Nurse practitioners are better than MDs

[762513]

Depends on your patient population and whether or not they are a transgender, type II diabetic, with fibro, MS, chronic renal insufficiency, CHF, COPD-mediated emphysema, and a med list as long as my arm with an equally impressive allergy list.

Better consult cards, pain management, pulm and nephrology then, and it’s not just NP’s doing that.

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[Ho0v-man]

I’ve never heard a single NP discredit a physicians education. What I have heard them ask is in the age of specialized medicine, is a family physician over prepared for primary care?

You’ve done so multiple times in this thread. Whether you realize it or not, claiming equivalency to physician education with an online participation trophy of a degree does in fact discredit physician education.

 

[flightnurse2MD]

Better consult cards, pain management, pulm and nephrology then, and it’s not just NP’s doing that.

Easier said than done. Besides, consults are mainly in the inpatient setting while referrals are in the outpatient setting with many, many specialties not available or not accepting new patients.

 

[762513]

You’ve done so multiple times in this thread. Whether you realize it or not, claiming equivalency to physician education with an online participation trophy of a degree does in fact discredit physician education.

Name one time I said MD=NP.

 

[Chibucks15]

Better consult cards, pain management, pulm and nephrology then, and it’s not just NP’s doing that.

the thing that all of us are saying is that there are some NPs (not saying all) that won't know when to call those consults. They'll miss the diagnosis or even the warning signs because they arent in the algorithm that NPs are taught. It's already happened...I can think of that one case where the VA got sued after an NP missed prostate cancer and I'm sure there's many more.

And before you say it, yes there are docs that miss signs too, but based on pure actual scientific knowledge I'll take my chances. I have nothing against nurses, I worked with them forever and applied to get a entry-level masters before I got into medical school. Your logic that its equivalent is simply flawed.

Lastly, while it may not be all NPs that are outwardly bashing our education (although there are quite a bit), saying that you could do our jobs with less than half the training, less than half the clinical hours, and not even remotely close to the level of scientific knowledge of the body is the epitome of discrediting our education that makes us qualified to practice medicine

 

[762513]

the thing that all of us are saying is that there are some NPs (not saying all) that won't know when to call those consults. They'll miss the diagnosis or even the warning signs because they arent in the algorithm that NPs are taught. It's already happened...I can think of that one case where the VA got sued after an NP missed prostate cancer and I'm sure there's many more.

And before you say it, yes there are docs that miss signs too, but based on pure actual scientific knowledge I'll take my chances. I have nothing against nurses, I worked with them forever and applied to get a entry-level masters before I got into medical school. Your logic that its equivalent is simply flawed.

Lastly, while it may not be all NPs that are outwardly bashing our education (although there are quite a bit), saying that you could do our jobs with less than half the training, less than half the clinical hours, and not even remotely close to the level of scientific knowledge of the body is the epitome of discrediting our education that makes us qualified to practice medicine

NP’s are not saying that they are equivilant to MD’s. They are simply stating that based on all the evidence so far, they are SAFE to care for most patients. I better understand your perspective now, thank you for explaining it in a non hostile way.

You should all remember though that NP’s have been around since the 70’s, longer than most medical students have been alive, and from the NP perspective, physicians are also attacking them and insulting their education and intelligence.

 

[Chibucks15]

NP’s are not saying that they are equivilant to MD’s. They are simply stating that based on all the evidence so far, they are SAFE to care for most patients. I better understand your perspective now, thank you for explaining it in a non hostile way.

You should all remember though that NP’s have been around since the 70’s, longer than most medical students have been alive, and from the NP perspective, physicians are also attacking them and insulting their education and intelligence.

Unfortunately, the studies that provide the evidence are pretty decently flawed (as my colleagues have explained above), so until there are more reputable studies I personally won't be changing my mind. NPs may be safe for the routine, run of the mill practice settings. However, I would be very wary of letting full autonomous practice happen. There is no way that you or any NP can say you know medicine to the depth that MD/DOs do. Given that, there are always uncommon presentations of diseases, rare diseases, etc that an NP would have a much higher chance to miss. If NPs wanna run the minute clinic, go for it, but opening up your own offices is bad news waiting to happen. If doctors get sued as much as they do, lawyers will have a field day with NPs purely based on education discrepancy alone.

