Nurse Practitioner take-over = PA profession death?

[NEU2014]

So, I was talking to my boyfriend (a PA student) and he was explaining to me how to nurse practitioner profession is the "competing midlevel profession" for the PA's and how NP's are become independent, increasing reimbursement rates to physician rates, openly claiming to be more superior then PA's (and surprisingly, MD/DO's) and "basically taking over" medicine. Now, while I haven't been through either nursing, pa or med school, I personally cant say anything as to who is superior, but I can certainly say that I thought it was down-right surprising that some nurse websites claim to be better then doctors.

What do you guys think this rapid proliferation of NPs will do to PAs? NPs were just listed as primary care providers 100% interchangeable with FP/IM doctors today by bcbs (insurance company). How could medical boards allow this? Will this trend continue? If this catches some ground, I cant see such a provider like a PA in the future.

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[NEU2014]

CareFirst BlueCross BlueShield Now Includes NPs as Independent Primary Care Providers

Here is the link by the way

 

[PSYCHNP]

So, I was talking to my boyfriend (a PA student) and he was explaining to me how to nurse practitioner profession is the "competing midlevel profession" for the PA's and how NP's are become independent, increasing reimbursement rates to physician rates, openly claiming to be more superior then PA's (and surprisingly, MD/DO's) and "basically taking over" medicine. Now, while I haven't been through either nursing, pa or med school, I personally cant say anything as to who is superior, but I can certainly say that I thought it was down-right surprising that some nurse websites claim to be better then doctors.

What do you guys think this rapid proliferation of NPs will do to PAs? NPs were just listed as primary care providers 100% interchangeable with FP/IM doctors today by bcbs (insurance company). How could medical boards allow this? Will this trend continue? If this catches some ground, I cant see such a provider like a PA in the future.

Don't worry I am sure he will still have a job. PA programs are very thorough and they can work in any subspecialty. I don't see PAs as competition at all. It would be foolish, like crabs in a barrel. I read your link and it does not state that NPs will be 100% interchangeable with doctors. Furthermore, I don't know one nurse that thinks he or she is superior to MDs. I do know pharmacists going around calling themselves doctors though. If you as a pharmacist want to prescribe why don't you go to the dual pharmacy/NP program in Hawaii and take the needed physical assessment classes etc. I don't see why you are so concerned with PAs or NPs when you would be making more than both of them (about $60/hr for standing on your feet in a cold store behind a counter all day), off of the prescriptions that they write.

 

[NEU2014]

Don't worry I am sure he will still have a job. I read your link and it does not state that NPs will be 100% interchangeable with doctors. Furthermore, I don't know one nurse that thinks he or she is superior to MDs. I do know pharmacists going around calling themselves doctors though. If you as a pharmacist want to prescribe why don't you go to the dual pharmacy/NP program in Hawaii and take the needed physical assessment classes etc. I don't see why you are so concerned with PAs or NPs when you would be making more than both of them, about $60/hr for standing on your feet behind a counter all day.

I think there are certainly more DNP's trying to be doctors then pharmacists trying to be called dr. Plus, a pharmacist is in a pharmacy(for the most part), while a NP is in a hospital/clinic. Her calling herself doctor is certainly confusing to patients; obv a pharmacist behind a counter calling himself a doctor is not trying to be a physician. Eitherway, no pharmacist I know uses the title Doctor in any setting. Anyways

I never said anything about wanting to prescribe. These words are coming out from you; not me. The reason I bother about PA/NP is because my boyfriend(soon to be fiance) is one.

 

[ARAI]

So, I was talking to my boyfriend (a PA student) and he was explaining to me how to nurse practitioner profession is the "competing midlevel profession" for the PA's and how NP's are become independent, increasing reimbursement rates to physician rates, openly claiming to be more superior then PA's (and surprisingly, MD/DO's) and "basically taking over" medicine. Now, while I haven't been through either nursing, pa or med school, I personally cant say anything as to who is superior, but I can certainly say that I thought it was down-right surprising that some nurse websites claim to be better then doctors.

What do you guys think this rapid proliferation of NPs will do to PAs? NPs were just listed as primary care providers 100% interchangeable with FP/IM doctors today by bcbs (insurance company). How could medical boards allow this? Will this trend continue? If this catches some ground, I cant see such a provider like a PA in the future.

My guess is that this may force more PAs into specialties where NPs cannot follow.

Also, I highly doubt NPs are superior to PAs. And they definitely are not superior to MD/DOs.

 

[NEU2014]

My guess is that this may force more PAs into specialties where NPs cannot follow.

Also, I highly doubt NPs are superior to PAs. And they definitely are not superior to MD/DOs.

Never meant to say NPs are superior to PAs at all, sorry if it came out that way. Education-wise, PAs certainly get much more education, both didactic & clinical, then NPs (in my opinion), but more education doesn't necessarily equate to being more employable.

 

[PSYCHNP]

I think there are certainly more DNP's trying to be doctors then pharmacists trying to be called dr. Plus, a pharmacist is in a pharmacy(for the most part), while a NP is in a hospital/clinic. Her calling herself doctor is certainly confusing to patients; obv a pharmacist behind a counter calling himself a doctor is not trying to be a physician. Eitherway, no pharmacist I know uses the title Doctor in any setting. Anyways

I never said anything about wanting to prescribe. These words are coming out from you; not me. The reason I bother about PA/NP is because my boyfriend(soon to be fiance) is one.

