New idea for NP/PA to MD

[Green85]

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The resident gets over 10,000 hours... hmmm. I've had over 12,000 hours of supervised experience in the last 5 years of practice. Soooo...



I can cut it down because I don't need to learn how to listen to a heart and lungs. I don't need to know what an H&P is. If you don't think so, then test me. If I fail, I'll be happy to take whatever course you think is necessary. If I pass, then maybe we aren't just a bunch of brainless bodies filling spots because they're there.




Again, shortcut means a shorter route to the same place. I'm proposing taking several additional years onto the 8 I have completed along with the many years of experience. 18 years is longer than 11.



Yes it does. So make it available to more than a few who aren't really willing to do primary care in the first place.




Kaushik: "The only way to get to the NBA is to practice on the court on University campuses."

Me: "But I have a regulation court that is exactly the same in my rural town that I've been playing on for ten years, I just need someone to come here and help me learn."

Kaushik: "Sorry, that doesn't count. We've been doing it this way for over 100 years."

Me: "Why can't we come up with new ways to accomplish the same thing?"

Kaushik: "Just because"


Thank you for helping me prepare for answering these questions when they come to me from people who care about the healthcare of this country. I appreciate it.

BBBWWAHAHAHAHAHAHAHAHAHAHAHAHHAHA

 

[vivalavie]

huh, interesting ideas came out in my absence. I hadn't proposed anything regarding the clinical stuff, I just figured they'd do a standard 1 year clinical rotation wherein they only rotate through primary care specialties and upon graduating they can only go into primary care. your idea could conceivably abbreviate the process beyond what even I had in mind.

My idea for further abbreviating the 3 year med school model for nurses was to accelerate courses that nurses have taken before, so, they're responsible for the same material, take the same tests, but cover it more quickly because they have, presumably, seen it before. Again, if they can't hack it they decelerate to a normal med school pace, no harm no foul, and if they can they've proven their knowledge.

I'm gonna put it out there that I think the entire pre-clinical curriculum should absolutely be reducible to a year. I mean, Duke does this for their NORMAL med students, should not be an issue. So... reduce a 3-year program by a year and you've got yourself a viable 2 year path to med school for nurses which still holds them accountable for all the same knowledge and skills. Seems like a pretty sweet idea to me, lots less debt and years wasted not pulling an income.

 

[deleted6669]

2 YRS WON'T WORK.
the min is 130 weeks to meet credentialing requirements if I am remembering correctly. lecom pa to do is 138 weeks.

 

[vivalavie]

2 YRS WON'T WORK.
the min is 130 weeks to meet credentialing requirements if I am remembering correctly. lecom pa to do is 138 weeks.

k... but why? If the board that came up with that rule looked at my idea, where would their outrage come from? Find the flaw. They're responsible for everything every other med student was ever responsible for, what's the problem? It's not enough anymore to say this is the way it is and everything else is wrong. I know you're a conventionalist and I think that's adorable but it's big boy time, no great human triumph was heralded by typing indignantly in caps lock about the status quo.

 

[FutureDoc4]

k... but why? If the board that came up with that rule looked at my idea, where would their outrage come from? Find the flaw. They're responsible for everything every other med student was ever responsible for, what's the problem? It's not enough anymore to say this is the way it is and everything else is wrong. I know you're a conventionalist and I think that's adorable but it's big boy time, no great human triumph was heralded by typing indignantly in caps lock about the status quo.

I think its cute that you think that its "easy" to learn the same amount of material that some of the most "high selected" academic elite of our country (yes, its true---you can look up avgs if you want/don't believe me) STRUGGLE with could be learned by people in 3/4 to 1/2 the time.

No, these other providers don't learn the "same stuff" as we do...even PAs, who are the closests, still are not required to know the exact same amount of information (otherwise PA school = Medical school)

Frankly, you want "big boy time"---most of these "other providers" (EXCEPT PAS--PAS PLEASE NOTICE THE CAPS), don't even take the 'real hard sciences' as undergrads/professional school.

You want to talk about "big boy time"---lets see them handle the REAL academic rigors. Frankly, they/you haven't even earned the right to play in the major leagues yet.

It's like saying you played awesome high school baseball, so that should automatically let you make it to the all star game (medical school); when, we have to see how you would even handle the MLB.

That's reality.

 

[zenman]

You want to talk about "big boy time"---lets see them handle the REAL academic rigors. Frankly, they/you haven't even earned the right to play in the major leagues yet.


That's reality.

Yea, if you got some REALLY BIG ONES, go into physics:

"I am a Medical Doctor with credentials in internal medicine and nephrology (kidneys). I received a bachelor’s degree in theoretical physics in 1987 from Rutgers University. I mention the college degree in case any doubtful readers question my mental prowess. One can doubt my intellectual ability less if they first realize that I know how to figure out difficult things. I know how to look at something in depth for many hours or days until I understand the inner workings of it. This is what I learned to do in college. In fact the strenuous mind-bending exercise that was part of the physics curriculum made medical school easy. I found the study of the human body, chemistry and biology to be in comparison quite shallow, simple and easy to comprehend."

Suzanne Humphries, MD

 

[vivalavie]

I think its cute that you think that its "easy" to learn the same amount of material that some of the most "high selected" academic elite of our country (yes, its true---you can look up avgs if you want/don't believe me) STRUGGLE with could be learned by people in 3/4 to 1/2 the time.

No, these other providers don't learn the "same stuff" as we do...even PAs, who are the closests, still are not required to know the exact same amount of information (otherwise PA school = Medical school)

Frankly, you want "big boy time"---most of these "other providers" (EXCEPT PAS--PAS PLEASE NOTICE THE CAPS), don't even take the 'real hard sciences' as undergrads/professional school.

You want to talk about "big boy time"---lets see them handle the REAL academic rigors. Frankly, they/you haven't even earned the right to play in the major leagues yet.

It's like saying you played awesome high school baseball, so that should automatically let you make it to the all star game (medical school); when, we have to see how you would even handle the MLB.

That's reality.

I'm not going to respond to this post until you actually go back and read what I am proposing. It is clear that you just saw "2 YR PROGRAM" and could not resist the impulse to comment, regardless of your ignorance to our ongoing conversation.

My proposal is thoughtful and thorough and warrants more than your condescension.

Edit: When you use quotation marks, you should be quoting someone. You certainly weren't quoting me. Nor were you even accurately representing my sentiments. Sorry, that stuff gets on my nerves.

 

[Charles_Carmichael]

I'm not going to respond to this post until you actually go back and read what I am proposing. It is clear that you just saw "2 YR PROGRAM" and could not resist the impulse to comment, regardless of your ignorance to our ongoing conversation.

My proposal is thoughtful and thorough and warrants more than your condescension.

Edit: When you use quotation marks, you should be quoting someone. You certainly weren't quoting me. Nor were you even accurately representing my sentiments. Sorry, that stuff gets on my nerves.

If you're a nursing midlevel and want to be a physician, go through 4 years of med school + residency. There's absolutely no need to make a "shortcut" for nurses. Especially when PA's, who have far, far, far, far, far superior basic science AND clinical training than nursing midlevels still require 3 years of med school.

And I do agree with FutureDoc that the courses nurses/nursing midlevels take are unlikely to be on the same level as what premeds/med students take, at least from my experience. My undergrad, for example, had separate courses for nurses (ex. chemistry for nursing majors, biology for nursing majors, that type of thing) and it was widely known that these courses were not as rigorous as what most others (including other non-majors) took.

I find it veeeeeery hard to believe that a nursing midlevel gets the same exact course as a medical student does. So, I repeat: there's absolutely no need for a nursing midlevel-to-physician pathway to exist. I would advise all the nursing midlevels trying to put so much effort into this idea (if they actually are) to redirect those efforts in getting the prereqs done and getting accepted to med school instead. You're likely to be more successful at that than actually implementing this program.