NPs are not stupid people by any means, and nobody is insinuating that they are. NPs simply cannot compare to knowledge level of doctors. Thats the truth and there is no arguing that fact. Another thing is that NPs practicing on their own also requires them to take full malpractice insurance, which some people I have heard just want the full practice rights without being close to the liability.

Basically, my point comes down to this. If you want to be a doctor, go to medical school. There is no way NPs should be full autonomous practice except in actually rural areas (most new NPs are taking jobs in cities like the rest of us). It may be "safe" for the bread and butter cases, but once something dire hits, I don't really trust their knowledge base. I've seen the NP curriculum, and it simply doesn't compare in the slightest

 

[Fission Chips]

You stated "Yet they are able to conclude "Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians" without addressing those exact same confounding variables?"

Its clearly not "painfully obvious" that you read the limitations of the study. If you had read the limitation you would have said something like 'I am unsure I could draw these same conclusions based on the limitations of the study.'

Wow, I'm really going to have to hold your hand through this. I am trying to get you to come to terms with your own contradictions. That was in response to your argument that "They didn't include that finding (that 78% of patients treated by MD's followed up with either their PCP or Pulmonologist, vs 62% of the patients treated by APP's (p = <.001; CI = 0.39 - 0.51).) in the conclusion because of the confounding variables you just listed."

Do you not see your own contradiction here? They didn't include that because of the confounding variables that I listed that they also just so happened to list in the limitations but that didn't prevent them from making other, similar conclusions? That additionally makes no mention of skewing the conclusion of other studies to fit their discussion, which is what I was truly interested in hearing your defense of.

It is indeed painfully obvious that I read the limitations of the study, as I have been trying to use them to get you to come to terms with how amazingly flawed your process of thinking is. "They weren't able to conclude X because of confounders, but they were able to conclude Y because they addressed those confounders in the limitations section. Derrrr, I'm not going to walk you through the limitations section."

 

[SLC]

Basically, my point comes down to this. If you want to be a doctor, go to medical school. There is no way NPs should be full autonomous practice except in actually rural areas (most new NPs are taking jobs in cities like the rest of us). It may be "safe" for the bread and butter cases, but once something dire hits, I don't really trust their knowledge base. I've seen the NP curriculum, and it simply doesn't compare in the slightest

Good post, but I’d argue that NP’s absolutely shouldn’t be in Rural Areas. In Rural locales, backup is often far away, if it even exists at all. That’s where you want a fully trained Physician, in the city, NP’s can refer to their hearts content.

 

[762513]

Unfortunately, the studies that provide the evidence are pretty decently flawed (as my colleagues have explained above), so until there are more reputable studies I personally won't be changing my mind. NPs may be safe for the routine, run of the mill practice settings. However, I would be very wary of letting full autonomous practice happen. There is no way that you or any NP can say you know medicine to the depth that MD/DOs do. Given that, there are always uncommon presentations of diseases, rare diseases, etc that an NP would have a much higher chance to miss. If NPs wanna run the minute clinic, go for it, but opening up your own offices is bad news waiting to happen. If doctors get sued as much as they do, lawyers will have a field day with NPs purely based on education discrepancy alone.

NPs are not stupid people by any means, and nobody is insinuating that they are. NPs simply cannot compare to knowledge level of doctors. Thats the truth and there is no arguing that fact. Another thing is that NPs practicing on their own also requires them to take full malpractice insurance, which some people I have heard just want the full practice rights without being close to the liability.

Basically, my point comes down to this. If you want to be a doctor, go to medical school. There is no way NPs should be full autonomous practice except in actually rural areas (most new NPs are taking jobs in cities like the rest of us). It may be "safe" for the bread and butter cases, but once something dire hits, I don't really trust their knowledge base. I've seen the NP curriculum, and it simply doesn't compare in the slightest

I can’t disagree with your statement. Earlier in the thread I stated I think there should be separate exam and a period of mandatory years long supervised practice before independence is granted. I’m not completely on board with NP independence and I never have been. Thanks for being a good SDN poster.

 

[MedicineZ0Z]

A new for-profit DO school founded by an anti-science institution.