Anyhow, the large chain community pharmacist we use adresses herself as DR. so and so on her voice mail. She answers health related questions and tries to act like she is some sort of real doctor. I would be confused by her if I didn't know better. I think your significant other's job is pretty safe. What about all of the PAs/MDs/DOs who graduate each semester? Are they not his "competition"? If we all had that attitude there would be no preceptors out there. Do LCSWs look at Psychologists and psych NPs as "the competition"? Do PTs regard chiropractors as "the competition". This type of thinking seems absurd to me. I don't believe in degrading others to promote myself. He just needs to be the best PA he can be and the rest will fall into place.

My question to you is, are Pharmacists giving vaccines and wanting to write prescriptions the new "competition" for MDs/PAs/and DOs?

 

[NEU2014]

Anyhow, the large chain community pharmacist we use adresses herself as DR. so and so on her voice mail. I think your significant other's job is pretty safe. What about all of the PAs/MDs/DOs who graduate each semester? Are they not his "competition"? If we all had that attitude there would be no preceptors out there. Do LCSWs look at Psychologists and psych NPs as "the competition"? Do PTs regard chiropractors as "the competition". This type of thinking seems absurd to me. I don't believe in degrading others to promote myself. He just needs to be the best PA he can be and the rest will fall into place.

My question to you is, are Pharmacists giving vaccines and wanting to write prescriptions the new "competition" for MDs/PAs/and DOs?

I myself think such a "competitive" approach is absurd. But, we are talking about the AANA here, not the APhA. I have several relatives in my family who are anesthesiologists who regret going into their field because the Nurse anesthetists are literally replacing them. So, sorry if its absurd to you, but I have experienced this issue first-hand in my family and if anesthesiologists can be threatened, PAs are a much easier target.

And for the record, I don't advocate for pharmacist prescription rights, we have enough things to keep us busy

 

[PSYCHNP]

I myself think such a "competitive" approach is absurd. But, we are talking about the AANA here, not the APhA. I have several relatives in my family who are anesthesiologists who regret going into their field because the Nurse anesthetists are literally replacing them. So, sorry if its absurd to you, but I have experienced this issue first-hand in my family and if anesthesiologists can be threatened, PAs are a much easier target.

And for the record, I don't advocate for pharmacist prescription rights, we have enough things to keep us busy

I know what you are saying. I don't see PAs being threatened by NPs because they are both considered "midlevels" and are regarded by society and academia in much the same way. For goodness sake they make the same amount of money. Now if he wants to be on a higher level he needs to invest the time and money and go to MD or DO school amd become a surgeon. He can even go to pharmacy school. It is what it is. Why isn't he threatened by another PA graduating from another PA program? Why aren't you threatened by all the pharmacists graduating each year? This battle between PAs and NPs does not make any sense to me.

As far as the anesthesiologists are concerned we all know that they are way more highly educated than nurse anesthetists. But the fact still remains that nurse anesthetists are effective providers and we cannot deny that .

 

[NEU2014]

But the fact still remains that nurse anesthetists are effective providers and we cannot deny that .

Not a fact. It is your opinion, and I'll respect it.

 

[Denatured]

Obviously guys, this is not a pharmacist. It is a med stud/doctor with an axe to grind. Don't waste your time.
:troll:

 

[NEU2014]

Obviously guys, this is not a pharmacist. It is a med stud/doctor with an axe to grind. Don't waste your time.
:troll:

Troll? What would makes you say that?!?

And your right I'm not a pharmacist, I'm a pharm. student

 

[Coastie]

Yawn. BCBS is ripping off its customers now? What a pathetic joke these noctors are playing on America.

To the OP: PAs are far far far better trained than any NP..period.

 

[ARAI]

Never meant to say NPs are superior to PAs at all, sorry if it came out that way.

I know that you, personally, didn't say that. I was just addressing the part of your first post that said...

[NPs are] openly claiming to be more superior then PA's (and surprisingly, MD/DO's)"

I don't think that PAs and NPs should ever argue about who is superior to the other. It is a PA's nature to be humble, so I don't feel that they should run around tooting their horns. But at the same time (at my school) 3 year DNP programs are still 50 semester credits SHORTER than an intensive 2 year Masters PA program. Just something to consider.

Finally, neither PAs nor NPs should ever claim to be superior to MD/DOs.

 

[PrinceVersed]

Troll? What would makes you say that?!?

And your right I'm not a pharmacist, I'm a pharm. student

If you had ever actually worked in health care (which I have never seen a pharm do) you would understand that a very large majority of the people that come into the hospital or the clinic do not require a MD to treat them. Runny nose, ear infection, and sore throat does not require a master mind to treat. No NP or PA will ever be able to function as well as a MD but to even imagine that they can't manage FP type patients is asinine.

And this is all coming from a person that thinks it is an embarrassment for any nurse to call themselves a doctor outside the world of academia (I am a nurse).

