Nurse Practioners encroaching upon Physician territory?

[TexasFight]

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what was the decision? 😳

I feel like this thread has decided on something, multiple times. But it just won't die...

 

[LuciusVorenus]

So how would an average NP have a better chance at MD residency than the top NP? The top NP is going to have a tough case against traditional med students anyway, let alone the nurse who only maintained a 3.0, did a non-thesis option, was not involved in any clubs, no leadership, no undergrad mentoring/TA work, did no volunteering, no research, and was not invited to join any honor society's upon graduation.

Wait, what? I know an average NP wouldn't stand a chance, that's why I said what I said. I'm saying that ONLY the top NPs should be allowed into those residencies (and have individual practice rights) as opposed to just granting any NP individual rights without an MD/DO residency (which seems to be the trend right now). So I don't know what you're saying exactly.

If you don't adequately reward FPs, then you wont have anymore med students rushing to this specialty. The need for NPs will only grow. Clearly NPs need to be NPs and FPs need to be FPs....rewarded adequately and respected equally among physicians. Allowing NPs to compete for FM residencies only encourages the very issue you are against.

I agree that NPs should stay as NPs, but that's not what they want, they want to be FPs it seems. I'm not arguing against NPs being allowed into FM residencies, I'm arguing against the idea that NPs should be able to practice as FPs WITHOUT an MD residency.

What do you mean not do well in nursing school? NP school is like all graduate school, you have to maintain a 3.0 or better to keep playing. However, all NPs take a national exam before they can be licensed/practice...so even if you get a 3.0, you still have to pass the same test as girl with the 4.0

That pretty much holds true for MD school as well except that the higher you score, the more options of specialties you have (i think?). So what if a nurse took the Step III, or whatever, and absolutely killed it...could she then go into a neurosurgery residency?

Yes, exactly, you can graduate with a 3.0 (which is average) and practice independently if this trend of giving NPs the same power as FPs without requiring a residency continues. And like I said before, passing a standardized test does not equal proficiency in real life, rather that you have the groundwork to acquire that proficiency (which comes through a residency!)

As for the neurosurgery residency, giving nurses that ability would make this entire argument null, because if premends knew they could get to any residency through an NP route as well as an MD route, that would just open up another set of schools we could apply to, and so acceptance rates would go down and eventually NP schools (just like DO schools) would just become like regular MD schools, in both curriculum and competitiveness. So then you'd no longer be going to nursing school, you'd just be going to medical school.

 

[VassarLiberal]

I agree that NPs should stay as NPs, but that's not what they want, they want to be FPs it seems. I'm not arguing against NPs being allowed into FM residencies, I'm arguing against the idea that NPs should be able to practice as FPs WITHOUT an MD residency.

The issue here, and I think you'll agree with me, is that the educational background - regardless of experience and their position in the NP program - of a nurse practitioner is deficient to practice medicine. The amount of training they have in medical management is quite limited. As a non-physician, I do not feel qualified to state that there is a difference in the difficulty of training, but when I look at reasonably objective measures of clinical and scientific knowledge, namely the number of hours of pharmacological training, coursework in physiology and pathophysiology, as well as the pass rates for the USMLE Step 3 versus the DNP "Step 3" that the NBME determined was not equivalent to the test administered to physicians, it it quite apparent that NPs should not have the near-unlimited independent practice rights without a residency, and perhaps even with residency training.

In terms of medical knowledge necessary for the practice of medicine, it seems to me, again, a non-physician, that the amount of said knowledge has increased over time. If nurse practitioners expect to continue to do what is essentially the practice of medicine without medical training or supervision, then they are certainly not providing the highest standard of care possible. Give it some time. Once NPs start performing procedures far beyond the scope of nursing and their training, or, rather, in the grey area where medicine and nursing overlap, attorneys and public interest groups will have a field day.

