Nurse practitioners are better than MDs

[RNthenDoc]

So I guess I’m not an expert on the matter, but why would an NP be more qualified than an RN?

...........they literally have advanced education and training.

That’s like asking why a PA and an MA have different levels of qualification. Two separate fields entirely.

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[RNthenDoc]

To the second bolded, come on some of my rotations with me and I'd bet you'd change your mind pretty fast. I've met more than a few who I felt needed significant oversight (more than they were receiving) and a couple who I legitimately considered reporting to the state Board of Healing Arts because they were so incompetent, and one of them was very vocal about how NPs should be allowed to practice without supervision.

It could certainly be that my practice has only seen a good selection of mid levels. I’ve only practiced in two states/regions in the CONUS. If you’re a student, though, it could be that you happen to have a particularly *bad* sample, though, right?

That’s why I want better data.

 

[libertyyne]

I agree with the bolded, but it doesn't change the issue with "rate" of expansion.

The issue with match outcomes is again irrelevant to the point I was making, but if you want to compare match rates then no, they're not that different. Marian has a match rate of 99%. Alabama-COM had an AOA match rate of 100% and a NRMP match rate of 86% with 100% placement. Those are the two newest schools to have classes go through the match. Considering the national mean match rate for USMD schools is 95% I'd say the new DO schools are doing just fine in terms of rate. If you want to talk about outcomes in terms of where they match I won't argue that one, but looking at just match rate there's no significant difference at this time.

Also, do you really think that if there were already as many DO schools as MD schools that COCA would be accrediting new schools at an equivalent percentage as they are now? Of course they wouldn't! It would be the same raw numbers, which is why I'm saying the argument using percentages is ridiculous and we should be using the physical numbers instead. I thought that would be obvious.



I think you're underestimating the number that falls into the first bolded category. It's by no means the majority, but it's a significant enough number (and certainly enough of them are vocal about it) that it needs to be addressed. As long as other NPs aren't standing up against their own who are over-reaching, someone else needs to.

To the second bolded, come on some of my rotations with me and I'd bet you'd change your mind pretty fast. I've met more than a few who I felt needed significant oversight (more than they were receiving) and a couple who I legitimately considered reporting to the state Board of Healing Arts because they were so incompetent, and one of them was very vocal about how NPs should be allowed to practice without supervision.

you still dont understand or refuse to acknowledge that growing at the rate COCA has been can be disastrous if you want to keep quality the same. Those placement numbers into TRIs are barely apples to apples comparisons vs a match rate which the MD schools are listing. The argument for percentages is pertinent, because if you have doubled soo quickly without regard to keeping standards high what is going to stop you from continuing to do so ? If DO schools continue to have match rates in the 80's maybe it might bring about some change, but according to you everything is a ok .

 

[Stagg737]

I saw when she posted that. Pretty hilarious.

Serious question, though.... Would a free market eventually quash practices like hers?

If she truly cannot deliver on what her clients want, if a physician can truly deliver the same more competently, won’t the market eventually correct? This is a tangential discussion, and I obviously don’t think the right thing to do is to wait for that to happen... this lady is probably dangerous.

But still, the best surgeons in my town are known for outcomes... surely a snake oil salesmen will eventually run out of victims in the digital age?

In the current US I don't believe it would. We have significant numbers of people going to naturopaths, chiropractors, and many other BS practitioners in spite of the mountains of evidence that what they practice is almost completely BS. The major thing that nurses get that many physicians don't is the customer service aspect of medicine. I've seen numerous NPs joke about every patient getting a door prize (usually in the form of antibiotics or steroids) when there is literally no indication for them at all because it makes the patients happy. Patients care a lot less about their negative outcome when they feel like they were treated, even when that treatment was BS and those are the patients who seem to advocate to going to an NP over a physician.

It could certainly be that my practice has only seen a good selection of mid levels. I’ve only practiced in two states/regions in the CONUS. If you’re a student, though, it could be that you happen to have a particularly *bad* sample, though, right?

That’s why I want better data.

I'd like better data as well, but my experience comes from more than just my time as a med student. I worked in various healthcare settings before med school and the two fields that always seemed to think they knew more than they really did were nurses (the more experience/education, the worse they were) and Paramedics who thought they knew more than the ED physicians. Most of the people I worked with were fine, but when I saw real issues it was almost always with advanced nurses or those wanting to pursue that path.

you still dont understand or refuse to acknowledge that growing at the rate COCA has been can be disastrous if you want to keep quality the same. Those placement numbers into TRIs are barely apples to apples comparisons vs a match rate which the MD schools are listing. The argument for percentages is pertinent, because if you have doubled soo quickly without regard to keeping standards high what is going to stop you from continuing to do so ? If DO schools continue to have match rates in the 80's maybe it might bring about some change, but according to you everything is a ok .