 

[deleted87716]

If you had ever actually worked in health care (which I have never seen a pharm do) you would understand that a very large majority of the people that come into the hospital or the clinic do not require a MD to treat them. Runny nose, ear infection, and sore throat does not require a master mind to treat. No NP or PA will ever be able to function as well as a MD but to even imagine that they can't manage FP type patients is asinine.

And this is all coming from a person that thinks it is an embarrassment for any nurse to call themselves a doctor outside the world of academia (I am a nurse).

Do you seriously think that runny noses, ear infections, and sore throats constitute "a very large majority" of the patients in primary care...?

You're in for a rude awakening one of these days.

 

[youngdoc8205]

This is from a discussion I had with a WSJ blogger, with whom I am friends with,

This topic has been talked about to death, and putting it here is like preaching to the choir, but I have the day off, and sadly nothing better to do at 1 in the afternoon

residents are not techically allowed to work longer then 80 hrs/week, virtually all programs and fields will milk every bit of that from the resident, most high intensity fields: i.e. surgery, OB/GYN will often go over those hours, and not report it, let's say on average that works out to be approximately 90 hrs a week, though it's more frequently over 100 hrs.
so in one year a resident who works 80 hrs a week will have worked a total of 3840 hrs, since most residencies are between 3-7 years (excluding sub-specialty fellowship training, where there are no work hour restrictions) that works out to be 11520 to 26680 of training, add to that the 4 years of medical school (Which most non-MD health care providers are quick to discount as "worthless" ) and you have between 14k-30k of training, with with primary care specialties (peds, FM, IM ) on the lower end and surgical specialties (Neurosurgery) on the higher end.

I will quote the requirements for a FNP program from old-dominion university college of health sciences:

Each student is required to complete 616 hours of clinical. The hours of clinical are as follows:
Primary Care 336 hours(or 392 if a specialty is not taken)
Women's Health 112 hours
Pediatrics 112 hours
Specialty 56 hours (optional)

That's is the whole length of their training, our degree program (MD/DO) is approximately 4x lengthier in terms of hours, and then these people go out into practice, and demand independent practice rights with little to no additional training and not nearly the fudemental knowleged of anatomy and phathophysiology that EVERY SINGLE doctor (from pediatrics to neurosurgery) has. Many APNs will claim they have "prior experience" in nursing, this means that they have experience in putting in IVs, dressing wounds, monitoring VS, changing the sheets, and pushing meds, not to discount the importance of these tasks, but they do not magically translate into basic understanding of disease processes and treatments. Many will also claim that they "focus on the patient" much more then the doctors, sure when you have 4 patients in a 12 hour shift, compared to 10-15 in hour 30 hr shift, plus the additionalt 20-30 that we cover overnight, that often translates into more face time on the nursing end.

Our (MD/DO) response to independent nursing practice has nothing to do with having an advanced degree and being "better", in other countries physicians degrees are baccalaureate, and they STILL have more training and fundamental knowledge than nurses with advanced or doctoral degrees. This has everything to do with the toil and sacrifice that we put in to practice our trade.

Most people fighting for independent rights claim that if they come to something they can't handle they will refer to a physician, I have two issues with that

1)they frequently lack the knowlege to determine when something is out of their league, but before it gets to be a gigantic life threatening problem, I've personaly experienced this as a med student on ambulatory pediatrics where I saw an inordinate amount of scarlet fever because the local NPs were misdiagnosing strep throat as a cold

2)the amount of hubris some of these midlevels demonstrate will often prevent them from recognizing that they are in fact out of their element


Something to think about:
Who would you want taking care of your mother, father, daughter or son? someone that took the easy way or someone that worked approximately 50x as hard (that's 30,000 hr/ 616 hr )

 

[Denatured]

Troll? What would makes you say that?!?

And your right I'm not a pharmacist, I'm a pharm. student

Because you have a new account and this is one of the first things you decided to talk about?

I agree with you that PAs are better trained than NPs (though I think a good provider depends more on the person) and that neither are as good as MD/DO.

What really told me you are a troll is you brought CRNAs into the mix. You have no contact with them whatsoever, but you know they are ineffective providers? So you just happen to be a "pharmacy student" (good job picking an intelligent, seemingly unbiased observer) that has a PA boyfriend you is being picked on by the big bad NPs (I know just as many or more employers that prefer PAs, sorry) and family members that are picked on by the big bad CRNAs? Spend a few post in a pharmacy debt thread and then STRAIGHT to the anesthesiology forums and then here? Coincidence? I think not. You're just here to stir up a frenzy.

 

[PrinceVersed]

Do you seriously think that runny noses, ear infections, and sore throats constitute "a very large majority" of the patients in primary care...?

You're in for a rude awakening one of these days.

That is not what I said at all, though I can see how you would think that if you are looking for a fight. And yes, I stand by what I said. The large majority of people do not need a MD to treat or see them. I am not under valuing MD/DO at all. In fact, I very much want to be an MD. What I am saying is that a lot of pts are either a waste of time(colds, strep, etc) or routine stuff/check ups. I don't want my doctor bogged down by BS patients so much so that he/she can't focus on the actual sick ones.

 

[jwk]

In fact, I very much want to be an MD. What I am saying is that a lot of pts are either a waste of time(colds, strep, etc) or routine stuff/check ups. I don't want my doctor bogged down by BS patients so much so that he/she can't focus on the actual sick ones.