 

[vivalavie]

If you're a nursing midlevel and want to be a physician, go through 4 years of med school + residency. There's absolutely no need to make a "shortcut" for nurses. Especially when PA's, who have far, far, far, far, far superior basic science AND clinical training than nursing midlevels still require 3 years of med school.

Kaushik, I am in no mood for you. Your parrot-like rhetoric is the original source of the term "bird brain."

There are 3-year schools out there for non-nurses who want to go into primary care. This is achieved by reducing clinical rotations to just one year, pure primary care specialties.

Duke condenses the preclinical years to 1 year.

One year preclinical+one year clinical... hrm, check my math Kaushik.

If you are denying that a 2 year program could work you are the worst kind of fool. While nurses are not the only ones who could benefit from such a program they are uniquely suited to it because of their commitment and desire for such a bridge. Plus it'd help with the PCP shortage.

 

[nlax30]

Kaushik, I am in no mood for you. Your parrot-like rhetoric is the original source of the term "bird brain."

There are 3-year schools out there for non-nurses who want to go into primary care. This is achieved by reducing clinical rotations to just one year, pure primary care specialties.

Duke condenses the preclinical years to 1 year.

One year preclinical+one year clinical... hrm, check my math Kaushik.

If you are denying that a 2 year program could work you are the worst kind of fool. While nurses are not the only ones who could benefit from such a program they are uniquely suited to it because of their commitment and desire for such a bridge. Plus it'd help with the PCP shortage.

Where are you getting 2 years from? You can't combine attributes from two different programs and call it sufficient training. There are some 3 year programs for primary care, but Duke is still 4 years. The first years basic sciences, and then 2 yrs of clinicals with a research year in there.

 

[vivalavie]

Where are getting 2 years from? You can't combine attributes from two different programs. There are some 3 year programs for primary care, but Duke is still 4 years. The first years basic sciences, and then 2 yrs of clinicals with a research year in there.

good god... are there actually people like you out there?

 

[vivalavie]

To everyone I've insulted in the past hour-

Sorry, crabby day! I respect you as potential future doctors and all that. 🙂

 

[Charles_Carmichael]

good god... are there actually people like you out there?

Duke only has 10-12 months set aside for research or another scholarly activity. I think it's your math that's off. They still have 3 years of med school. And nlax is right. Duke is still a 4-year medical school. Check out the website if you don't believe us.

 

[Charles_Carmichael]

Kaushik, I am in no mood for you. Your parrot-like rhetoric is the original source of the term "bird brain."

Nice.

There are 3-year schools out there for non-nurses who want to go into primary care. This is achieved by reducing clinical rotations to just one year, pure primary care specialties.

The only one I know of is the LECOM PA-to-DO curriculum.

Duke condenses the preclinical years to 1 year.

One year preclinical+one year clinical... hrm, check my math Kaushik.

I checked your math. You're wrong. See previous post.

If you are denying that a 2 year program could work you are the worst kind of fool. While nurses are not the only ones who could benefit from such a program they are uniquely suited to it because of their commitment and desire for such a bridge. Plus it'd help with the PCP shortage.

Really? I'm a fool even though there's no evidence at all that suggests that a 2 year medical school curriculum would work? Can you cite some data to support your stance that it will work? Or are you just speculating (ie. guessing wildly with no basis on fact)?

 

[vivalavie]

Duke only has 10-12 months set aside for research or another scholarly activity. I think it's your math that's off. They still have 3 years of med school. And nlax is right. Duke is still a 4-year medical school. Check out the website if you don't believe us.

Every time you post something stupid and redundant I'm just going to reply with a SQUACK from now on. Y'know. Bird brain and all that.

Duke has 1 preclinical year. They also have research, which shouldn't be necessary to produce a good PCP, agreed?
If, instead of 2 clinical years dedicated to all manner of random haberdashery, they had 1 clinical year dedicated to only primary care specialties, voila, we have a two year program. Pretty sneaky, huh, sis?

Again, graduates would only go into PC specialties... but then that's the point, isn't it?

 

[vivalavie]

nice.



The only one i know of is the lecom pa-to-do curriculum.



I checked your math. You're wrong. See previous post.


Really? I'm a fool even though there's no evidence at all that suggests that a 2 year medical school curriculum would work? Can you cite some data to support your stance that it will work? Or are you just speculating (ie. Guessing wildly with no basis on fact)?

Squack.

 

[VA Hopeful Dr]

Kaushik, I am in no mood for you. Your parrot-like rhetoric is the original source of the term "bird brain."

There are 3-year schools out there for non-nurses who want to go into primary care. This is achieved by reducing clinical rotations to just one year, pure primary care specialties.

Duke condenses the preclinical years to 1 year.

One year preclinical+one year clinical... hrm, check my math Kaushik.

If you are denying that a 2 year program could work you are the worst kind of fool. While nurses are not the only ones who could benefit from such a program they are uniquely suited to it because of their commitment and desire for such a bridge. Plus it'd help with the PCP shortage.

You're missing a few things.

First, I think we can all agree that Duke likely gets some of the best medical students in the country. We're not talking your average still pretty darn bright med students, this is cream of the crop type stuff. There's a reason why most schools have 2 years of basic sciences. In addition, that research year likely involves some fairly intense PBL-type learning of those same basic sciences.

Second, let's ask around here to get some perspective. There are more than a few nurses who then went on to regular med school - heck, my program just matched 2 of them. We can ask how nursing school anatomy/pharm/physiology compares to med school. The PAs around here admit that they pretty much need to repeat all of the basic sciences, and their training is the most similar to ours.

Third, I just looked at the nursing school (BSN) curriculum at the university where I attended med school. 3 bio courses.... that's it. Hell, I had to take 4 just to apply to med school and you want to shorten it with less prep? Now, if you're talking NP to MD/DO, just ignore this paragraph.

Fourth, those 3-year med schools can be entered from nursing/PA without any problem. You want a shortened curriculum - there it is. 2 years just cuts out too much. Don't forget that in those 2 years you also have to pass 2 licensing exams, apply/interview for residency, and still manage the massive amount of work that would come from a shortened curriculum.

I appreciate you being pro-active for your profession, but there's just too much to cover. Plus, I find a comment you made later:

"If, instead of 2 clinical years dedicated to all manner of random haberdashery, they had 1 clinical year dedicated to only primary care specialties, voila, we have a two year program. Pretty sneaky, huh, sis?"

to be pure ignorance. Primary care physicians need to have a very broad, reasonably in-depth training. Otherwise, you're nothing more than a referral monkey. Plus, there is great value in having worked with other specialists so you know how they think (and can interpret what they say, as each specialist has a different language), what they expect of PCPs, and even gain some knowledge to make you a better doctor.

Go through medical school, then tell those of us who did that 2 of those years were a waste.

 

[Charles_Carmichael]

Every time you post something stupid and redundant I'm just going to reply with a SQUACK from now on. Y'know. Bird brain and all that.

Duke has 1 preclinical year. They also have research, which shouldn't be necessary to produce a good PCP, agreed?
If, instead of 2 clinical years dedicated to all manner of random haberdashery, they had 1 clinical year dedicated to only primary care specialties, voila, we have a two year program. Pretty sneaky, huh, sis?

Again, graduates would only go into PC specialties... but then that's the point, isn't it?

Squack.

So what you're saying is that you have no argument? Am I understanding you right? Just want to make sure.

Considering that PAs, who have vastly superior training compared to nursing midlevels, still have a 3 year bridge, why would there ever be a need to have a shorter path for nursing midlevels? Especially when the nursing midlevels are far weaker in both the basic and clinical sciences? You're right. My questioning does require a "squack" response. I guess it's your response whenever you don't have any convincing support for your argument.

I'm predicting that I'll be getting a "squack" for this post as well. Keep going though. It's entertaining enough.

 

[FutureDoc4]

Every time you post something stupid and redundant I'm just going to reply with a SQUACK from now on. Y'know. Bird brain and all that.

