your signature? Did you earn your stripes(C). If so congrats.

E.

yup, star made the big show. now he's wallowing in job offers....seriously....

 

[Therapist4Chnge]

ian territory? give them a bridge to the MD.
3) I honestly think the caliber of doctor coming out of these programs would be extremely high. There would be fierce competition to get into them among NPs and the graduates will have an interesting vantage point from which to view health care.

1. Assuming the training is tightly controlled.
2. Assuming the numbers are limited and the floodgates are not opened to the masses of applicants.
3. Assuming the people don't try and push the boundaries into other specialities. Once in the door of a house, it is quite hard to keep people to just one room...

Why re-invent the wheel? There are thousands of spots each year for medical school.

 

[Charles_Carmichael]

1.) I agree premeds shouldn't interject too much BUT see below

That's a fair statement and I'm not arguing against it. Just like you said, I don't have experience with med school, residency, and beyond (yet). And you're right to be cautious when reading my posts. With that being said, however, have I said anything incredibly unreasonable or illogical? I would contend that I'm one of the few posters who has done side-by-side comparisons of a ton of NP/DNP and medical curricula (even posted one comparison on several threads...not sure if I did in this one, but I know I did in the other active thread in these forums) and tried to be objective with number of clinical hours of training, basic science courses that would impact taking care of individual patients, etc.

I mean, I don't think you have to be in the medical profession to realize that 10000+ hours of clinical training >>>>>>>>> 500-1000 hours of clinical training. You're free to point out any and all flaws in what I've said though. I'm more than willing to admit it if I'm wrong about something. I mean, I've always stated that M3s halfway through 3rd year have better clinical training than NPs/DNPs do, but J-Rad recently pointed out in another thread that I was wrong about that and made a reasonable argument as to why he/she thinks I'm wrong. So from now on, I'll be using clinical hours of training solely from residency rather than including those gained in M3/M4 as well. I'm a reasonable person (for the most part 🙂).

 

[zenman]

1.)
2.)No offense. Your a Psycho-Np. I wouldn't let you or your kind come near me with a 10ft pool. I have had too many missed dx by NPs hence its why I became a PA before a Doc. MLP(NP) independence needs to be SHUT DOWN. I would say allow a bridge for NPs to come about only if they meet or exceed the PA educational standards(before you bring up that you were a nurse for xyears which gives you more insight than a PA student, I will disagree with you. I have friends that I love to death that have become NP's and they cannot read EKG's, suture, or do other simplistic procedures that I was trained to do as a PA-S. Also they were able to go to school part time, PA's do not have this option-there maybe a rogue program or two doing it but not the majority)

From the lowly future FM doc,
E PA-C

As a Psych NP, I can't read anything more than a basic EKG, although as an ICU nurse I once could very well. Just have no interest in it anymore. Same with suturing and other simplistic techniques that I was taught as an ARMY medic.

What about part-time? Not having that option just means your educational program is not caring about the subset of students who can't attend full-time. I also hope you're not of the mind-set that you have to do 80 hours a week and suffer extreme hardships in school otherwise you're just not up to snuff and don't deserve to wear that Ranger badge, lol!

I also had 35 years of nursing experience, starting with a Level I ED, before I became an NP. I'm not the brightest tool in the shed but I wouldn't trade my experience in the USA and other countries for anything.

Regarding missed diagnosis, I added Cyclothymic Disorder to a patient a few days ago and changed her meds and PTSD today to another and added Prazosin.

Point I'm making is be careful when you make blanket statements.

BTW, how deep is a 10 ft pool?

 

[Makati2008]

As a Psych NP, I can't read anything more than a basic EKG, although as an ICU nurse I once could very well. Just have no interest in it anymore. Same with suturing and other simplistic techniques that I was taught as an ARMY medic.

What about part-time? Not having that option just means your educational program is not caring about the subset of students who can't attend full-time. I also hope you're not of the mind-set that you have to do 80 hours a week and suffer extreme hardships in school otherwise you're just not up to snuff and don't deserve to wear that Ranger badge, lol!

I also had 35 years of nursing experience, starting with a Level I ED, before I became an NP. I'm not the brightest tool in the shed but I wouldn't trade my experience in the USA and other countries for anything.

Regarding missed diagnosis, I added Cyclothymic Disorder to a patient a few days ago and changed her meds and PTSD today to another and added Prazosin.

Point I'm making is be careful when you make blanket statements.

BTW, how deep is a 10 ft pool?