Wow, you really need a reality check if you want to be an MD. Bring that attitude with you to a med school interview. Tell them you want to only take care of REALLY sick people and see how far it gets you.

 

[PrinceVersed]

Wow, you really need a reality check if you want to be an MD. Bring that attitude with you to a med school interview. Tell them you want to only take care of REALLY sick people and see how far it gets you.

Well, I actually have gone to a med school interview (bet that hurts your ego). And I am sorry that honesty has gone by the wayside in medicine/medical education. I didn't flat out tell them that I don't want to take care of BS pts but that is only because that never came up. However, I would have been more than willing had the subject been broached. If I don't get an acceptance, that is fine. At least I didn't have to sell my dignity.

 

[PSYCHNP]

I don't think that PAs and NPs should ever argue about who is superior to the other. It is a PA's nature to be humble, so I don't feel that they should run around tooting their horns. But at the same time (at my school) 3 year DNP programs are still 50 semester credits SHORTER than an intensive 2 year Masters PA program. Just something to consider.

Finally, neither PAs nor NPs should ever claim to be superior to MD/DOs.[/QUOTE]

The topic of semester credits is an area I believe many of the educational institutions are misleading our students. I looked at Keiser University's PA program and it is 6 semesters in duration and consists of "138 credits". Are they really trying to rip students off or what? Couldn't many of the topics covered in the 138 credit hours be taught in fewer. This only causes students to pay way more for their education piling up large amounts of debt. I mean the students already have to enter the program with a bachelor's degree. I don't advocate for institutions to charge students to be taught 1/4 of the syllabus.

If you are truly doing a fair amount of work in a class even nine credits could be a considerable amount (i.e. if you are taking a college level general chemistry class, physics, and english class simultaneously). How do you take 29 or 30 and absorb all of that info? 12-15 credits in most institutions is considered a full time load.

Here are semesters 2 and 3. How is it possible to take 29 credits if all of them are rigorous and challenging? I'm sorry I have to question some of these practices. These institutions just seem greedy.

Semester 2
Course
Number
Course Title

Semester Credit Hours ​

MPA525
Clinical Laboratory Medicine I

1​

MPA535
Clinical Laboratory Medicine II

2​

MPA524
Fund of Clinical Medicine and Surgery I

5​

MPA534
Fund of Clinical Medicine and Surgery II

6​

MPA512
Clinical Pathophysiology

3​

MPA522
Ethical and Legal Medicine

3​

MPA523
Clinical Pharmacology

2​

MPA533
Pharmacotherapeutics I

4​

MPA520
Physical Diagnosis II

2​

TOTALS​

29​

Semester 3

Course
Number
Course Title​

Semester Credit Hours ​

MPA540
Clinical Psychiatry​

3​

MPA530
Physical Diagnosis III​

3​

MPA531
Principles of Life Support and Electrocardiography​

5​

MPA544
Fund of Clinical Med and Surgery III​

8​

MPA532
Clinical and Surgical Procedures​

4​

MPA538
Medical Genetics​

1​

MPA543
Pharmacotherapeutics II​

3​

MPA502
Fundamentals of Diagnostic Methods​

3​

MPA539
Alternative and Complementary Med​

2​

TOTALS​

30​

 

[deleted6669]

it's doable, it's just a lot of work.
as an undergrad I took 20 units/quarter of "real classes"; a+p, chem, physics, genetics, etc( at a place that considered 12 full time and > 15 required permission of an advisor) while working 26 hrs/week as an er tech....
believe me when I tell you that there is very little fluff in pa school.
in my entire program we had 2 courses that I considered fluff; medical ethics and biopsychosocial issues in health care. the rest was hard core with lots of reading, frequent exams, papers, etc
we were in class 8-5 or 8-6 most days for 14 months and our clinical yr(actually 54 weeks) was interchangeable with the ms3 clinical yr at the medschool my program was based out of with most students doing >3000 hrs of clinicals during that yr.

 

[PSYCHNP]

it's doable, it's just a lot of work.
as an undergrad I took 20 units/quarter of "real classes"; a+p, chem, physics, genetics, etc( at a place that considered 12 full time and > 15 required permission of an advisor) while working 26 hrs/week as an er tech....
believe me when I tell you that there is very little fluff in pa school.
in my entire program we had 2 courses that I considered fluff; medical ethics and biopsychosocial issues in health care. the rest was hard core with lots of reading, frequent exams, papers, etc
we were in class 8-5 or 8-6 most days for 14 months and our clinical yr(actually 54 weeks) was interchangeable with the ms3 clinical yr at the medschool my program was based out of with most students doing >3000 hrs of clinicals during that yr.

I know its a whole lot of work. I just question charging the students for the "fluff" that's all.

 

[atcpt1]

I know its a whole lot of work. I just question charging the students for the "fluff" that's all.

You have no clue and yes you can work this hard
No fluff in my schedule - NONE
8-5pm M-F
Exams are all before class each day
Labs 2 x week after 5pm

2 sometimes 3 exams a week
You cannot work
In two years it's far more work and class time than a 120 credit 4 year undergraduate degree

It's very intensive

Nursing if fluff by comparison

 

[atcpt1]

I don't think that PAs and NPs should ever argue about who is superior to the other. It is a PA's nature to be humble, so I don't feel that they should run around tooting their horns. But at the same time (at my school) 3 year DNP programs are still 50 semester credits SHORTER than an intensive 2 year Masters PA program. Just something to consider.