Duke has 1 preclinical year. They also have research, which shouldn't be necessary to produce a good PCP, agreed?
If, instead of 2 clinical years dedicated to all manner of random haberdashery, they had 1 clinical year dedicated to only primary care specialties, voila, we have a two year program. Pretty sneaky, huh, sis?

Again, graduates would only go into PC specialties... but then that's the point, isn't it?

No!

THis is the problem with the way medicine is going. You want to reduce a physician into a TECH/with no technical thought/creativity to problem solve

Could you produce "physicians" this way ?(I use that term loosely)

Yes, but they would be no different than a mid-level provider.

Over 1/2 of medical students perform research at some point.

I've heard up to 1/4 of medical students now take time off to do research/second degree/independent study and most medical curriculum now focus on evaluating the literature and EBM (this is critical to becoming a successful physician)

It's not as simple as producing a "tech" to produce more PCPs--frankly, I want my PCP to not just be thoughtlesss tech(automaton) that can follow a checklist

I want someone a who is creative and understands medicine/physiology/pathophysiology and how everything fits together to brings me the right treatment based on EBM.

A 2-year program with no time for independent study is NOT likely to produce that---you would just produce a TECH.

This process takes time and there ARE no short-cuts.

How hard is it for everyone to realize that achievement takes work and sacrifice?

Someone said it previously, but hit it perfectly

PI=physician
Post-Doc=Resident
Graduate Student=medical student
Nurse=Tech

IF you ever worked in a lab/research, this will really make sense. ALthough from a "technical standpoint" the tech(nurse), might be at the same level as the medical student, (e.g. performing a western)--the graduate student (e.g. medical student), will understand the theory behind the western blot and WHY they are performing that experiment and how it fits in the literature---while the tech(nurse), will know the STEPS and will perform it correctly but cannot as easily see what they doing fits into the "theory" or the literature.

This is the difference between a TECH and a Graduate Student and a Nurse and a Medical Student.

Their jobs overlap, but they are very different in their focus.

 

[nlax30]

Every time you post something stupid and redundant I'm just going to reply with a SQUACK from now on. Y'know. Bird brain and all that.

Duke has 1 preclinical year. They also have research, which shouldn't be necessary to produce a good PCP, agreed?
If, instead of 2 clinical years dedicated to all manner of random haberdashery, they had 1 clinical year dedicated to only primary care specialties, voila, we have a two year program. Pretty sneaky, huh, sis?

Again, graduates would only go into PC specialties... but then that's the point, isn't it?

You're assuming that the knowledge learned in the preclinical vs clinic years is totally separate with no redundancy. Yeah, one program gets away with 1 preclinical year, but still has 2 clinical plus a research year, and another program gets away with 1 clinical year but still has 2 preclinical years.

You're logic is "fail" if you think just 1 clinical and 1 preclinical year is sufficient. It doesn't work like that.

Even throughout the clinical years we still deal with and learn the basic sciences that we had the first two years, and even during the first 2 years we are exposed to the "clinical side" and start on those skills. It's more about an overall amount of time needed to be exposed to all this info than condensing two "separate" preclinical and clinical knowledge bases into the shortest possible time.

Do I think one year of research is needed for a PCP? Of course not as there are tons of great PCPs practicing who did not do much if any research. But in this case with Duke having 1 preclinical year I guarantee you that there is also time spent during that research year learning and studying some of that same material that would be part of the preclinical years. It certainly is not a freebie year that doesn't contribute to their knowledge base.

So you can't just say 1 year is enough when that's not truly the case, they still have 4 (or 3 years) to cover the material and get the required clinical exposure.

 

[vivalavie]

You're missing a few things.

First, I think we can all agree that Duke likely gets some of the best medical students in the country. We're not talking your average still pretty darn bright med students, this is cream of the crop type stuff. There's a reason why most schools have 2 years of basic sciences. In addition, that research year likely involves some fairly intense PBL-type learning of those same basic sciences.

Second, let's ask around here to get some perspective. There are more than a few nurses who then went on to regular med school - heck, my program just matched 2 of them. We can ask how nursing school anatomy/pharm/physiology compares to med school. The PAs around here admit that they pretty much need to repeat all of the basic sciences, and their training is the most similar to ours.

Third, I just looked at the nursing school (BSN) curriculum at the university where I attended med school. 3 bio courses.... that's it. Hell, I had to take 4 just to apply to med school and you want to shorten it with less prep? Now, if you're talking NP to MD/DO, just ignore this paragraph.

Fourth, those 3-year med schools can be entered from nursing/PA without any problem. You want a shortened curriculum - there it is. 2 years just cuts out too much. Don't forget that in those 2 years you also have to pass 2 licensing exams, apply/interview for residency, and still manage the massive amount of work that would come from a shortened curriculum.

I appreciate you being pro-active for your profession, but there's just too much to cover. Plus, I find a comment you made later:

"If, instead of 2 clinical years dedicated to all manner of random haberdashery, they had 1 clinical year dedicated to only primary care specialties, voila, we have a two year program. Pretty sneaky, huh, sis?"

to be pure ignorance. Primary care physicians need to have a very broad, reasonably in-depth training. Otherwise, you're nothing more than a referral monkey. Plus, there is great value in having worked with other specialists so you know how they think (and can interpret what they say, as each specialist has a different language), what they expect of PCPs, and even gain some knowledge to make you a better doctor.

Go through medical school, then tell those of us who did that 2 of those years were a waste.

At last, a worthy opponent.

1st, I don't want to "[cut] out" anything. My proposal was for an accelerated preclinical program much like Duke's, which you claim would be too difficult for nurses. Ok, that's an argument.

I think you may be right about this being ideal for NPs, and I think that's the right place to start with a bridge. My idea was to look as the program specifically of whatever population we are taking (i.g. nursing school if we're taking nurses) and accelerating all of the subjects that have been seen before. For an NP program, I would imagine a LOT of subjects would be accelerated. In this way I think it is perfectly viable to produce a 1 year condensation and my evidence was Duke's program. This is a typical medical school with students who have taken nothing but premed classes prior to this. Yes, they're probably exceptionally smart, but I think the Duke program demonstrates that this is a realistic goal, especially considering they've seen much of this material before.

About the 1/2 med students doing research thing, I'd imagine the percentage who end up in PC is less, but I can't quote you any figures. PCPs should be clinicians first and scientists a distant second. That's just my opinion though.

Your argument about condensing clinical years is also compelling on its own, but consider the fact that 3 year medical schools already do this and produce fine PCPs. I can't comment on whether or not they are referral monkeys, but they're out there, and if you're against my program because it has only one year of clinical work only in PC specialties than you have to be against those other schools and not recognize THEIR MD and DO degrees as valid either.

Thanks for the sport and acknowledging my intentions. I do want the best for my chosen field, and I do appreciate like minded individuals who are willing to think and challenge the norms that have been passed to us.

 

[vivalavie]

No!

THis is the problem with the way medicine is going. You want to reduce a physician into a TECH/with no technical thought/creativity to problem solve

Could you produce "physicians" this way ?(I use that term loosely)

Yes, but they would be no different than a mid-level provider.

Over 1/2 of medical students perform research at some point.

I've heard up to 1/4 of medical students now take time off to do research/second degree/independent study and most medical curriculum now focus on evaluating the literature and EBM (this is critical to becoming a successful physician)

It's not as simple as producing a "tech" to produce more PCPs--frankly, I want my PCP to not just be thoughtlesss tech(automaton) that can follow a checklist

I want someone a who is creative and understands medicine/physiology/pathophysiology and how everything fits together to brings me the right treatment based on EBM.

A 2-year program with no time for independent study is NOT likely to produce that---you would just produce a TECH.

This process takes time and there ARE no short-cuts.

How hard is it for everyone to realize that achievement takes work and sacrifice?