Yes, I would trust a reputable NP program more than “physicians” from that program.

lol. Those DOs still have to pass the COMLEX level 1, 2 CK, PE, and 3 (which is now a 2 day exam) and most will pass USMLE step 1 and 2. Then they'll go onto residency and have to pass their specialty's board exam.
In what delusional world is any NP in the country passing any exam that even compares to any of those? Even obtaining a literal borderline passing score on the COMLEX is infinitely more difficult than obtaining a high score on the NP or DNP exam(s).

What are your thoughts involving Caribbean graduates vs NPs?

Again... it is literally impossible for an NP to have the breadth and depth of knowledge to pass any of licensing exams doctors take.

I’ve never heard a single NP discredit a physicians education. What I have heard them ask is in the age of specialized medicine, is a family physician over prepared for primary care?

Ah primary care... the world where you can get every chief complaint under the sun in your office. Surely doctors can be over prepared for that... lol.. Like how ridiculous is it that NPs can think that?

You can literally discredit every job and say that workers are overqualified in 2018. Do dentists really need to know reproductive pathology? Can't pharm techs do almost the full job of a pharmacist? You can go on and on about this. It's the 5-10% of chief complaints coming in that require in-depth training.

 

[Chibucks15]

I can’t disagree with your statement. Earlier in the thread I stated I think there should be separate exam and a period of mandatory years long supervised practice before independence is granted. I’m not completely on board with NP independence and I never have been. Thanks for being a good SDN poster.

I'm gonna be honest and say that you seem to have been fully on board with full independence in this and other threads...it should never be that way until NPs have actually taken a medical school course load and taken the same boards we do. Until then, they rightly will be mid level providers and should be doing nothing more

 

[MedicineZ0Z]

NP’s are not saying that they are equivilant to MD’s. They are simply stating that based on all the evidence so far, they are SAFE to care for most patients. I better understand your perspective now, thank you for explaining it in a non hostile way.

You should all remember though that NP’s have been around since the 70’s, longer than most medical students have been alive, and from the NP perspective, physicians are also attacking them and insulting their education and intelligence.

Maybe if you didn't lobby and push for independent rights, hence causing a turf war - there wouldn't be a fight now.

 

[762513]

lol. Those DOs still have to pass the COMLEX level 1, 2 CK, PE, and 3 (which is now a 2 day exam) and most will pass USMLE step 1 and 2. Then they'll go onto residency and have to pass their specialty's board exam.
In what delusional world is any NP in the country passing any exam that even compares to any of those? Even obtaining a literal borderline passing score on the COMLEX is infinitely more difficult than obtaining a high score on the NP or DNP exam(s).

Again... it is literally impossible for an NP to have the breadth and depth of knowledge to pass any of licensing exams doctors take.

Ah primary care... the world where you can get every chief complaint under the sun in your office. Surely doctors can be over prepared for that... lol.. Like how ridiculous is it that NPs can think that?

You can literally discredit every job and say that workers are overqualified in 2018. Do dentists really need to know reproductive pathology? Can't pharm techs do almost the full job of a pharmacist? You can go on and on about this. It's the 5-10% of chief complaints coming in that require in-depth training.

I’m not debating that MD’s catch more than NP’s. I’m stating fact that NP’s catch more than no provider at all or a 6 month wait to see one.

 

[MedicineZ0Z]

I’m not debating that MD’s catch more than NP’s. I’m stating fact that NP’s catch more than no provider at all or a 6 month wait to see one.

Then they should be limited to those geographic areas or hired under a doctor's discretion.
Instead they push for ICU or hospitalist jobs in decent areas with enough physicians.

 

[762513]

I'm gonna be honest and say that you seem to have been fully on board with full independence in this and other threads...it should never be that way until NPs have actually taken a medical school course load and taken the same boards we do. Until then, they rightly will be mid level providers and should be doing nothing more

I have made my opinion clear in other threads there should be a two tiered NP process. If you are taking my posting research results as me stating MD=NP, it is very difficult to find a hypothesis that states 'NP outcomes are ehhhh good enough"

 

[Chibucks15]

I have made my opinion clear in other threads there should be a two tiered NP process. If you are taking my posting research results as me stating MD=NP, it is very difficult to find a hypothesis that states 'NP outcomes are eh good enough"