Finally, neither PAs nor NPs should ever claim to be superior to MD/DOs.

The topic of semester credits is an area I believe many of the educational institutions are misleading our students. I looked at Keiser University's PA program and it is 6 semesters in duration and consists of "138 credits". Are they really trying to rip students off or what? Couldn't many of the topics covered in the 138 credit hours be taught in fewer. This only causes students to pay way more for their education piling up large amounts of debt. I mean the students already have to enter the program with a bachelor's degree. I don't advocate for institutions to charge students to be taught 1/4 of the syllabus.

If you are truly doing a fair amount of work in a class even nine credits could be a considerable amount (i.e. if you are taking a college level general chemistry class, physics, and english class simultaneously). How do you take 29 or 30 and absorb all of that info? 12-15 credits in most institutions is considered a full time load.

Here are semesters 2 and 3. How is it possible to take 29 credits if all of them are rigorous and challenging? I'm sorry I have to question some of these practices. These institutions just seem greedy.

Semester 2
Course
Number
Course Title

Semester Credit Hours ​

MPA525
Clinical Laboratory Medicine I

1​

MPA535
Clinical Laboratory Medicine II

2​

MPA524
Fund of Clinical Medicine and Surgery I

5​

MPA534
Fund of Clinical Medicine and Surgery II

6​

MPA512
Clinical Pathophysiology

3​

MPA522
Ethical and Legal Medicine

3​

MPA523
Clinical Pharmacology

2​

MPA533
Pharmacotherapeutics I

4​

MPA520
Physical Diagnosis II

2​

TOTALS​

29​

Semester 3

Course
Number
Course Title​

Semester Credit Hours ​

MPA540
Clinical Psychiatry​

3​

MPA530
Physical Diagnosis III​

3​

MPA531
Principles of Life Support and Electrocardiography​

5​

MPA544
Fund of Clinical Med and Surgery III​

8​

MPA532
Clinical and Surgical Procedures​

4​

MPA538
Medical Genetics​

1​

MPA543
Pharmacotherapeutics II​

3​

MPA502
Fundamentals of Diagnostic Methods​

3​

MPA539
Alternative and Complementary Med​

2​

TOTALS​

30​

[/QUOTE]

It's modeled after medical school
PA's complete over 111 weeks or more of full-time (8-5pm M-F) training over two years
Compared to Medical school's 155 over 4 years

You're right to question it - because it actually is insane

 

[deleted6669]

I know its a whole lot of work. I just question charging the students for the "fluff" that's all.

that's 4 credits of fluff out of around 140 credits. I can live with that. I think there is a national requirement for an ethics class as well as a course that addresses what was in the biopsychosocial issues course.

 

[fab4fan]

because you have a new account and this is one of the first things you decided to talk about?

I agree with you that pas are better trained than nps (though i think a good provider depends more on the person) and that neither are as good as md/do.

What really told me you are a troll is you brought crnas into the mix. You have no contact with them whatsoever, but you know they are ineffective providers? So you just happen to be a "pharmacy student" (good job picking an intelligent, seemingly unbiased observer) that has a pa boyfriend you is being picked on by the big bad nps (i know just as many or more employers that prefer pas, sorry) and family members that are picked on by the big bad crnas? Spend a few post in a pharmacy debt thread and then straight to the anesthesiology forums and then here? Coincidence? I think not. You're just here to stir up a frenzy.

+1

 

[PSYCHNP]

You have no clue and yes you can work this hard
No fluff in my schedule - NONE
8-5pm M-F
Exams are all before class each day
Labs 2 x week after 5pm

2 sometimes 3 exams a week
You cannot work
In two years it's far more work and class time than a 120 credit 4 year undergraduate degree

It's very intensive

Nursing if fluff by comparison

I know the program is intensive and you cannot work. Most medical programs are like that like RN, PT, MD, OT, dentistry, chiropractor, audiology, and podiatry. Did I leave one out? Just try them. Here are two semesters from UF's pharmacy program. I am sure it is rigorous and you can't work too, but they only have to pay for 34 credits, as opposed to maybe 60. Not to mention their total program is 134 credits spread out over a period of 4 years and they are awarded a PharmD degree. Keiser's PA program is "138 credit hours" completed in 6 semesters and they are awarded a master's degree. Furthermore, I believe being a Pharmacist is more prestigious and more respected in our society than being a PA. Like I said earlier I believe institutions may be misleading the students with an abundance of "credit hours".