Someone said it previously, but hit it perfectly

PI=physician
Post-Doc=Resident
Graduate Student=medical student
Nurse=Tech

IF you ever worked in a lab/research, this will really make sense. ALthough from a "technical standpoint" the tech(nurse), might be at the same level as the medical student, (e.g. performing a western)--the graduate student (e.g. medical student), will understand the theory behind the western blot and WHY they are performing that experiment and how it fits in the literature---while the tech(nurse), will know the STEPS and will perform it correctly but cannot as easily see what they doing fits into the "theory" or the literature.

This is the difference between a TECH and a Graduate Student and a Nurse and a Medical Student.

Their jobs overlap, but they are very different in their focus.

Nice analogy, I hadn't thought of nurses like that but it's an apt comparison. Think I addressed a lot of your points in my last post, let me know if not. I think quality is possible through my method simply because I'm not proposing anything truly novel. Great post though, if I didn't answer all your concerns state them again and I will, you deserve a more thoughtful response than what I can give right now.

 

[Charles_Carmichael]

At last, a worthy opponent.

1st, I don't want to "[cut] out" anything. My proposal was for an accelerated preclinical program much like Duke's, which you claim would be too difficult for nurses. Ok, that's an argument.

I think you may be right about this being ideal for NPs, and I think that's the right place to start with a bridge. My idea was to look as the program specifically of whatever population we are taking (i.g. nursing school if we're taking nurses) and accelerating all of the subjects that have been seen before. For an NP program, I would imagine a LOT of subjects would be accelerated. In this way I think it is perfectly viable to produce a 1 year condensation and my evidence was Duke's program. This is a typical medical school with students who have taken nothing but premed classes prior to this. Yes, they're probably exceptionally smart, but I think the Duke program demonstrates that this is a realistic goal, especially considering they've seen much of this material before.

About the 1/2 med students doing research thing, I'd imagine the percentage who end up in PC is less, but I can't quote you any figures. PCPs should be clinicians first and scientists a distant second. That's just my opinion though.

Your argument about condensing clinical years is also compelling on its own, but consider the fact that 3 year medical schools already do this and produce fine PCPs. I can't comment on whether or not they are referral monkeys, but they're out there, and if you're against my program because it has only one year of clinical work only in PC specialties than you have to be against those other schools and not recognize THEIR MD and DO degrees as valid either.

Thanks for the sport and acknowledging my intentions. I do want the best for my chosen field, and I do appreciate like minded individuals who are willing to think and challenge the norms that have been passed to us.

1. It's unlikely that a 2-year bridge program would be suitable for NPs/DNPs either. If you take the time to look through NP/DNP curricula, not only will you see a huge amount of variance between schools, but you'll also see that a significant (majority at several places) portion of the curricula involves health policy, research, epidemiology, etc. Not more basic science courses. And they average 500-1000 hours of clinical training (several BSN-to-DNP and direct-entry DNP programs I've looked at had only 1000 hours of clinical training required). That's not even close to what PAs receive, in terms of both basic science courses as well as clinical hours of training. That's why it's extreeeemely unlikely for a 2-year bridge to materialize for nursing midlevels.

2. I agree with VA (and I've emphasized this in most of the NP/DNP threads I post in) that, intuitively, it makes more sense for PCPs to receive more training, not less, since they have such a broad scope of practice compared to specialists. That's another reason why NPs/DNPs will not have a 2-year bridge program. I imagine that the PA bridge cuts down on one year only because PAs already receive solid clinical training (especially compared to nursing midlevels). I cannot imagine any US medical school cutting it down to 2 years because nursing midlevels aren't willing to spend a minimum of 3 years in school (for those rare few med schools that have 3-year programs).

3. The 3-year med schools, as far as I know, don't cut down on clinical years. They still have 2 years of clinical training. What they condense is the preclinical curriculum.

Like I said previously, your arguments for a 2-year bridge program for nurses just isn't based on sound info. But you kept pushing the same thing again and again and then I started responding the way I did. And then you got mad and squacked and so on. The ultimate point is that there is very little overlap between nursing/NP/DNP curricula and medical curricula, unlike the PAs who train under a curriculum similar to that of medical school. That's the biggest reason why a 2-year bridge program for nurses is very unlikely to materialize no matter how much you want it to.

 

[jl13]

I absolutely agree with the above post. While a tech may be able to perform the same experiments as the graduate student, the graduate student is the one advancing knowledge. This parallels a physician versus a nurse. Often physicians not only treat patients but they also are advancing medicine. Nurses on the other hand follow protocol. If we reduce medical education to what the midlevel providers on this forum want (ie the ability and rights to follow a protocol accurately with the least amount of effort put towards it) they will not have the understanding to advance knowledge and improve care.

I am a firm supporter of "paying ones dues" in medicine and in life. I believe this plays a vital role in medical care not in the patients that can be treated most of the time (anyone with half a brain can take a bp and look up the definition for hypertension), but for the atypical patient whose "standard" presentation may be due to a less obvious underlying cause. The added years of critical thought and extra mental conditioning allows for the provider to have more confidence and the ability to say that just this once, this patient may not be the typical case.

I can't tell whether the midlevels who post here just have a massive inferiority complex or whether they actually think they will do some good by filling a so called "PCP gap". If there actually is a PCP gap, its because we don't pay our fully trained MD/DOs enough in PCP. The solution is not by producing more half-assed, back-door taking doctors (or should i say noctors), but by increasing incentives for otherwise educationally-qualified MD/DOs to choose PCP.

Please don't get me wrong, midlevels play a vital role in health care in the middle-- under a qualified individual. Its when people overstep their boundaries that is frustrating.

Last thought- it looks ridiculous when midlevels where the same whitecoats as doctors and don't correct patients when they foolishly and mistakingly refer to them as doctor.

 

[vivalavie]

You're assuming that the knowledge learned in the preclinical vs clinic years is totally separate with no redundancy. Yeah, one program gets away with 1 preclinical year, but still has 2 clinical plus a research year, and another program gets away with 1 clinical year but still has 2 preclinical years.

You're logic is "fail" if you think just 1 clinical and 1 preclinical year is sufficient. It doesn't work like that.

Even throughout the clinical years we still deal with and learn the basic sciences that we had the first two years, and even during the first 2 years we are exposed to the "clinical side" and start on those skills. It's more about an overall amount of time needed to be exposed to all this info than condensing two "separate" preclinical and clinical knowledge bases into the shortest possible time.

Do I think one year of research is needed for a PCP? Of course not as there are tons of great PCPs practicing who did not do much if any research. But in this case with Duke having 1 preclinical year I guarantee you that there is also time spent during that research year learning and studying some of that same material that would be part of the preclinical years. It certainly is not a freebie year that doesn't contribute to their knowledge base.

So you can't just say 1 year is enough when that's not truly the case, they still have 4 (or 3 years) to cover the material and get the required clinical exposure.

Better.

I can't comment for sure if 2 years is enough time to absorb all of the information needed to be a great doctor. That's kind of the point, it's never been done before. It's something new. Doesn't that just get the blood percolating? I think part of what makes it viable is the bridge aspect. NPs have seen a lot of this before and can probably process it a lot more efficiently than a newby. That said I don't have all the answers and I don't know for sure how it would work, but I like the idea and what it could mean for under-served communities in need of a good PCP.

 

[Charles_Carmichael]

Better.

I can't comment for sure if 2 years is enough time to absorb all of the information needed to be a great doctor. That's kind of the point, it's never been done before. It's something new. Doesn't that just get the blood percolating? I think part of what makes it viable is the bridge aspect. NPs have seen a lot of this before and can probably process it a lot more efficiently than a newby. That said I don't have all the answers and I don't know for sure how it would work, but I like the idea and what it could mean for under-served communities in need of a good PCP.

It wouldn't do the underserved communities much good if the physician ends up being under-trained.