No I am assuming that you are advocating for expanding practice rights of NPs (even if not fully independent). Say this is the case...whats stopping everyone who wants to be a doctor from going the NP route, there's no denying its easier and cheaper. This would make the provider shortage even worse and almost insurmountable. Why pay 250,000 for medical school when I can do the same as an NP? NPs and PAs are incredibly valuable in the correct role. Taking full reign over primary care is not the correct role by any means

 

[762513]

No I am assuming that you are advocating for expanding practice rights of NPs (even if not fully independent). Say this is the case...whats stopping everyone who wants to be a doctor from going the NP route, there's no denying its easier and cheaper. This would make the provider shortage even worse and almost insurmountable. Why pay 250,000 for medical school when I can do the same as an NP? NPs and PAs are incredibly valuable in the correct role. Taking full reign over primary care is not the correct role by any means

Why would you assume that I am pushing for expanded practice rights? You are assuming because I state that NP's are SAFE to care for patients, and state that many NP's wonder if the depth of training for a MD may be better spent in an acute care or specialist environment, those are my personal opinions? What I am mostly confronting is the posters who say NP's should be fired, never trained, and cease to be a part of the healthcare team. Which there are many posters on this very thread who feel that way.

 

[787593]

really weird trend that i saw somewhere was a study was done showing that the amount of Male nurses has sky rocketed in the past 15 years and the amount of Female medical students/doctors has gone up respectively as well. it was showing that the number of females in medical school now exceeds that of males for the first time ever

 

[AnatomyGrey12]

physicians are also attacking them and insulting their education and intelligence.

We are. When 500 hrs worth of shadowing in an outpatient clinic is considered acceptable, when you have curriculums that aren’t standardized and there are programs that do not even include additional pathophysiology courses beyond the BSN level, and when a very large chunk of programs do not even require prior nursing experience then I am 100% attacking your education. Until NP programs are as standardized as PA programs then I will never hire one in my future practice.

 

[Chibucks15]

Why would you assume that I am pushing for expanded practice rights? You are assuming because I state that NP's are SAFE to care for patients, and state that many NP's wonder if the depth of training for a MD may be better spent in an acute care or specialist environment, those are my personal opinions? What I am mostly confronting is the posters who say NP's should be fired, never trained, and cease to be a part of the healthcare team. Which there are many posters on this very thread who feel that way.

I have been nothing but calm in my responses I suggest you do the same. Any time someone has said anything along the lines of NPs should be staying in their midlevel roles, you have come out firing against them. No one is saying that there should be no such thing as NPs. Nobody has come remotely close to saying that. They are useful in their correct roles and make a huge difference in them. But once you start biting off more than you can chew it isn't going to be pretty. Also, you are on a physician forum, you really shouldn't be so surprised that when you insinuate that NPs are able to do our jobs safely with nowhere near the education, that people get mad.
The fact of the matter is, sure NPs are safe with supervision. Nobody argues that. Its when NPs start trying this whole "equal pay for equal work" thing is when its gonna be bad. And it's going to be much worse for NPs if the lobby is attempting to start a turf war with doctors. And since you have not come out and said you were against expansion, it is assumed you are for it.

Again, I've mentioned this to you on other posts as well...know your audience. The rhetoric isn't gonna resonate well with a bunch of medical students and doctors who are busting their butts to be physicians, while certain NPs try to take the shortcut and undercut our hard work.

 

[762513]

We are. When 500 hrs worth of shadowing in an outpatient clinic is considered acceptable, when you have curriculums that aren’t standardized and there are programs that do not even include additional pathophysiology courses beyond the BSN level, and when a very large chunk of programs do not even require prior nursing experience then I am 100% attacking your education. Until NP programs are as standardized as PA programs then I will never hire one in my future practice.

So you are of the opinion NP's shouldn't exist, and you wonder why the NP lobby is so militant?

 

[762513]

I have been nothing but calm in my responses I suggest you do the same. Any time someone has said anything along the lines of NPs should be staying in their midlevel roles, you have come out firing against them. No one is saying that there should be no such thing as NPs. Nobody has come remotely close to saying that. They are useful in their correct roles and make a huge difference in them. But once you start biting off more than you can chew it isn't going to be pretty. Also, you are on a physician forum, you really shouldn't be so surprised that when you insinuate that NPs are able to do our jobs safely with nowhere near the education, that people get mad.
The fact of the matter is, sure NPs are safe with supervision. Nobody argues that. Its when NPs start trying this whole "equal pay for equal work" thing is when its gonna be bad. And it's going to be much worse for NPs if the lobby is attempting to start a turf war with doctors. And since you have not come out and said you were against expansion, it is assumed you are for it.