Course # Name Credits
PHA 5451 Clinical Biochemistry 4
PHA 5100 Dosage Forms I 3
PHA 5433 Fundamentals of Medicinal Chemistry 1
PHA 5560C Physiological Basis of Disease I 5
PHA 5727 Intro to Pharmacists, Pharmaceuticals, 3
And the Health Care System
PHA 5941C IPPE I 1
17
[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Spring Semester ..
PHA 5101 Dosage Forms II 2
PHA 5436 Structure and Function of Nucleotides: Basis for Therapy 2
PHA 5515 Basic Principles of Pharmacology 1
PHA 5561C Physiological Basis of Disease II 5
MCB 5252 Microbiological and Immunological Basis for Therapy 4
PHA 5781 Pharmacotherapy I 2
PHA 5942C IPPE II 1
17

 

[fab4fan]

That is not what I said at all, though I can see how you would think that if you are looking for a fight. And yes, I stand by what I said. The large majority of people do not need a MD to treat or see them. I am not under valuing MD/DO at all. In fact, I very much want to be an MD. What I am saying is that a lot of pts are either a waste of time(colds, strep, etc) or routine stuff/check ups. I don't want my doctor bogged down by BS patients so much so that he/she can't focus on the actual sick ones.

Please remind me to bow and scrape if I ever have the privilege of having you as my physician. I hope my illness will be worthy of your awesomeness.

 

[PrinceVersed]

Please remind me to bow and scrape if I ever have the privilege of having you as my physician. I hope my illness will be worthy of your awesomeness.

That was in no way even close to the issue. I am sorry that a lot of you fail to see the point that most minor issues do not require a doctor. Hell, I have read 100 post in which 3rd year medical students (not even close to being full fledged doctors) could run circles around NP's. If that is the case it strengths my argument even more. YOU DO NOT NEED A MD FOR MINOR MEDICAL ISSUES. A NP or even a 3rd year med student, apparently, could handle them just fine.

 

[PSYCHNP]

[/QUOTE]

It's modeled after medical school
PA's complete over 111 weeks or more of full-time (8-5pm M-F) training over two years
Compared to Medical school's 155 over 4 years

You're right to question it - because it actually is insane[/QUOTE]

Let's not compare PA school to Medical School. MDs and DOs receive far more training and I believe the scope and depth is at a higher level as well. That is why PAs are called physician assistants.

 

[pianoman511]

That was in no way even close to the issue. I am sorry that a lot of you fail to see the point that most minor issues do not require a doctor. Hell, I have read 100 post in which 3rd year medical students (not even close to being full fledged doctors) could run circles around NP's. If that is the case it strengths my argument even more. YOU DO NOT NEED A MD FOR MINOR MEDICAL ISSUES. A NP or even a 3rd year med student, apparently, could handle them just fine.

Yes, but the problem (and what those who claim physician equivalency maintain) is not that we question their ability to handle a minor medical issue, but simply that every patient who comes in to the office requires a differential diagnosis. Physicians have a really broad differential list, while other providers have a short list since their education is not equal to that of a physician. Most of the patients they see will be treated (don't get me started on antibiotics for viral pharyngitis but we're all guilty of it). The problem is that one patient that is overlooked.

One of my pediatric attendings told me a story yesterday about a patient that was seen by an NP who looked in their ear and saw it was red. The patient had a fever & wasn't feeling well so they got their amoxicillin for OM and went on their way. The fever didn't go away and in another few days they came back, ear still red, got a prescription for augmentin....still no results. The patient finally goes to the doctor and the doctor looks and sees some huge lymph nodes, does a CBC and diagnoses the kid with Kawasaki disease.

Does this case happen every day ? No...but how many cases are acceptable to miss because you're only treating the "minor stuff" ? I don't know every single disease in existence and it scares the heck out of me because one day I will be in practice and have to consider these things all the time. There are a ton of things that seem benign but really are not.

Here's another thing to consider. These days people neglect a ton of things and just come in for acute problems. A patient comes in for back pain which has been going on for a while, getting worse as time progresses. One provider gives them a muscle relaxer, lortab, rx for PT and sends them on their way without really examining them. The other takes a look, realizes this pain isn't musculoskeletal, but referred visceral pain and after a short workup finds metastatic prostate CA. Back pain...minor right ?

 

[PrinceVersed]

Yes, but the problem (and what those who claim physician equivalency maintain) is not that we question their ability to handle a minor medical issue, but simply that every patient who comes in to the office requires a differential diagnosis. Physicians have a really broad differential list, while other providers have a short list since their education is not equal to that of a physician. Most of the patients they see will be treated (don't get me started on antibiotics for viral pharyngitis but we're all guilty of it). The problem is that one patient that is overlooked.

One of my pediatric attendings told me a story yesterday about a patient that was seen by an NP who looked in their ear and saw it was red. The patient had a fever & wasn't feeling well so they got their amoxicillin for OM and went on their way. The fever didn't go away and in another few days they came back, ear still red, got a prescription for augmentin....still no results. The patient finally goes to the doctor and the doctor looks and sees some huge lymph nodes, does a CBC and diagnoses the kid with Kawasaki disease.

Does this case happen every day ? No...but how many cases are acceptable to miss because you're only treating the "minor stuff" ? I don't know every single disease in existence and it scares the heck out of me because one day I will be in practice and have to consider these things all the time. There are a ton of things that seem benign but really are not.

Here's another thing to consider. These days people neglect a ton of things and just come in for acute problems. A patient comes in for back pain which has been going on for a while, getting worse as time progresses. One provider gives them a muscle relaxer, lortab, rx for PT and sends them on their way without really examining them. The other takes a look, realizes this pain isn't musculoskeletal, but referred visceral pain and after a short workup finds metastatic prostate CA. Back pain...minor right ?