1.)I respect your previous training as an Army Medic very much. Thanks for your service. Remember most of your colleagues don't have your previous background.
2.)I feel as though those techniques should be taught to anyone. A generalist education should be recieved by all MLPs at the least.
3.)I personally don't think part-time medical education is a good idea(just my opinion). I think that "subset" can find a way to become a MLP if they truly want it bad enough. Also personally PA school was by far not the worst thing in the word lol.
4.)I also get irritated by people such as Psych NP who make the comments about FM Docs. If you can honestly tell me that a Psych NP is better trained than a Family Medicine Doc then I smell a rat.

 

[Makati2008]

1.)I respect your previous training as an Army Medic very much. Thanks for your service. Remember most of your colleagues don't have your previous background.
2.)I feel as though those techniques should be taught to anyone. A generalist education should be recieved by all MLPs at the least.
3.)I personally don't think part-time medical education is a good idea(just my opinion). I think that "subset" can find a way to become a MLP if they truly want it bad enough. Also personally PA school was by far not the worst thing in the word lol.
4.)I also get irritated by people such as Psych NP who make the comments about FM Docs. If you can honestly tell me that a Psych NP is better trained than a Family Medicine Doc then I smell a rat.

Pool=Pole. I notoriously have typos I usually apologize for them in advance.

 

[PSYCHNP]

That's a fair statement and I'm not arguing against it. Just like you said, I don't have experience with med school, residency, and beyond (yet). And you're right to be cautious when reading my posts. With that being said, however, have I said anything incredibly unreasonable or illogical? I would contend that I'm one of the few posters who has done side-by-side comparisons of a ton of NP/DNP and medical curricula (even posted one comparison on several threads...not sure if I did in this one, but I know I did in the other active thread in these forums) and tried to be objective with number of clinical hours of training, basic science courses that would impact taking care of individual patients, etc.

I mean, I don't think you have to be in the medical profession to realize that 10000+ hours of clinical training >>>>>>>>> 500-1000 hours of clinical training. You're free to point out any and all flaws in what I've said though. I'm more than willing to admit it if I'm wrong about something. I mean, I've always stated that M3s halfway through 3rd year have better clinical training than NPs/DNPs do, but J-Rad recently pointed out in another thread that I was wrong about that and made a reasonable argument as to why he/she thinks I'm wrong. So from now on, I'll be using clinical hours of training solely from residency rather than including those gained in M3/M4 as well. I'm a reasonable person (for the most part 🙂).

Reading Sports Illustrated is worlds apart from "actually getting in the game".

I think residents and MDs alike should be highly offended when pre-meds who just took a few pre-reqs (general chemistry/physics) and shadowed someone say they know what they are going through.

Just look at the research done on medical students regarding such problems as addictions and divorce rates.

I think seasoned medical professionals even need to be leary about recent PA grads. When it comes to the "medical field" experience is priceless. As I said in my previous posts it usually takes about 10 years to become an expert at anything, especially medicine.

Would you really trust an automobile mechanic, PA, or even surgeon with less than a year of experience under his or her belt?

Let's face it in PA school for the first two or three semesters the PA is probably just modeling after his or her preceptor. It is not until the fourth semester that comprehension, application, and the synthesis of knowledge is taking place (with the supervision and guidance of an MD). In one of the posts an attending on SDN made, he stated that he would give his PA students frivolous tasks like reading charts and filing.

With that being said, in the grand scheme of things the 2,000 clinical hours of training the PA receives is in reality futile. That is the reason why hospitals typically don't like to hire new grads. In addition to this, the reason why NP students with decades of experience as ICU/ER/MED SURG RNs are humored by PAs who boast about their 2,000 clinical hours of training. NP students are generally older with much more medical experience than PA students ("their eyes have seen much much more").

In terms of safety I would much prefer the services of an NP recent grad with ICU/ER/MED SURG RN experience than a PA new grad.

As for pre-meds, they don't have a clue about actual "medicine" and should refrain from commenting on issues they have no knowledge of.

 

[Makati2008]

If you can provide proof about my education and my training being subpar please let me know. I truly doubt you know much about the PA education at all. If NP's training is so much better than PA's, tell me why we had several RN's in my PA class and I have worked with numerous other ones that went the PA route when the NP route was available to them?

Furthermore, my first job was in a pretty large ER and the ER director blatantly admitted he preferred PA's because we practiced medicine and didn't do everything based on an algorithm and if it didn't fit come running to him confused over the simplest of cases due us actually being able to think outside of these algorithms.

Also there is a reason why PA's can see patients from the cradle to the grave while some NP's cannot.(I was hired due to this reason-> a NP could not see the full spectrum of patients so she was let go)

Since we are just basing our thoughts on personal experience I figured I would share mine.

As usual apologize for typos,
E.