What makes you think there's so many more DOs from new schools matching into TRI's than MDs from new schools? Why do you think standards aren't being kept high (COCA standards are becoming stricter with time) or that they're dropping? And again, do you really think DOs would still be doubling if there were already as many grads as MDs? It's easy to double when your baseline is 1. It's a lot harder when the baseline is 100. How is this even being argued? Also, DOs have ACGME match rates in the 80's, overall match rates are much higher (comparable to MDs). We'll have to see how that's affected with the merger, but the number of residency slots isn't dropping, it's increasing, so why do you think overall match rates for DOs is suddenly going to plummet?

Just so we're clear, I have a big problem with the expansion of schools accredited by COCA, but I also have a big problem with the expansion of schools accredited by LCME as well. We don't need any med school expansion unless we're going to significantly decrease the number of IMG and FMGs allowed to enter the match. I would personally love for COCA and the DO degree to be absorbed into the LCME and MD degree as it would completely standardize physician education, but I think that's just wishful thinking on my part at this point.

 

[Lawpy]

By doing so, you're basically falling into Simpson's paradox.

Good to see some advanced statistics concepts used on SDN

 

[libertyyne]

In the current US I don't believe it would. We have significant numbers of people going to naturopaths, chiropractors, and many other BS practitioners in spite of the mountains of evidence that what they practice is almost completely BS. The major thing that nurses get that many physicians don't is the customer service aspect of medicine. I've seen numerous NPs joke about every patient getting a door prize (usually in the form of antibiotics or steroids) when there is literally no indication for them at all because it makes the patients happy. Patients care a lot less about their negative outcome when they feel like they were treated, even when that treatment was BS and those are the patients who seem to advocate to going to an NP over a physician.



I'd like better data as well, but my experience comes from more than just my time as a med student. I worked in various healthcare settings before med school and the two fields that always seemed to think they knew more than they really did were nurses (the more experience/education, the worse they were) and Paramedics who thought they knew more than the ED physicians. Most of the people I worked with were fine, but when I saw real issues it was almost always with advanced nurses or those wanting to pursue that path.



What makes you think there's so many more DOs from new schools matching into TRI's than MDs from new schools? Why do you think standards aren't being kept high (COCA standards are becoming stricter with time) or that they're dropping? And again, do you really think DOs would still be doubling if there were already as many grads as MDs? It's easy to double when your baseline is 1. It's a lot harder when the baseline is 100. How is this even being argued? Also, DOs have ACGME match rates in the 80's, overall match rates are much higher (comparable to MDs). We'll have to see how that's affected with the merger, but the number of residency slots isn't dropping, it's increasing, so why do you think overall match rates for DOs is suddenly going to plummet?

Just so we're clear, I have a big problem with the expansion of schools accredited by COCA, but I also have a big problem with the expansion of schools accredited by LCME as well. We don't need any med school expansion unless we're going to significantly decrease the number of IMG and FMGs allowed to enter the match. I would personally love for COCA and the DO degree to be absorbed into the LCME and MD degree as it would completely standardize physician education, but I think that's just wishful thinking on my part at this point.

Im going bed right now, but seriously, starting class sizes, quality of rotations, availability of home residency programs none of these issues concern you? You are seriously going to sit there and claim coca is doing a bang up job. The next few years of match will be telling when AOA will not happen. Maybe afterwards you might rethink that COCA's rapid rate of expansion has been good for the DO brand.

Doubling of baseline is telling , Because what makes you think they will stop their 5-10% annual growth?

I dont think match rates will plummet I think they will stay in the 80's.

I would bet that a large number of the new DO schools would not meet LCME accreditation standards. So when your standards are weak to begin with expanding doesnt help your total pool.

 

[762513]

...........they literally have advanced education and training.

That’s like asking why a PA and an MA have different levels of qualification. Two separate fields entirely.

This is what I'm talking about lol. So now RN and NP are exactly the same skill level? Can't make this stuff up. Here a visual representation of the SDN posters whenever someone dares to call a NP a safe provider.

 

[deleted103644]

Yes, and?

Why should I bother trying to figure out which DO schools are the good ones?

At least NPs don’t have to pretend OMM is real.

If I wanted to hire a chiropractor, I would.

 

[deleted103644]

...you do know that Nurse Practitioners are boarded, right?

They don’t take three-step boards, as they aren’t physicians. The reason this level of practice has less standardization is because it is in its infancy. It certainly needs to change, and unification would be great, but right now there are multiple degree levels, multiple experience levels and all sorts of other things that will become a nightmare to remedy.

...and instead of being constructive and pushing for positive change, this thread gives gems like:

“I’ll never help them learn”
“I’ll never hire them”

Which is ironic to me.

This isn’t my fight to fight, but gosh it seems counterproductive for the amount of effort being invested here.

Yeah, the answer is clearly better standards for NP degrees, abolishing the direct to NP programs, and adding some licensing exams.

Most of the stuff on this forum is just protectionism though...

 

[Lucca]

Closing thread. Eight pages of taking the bait? C'mon y'all.