You're preaching to the choir, dude. I am totally with you. But there isn't enough of you (FP/Primary care MD's) to go around. And that is of course assuming that you go into primary care which just on a hunch I am going to guess you don't want to do.

No NP will ever be able to do what a MD does. Fact. I am sure they will miss more than a MD under any sort of normal situation. But what about when you are not under normal circumstances? How much will you miss when you have to work non stop w no sleep because someone has to be there all the time to diagnose OM?

The NP is supposed to be able to consult the doctors they works with/for whenever they feel they are out of their depth. In a perfect world that would cut back misdiagnosing pts. It is not a perfect solution or system, I agree. But I still feel that NP/PA have their place.

 

[jwk]

That was in no way even close to the issue. I am sorry that a lot of you fail to see the point that most minor issues do not require a doctor. Hell, I have read 100 post in which 3rd year medical students (not even close to being full fledged doctors) could run circles around NP's. If that is the case it strengths my argument even more. YOU DO NOT NEED A MD FOR MINOR MEDICAL ISSUES. A NP or even a 3rd year med student, apparently, could handle them just fine.

No, your point seems to be that "routine" patient issues are simply not worth your time, that they're beneath you. You know, those "BS patients" that you've now mentioned in two separate posts.

 

[Denatured]

I have to agree with princeversed. Not every medical issue necessitates physician involvment. Even with their broad DDx list, doesn't mean than can test (or should test) for every little thing. Someone comes in with high blood pressure, are you going to test them for pheochromocytoma? No, you will not. If a FP suspects that, he will refer out just as same as the NP.

 

[Denatured]

+1

Glad you agree. Unfortunately they have done what they came here to do.

 

[PrinceVersed]

No, your point seems to be that "routine" patient issues are simply not worth your time, that they're beneath you. You know, those "BS patients" that you've now mentioned in two separate posts.

I never said that anyone was beneath me. Those are your words. But yes, after my years in health care I do not have much patience for people that come in and take my time, energy, and focus away from a patient that actually requires it. If that some how makes me a bad person, then so be it. You can try to paint me however you like but that does not change the truth of the situation. You are an AA, correct? So all the pts you see need to be there as they are about to have surgery. That is not always the case for people that come into the ER and/or are admitted to my hospital.

When I have to leave my post op CABG pt that also has a IABP in and is getting dialysis to go deal with a woman that complained of chest pain because she needs a xanax, yes, it bothers me.

 

[pianoman511]

I have to agree with princeversed. Not every medical issue necessitates physician involvment. Even with their broad DDx list, doesn't mean than can test (or should test) for every little thing. Someone comes in with high blood pressure, are you going to test them for pheochromocytoma? No, you will not. If a FP suspects that, he will refer out just as same as the NP.

...Or the FP would just do a urine for VMA/metanephrines & get a CT while the NP could continue increasing the dosage of BP meds...

I am glad you are against defensive medicine, because without a broad DDx list, a provider would do the 'shotgun' approach and do unnecessary testing because of that very reason. If you don't know what you're testing for, then why test for it ?

 

[PSYCHNP]

Yes, but the problem (and what those who claim physician equivalency maintain) is not that we question their ability to handle a minor medical issue, but simply that every patient who comes in to the office requires a differential diagnosis. Physicians have a really broad differential list, while other providers have a short list since their education is not equal to that of a physician. Most of the patients they see will be treated (don't get me started on antibiotics for viral pharyngitis but we're all guilty of it). The problem is that one patient that is overlooked.

One of my pediatric attendings told me a story yesterday about a patient that was seen by an NP who looked in their ear and saw it was red. The patient had a fever & wasn't feeling well so they got their amoxicillin for OM and went on their way. The fever didn't go away and in another few days they came back, ear still red, got a prescription for augmentin....still no results. The patient finally goes to the doctor and the doctor looks and sees some huge lymph nodes, does a CBC and diagnoses the kid with Kawasaki disease.

Does this case happen every day ? No...but how many cases are acceptable to miss because you're only treating the "minor stuff" ? I don't know every single disease in existence and it scares the heck out of me because one day I will be in practice and have to consider these things all the time. There are a ton of things that seem benign but really are not.

Here's another thing to consider. These days people neglect a ton of things and just come in for acute problems. A patient comes in for back pain which has been going on for a while, getting worse as time progresses. One provider gives them a muscle relaxer, lortab, rx for PT and sends them on their way without really examining them. The other takes a look, realizes this pain isn't musculoskeletal, but referred visceral pain and after a short workup finds metastatic prostate CA. Back pain...minor right ?

I don't think this clinical case should be used as a basis of comparison. Due to the fact that two interventions were already tried by the NP. We cannot overlook such variables. Sorry Doc. I know for the most part MDs receive higher training than NPs but let's be fair.

 

[Denatured]

...Or the FP would just do a urine for VMA/metanephrines & get a CT while the NP could continue increasing the dosage of BP meds...

I am glad you are against defensive medicine, because without a broad DDx list, a provider would do the 'shotgun' approach and do unnecessary testing because of that very reason. If you don't know what you're testing for, then why test for it ?

I thought the clonidine suppression test was all the rage these days? I dunno, haven't been involved in that stuff in a while.