My argument against this idea is that NPs haven't seen "a lot" this before. I understand that the idea sounds exciting to you, but it's a drastic change from the current, and more importantly, proven medical training model. So there needs to be a substantial amount of data suggesting that a 2-year NP/DNP-to-MD/DO bridge would produce graduates of equivalent caliber as the traditional curriculum does. And, at the moment, there's no evidence suggesting that this would work. It would be years (more than a decade is more likely) before any research regarding this idea would produce convincing enough evidence for schools to accept and incorporate such a bridge program.

Finally, even if such a bridge program were incorporated, it's likely that only one (like the PA bridge), or a few schools, would go through with it. And graduating 10-20 extra physicians a year with this bridge program will make absolutely no dent whatsoever on the the PCP shortage.

It's better to focus our energies on making primary care more attractive to med students so that more students choose primary care rather than spend a ton of time/money investigating how to increase the number of people going into primary care by a very insignificant amount each year. Make sense?

 

[ahyes]

vivalavie,

You speak of "under-served communities in need of a good PCP." While this may be true, they are not in need of an undertrained PCP that took the back door into medicine through a two year medical curriculum (or whatever ridiculous program you think working as a nurse or midlevel qualifies you for). Nurses and midlevels usually havn't even take the prerequisites to get into medical school, let alone classes that are comparable to the point where they are entitled to skip years of formal schooling. I just don't understand why you think that midlevels should be entitled to special treatment. No one should get special treatment. Should a patient care technician be allowed to become an RN in 3 months? But what if they really, really want to? But what if they have been wheeling people around the wards for years and have observed nurses and think they can do the same job?

The bottom line is that the prereqs, stupid standardized tests, berating by superiors, uninteresting research to boost CV and everything else about our medical system is in place for a reason. It is to weed people out that wouldn't make a competent physician. If you want to be a physician then jump through the hoops like the rest of us....NO special treatment because your older, feel entitled, have seen physicians work for years, have worked under a doctor or whatever other nonsense reasons you can think of.

jl13,

I agreed about the white coats. But I might also add that they do help keep clothes clean and thus serve a purpose for anyone wearing them. That is except for medical students, our stupid (and embarrassing) short coats don't help keep anything clean.

 

[nlax30]

Better.

I can't comment for sure if 2 years is enough time to absorb all of the information needed to be a great doctor. That's kind of the point, it's never been done before. It's something new. Doesn't that just get the blood percolating? I think part of what makes it viable is the bridge aspect. NPs have seen a lot of this before and can probably process it a lot more efficiently than a newby. That said I don't have all the answers and I don't know for sure how it would work, but I like the idea and what it could mean for under-served communities in need of a good PCP.

On the clinical side of things yea, an NP and PA can probably deal with an accelerated clinical curriculum. But even then there are differences. During our clinical years we are exposed to many different fields of medicine, I'm not sure how much of that depth and variety an NP gets during training, and certainly would not be the case for a nurse.

And I just think an accelerated preclinical curriculum would not be appropriate for a nursing background. I certainly don't think that basic science knowledge base of a nurse or NP would allow any acceleration of the preclinical or offer any advantages over a typical premed with the type of science background they come in with.

At my school we had a couple nurses, and a PA and they definitely had no advantage when it came to the preclinical years. A little less so with the PA since their training follows a similar format, but even then, being several years out from his preclinical training offered no real advantage when it came to the amount and depth of material covered during the first 2 years.

I'm sure you do want what's best for your profession, but come up with shortcuts to get into a DIFFERENT profession with a completely different set of standards, knowledge base, and focus is not going to achieve your goal.

 

[vivalavie]

1. It's unlikely that a 2-year bridge program would be suitable for NPs/DNPs either. If you take the time to look through NP/DNP curricula, not only will you see a huge amount of variance between schools, but you'll also see that a significant (majority at several places) portion of the curricula involves health policy, research, epidemiology, etc. Not more basic science courses. And they average 500-1000 hours of clinical training (several BSN-to-DNP and direct-entry DNP programs I've looked at had only 1000 hours of clinical training required). That's not even close to what PAs receive, in terms of both basic science courses as well as clinical hours of training. That's why it's extreeeemely unlikely for a 2-year bridge to materialize for nursing midlevels.

2. I agree with VA (and I've emphasized this in most of the NP/DNP threads I post in) that, intuitively, it makes more sense for PCPs to receive more training, not less, since they have such a broad scope of practice compared to specialists. That's another reason why NPs/DNPs will not have a 2-year bridge program. I imagine that the PA bridge cuts down on one year only because PAs already receive solid clinical training (especially compared to nursing midlevels). I cannot imagine any US medical school cutting it down to 2 years because nursing midlevels aren't willing to spend a minimum of 3 years in school (for those rare few med schools that have 3-year programs).

3. The 3-year med schools, as far as I know, don't cut down on clinical years. They still have 2 years of clinical training. What they condense is the preclinical curriculum.

Like I said previously, your arguments for a 2-year bridge program for nurses just isn't based on sound info. But you kept pushing the same thing again and again and then I started responding the way I did. And then you got mad and squacked and so on. The ultimate point is that there is very little overlap between nursing/NP/DNP curricula and medical curricula, unlike the PAs who train under a curriculum similar to that of medical school. That's the biggest reason why a 2-year bridge program for nurses is very unlikely to materialize no matter how much you want it to.

Hrm, I had a nice long response to this but now it seems like I've fallen far behind. I hope I can address everyone soon, this is an interesting debate and many of you have great perspectives. I'm the first to admit that I may be misguided, this idea may be half-baked, but I like that we're thinking about it.

So... to this post I will just say, Kaushik, where you say that my information is wrong, check the facts. Look up the curriculum at LECOM and Texas Tech, it's not so cut and dry as either of us said, but it's clearly closer to what I am saying.

 

[deleted6669]

OK, so can we all agree on a 2 yr dnp to pa bridge....🙂

 

[mydogtobbi]

I think its cute that you think that its "easy" to learn the same amount of material that some of the most "high selected" academic elite of our country (yes, its true---you can look up avgs if you want/don't believe me) STRUGGLE with could be learned by people in 3/4 to 1/2 the time.

No, these other providers don't learn the "same stuff" as we do...even PAs, who are the closests, still are not required to know the exact same amount of information (otherwise PA school = Medical school)

Frankly, you want "big boy time"---most of these "other providers" (EXCEPT PAS--PAS PLEASE NOTICE THE CAPS), don't even take the 'real hard sciences' as undergrads/professional school.

You want to talk about "big boy time"---lets see them handle the REAL academic rigors. Frankly, they/you haven't even earned the right to play in the major leagues yet.

It's like saying you played awesome high school baseball, so that should automatically let you make it to the all star game (medical school); when, we have to see how you would even handle the MLB.

That's reality.

delete

 

[mydogtobbi]

Yea, if you got some REALLY BIG ONES, go into physics:

"I am a Medical Doctor with credentials in internal medicine and nephrology (kidneys). I received a bachelor's degree in theoretical physics in 1987 from Rutgers University. I mention the college degree in case any doubtful readers question my mental prowess. One can doubt my intellectual ability less if they first realize that I know how to figure out difficult things. I know how to look at something in depth for many hours or days until I understand the inner workings of it. This is what I learned to do in college. In fact the strenuous mind-bending exercise that was part of the physics curriculum made medical school easy. I found the study of the human body, chemistry and biology to be in comparison quite shallow, simple and easy to comprehend."

Suzanne Humphries, MD

I agree with this. A doctorate program in physics or math is much more conceptually difficult than medicine itself, in fact even at the undergraduate level. I have had students that could not understand math beyond calculus (after seriously trying) that had gone on to med school. One student wanted to be an engineer and couldn't handle the prereqs to get in, but she was able to go to med school because the premed requirements are not that math intensive.