Again, I've mentioned this to you on other posts as well...know your audience. The rhetoric isn't gonna resonate well with a bunch of medical students and doctors who are busting their butts to be physicians, while certain NPs try to take the shortcut and undercut our hard work.

I actually appreciate you being very level headed in the discussion. I feel I'm being pretty calm. However, many of your fellow posters do feel that NP's should not exist. That is not arguable. These are the people I would like to have a discussion with, not level headed people with reasonable opinions like yourself who I pretty much agree with.

 

[libertyyne]

It is also false to state that NPs are alleviating any MD shortage. They are settling in states with the highest saturation of MDs .

 

[Lawpy]

We are. When 500 hrs worth of shadowing in an outpatient clinic is considered acceptable, when you have curriculums that aren’t standardized and there are programs that do not even include additional pathophysiology courses beyond the BSN level, and when a very large chunk of programs do not even require prior nursing experience then I am 100% attacking your education. Until NP programs are as standardized as PA programs then I will never hire one in my future practice.

So you are of the opinion NP's shouldn't exist, and you wonder why the NP lobby is so militant?

The argument literally asks for NP education to be standardized

 

[You shall know the Truth]

Read this: What is the WORST medical school?

Just to clarify, I previously said that I think LUCOM students/graduates are fine, it's just that the school itself is problematic.

Subjective views predicated upon misinformed/biased presuppositions is not really a valid argument to why Liberty is a problematic school. What specifically do you not like about the school? Do you not like them because they are Christian or is it because of politics?

 

[Lawpy]

Subjective views predicated upon misinformed/biased presuppositions is not really a valid argument to why Liberty is a problematic school. What specifically do you not like about the school? Do you not like them because they are Christian or is it because of politics?

Did you read that thread? The views aren’t entirely subjective and there are legitimate concerns regarding their school policy, which are discussed in detail there.

But if you want to support LUCOM policies, by all means go for it. I don’t want to derail this thread to talk about LUCOM.

 

[W19]

So you are of the opinion NP's shouldn't exist, and you wonder why the NP lobby is so militant?

They should regulate themselves... My guess is that you are not happy with the proliferation of online programs that require no experience and are ok with 5oo-700 hrs preceptorship. That will make most docs skeptical of the whole NP profession...

Meharry Medical College is not Harvard, but at least LCME said to all med schools: These are the minimum requirements your school has to meet in order to exist as a medical school.

 

[762513]

The argument literally asks for NP education to be standardized

I agree. By all means, don't hire any NP from any substandard school, there are plenty of good NP school's out there. You stated you would hire no one until everything was fixed. I can read between the lines pretty well.

 

[762513]

They should regulate themselves... My guess is that you are not happy with the proliferation of online programs that require no experience and are ok with 5oo-700 hrs preceptorship. That will make most docs skeptical of the whole NP profession...

Meharry Medical College is not Harvard, but at least LCME said to all med schools: These are the minimum requirements your school has to meet in order to exist as a medical school.

There are many bad NP schools. Don't hire those people. But you and many others have called for the end of advanced practice nursing all together. That's my beef.

 

[W19]

There are many bad NP schools. Don't hire those people. But you and many others have called for the end of advanced practice nursing all together. That's my beef.

Never said that...

 

[studentdoct4281]

nurses should only be good for taking blood pressures, doing an hpi and maybe putting an IV in or retrieving food or water for bed ridden patients. otherwise they should be jobless--not fighting for individual practice rights. and even if they aqcuired more independence or whatever, they still have to communicate and dictate notes for and with other actual doctors....they wont understand whats going on 50% of the time...

 

[flightnurse2MD]

NP’s are not saying that they are equivilant to MD’s. They are simply stating that based on all the evidence so far, they are SAFE to care for most patients. I better understand your perspective now, thank you for explaining it in a non hostile way.

You should all remember though that NP’s have been around since the 70’s, longer than most medical students have been alive, and from the NP perspective, physicians are also attacking them and insulting their education and intelligence.

Not this medical student...

 

[762513]

Never said that...