To address the legal distinctions between nursing and medicine, I'd like to cite Sermchief v. Gonzales, a 1983 case from Missouri, in which the court ruled that the state's nursing practice act protected the nurse practitioners from the charge of practicing medicine without a license since it was covered by the nursing practice act. The court further stated that there is a limited division between nursing and medicine, due to the great degree of overlap. Still, state-by-state distinctions are quite important to NP practice.

 

[Hoody]

I dont know why they dont let us make the rules... 😀

 

[LuciusVorenus]

I dont know why they dont let us make the rules... 😀

If by us you mean SDN, then I agree. We probably think/argue over things like this more than Congress does anyways 🙄
Not to mention we're probably better educated that a great deal of them

No one here has been lobbied
right?
RIGHT?

 

[NAVY DDS 2010]

It's a slap in the face for primary care physicians. This will encourage medical students to enter highly specialized fields since primary care physicians are being squeezed out.

The problem isn't that primary care physicians are being squeezed out. It is that physicians are choosing highly lucrative specialties over primary care these days. If there was more regulation in percentages of people going into each of the medical specialties including primary care, then there wouldn't be the deficiency in number of primary care phsycians nationwide. In an ideal world, this is where the nurse practioners would fill in for the primary treatment. For advanced illnesses, they would refer out to either a more qualified primary care physician or a specialist.

If more phsycians would got he primary care route, then you wouldn't be in this situation today.

I know from my perspective, my aunt has been a NP for over 10 years. She works in Podunk, KY where it is extremely hard to get primary care physicians to practice. So, they hired on a group of NPs to treat what patients they can and then refer out what they cannot.

 

[Charles_Carmichael]

The problem isn't that primary care physicians are being squeezed out. It is that physicians are choosing highly lucrative specialties over primary care these days. If there was more regulation in percentages of people going into each of the medical specialties including primary care, then there wouldn't be the deficiency in number of primary care phsycians nationwide. In an ideal world, this is where the nurse practioners would fill in for the primary treatment. For advanced illnesses, they would refer out to either a more qualified primary care physician or a specialist.

If more phsycians would got he primary care route, then you wouldn't be in this situation today.

I know from my perspective, my aunt has been a NP for over 10 years. She works in Podunk, KY where it is extremely hard to get primary care physicians to practice. So, they hired on a group of NPs to treat what patients they can and then refer out what they cannot.

The reason why med students seem to avoid primary care is because of all the hassles involved with. When you're faced with a 150k+ debt and want to pay it off as quickly as possible, would you choose the lowest reimburising specialty?

I suggested earlier (jokingly) that they should allow 4th year med students to practice independently as PCPs. Med school is geared towards putting out generalists (look at the core clerkships in M3 for example) and as I've pointed out, a 4th year med student has significantly greater basic science knowledge than NPs/DNPs and they also have significantly more clinical hours as well. So by logic, if people think it's safe to let someone with less training than a 4th year med student practice independently, it makes more sense to let 4th year med students themselves practice independently. I can somewhat confidently say that this would increase the number of students going into primary care. They will avoid a year's worth of tuition and they will avoid the hell of residency; so they can start paying off their loans earlier, etc.

The problem with saying NPs/DNPs should handle the easy stuff while pushing off the complex stuff to physicians is that how are these NPs/DNPs trained to recognize something that's beyond their skill? I mean, their curricula has barely any pathophys so how would they know that something that appears benign is actually far more serious? Also, by taking all the easy cases, which require not much more than algorithmic medicine (and thus, no thinking really), they'll push the hard cases that require more thinking onto physicians. This means more liability for those physicians. How is that fair?

I'm strongly against NPs/DNPs filling in for PCPs. It is my opinion that primary care is one of the harder specialties due to its wide scope and range of pathologies. As a resident somewhere on this site mentioned, "substandard primary is easy to do, but good primary is hard to do" or something along those lines. It's a bad idea to replace physicians in a specialty that requires a strong knowledge base with lesser trained individuals. And NPs/DNPs have far less training, both in basic sciences and in clinical practice, than physicians do.