 

[deleted6669]

yup, agree with above.
the brightest guys I know aren't physicians. they are folks with 1 or more phd's...I have a buddy who has advanced training in theoretical math.
he plays 3-d chess ( 3 overlapping boards) without looking at the board. he can keep it all in his head and carry on a conversation about another difficult topic at the same time. and he always wins the chess game against the guy looking at the board.

 

[vivalavie]

vivalavie,

You speak of "under-served communities in need of a good PCP." While this may be true, they are not in need of an undertrained PCP that took the back door into medicine through a two year medical curriculum (or whatever ridiculous program you think working as a nurse or midlevel qualifies you for). Nurses and midlevels usually havn't even take the prerequisites to get into medical school, let alone classes that are comparable to the point where they are entitled to skip years of formal schooling. I just don't understand why you think that midlevels should be entitled to special treatment. No one should get special treatment. Should a patient care technician be allowed to become an RN in 3 months? But what if they really, really want to? But what if they have been wheeling people around the wards for years and have observed nurses and think they can do the same job?

The bottom line is that the prereqs, stupid standardized tests, berating by superiors, uninteresting research to boost CV and everything else about our medical system is in place for a reason. It is to weed people out that wouldn't make a competent physician. If you want to be a physician then jump through the hoops like the rest of us....NO special treatment because your older, feel entitled, have seen physicians work for years, have worked under a doctor or whatever other nonsense reasons you can think of.

I would that this last paragraph were true, if only to make me feel better for having gone through all of that stuff, but when it comes down to it so much of the stupid crap they put us through is completely absurd. The process is skewed in favor of rich kids who can go volunteer in Peru and take those Kaplan classes to get their scores up and can do cool research over the summer because they don't have to work. I posit that there are people just as driven, just as capable of being great physicians who are passed over because they have to be pragmatists. You talk of paying your dues by doing all the useless admissions crap, how is spending years training and practicing as a nurse not paying dues?

What I propose is not, was never a shortcut. They will take the same exams, they will work their butts off, they will compete like crazy to get into this program against other qualified nurses. This program is accelerated medical school with a limited clinical component restricted to primary care. I'm still failing to see the problem.

 

[vivalavie]

On the clinical side of things yea, an NP and PA can probably deal with an accelerated clinical curriculum. But even then there are differences. During our clinical years we are exposed to many different fields of medicine, I'm not sure how much of that depth and variety an NP gets during training, and certainly would not be the case for a nurse.

And I just think an accelerated preclinical curriculum would not be appropriate for a nursing background. I certainly don't think that basic science knowledge base of a nurse or NP would allow any acceleration of the preclinical or offer any advantages over a typical premed with the type of science background they come in with.

At my school we had a couple nurses, and a PA and they definitely had no advantage when it came to the preclinical years. A little less so with the PA since their training follows a similar format, but even then, being several years out from his preclinical training offered no real advantage when it came to the amount and depth of material covered during the first 2 years.

I'm sure you do want what's best for your profession, but come up with shortcuts to get into a DIFFERENT profession with a completely different set of standards, knowledge base, and focus is not going to achieve your goal.

I appreciate this response, having worked with nurses in medical school you provide a valuable perspective to which I am not privy. I admit, this gives me pause. I can't say whether it would be different for an NP. I can say that I have a close friend in his third year of medical school who first earned a DPT and he thinks that the prior degree has helped him a great deal in medical school. I do not know how much the NP curriculum overlaps with the MD curriculum, but I think it's a question that warrants some finer analysis than we can offer. As I've said before, we need someone who has gone through both programs.

I think such a program is possible for bright individuals. I've seen MDs on these forums say they wished they could condense the first two years to one preclinical year and get it over with, and I think the NPs who apply and are admitted to the program I propose would be exceptionally driven and capable of learning all they need to know to be great PCPs in this kind of two year program. And, as I've said, the ones that can't can decelerate to a standard 3 year program, no harm, no foul.

 

[vivalavie]

I absolutely agree with the above post. While a tech may be able to perform the same experiments as the graduate student, the graduate student is the one advancing knowledge. This parallels a physician versus a nurse. Often physicians not only treat patients but they also are advancing medicine. Nurses on the other hand follow protocol. If we reduce medical education to what the midlevel providers on this forum want (ie the ability and rights to follow a protocol accurately with the least amount of effort put towards it) they will not have the understanding to advance knowledge and improve care.

I am a firm supporter of "paying ones dues" in medicine and in life. I believe this plays a vital role in medical care not in the patients that can be treated most of the time (anyone with half a brain can take a bp and look up the definition for hypertension), but for the atypical patient whose "standard" presentation may be due to a less obvious underlying cause. The added years of critical thought and extra mental conditioning allows for the provider to have more confidence and the ability to say that just this once, this patient may not be the typical case.

I can't tell whether the midlevels who post here just have a massive inferiority complex or whether they actually think they will do some good by filling a so called "PCP gap". If there actually is a PCP gap, its because we don't pay our fully trained MD/DOs enough in PCP. The solution is not by producing more half-assed, back-door taking doctors (or should i say noctors), but by increasing incentives for otherwise educationally-qualified MD/DOs to choose PCP.

Just want to say this is a great post. I want to address it because it challenges me and has some well executed and compelling arguments. I'll try my best when I have more time to answer your points.

 

[Makati2008]

I appreciate this response, having worked with nurses in medical school you provide a valuable perspective to which I am not privy. I admit, this gives me pause. I can't say whether it would be different for an NP. I can say that I have a close friend in his third year of medical school who first earned a DPT and he thinks that the prior degree has helped him a great deal in medical school. I do not know how much the NP curriculum overlaps with the MD curriculum, but I think it's a question that warrants some finer analysis than we can offer. As I've said before, we need someone who has gone through both programs.

I think such a program is possible for bright individuals. I've seen MDs on these forums say they wished they could condense the first two years to one preclinical year and get it over with, and I think the NPs who apply and are admitted to the program I propose would be exceptionally driven and capable of learning all they need to know to be great PCPs in this kind of two year program. And, as I've said, the ones that can't can decelerate to a standard 3 year program, no harm, no foul.

1.)Two years is not enough for you to learn medicine from a physician stand point(I speak as PA and someone who has seen many many mistakes of NP). I am currently in a 4yr med. program.
2.)Only someone who is insane would want to have all of their preclinical months slammed into 12months(even then there could be no breaks at all) and be expected to pass Step 1(I would think a few would be able to but many NP's can't even pass a watered down version of one of the Steps)
3.)Why are we having this discussion. I am willing to be a good chunk of change that NO ONE(AMA/AOA/COCA) would allow this plan to fly. You should be focusing on more important matters. I say this because you are acting quite immature when someone disagrees with your thought process-ie Squawking and the like.

 

[Charles_Carmichael]

I appreciate this response, having worked with nurses in medical school you provide a valuable perspective to which I am not privy. I admit, this gives me pause. I can't say whether it would be different for an NP. I can say that I have a close friend in his third year of medical school who first earned a DPT and he thinks that the prior degree has helped him a great deal in medical school. I do not know how much the NP curriculum overlaps with the MD curriculum, but I think it's a question that warrants some finer analysis than we can offer. As I've said before, we need someone who has gone through both programs.

There is almost no overlap between NP/DNP curricula and medical school curricula. This has been pointed out repeatedly on these forums. I don't understand why you continually keep ignoring this. That's why this NP/DNP "bridge" doesn't warrant more looking-into. The reason your DPT friend thought his previous degree helped ease the med school workload a bit is likely because the DPT curricula is more similar to that of med school curricula.

Search this forum as well. I know there have been posters in the past who were NP-turned-MDs and they have emphasized that having an NP degree didn't help them at all for med school. I don't think those posters are active anymore but you should still be able to find their comments in previous NP/DNP discussion threads.

I think such a program is possible for bright individuals. I've seen MDs on these forums say they wished they could condense the first two years to one preclinical year and get it over with, and I think the NPs who apply and are admitted to the program I propose would be exceptionally driven and capable of learning all they need to know to be great PCPs in this kind of two year program. And, as I've said, the ones that can't can decelerate to a standard 3 year program, no harm, no foul.