Not on THIS thread

 

[RNthenDoc]

nurses should only be good for taking blood pressures, doing an hpi and maybe putting an IV in or retrieving food or water for bed ridden patients. otherwise they should be jobless--not fighting for individual practice rights

Bahahahahaha Hahahahahah.......

HAHAHAHAHAHHA....

What a poor attempt at trolling.

 

[762513]

nurses should only be good for taking blood pressures, doing an hpi and maybe putting an IV in or retrieving food or water for bed ridden patients. otherwise they should be jobless--not fighting for individual practice rights. and even if they aqcuired more independence or whatever, they still have to communicate and dictate notes for and with other actual doctors....they wont understand whats going on 50% of the time...

Thanks for helping!

 

[W19]

Not on THIS thread

Show me a post where I said the NP profession should not exist..

 

[762513]

Show me a post where I said the NP profession should not exist..

That's pretty clear cut.

 

[762513]

Show me a post where I said the NP profession should not exist..

I can keep going if you want...

 

[W19]

That's pretty clear cut.
View attachment 231060

That's not clear cut... I was not talking about getting rid of NP entirely.

 

[762513]

That's not clear cut... I was not talking about getting rid of NP entirely.

I can keep going. You get far more offensive than that. I'm not gonna derail the thread tho.

 

[787593]

 

[studentdoct4281]

.

 

[AnatomyGrey12]

By all means, don't hire any NP from any substandard school, there are plenty of good NP school's out there.

Why should I have to make time to go through all the NP programs and figure out which ones are good? Especially when I can hire any PA and know that there is a certain level of competence that they had to achieve due to the oversight given to their degree pathway?

 

[RNthenDoc]

If NPs truly waste money by ordering unnecessary tests, don’t provide good outcomes, aren’t as good with bedside manner etc.

Why should I have to make time to go through all the NP programs and figure out which ones are good? Especially when I can hire any PA and know that there is a certain level of competence that they had to achieve due to the oversight given to their degree pathway?

Aren’t you an OMS?

 

[AnatomyGrey12]

If NPs truly waste money by ordering unnecessary tests, don’t provide good outcomes, aren’t as good with bedside manner etc.


Aren’t you an OMS?

Yes, and?

 

[Stagg737]

this is disengenous. It is like looking at 5000 muders in NYC and 5000 Murders in a San Jose and calling them equal. You and I both know DO schools have expanded more rapidly compared to their initial size and that the standards for COCA are absurdly low compared to LCME. DO's went from being 1/8th the total graduating seniors to 1/4th.

I'm not going to get into COCA standards because that's a separate issue, but your point about equivalency is moot when looking at things at the national level. Adding 5,000 murders to the national count is the same whether they take place in NYC or SJ, the percentage within the bubble is irrelevant.

It's not disingenuous to say they're growing at the same rate overall when they are in fact growing at the same rate overall in terms of actual numbers. Even when the growth in terms of percentage rate differs. That is unless you're going to argue that the rate of growth is compounded based on percentage, which is incorrect. By doing so, you're basically falling into Simpson's paradox.

That's pretty clear cut.
View attachment 231060

I can keep going if you want...
View attachment 231061

Saying we shouldn't hire flight attendants to fly a plane doesn't mean you want to put an end to the career of flight attendant, and saying "no one should hire flight attendants" isn't calling for that either. It's saying you stop the expansion and prevent an oversaturation and over-reach of scope by cutting off demand and essentially setting a cap. It's not a hard concept to grasp.

 

[RNthenDoc]

There’s about a million topics on SDN stating that MD schools offer better, more standardized clinical training than DO schools.

By your logic, shouldn’t my hospital spurn DOs?

(Note: I don’t harbor any bias against DOs or osteopathy, but the irony here is tangible)

 

[Lawpy]

There’s about a million topics on SDN stating that MD schools offer better, more standardized clinical training than DO schools.

By your logic, shouldn’t my hospital spurn DOs?

(Note: I don’t harbor any bias against DOs or osteopathy, but the irony here is tangible)

Except DO education is standardized. By COCA.

 

[RNthenDoc]

Except DO education is standardized. By COCA.

So then the argument is that PA school has more standardization than NP school?

I thought we were discussing parity?

I thought COCA was terrible, and doing a bad job?

Because in 99% of the threads here the sky is falling, but then in this thread COCA does a good job of standardizing education?