You make a valid point which would require a NP to know when they should refer out without doing the "shotgun" approach. I think that most know when to do such, but that's just my opinion.

 

[Coastie]

That was in no way even close to the issue. I am sorry that a lot of you fail to see the point that most minor issues do not require a doctor. Hell, I have read 100 post in which 3rd year medical students (not even close to being full fledged doctors) could run circles around NP's. If that is the case it strengths my argument even more. YOU DO NOT NEED A MD FOR MINOR MEDICAL ISSUES. A NP or even a 3rd year med student, apparently, could handle them just fine.

Argument 1, Bold: Yes, 3rd year med students run circles around NPs, even "seasoned" ones.

Argument 2, Bold/Italic: Your logic doesn't follow.

 

[Coastie]

I don't think this clinical case should be used as a basis of comparison. Due to the fact that two interventions were already tried by the NP. We cannot overlook such variables. Sorry Doc. I know for the most part MDs receive higher training than NPs but let's be fair.

For the most part?

On every part. NP training is laughable compared to MD training...even compared to PA training.

 

[PrinceVersed]

Argument 1, Bold: Yes, 3rd year med students run circles around NPs, even "seasoned" ones.

Argument 2, Bold/Italic: Your logic doesn't follow.

I thought it was said that 3rd year med students could adequately take care of non-emergent/minor illness type pts. If that isn't that case, then sorry.

On every part. NP training is laughable compared to MD training...even compared to PA training.

I 100% agree with you. I think NP program is soft and based mainly on "nursing theory" and not good science or medicine. I, personally, would never attend one. However, I still don't feel that that negates their worth. They are good for their purpose, nothing more. In saying that, a sub par graduate program does not mean that the NP does not have a wealth of knowledge from their time spent as a nurse.

 

[PSYCHNP]

For the most part?

On every part. NP training is laughable compared to MD training...even compared to PA training.

My question is since your training is so superior, why feel threatened? In my experience it is mainly the FP physicians and residents who are so opposed to NPs and look down on "midlevels". I guess the top MDs, which none of you are, don't have the time for such idol chatter (i.e. surgeons, derms, orthopedics ect.). Don't worry doc it will all be ok, trust me.

 

[ARAI]

My question is since your training is so superior, why feel threatened?

Simple. It doesn't take an MD to catch a zebra these days. Medical education has become so efficient that even a 2nd semester PA student can catch cardiac tamponade the minute it walks through the ER door.

Should MD/DOs feel threatened by this? That depends. If their primary reason for going into medicine was money, "yes." However, if they went into medicine with a purpose other than monetary gains then "no, not at all."

 

[Paseo Del Norte]

I suspect the reason any of us work is for money? If not, you have more money than most and do it for the fun. Life would be wonderful if it was all about saving the world. Unfortunately, that is a tall order when you are homeless. So, I'm not going to cry a river over a physician wanting to make a buck...

 

[Dr Oops]

My question is since your training is so superior, why feel threatened? In my experience it is mainly the FP physicians and residents who are so opposed to NPs and look down on "midlevels". I guess the top MDs, which none of you are, don't have the time for such idol chatter (i.e. surgeons, derms, orthopedics ect.). Don't worry doc it will all be ok, trust me.

Simple. It doesn't take an MD to catch a zebra these days. Medical education has become so efficient that even a 2nd semester PA student can catch cardiac tamponade the minute it walks through the ER door.

Should MD/DOs feel threatened by this? That depends. If their primary reason for going into medicine was money, "yes." However, if they went into medicine with a purpose other than monetary gains then "no, not at all."

I wouldnt say threatened, more like scared. The nurses in charge are running a good old PR campaign, they produce bs, poorly run studies, say theyre cheaper(but want equal pay because of their "equivalence"), and claim they "Care more about the patients" (which since they are in the room more often people believe it).

Its scary to think that someone with a quarter of the training thinks they can do the job a physician at the same level or even better as some nurses claim.

Its scary that idiot politicians fall for this crap.

Its scary to even think about getting sick in the future.

 

[Coastie]

My question is since your training is so superior, why feel threatened? In my experience it is mainly the FP physicians and residents who are so opposed to NPs and look down on "midlevels". I guess the top MDs, which none of you are, don't have the time for such idol chatter (i.e. surgeons, derms, orthopedics ect.). Don't worry doc it will all be ok, trust me.

Nurses have far superior lobbying ability than physicians currently...and they are the queen bees of the healthcare bureaucracy.

While physicians were busy saving lives, BIG NURSING took over healthcare. Unfortunate, really.

Many surgeons have the foolish idea that they are immune to the coming tsunami of nursing takeover. They are very mistaken..Derms are already being attacked heavily, and they have been fighting back.

My question is since your training is so inferior to that of a physicians, why do you continue to demand equality in practice rights and income? Seems awfully ignorant and arrogant to believe that your 600 clinical hours and online NP = 10,000's and a hard-fought, top-academic MD. I can't imagine how "great" the clinical "judgement" of noctors who believe such drivel must be.

 

[deleted87716]

That is not what I said at all

Um...yes, it was a direct quote.

As for "looking for a fight," I refuse to engage in a battle of wits against an unarmed opponent.