That's a questionable statement. I would argue that traditional applicants are just as driven to succeed. I would also argue that the traditional applicants who get accepted are more likely to be successful in such a short program than NPs/DNPs who apply to the bridge program.

And primary care is a very tough field and has a very broad scope of practice compared to specialties. It would be foolish to cut down on generalist training because nursing midlevels want a shortcut. From what a couple of deans have told me when I was interviewing for med school, it puts a lot of stress when even a couple of extra people are accepted for a class (ex. 172 students instead of the 170 that they actually have spots for), especially when it comes to clinical rotations. So, your "no harm, no foul" for dropping from the 2 year program to a 3 year one isn't very realistic either. With that being said, that latter part of this paragraph is based on second-hand info I received on the interview trail and I don't know as much about the administrative stuff of med school.

 

[vivalavie]

2.)Only someone who is insane would want to have all of their preclinical months slammed into 12months(even then there could be no breaks at all) and be expected to pass Step 1(I would think a few would be able to but many NP's can't even pass a watered down version of one of the Steps)

I guess everyone who attends Duke is insane. And they don't pass step 1.

3.)Why are we having this discussion. I am willing to be a good chunk of change that NO ONE(AMA/AOA/COCA) would allow this plan to fly. You should be focusing on more important matters. I say this because you are acting quite immature when someone disagrees with your thought process-ie Squawking and the like.

You have your concept of relevance and I have mine. Please don't dismiss my ideas on the basis of my perceived childishness. My immature comments, you might notice, are completely limited to one - admittedly - grumpy day. And mostly they're towards Kaushik, but he and I have our own special relationship and I think he knows I'm just giving him crap 🙂

 

[Makati2008]

I guess everyone who attends Duke is insane. And they don't pass step 1.

You have your concept of relevance and I have mine. Please don't dismiss my ideas on the basis of my perceived childishness. My immature comments, you might notice, are completely limited to one - admittedly - grumpy day. And mostly they're towards Kaushik, but he and I have our own special relationship and I think he knows I'm just giving him crap 🙂

1)We all know that Duke is the exception and not the rule to this. They are some of the brightest students in the nation and they would be the ones to do this. Until you experience a full medical school course load I doubt that you will fathom how intense it is. Also food for thought if this was viable for so many medical schools why isnt it common occurence? A school is more likely to offer a decelerated program for its students due to the rigors of the preclinical years than an accelerated one. Let me ask you-Are you a Nurse? Pre-Nurse? or ???
2.)When you attack members of a forum in such a baseless manner you tend to lose all credibility to your argument(ie PyschNP I hope she doesn't pop up now lol)

 

[vivalavie]

There is almost no overlap between NP/DNP curricula and medical school curricula. This has been pointed out repeatedly on these forums. I don't understand why you continually keep ignoring this.

Mostly because I'm not convinced of it. Give me a reliable source and I'll believe you. Posts from yesteryear don't interest me, I want to see facts.

That's a questionable statement. I would argue that traditional applicants are just as driven to succeed. I would also argue that the traditional applicants who get accepted are more likely to be successful in such a short program than NPs/DNPs who apply to the bridge program.

I disagree. I think traditional applicants are the ones most likely to have a trust fund. I think NPs who took all the crap and kept on coming, kept wanting to expand their knowledge base and learn all they could to help their patients and it was never enough so they sought this MD route and competed with all of the best NPs across the country and got in... I think those guys are gonna be a force to be reckoned with.

And primary care is a very tough field and has a very broad scope of practice compared to specialties. It would be foolish to cut down on generalist training because nursing midlevels want a shortcut. From what a couple of deans have told me when I was interviewing for med school, it puts a lot of stress when even a couple of extra people are accepted for a class (ex. 172 students instead of the 170 that they actually have spots for), especially when it comes to clinical rotations. So, your "no harm, no foul" for dropping from the 2 year program to a 3 year one isn't very realistic either. With that being said, that latter part of this paragraph is based on second-hand info I received on the interview trail and I don't know as much about the administrative stuff of med school.

I agree that primary care is a tough field. And I'm actually on board with you on improving compensation and all that. It's dumb that we can't compensate these guys as much as the guys who give you your botox injections. I think a lot of aspects of the system could do with a bit of tinkering. But I think you don't sacrifice training with my plan. Duke proves my preclinical component works and I think if you get rid of elective rotations and focus on clinical rotations related to primary care you can produce excellent PCPs in half the time.

 

[vivalavie]

1)We all know that Duke is the exception and not the rule to this. They are some of the brightest students in the nation and they would be the ones to do this. Until you experience a full medical school course load I doubt that you will fathom how intense it is. Also food for thought if this was viable for so many medical schools why isnt it common occurence? A school is more likely to offer a decelerated program for its students due to the rigors of the preclinical years than an accelerated one. Let me ask you-Are you a Nurse? Pre-Nurse? or ???
2.)When you attack members of a forum in such a baseless manner you tend to lose all credibility to your argument(ie PyschNP I hope she doesn't pop up now lol)

I've addressed the Duke question and stand by my opinion. You are entitled to disagree.

I am not a nurse. I'm sorry if I ever gave that impression. I try to point out wherever I have conjectured. I begin medical school in August at a traditional, 4-year MD program.

My attacks are never baseless.

 

[Makati2008]

Mostly because I'm not convinced of it. Give me a reliable source and I'll believe you. Posts from yesteryear don't interest me, I want to see facts.



I disagree. I think traditional applicants are the ones most likely to have a trust fund. I think NPs who took all the crap and kept on coming, kept wanting to expand their knowledge base and learn all they could to help their patients and it was never enough so they sought this MD route and competed with all of the best NPs across the country and got in... I think those guys are gonna be a force to be reckoned with.



I agree that primary care is a tough field. And I'm actually on board with you on improving compensation and all that. It's dumb that we can't compensate these guys as much as the guys who give you your botox injections. I think a lot of aspects of the system could do with a bit of tinkering. But I think you don't sacrifice training with my plan. Duke proves my preclinical component works and I think if you get rid of elective rotations and focus on clinical rotations related to primary care you can produce excellent PCPs in half the time.

1.)NP training is not standardized vs. MD/DO. Compare it online yourself and you will be surprised!!! Also some NP programs are part time which I disagree with. Medical eduation is something that should not be done on a part time manner(when I say part time I have heard some NP's say they had class 1 or 2 days a week and kept working full time)
2.)I partially agree with this post. The most motivated could possibly do well but its highly unlikely. Your NP's failed a diluted Step*I think step 3 google it to find out.
3.)You seem to have some issues with people with money. There are a lot of people in my medical school class(by far not the majority) and they seem to be just as motivated as those of us who came from middle class familes. Some of them are irritating(not knowing what is it to work hard) but for the most part they are better medical students than myself by far with tremendous motiviation. If they have a trust fund I am jealous lol. they can pay this 200k back with ease......

 

[Makati2008]

I've addressed the Duke question and stand by my opinion. You are entitled to disagree.

I am not a nurse. I'm sorry if I ever gave that impression. I try to point out wherever I have conjectured. I begin medical school in August at a traditional, 4-year MD program.

My attacks are never baseless.

Edit: I'd like to point out that there is an argument that goes something like this: If your idea were viable someone would have implemented it or such things would be more common. I want to go on the record and say people who employ this argument are bad for America. That is all.
Decelerating IS more common (very common, ahem, Kaushik, ahem) but I believe that there is a sizable population willing and able to merge the preclinical years.

Lol. I do rural ER/FM providing care for the un/underinsured. If I am bad for America lol so be it. Get back to me when you have some true clinical exposure kiddo.->Way off target about your argument but so is yours about being bad for america based on one comment......

Also since you feel this way why don't you type this proposal out and email it to all of the Dean's of the MD/DO schools and get back to me with their responses? If I am wrong I will totally say I am sorry.

 

[vivalavie]

1.)NP training is not standardized vs. MD/DO. Compare it online yourself and you will be surprised!!! Also some NP programs are part time which I disagree with. Medical eduation is something that should not be done on a part time manner(when I say part time I have heard some NP's say they had class 1 or 2 days a week and kept working full time)
2.)I partially agree with this post. The most motivated could possibly do well but its highly unlikely. Your NP's failed a diluted Step*I think step 3 google it to find out.
3.)You seem to have some issues with people with money. There are a lot of people in my medical school class(by far not the majority) and they seem to be just as motivated as those of us who came from middle class familes. Some of them are irritating(not knowing what is it to work hard) but for the most part they are better medical students than myself by far with tremendous motiviation. If they have a trust fund I am jealous lol. they can pay this 200k back with ease......

1st point is terrifying, best argument against my whole proposal by far. Have to look more into that, maybe NPs aren't the way to go.

2nd point, well, they didn't go through med school, I wouldn't expect them to pass the step 1. You realize I want them to take all of the same classes and exams any med student has to take, just accelerated, right?

3rd point... yeah, you may be right about my anti-rich bias, but it doesn't make my argument any less valid. The system is biased towards the wealthy, and a lot of smart and hardworking people get overlooked because they can't gamble on the risky and expensive game of getting into medical school.

 

[vivalavie]

Lol. I do rural ER/FM providing care for the un/underinsured. If I am bad for America lol so be it. Get back to me when you have some true clinical exposure kiddo.->Way off target about your argument but so is yours about being bad for america based on one comment......

Also since you feel this way why don't you type this proposal out and email it to all of the Dean's of the MD/DO schools and get back to me with their responses? If I am wrong I will totally say I am sorry.

Heh, I'd taken that down by the time you posted, unnecessarily antagonistic. Obviously I don't think you're bad for America, just a sardonic flourish.

I'm thinking about doing something like that, but I wanna hash out the details first. Obviously this thing is still half-baked, but if I could lay a full proposal at their feet they might be more receptive. Figure out which MLPs could potentially benefit and what it would mean in real terms for PCP levels. Probably be easier once I'm in the system, too.

 

[Makati2008]

Heh, I'd taken that down by the time you posted, unnecessarily antagonistic. Obviously I don't think you're bad for America, just a sardonic flourish.

I'm thinking about doing something like that, but I wanna hash out the details first. Obviously this thing is still half-baked, but if I could lay a full proposal at their feet they might be more receptive. Figure out which MLPs could potentially benefit and what it would mean in real terms for PCP levels. Probably be easier once I'm in the system, too.

Ok. Here is a link for a NP program: One of the programs gives you five years to complete a 2yr program. My med. school back home only gives you 6yrs to complete the med. school program and that is due to EXTREME hardships only......
http://hs.odu.edu/nursing/academics/family_nurse/family_nurse.shtml
http://www.npcentral.net/ce/np-progs.shtml

And one of a PA program:
http://www.hsc.stonybrook.edu/shtm/pa/courses.cfm

Look at the differences in the programs. Also be sure to see the part time options. Would look up more but tired.
GN.

 

[Charles_Carmichael]

Mostly because I'm not convinced of it. Give me a reliable source and I'll believe you. Posts from yesteryear don't interest me, I want to see facts.

So, let me get this straight. I give you direct comparisons of NP/DNP curricula (taken from the websites of the respective schools with links and everything included) with that of MD/DO curricula (again with links directly to the school websites) and that's not "reliable" for you? Again, to reiterate, my curricular analysis was taken directly from the school websites. The content of my post "from yesteryear" didn't change according to the working links.

Better yet, why don't you actually spend 30 minutes looking at NP/DNP curricula and med school curricula? I promise you that pretty much every school puts their curriculum online for everyone to see. Or if you don't trust the school websites (for whatever reason, since you don't seem to believe the school websites that I've provided), you can call up their admissions office and make personal inquiries.

So, again, there is very little overlap between NP/DNP and MD/DO curricula.

I disagree. I think traditional applicants are the ones most likely to have a trust fund. I think NPs who took all the crap and kept on coming, kept wanting to expand their knowledge base and learn all they could to help their patients and it was never enough so they sought this MD route and competed with all of the best NPs across the country and got in... I think those guys are gonna be a force to be reckoned with.

I highly disagree. I think those who have toughed it out with the premed prereqs, all the ECs that are "required," sat through the hell that is the MCAT (and performed well on it), would be in a better position to do well in an accelerated curriculum. More importantly, IMO, the traditional students don't have a long break between college and med school where they take time off from learning basic science material; the NPs/DNPs in your bridge programs will be several years out of the classroom, which might put them at a disadvantage. However, I don't have any data to back up my statement just like you don't have any data to back up yours. Let's just agree to disagree regarding this particular point.

I agree that primary care is a tough field. And I'm actually on board with you on improving compensation and all that. It's dumb that we can't compensate these guys as much as the guys who give you your botox injections. I think a lot of aspects of the system could do with a bit of tinkering. But I think you don't sacrifice training with my plan. Duke proves my preclinical component works and I think if you get rid of elective rotations and focus on clinical rotations related to primary care you can produce excellent PCPs in half the time.

I don't think Duke proves that your preclinical component works. Like someone else already mentioned, the type of students that get accepted to Duke Med are likely academic all-stars (considering the heavy emphasis Duke places on academia).

Again, I would argue that since the NPs/DNPs in your scenario will be several years out from their (limited) basic science courses, it'll be much tougher for them to get "back into the groove" of dealing with the incredible volume of basic science material compared to the traditional students who either don't have any break from coursework or have a short break (ex. 1-3 years). The latter are more likely to get into the swing of things pretty quickly compared to those who are many years out of practice with basic science material.

I also think, with my limited experience, that your statement regarding producing PCPs in half the time is borderline dangerous. As mentioned before, primary care has an incredibly broad scope and cutting down on clinical training can potentially have negative effects (again, I don't have data from the rare few schools that offer a 3 year path for those entering primary care). Med students and physicians who have more experience with this can chime in to support or refute what I've said.

 

[Charles_Carmichael]

2nd point, well, they didn't go through med school, I wouldn't expect them to pass the step 1. You realize I want them to take all of the same classes and exams any med student has to take, just accelerated, right?

No. They took a watered-down version of Step 3 and the passing score was also lowered. Note that, according the practically all of the physicians I've spoken to, Step 3 is the easiest Step to take (as the saying goes "Two months for Step I, two weeks for Step II, and bring a number 2 pencil for Step III").

So, the DNPs at Columbia (who are considered to be the cream-of-the-crop students) had a 50% failure rate on a watered-down version of the easiest Step exam physicians-in-training take (some even supposedly take it post-call). The residents have a nearly-100% pass rate by the way.

The funny thing was that Mundinger was so absolutely sure that her DNPs are equal/superior to physicians and that plan severely backfired on her even when she tried to tip the odds in favor of her DNPs (by making the exam easier).

If Columbia is indeed considered a top NP/DNP school, that alone should give a glimpse of the caliber of students that enter those programs. And these students, in my personal opinion, would have a very hard time even in a traditional medical school curriculum, let alone an accelerated one. Obviously, there will be exceptions.

 

[vivalavie]

Ok. Here is a link for a NP program: One of the programs gives you five years to complete a 2yr program. My med. school back home only gives you 6yrs to complete the med. school program and that is due to EXTREME hardships only......
http://hs.odu.edu/nursing/academics/family_nurse/family_nurse.shtml
http://www.npcentral.net/ce/np-progs.shtml

And one of a PA program:
http://www.hsc.stonybrook.edu/shtm/pa/courses.cfm

Look at the differences in the programs. Also be sure to see the part time options. Would look up more but tired.
GN.

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.